neurofibroma stimulates salivary gland neoplasm case report

1. P R E S E N T E D B Y
D r . A J I N S C B
PALATAL SOLITARY NEUROFIBROMA
SIMULATES A SALIVARY GLAND
NEOPLAM A CASE REPORT

2. INTRODUCTION
 Neurofibroma (NF) is a
benign peripheral nerve
sheath tumor
sporadically occurring in
the head and neck
region.
 It could be solitary or
multiple and intra or
extra osseous

3. ETIOLOGY
 However, its definitive cause is still unknown
 It is derived from perineural cells, Schwann cells and
fibroblasts within the myxoid matrix and varying
amounts of mature collagen.

4. CLINICAL FEATURES
 It is usually slow growing,well- circumscribed and
non-encapsulated in nature.
 It may affect any site in the oral cavity, the common
ones being the tongue and buccal mucosa followed
by lips and gingiva
 Intraosseous location has been described frequently;
however extraosseous occurrence is rare

5. CASE REPORT
 This is a case report of a young man with extra-
osseous solitary NF on the hard palate, which
clinically mimicked a salivary gland neoplasm

6. CHIEF COMPLAINT
 A 23-year-old male
reported to the dental
college with chief
complaint of a swelling
on his palate since past
two months, which was
insidious in onset and
gradually increased to
present size
 The swelling was not
associated with pain or
discomfort to the patient.

7.  Medical history : no medical history
 Dental history : no dental history
 Family history : no family history

8. INTRAORAL FEATURES
 On intraoralexamination,
the swelling was present on
posterior right side of the
hard palate, not crossing
the mid palatine raphe.
 It was oval in shape
measuring approximately
3×1 cm, non-compressible,
non-tender and fixed to
underlying structures with
normal overlying mucosa.

9. PROVISIONAL DIAGNOSIS
 Based on the clinical appearance and history, a
provisional diagnosis of pleomorphic adenoma of the
hard palate was made.

10.  Under general
anaesthesia,incision was
given on most prominent
part of the swelling. The
tumor was excised
completely along with
normal tissue outline and
sent for histopathological
examination.

11. HISTOPATHOLOGICAL FEATURES
 Biopsied tissue under microscope
showed fibrous capsule,
abundant spindle cells
proliferation and numerous
salivary gland acini.
 At one end, tissue exhibited
overlying stratified squamous
epithelium, hyalinized areas and
monotonous proliferation of
spindle cells around salivary
gland acini as well as sheets of
these tumor cells spread out in
the stroma.
 At other end, fibrous capsule was
present adjacent to which minor
salivary gland was seen.

12. UNDER HIGH MAGNIFICATION
 The histopathological
picture on high power
magnification revealed
monomorphic
proliferation of abundant
spindle cells with benign
slender oval nuclei and
pointed ends.
 Few areas showed wavy
nuclei intermingled with
intertwining connective
tissue fibrils

13. PAS STAINING
 PAS staining was performed and it came out to be
negative

14. IMMUNOHISTOCHEMISTRY
 The spindle cells were
positive for vimentin,
CD34 and S100 while
negative for SMA, β
catenin and myogenin

15. DIFFERENTIAL DIAGNOSIS
 The closest histological differential diagnoses include
solitary fibrous tumor, spindle cell lipoma,
leiomyoma and myoepithelioma with spindle cell
features

16. FINAL DIAGNOSIS
 Hence, it was finally diagnosed as neurofibroma.

17. TREATMENT
 Subsequently the patient was examined for any other
signs of VRD. After no other systemic
manifestation,it was finally concluded to be an extra-
osseous solitary NF and on successive follow-ups, no
recurrence has been reported.

18. DISCUSSION
 Therefore, in cases of spindle cell tumors, various origins
like neural, myofibroblastic, muscle, fibroblastic,
vascular, epithelial and odontogenic should be ruled out.
 If the patient is diagnosed with solitary NF he/she should
be kept on regular follow up, as it could be the first
manifestation of type I neurofibromatosis.
 Therefore, the ambiguity between salivary and neural
etiology provided a diagnostic challenge, so clinical,
histopathologic and immunohistochemical techniques
were helpful in rendering an accurate diagnosis.

19. REFERENCES
 Ramdurg P, Puranik SR, Dantu R, Shivanand R.
Solitary neurofibroma of the Soft palate: a rare
entity. Indian J Otolaryngol Head Neck Sur
 Pollack RP. Neurofibroma of the palatal mucosa. A
case report. J Periodontol
 Powell CA, Stanley CM, Bannister SR, McDonnell
HT, Moritz AJ, Deas DE. Palatal neurofibroma
associated with localized periodontitis. J Periodontol

20.  THANK YOU