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  • Open Access

Bilateral localization of necrotizing sialometaplasia: a case report

Cases Journal20092:9068

  • Received: 27 November 2008
  • Accepted: 3 April 2009
  • Published:



Necrotizing sialometaplasia is a rare disease first described in 1973. It involves salivary gland in the oral cavity.

Case presentation

We present a 32-year-old, white, male with rare bilateral localization of necrotizing sialometaplasia.


Clinically and histologically necrotizing sialometaplasia may mimic malignant lesions. In the above presented case, the patient's history was suggestive of a malignant process. Thus, knowledge and experience of both clinicians and histopathologists are essential to establish a correct diagnosis, which helps avoid radical surgery.


  • Oral Cavity
  • Mucous Membrane
  • Maxillary Sinus
  • Fine Needle Aspiration Biopsy
  • Minor Salivary Gland


Necrotizing sialometaplasia is an inflammatory process first described by Abrams et al. in 1973. The condition most frequently involves minor salivary glands in the hard palate region [1]; other anatomical locations, i.e., the oral cavity, minor salivary glands, and upper respiratory tract have also been observed [2]-[5]. An incidence of 0.03 to 0.063% has been reported [6, 7]. Although the ethiopathogenesis has not been fully elucidated, the lesion is usually regarded as resulting from an ischemic event [1, 8]. Predisposing factors include trauma, smoking, alcohol abuse [2, 8], and recurrent vomiting [9]. A patient usually presents with ulceration, and, although more rarely, swelling of the mucous membrane [2]. Histologically, there is necrosis of the minor salivary gland structures; however, lobular architecture is maintained. Squamous metaplasia is seen within the mucinous acini and ducts, which makes the condition similar to malignancy; mucin extravasation and inflammatory reaction are also present [1]. Necrotizing sialometaplasia is a self-healing disease usually resolving within a period of 3 to 12 weeks [2].

Case presentation

We report a case of 32-year-old white male who was seen in the Outpatient Clinic of the Maxillofacial Surgery Department in Katowice in April 2007 with a recurrent bilateral palate swelling which had appeared three years before. On the day of the examination the patient also complained of jelly-like nasal discharge and general malaise. The history was suggestive of neoplastic disease including a nondiagnosed palpable anal tumour and recent diagnostic procedures of lung lesions (no medical documentation available).

The clinical examination revealed a soft-elastic symmetrical affection in the area of the maxillary tuberosities; the covering mucous membrane was of normal appearance (Figure 1). The results of laboratory blood and urine tests were within normal range. Pantomogram and sinus X-ray did not detect any abnormalities. Facial CT showed a fluid-filled polypoid mucous membrane thickening of the medial maxillary sinus wall. The chest X-ray was normal. Rectoscopy revealed an anal varix to be first treated with anti-inflammatory agents, and then a surgical procedure. Fine needle aspiration biopsy showed 'epithelial nests and myxoid connective tissue suggesting a mixed tumor' (44035/BC Właszczuk). Therefore an incisional biopsy was performed with a diagnosis of necrotizing sialometaplasia (34685/K Pająk). The patient was hospitalized, and the lesion excised on the left side. Histologic features of the lesion were consistent with necrotizing sialometaplasia.
Figure 1
Figure 1

Symmetrical affection in the area of the maxillary tuberosities.


The location of necrotizing sialometaplasia was typical as most of the lesions were seen on the palate [2, 10]. However, bilateral symmetrical affection occurs rarely; Brannon et al. reported a 12% incidence [2]. The patient gave a 3-year history of symptoms recurrence, which is in accordance with the observations of Arguelles et al. [11]; however, our follow-up examinations did not confirm the patient's complaints.

Clinically and histologically necrotizing sialometaplasia may mimic malignant lesions. In the above presented case, the patient's history was suggestive of a malignant process. Thus, knowledge and experience of both clinicians and histopathologists are essential to establish a correct diagnosis which helps avoid radical surgery.




computed tomography.


Authors’ Affiliations

Clinic of the Maxillofacial Surgery Department, Medical University of Silesia in Katowice, Francuska St., 20-24, Poland


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© Niedzielska et al.; licensee Cases Network Ltd. licensee BioMed Central Ltd. 2009

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