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A Firm Palatal Nodule

Case Challenge Number: 24

Diagnostic Introduction

Additional History The patient is otherwise healthy and does not report any prior history of medical problems. She is not taking any medications and has no known drug allergies. She does not use tobacco products and occasionally drinks alcohol on social occasions. Clinical Findings The patient is a well-nourished Caucasian female who appears her stated age and is in no acute distress. Extraoral examination is within normal limits with no facial asymmetry or cervical lymphadenopathy evident. Intraoral examination reveals a firm, sessile nodule involving the left posterior hard palate and extending to the hard and soft palatal junction. (Figure 1) The lesion measures approximately 2 cm in maximum diameter, and the overlying mucosa appears normal to slightly erythematous. No ulceration is present, and the patient denies any pain or discomfort upon palpation.

Case Challenge 24 - Content - Diagnostic Introduction - Figure 1

Figure 1. A nodular mass involving the posterior hard palate.

Incisional Biopsy and Photomicrographs An incisional biopsy is performed and microscopic examination reveals a partially encapsulated proliferation of epithelial cells arranged in trabeculae, cords, and nests. In many areas there is formation of tubular or ductal structures lined by cuboidal epithelial cells. (Figure 2)

Case Challenge 24 - Content - Diagnostic Introduction - fig02-photomicrograph-low

Figure 2. A low-power photomicrograph depicts a proliferation of epithelial cells forming trabeculae, cords, and nests with focal formation of ductal or tubular structures. (Hematoxylin and eosin stain, original magnification 100x)

Other areas are comprised of collections of ovoid cells with rounded, eccentric nuclei and eosinophilic cytoplasm. There is a variable stromal background ranging from densely hyalinized areas to lightly staining, myxochondroid areas. (Figure 3) No obvious cellular pleomorphism, mitotic activity, or necrosis is identified.

case challenge 24 diagnostic introduction fig03-photomicrograph-high

Figure 3. The tumor exhibits variation in stromal background and cellularity. A lightly staining, myxochondroid area with low cellularity is seen in the lower portion of the field, and an eosinophilic, hyalinized area with greater cellularity is seen in the upper portion of the field. (Hematoxylin and eosin stain, original magnification 200x)