Ischemic Degenerative Changes


Necrotizing sialometaplasia can be seen in any of the salivary glands but is most commonly diagnosed in the minor salivary glands of the palate (Figure 13.6).

It is thought to be secondary to local ischemia with secondary necrosis of the gland and may be secondary to trauma or surgery but is usually


Figure 13.6a. Necrotizing sialometaplasia of palate with rolled edge and granular base clinically resembling squa-mous cell carcinoma.

Generalized acinar atrophy can occur in the major salivary glands with age. Frequently the glandular tissue is replaced with fat. In addition, oncocytic metaplasia increases in older patients. Oncocytes are large granular eosinophilic cells. Their granular cytoplasm appears to be secondary to numerous mitochondria. A diffuse oncocytosis of the salivary glands can occur. These changes are not clinically relevant, although oncocytes can give rise to an oncocytoma, which is usually benign but may occasionally be a malignant type. Oncocytomas are of interest as they are similar to Warthin's tumor in appearing as "hot" spots on technetium scans.

Figure 13.6b. Necrotizing sialometaplasia at a later stage with exposed palatal bone.

spontaneous. Initially there is swelling quickly followed by ulceration, which may be deep down to the bone. Healing may take 2-3 months. Biopsy may be necessary to distinguish this lesion from a malignancy and the histology may be misinterpreted. There is lobular necrosis of the salivary gland with squamous metaplasia of the ducts, and this can be misdiagnosed as mucoepidermoid carcinoma or squamous cell carcinoma. In addition the epithelium adjacent to the ulcer can display pseudo-epitheliomatous hyperplasia, which can also be mistaken for squamous cell carcinoma. If the patient keeps the lesion clean with mouth-washes, healing will occur and recurrence is not seen. Biopsy will often be required to rule out malignancy and histologic interpretation by an experienced pathologist is essential.

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