eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa

Necrotizing Sialometaplasia: Differential Diagnoses & Workup

Author: John Svirsky, DDS, Director of Dental Diagnostic Services, Professor, Department of Oral Pathology, Virginia Commonwealth University School of Dentistry
Coauthor(s): John E Fantasia, DDS, Attending, Chief, Division of Oral Pathology, Department of Dermatology, Long Island Jewish Medical Center, North Shore - Long Island Jewish Health System; Josephine Wu, DDS, Assistant Director, Molecular Pathology Laboratory, Department of Pathology, Mount Sinai School of Medicine, Consulting Staff, Division of Oral and Maxillofacial Pathology, Department of Dental Medicine, Long Island Jewish Medical Center
Contributor Information and Disclosures

Updated: Oct 28, 2008

Differential Diagnoses

Aphthous Stomatitis
Behcet Disease
Squamous Cell Carcinoma
Syphilis
Wegener Granulomatosis

Other Problems to Be Considered

Malignant salivary gland neoplasia
Benign salivary gland neoplasia
Lymphoma
Deep fungal Infections
Tuberculosis
Abscess
Oral lymphomatoid papulosis
Mucoepidermoid carcinoma
Subacute necrotizing sialadenitis

Workup

Imaging Studies

  • A definitive tissue diagnosis of necrotizing sialometaplasia should exclude the need for radiographic imaging.
  • If erosion of the palatal bone occurs with or without perforation, radiologic examination may be performed.

Procedures

  • Incisional biopsy is necessary to establish the diagnosis of necrotizing sialometaplasia (NS).
    • An inadequate biopsy specimen may lead to the misdiagnosis of squamous cell carcinoma or mucoepidermoid carcinoma.
    • Findings in a superficial or limited biopsy specimen may be misinterpreted as a nonspecific ulcer or pseudoepitheliomatous hyperplasia of the surface mucosa.

Histologic Findings

The microscopic features of necrotizing sialometaplasia include coagulative necrosis of glandular acini and squamous metaplasia of its ducts. Mucin pooling is present, and an associated inflammatory infiltrate consists of macrophages; neutrophils; and, less commonly, lymphocytes, plasma cells, and eosinophils.

Pseudoepitheliomatous hyperplasia of the overlying mucosa can also be present, but the cytologic features of the squamous component are usually bland. Occasionally, isolated mucous cells may be entrapped within the squamous islands; these cells should not be confused with those of mucoepidermoid carcinoma.

The microscopic differential diagnosis for necrotizing sialometaplasia includes mucoepidermoid carcinoma and squamous cell carcinoma. Some believe that subacute necrotizing sialadenitis is yet another entity that occurs within the spectrum of necrotizing sialometaplasia; it should be distinguished from necrotizing sialometaplasia.

More on Necrotizing Sialometaplasia

Overview: Necrotizing Sialometaplasia
Differential Diagnoses & Workup: Necrotizing Sialometaplasia
Treatment & Medication: Necrotizing Sialometaplasia
Follow-up: Necrotizing Sialometaplasia
Multimedia: Necrotizing Sialometaplasia
References
[ CLOSE WINDOW ]

References

  1. Abrams AM, Melrose RJ, Howell FV. Necrotizing sialometaplasia. A disease simulating malignancy. Cancer. Jul 1973;32(1):130-5. [Medline].

  2. Franchi A, Gallo O, Santucci M. Pathologic quiz case 1. Necrotizing sialometaplasia obscuring recurrent well-differentiated squamous cell carcinoma of the maxillary sinus. Arch Otolaryngol Head Neck Surg. May 1995;121(5):584, 586. [Medline].

  3. Schmidt-Westhausen A, Philipsen HP, Reichart PA. [Necrotizing sialometaplasia of the palate. Literature report of 3 new cases]. Dtsch Z Mund Kiefer Gesichtschir. Jan-Feb 1991;15(1):30-4. [Medline].

  4. Batsakis JG, Manning JT. Necrotizing sialometaplasia of major salivary glands. J Laryngol Otol. Sep 1987;101(9):962-6. [Medline].

  5. Zschoch H. [Mucus gland infarct with squamous epithelial metaplasia in the lung. A rare site of so-called necrotizing sialometaplasia]. Pathologe. Feb 1992;13(1):45-8. [Medline].

  6. Abrams AM. Necrotizing sialometaplasia of the nasal cavity. Otolaryngol Head Neck Surg. Mar 1986;94(3):416. [Medline].

  7. Chen KT. Necrotizing sialometaplasia of the nasal cavity. Am J Otolaryngol. Nov-Dec 1982;3(6):444-6. [Medline].

  8. Walker GK, Fechner RE, Johns ME, Teja K. Necrotizing sialometaplasia of the larynx secondary to atheromatous embolization. Am J Clin Pathol. Feb 1982;77(2):221-3. [Medline].

