Necrotizing sialometaplasia is a benign, self-limited inflammatory process that affects minor or major salivary glands. It may be misdiagnosed as carcinoma by the unwary.


Risk factors:

(1) local trauma, including surgery or dental manipulation

(2) ischemic injury

(3) recurrent vomiting

(4) smoking

(5) upper respiratory tract infection


Clinical features:

(1) one of the following:

(1a) painful, well-circumscribed ulcer with erythematous borders

(1b) painful, raised area of mucosa

(2) may be small or measure up to 3 cm in diameter


Histologic features:

(1) lobular infarction with or without spillage of mucin

(2) chronic inflammation

(3) pseudoepitheliomatous hyperplasia

(4) squamous metaplasia of acini and ducts

(5) preservation of the lobular architecture


Findings that exclude the diagnosis:

(1) perineural invasion

(2) lymphovascular invasion

(3) marked nuclear pleomorphism with atypical mitoses

(4) findings suggesting adenocarcinoma

(5) lymph node metastases


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