Necrotizing Sialometaplasia 

  • Author: ohn Svirsky, DDS; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jul 15, 2010
 

Background

Necrotizing sialometaplasia (NS) is a nonneoplastic inflammatory condition of the salivary glands. In 1973, Abrams et al first reported this condition.[1] The clinical and histopathologic features of necrotizing sialometaplasia often simulate those of malignancies such as squamous cell carcinoma or salivary gland malignancy.[2] All subsequent reports of necrotizing sialometaplasia stress the importance of correct diagnosis. Familiarity with necrotizing sialometaplasia and correct diagnosis are paramount in avoiding misdiagnosis and inappropriate treatment. Ischemia of salivary gland tissue leading to infarction (trauma) is the most likely cause.

A related eMedicine article that may be of interest is Cancers of the Oral Mucosa.

Next

Pathophysiology

Necrotizing sialometaplasia was first reported to involve the minor salivary glands of the oral cavity, particularly those of the palate. Seventy-five percent of all cases occur on the posterior palate.[3] Most are unilateral, with one third occurring in a bilateral or midpalatal location. Reports of this entity in the minor glands of the retromolar pad area, buccal mucosa, tongue, incisive canal, and labial mucosa followed. In addition, necrotizing sialometaplasia is recognized in the parotid and submandibular salivary glands,[4] minor mucous glands in the lung,[5] nasal cavity,[6, 7] larynx,[8, 9] trachea,[10] nasopharynx, and maxillary sinus.[11] Similar lesions are identified in the breast; the condition is referred to as posttraumatic lobular metaplasia of the breast.[12]

Previous
Next

Epidemiology

Frequency

United States

Mesa and colleagues reported an incidence of 0.03% based on findings in 10,000 oral biopsy specimens.[13] However, they state that this percentage does not account for cases of necrotizing sialometaplasia that heal spontaneously without biopsy.

International

Necrotizing sialometaplasia is reported worldwide. Isolated cases and reviews from Europe, North America, South America, and Asia are reported in the literature.

Mortality/Morbidity

The lesions of necrotizing sialometaplasia often are painless; less frequently, they cause pain and numbness. The clinical appearance that suggests cancer is the significant feature of this lesion. The clinical pictures show a patient with a lesion thought to be cancer who underwent biopsy and was monitored for 9 weeks. Over that time, regression of the lesion can be seen (see the images below).

Initial presentation. Initial presentation. Three weeks later after biopsy. Three weeks later after biopsy. At 6 weeks. At 6 weeks. Nine weeks. Salivary gland infarction. Nine weeks. Salivary gland infarction.

Race

Brannon and colleagues[14] reported that cases of necrotizing sialometaplasia in whites outnumbered cases in blacks by a ratio of 4.9:1. Given the ratio of whites to blacks in the United States, a significant racial predilection does not appear to exist.

Sex

The male-to-female ratio is approximately 2:1.

Age

The average age of patients with necrotizing sialometaplasia in the Armed Forces Institute of Pathology (AFIP) registry is 47.9 years, with a range of 17-80 years. The average age is 43.1 years for female patients and 50.3 years for male patients. A case of necrotizing sialometaplasia in an 18-month-old infant is reported.

Previous
Proceed to Clinical Presentation
 
 
Contributor Information and Disclosures
Author

ohn Svirsky, DDS  J Director of Oral Pathology Diagnostic Service, Professor, Department of Oral & Maxillofacial Pathology, Virginia Commonwealth University School of Dentistry

ohn 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  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.

Specialty Editor Board

Abdul-Ghani Kibbi, MD  Professor and Chair, Department of Dermatology, American University of Beirut Medical Center, Lebanon

Disclosure: none None None

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, Northside 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: Nothing to disclose.

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.

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

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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. Niedzielska I, Janic T, Markowski J. Bilateral localization of necrotizing sialometaplasia: a case report. Cases J. Sep 8 2009;2:9068. [Medline]. [Full Text].

  20. 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].

  21. 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].

  22. 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].

  23. Aframian DJ. Necrotizing sialometaplasia-a practical approach to the diagnosis. Arch Pathol Lab Med. Jan 2010;134(1):17. [Medline].

  24. 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].

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

  26. 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].

  27. 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.

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

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

  30. 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].

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

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

  33. 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].

 
Previous
Next
 
Initial presentation.
Three weeks later after biopsy.
At 6 weeks.
Nine weeks. Salivary gland infarction.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
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.