  9. Wenig BM. Necrotizing sialometaplasia of the larynx. A report of two cases and a review of the literature. Am J Clin Pathol. May 1995;103(5):609-13. [Medline].

  10. Romagosa V, Bella MR, Truchero C, Moya J. Necrotizing sialometaplasia (adenometaplasia) of the trachea. Histopathology. Sep 1992;21(3):280-2. [Medline].

  11. Bell GW, Loukota RA. Necrotizing sialometaplasia coincident with ipsilateral infarcted antral polyps. Br J Oral Maxillofac Surg. Feb 1996;34(1):129-31. [Medline].

  12. Hurt MA, Díaz-Arias AA, Rosenholtz MJ, Havey AD, Stephenson HE Jr. Posttraumatic lobular squamous metaplasia of breast. An unusual pseudocarcinomatous metaplasia resembling squamous (necrotizing) sialometaplasia of the salivary gland. Mod Pathol. Sep 1988;1(5):385-90. [Medline].

  13. Mesa ML, Gertler RS, Schneider LC. Necrotizing sialometaplasia: frequency of histologic misdiagnosis. Oral Surg Oral Med Oral Pathol. Jan 1984;57(1):71-3. [Medline].

  14. Brannon RB, Fowler CB, Hartman KS. Necrotizing sialometaplasia. A clinicopathologic study of sixty-nine cases and review of the literature. Oral Surg Oral Med Oral Pathol. Sep 1991;72(3):317-25. [Medline].

  15. Aframian D, Milhem I I, Kirsch G, Markitziu A. Necrotizing Sialometaplasia after Silastic Ring Vertical Gastroplasty: Case Report and Review of Literature. Obes Surg. May 1995;5(2):179-182. [Medline].

  16. Schöning H, Emshoff R, Kreczy A. Necrotizing sialometaplasia in two patients with bulimia and chronic vomiting. Int J Oral Maxillofac Surg. Dec 1998;27(6):463-5. [Medline].

  17. Rossie KM, Allen CM, Burns RA. Necrotizing sialometaplasia: a case with metachronous lesions. J Oral Maxillofac Surg. Dec 1986;44(12):1006-8. [Medline].

  18. Stafford RF, Sonis ST, Shklar G. Bilateral necrotizing sialometaplasia: a case report. J Oral Med. Apr-Jun 1981;36(2):28-30. [Medline].

  19. Mandel L, Kaynar A, DeChiara S. Necrotizing sialometaplasia in a patient with sickle-cell anemia. J Oral Maxillofac Surg. Jul 1991;49(7):757-9. [Medline].

  20. Rye LA, Calhoun NR, Redman RS. Necrotizing sialometaplasia in a patient with Buerger's disease and Raynaud's phenomenon. Oral Surg Oral Med Oral Pathol. Mar 1980;49(3):233-6. [Medline].

  21. Shigematsu H, Shigematsu Y, Noguchi Y, Fujita K. Experimental study on necrotizing sialometaplasia of the palate in rats. Role of local anesthetic injections. Int J Oral Maxillofac Surg. Jun 1996;25(3):239-41. [Medline].

  22. Ben-Izhak O, Ben-Arieh Y. Necrotizing squamous metaplasia in herpetic tracheitis following prolonged intubation: a lesion similar to necrotizing sialometaplasia. Histopathology. Mar 1993;22(3):265-9. [Medline].

  23. Anneroth G, Hansen LS. Necrotizing sialometaplasia. The relationship of its pathogenesis to its clinical characteristics. Int J Oral Surg. Oct 1982;11(5):283-91. [Medline].

  24. Brooks DG, Hottinger HA, Dunstan RW. Canine necrotizing sialometaplasia: a case report and review of the literature. J Am Anim Hosp Assoc. Jan-Feb 1995;31(1):21-5. [Medline].

  25. Forney SK, Foley JM, Sugg WE Jr, Oatis GW Jr. Necrotizing sialometaplasia of the mandible. Oral Surg Oral Med Oral Pathol. May 1977;43(5):720-6. [Medline].

  26. Fowler CB, Brannon RB. Subacute necrotizing sialadenitis: report of 7 cases and a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. May 2000;89(5):600-9. [Medline].

  27. Gnepp DR. Warthin tumor exhibiting sebaceous differentiation and necrotizing sialometaplasia. Virchows Arch A Pathol Anat Histol. 1981;391(3):267-73. [Medline].

  28. Granich MS, Pilch BZ. Necrotizing sialometaplasia in the setting of acute and chronic sinusitis. Laryngoscope. Sep 1981;91(9 Pt 1):1532-5. [Medline].

  29. Granick MS, Solomon MP, Benedetto AV, Hannegan MW, Sohn M. Necrotizing sialometaplasia masquerading as residual cancer of the lip. Ann Plast Surg. Aug 1988;21(2):152-4. [Medline].

  30. Imbery TA, Edwards PA. Necrotizing sialometaplasia: literature review and case reports. J Am Dent Assoc. Jul 1996;127(7):1087-92. [Medline].

  31. Jainkittivong A, Sookasam M, Philipsen HP. Necrotizing sialometaplasia: review of 127 cases. J Dent Assoc Thai. Jan-Feb 1989;39(1):11-6. [Medline].

  32. Jensen JL. Idiopathic diseases. In: Ellis GL, Auclair PL, Gnepp DR, eds. Surgical Pathology of the Salivary Glands. Philadelphia, Pa: WB Saunders; 1991:60-82.

  33. King DT, Barr RJ. Syringometaplasia: mucinous and squamous variants. J Cutan Pathol. Aug 1979;6(4):284-91. [Medline].

  34. Matsumoto T, Kuwabara N, Shiotsu H, Fukuda Y, Yanai A, Ichikawa G. Necrotizing sialometaplasia in the mouth floor secondary to reconstructive surgery for tongue carcinoma. Acta Pathol Jpn. Sep 1991;41(9):689-93. [Medline].

  35. Merwin GE, Duckert LG, Pollak K. Necrotizing sialometaplasia of the nasopharynx. Ann Otol Rhinol Laryngol. May-Jun 1979;88(3 Pt 1):348-51. [Medline].

  36. Nilsen R, Bernhoft CH, Gilhuus-Moe O. Necrotizing sialometaplasia. Int J Oral Surg. Dec 1978;7(6):580-4. [Medline].

  37. Poulson TC, Greer RO Jr, Ryser RW. Necrotizing sialometaplasia obscuring an underlying malignancy: report of a case. J Oral Maxillofac Surg. Jul 1986;44(7):570-4. [Medline].

  38. Pulse CL, Lebovics RS, Zegarelli DJ. Necrotizing sialometaplasia: report of a case after lower lip mucocele excision. J Oral Maxillofac Surg. Dec 2000;58(12):1419-21. [Medline].

  39. Russell JD, Glover GW, Friedmann I. Necrotizing sialometaplasia. J Laryngol Otol. Jun 1992;106(6):569-71. [Medline].

  40. Santis HR, Kabani SP, Roderiques A, Driscoll JM. Necrotizing sialometaplasia: an early, nonulcerative presentation. Oral Surg Oral Med Oral Pathol. Apr 1982;53(4):387-90. [Medline].

  41. Seifert G. Tumour-like lesions of the salivary glands. The new WHO classification. Pathol Res Pract. Oct 1992;188(7):836-46. [Medline].

  42. Sneige N, Batsakis JG. Necrotizing sialometaplasia. Ann Otol Rhinol Laryngol. Mar 1992;101(3):282-4. [Medline].

  43. Taxy JB. Necrotizing squamous/mucinous metaplasia in oncocytic salivary gland tumors. A potential diagnostic problem. Am J Clin Pathol. Jan 1992;97(1):40-5. [Medline].

  44. van der Wal JE, van der Waal I. Necrotizing sialometaplasia: report of 12 new cases. Br J Oral Maxillofac Surg. Oct 1990;28(5):326-8. [Medline].

  45. Williams RF. Necrotizing sialometaplasia after bronchoscopy. J Oral Surg. Nov 1979;37(11):816-8. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

necrotizing sialometaplasia, NS, salivary gland inflammation, ischemia of salivary gland

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

John Svirsky, DDS, Director of Dental Diagnostic Services, Professor, Department of Oral Pathology, Virginia Commonwealth University School of Dentistry
John Svirsky, DDS is a member of the following medical societies: American Academy of Oral Medicine and American Dental Association
Disclosure: Nothing to disclose.

Coauthor(s)

John E Fantasia, DDS, Attending, Chief, Division of Oral Pathology, Department of Dermatology, Long Island Jewish Medical Center, North Shore - Long Island Jewish Health System
John E Fantasia, DDS is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology
Disclosure: Nothing to disclose.

Josephine Wu, DDS, Assistant Director, Molecular Pathology Laboratory, Department of Pathology, Mount Sinai School of Medicine, Consulting Staff, Division of Oral and Maxillofacial Pathology, Department of Dental Medicine, Long Island Jewish Medical Center
Josephine Wu, DDS is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology and American Association for Cancer Research
Disclosure: Nothing to disclose.

Medical Editor

Abdul-Ghani Kibbi, MD, Chairman and Professor, Department of Dermatology, American University of Beirut Medical Center, Lebanon
Disclosure: none None None

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

Drore Eisen, MD, DDS, Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati
Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, and American Dental Association
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.