Mucoepidermoid Carcinoma of Hard Palate in a Pediatric Case

Salivary gland neoplasms are rare in childhood. Only 1 to5.5% of minor salivary gland tumours occur in children and adolescents. The most common malignant minor salivary gland tumours are mucoepidermoid


INTRODUCTION
Salivary gland tumors are rarely seen in childhood, accounting for only 4 pediatric head and neck tumors [1]. As w adults, salivary gland tumors of childhood are most frequently localized in parotid gland. Furthermore, these tumors are less commonly localized in minor salivary glands [2]. Two most common tumors developed in oral salivary glands are pleomorphic adenoma and mucoepidermoid carcinoma (MEC) [3]. MEC is developed most frequently in the parotid gland, followed by the submandibular gland. Furthermore, the most common presentation of oral MEC is palate [3].
MEC is classified into 3 groups as; low, intermediate, and high grade [4]. The risk of distant metastasis is extremely rare in low grade tumors. High grade tumors show a more aggressive course [5].
The aim of this study is to present the clinical approach of hard palate MEC in pediatric case.

PRESENTATION OF CASE
A twelve year old male patient was admitted to our clinic with the complaint of swelling on his palate. According to his medical history, the swelling had been present for 11 months, and had gradually grown in size. His examination revealed a mucosal nodular lesion at the posterior right side of the hard palate which was approximately 1x1 cm in size. The magnetic resonans imaging (MRI) examination showed mucosal mass which didn't show any bone destruction (Fig. 1). Radiological findings were suggesting a low grade or a benign tumor of hard palate. Incisional biopsy was performed and histopathological examination revealed the diagnosis of MEC (Figs. 2, 3). PET metabolic activity was only seen at the site of the lesion in hard palate, there was not any suggestive of metastasis. Large surgical resection was performed for the purpose of treatment. Afterwards there was no need for any additional treatment. After 15 months follow up, the patient did not show any sign of recurrence or metastasis (Fig. 4).

DISCUSSION
Epithelial derived minor salivary gland tumors account for 10-15% of all salivary gland tumors rs are rarely seen in childhood, accounting for only 4-5% of all pediatric head and neck tumors [1]. As with rs of childhood are most frequently localized in parotid gland. Furthermore, these tumors are less commonly [2]. Two most rs developed in oral salivary glands are pleomorphic adenoma and a (MEC) [3]. MEC is developed most frequently in the parotid gland, followed by the submandibular gland. Furthermore, the most common presentation of MEC is classified into 3 groups as; low, ade [4]. The risk of distant metastasis is extremely rare in low grade tumors. High grade tumors show a more The aim of this study is to present the clinical approach of hard palate MEC in pediatric case.
A twelve year old male patient was admitted to our clinic with the complaint of swelling on his palate. According to his medical history, the swelling had been present for 11 months, and had gradually grown in size. His examination ar lesion at the posterior right side of the hard palate which was approximately 1x1 cm in size. The magnetic resonans imaging (MRI) examination showed mucosal mass which didn't show any bone 1). Radiological findings were w grade or a benign tumor of hard palate. Incisional biopsy was performed and histopathological examination revealed the 3). PET-CT scan metabolic activity was only seen at the site of the lesion in hard palate, there was not any sign suggestive of metastasis. Large surgical resection was performed for the purpose of treatment. Afterwards there was no need for any additional treatment. After 15 months follow up, the patient did not show any sign of recurrence Epithelial derived minor salivary gland tumors 15% of all salivary gland tumors [6]. It has been estimated that about 1% to 5% of all salivary gland tumors of childhood and MEC is the most common malignancy [7]. al's study, among twenty MEC cases diagnosed in the first and second decades of life; the mean age was 13.5 and most common presentation age was fourteen, female/male ratio was 2.3/1 and most common side was hard palate While MEC is most commonly seen in the parotid gland (80%), it is rarely seen in minor salivary glands [8]. Intraoral MEC is most commonly presented in the palate, with other localizations including the buccal mucosa and retromolar area [9]. The disease often manifests with painles swelling. Symptoms such as bone destruction and numbness can be observed in tumors with an aggressive course [10]. A biopsy should certainly be performed in order to obtain the diagnosis. Tumors are histopathologically classified as high, intermediate, a Low and intermediate types are more common in children [2]. While low grade tumors contain a high proportion of mucus cells and multi areas, high grade tumors have lower proportion of mucus cells [6]. ; Article no.BJMMR.25755 [6]. It has been estimated that about 1% to 5% of all salivary gland tumors of childhood and MEC is the most common malignancy [7]. In Ritwik et al's study, among twenty MEC cases diagnosed in the first and second decades of life; the mean age was 13.5 and most common presentation age was fourteen, female/male ratio was 2.3/1 and most common side was hard palate [4]. seen in the parotid gland (80%), it is rarely seen in minor salivary glands [8]. Intraoral MEC is most commonly presented in the palate, with other localizations including the buccal mucosa and retromolar area [9]. The disease often manifests with painless swelling. Symptoms such as bone destruction and numbness can be observed in tumors with an aggressive course [10]. A biopsy should certainly be performed in order to obtain the diagnosis. Tumors are histopathologically classified as high, intermediate, and low grade. Low and intermediate types are more common in children [2]. While low grade tumors contain a high proportion of mucus cells and multi-cystic areas, high grade tumors have lower proportion Mucocelle and salivary gland tumors usually have similar clinical features. In a pediatric case with palatal cystic lesion usually first step prediagnosis is mucocelle. Both mucocelle and low-grade MECs may comprise mucous and pseudocsyt. As result both lesions may present with bluish-purple submucosal fluctuant swelling [6,11].

Fig. 3. Beside intermediate cells; widespread clear cells which contain glycogen and mucin are seen. (Hemotoxylin& eosin, x400)
Before planning the treatment, degree of extention and presence of distant metastasis should be determined by imaging methods. While the CT demonstrates presence of bone destruction very accurately, and MRI gives information about soft tissue invasion [11] there is no bone destruction, large mucosal resection would be sufficient for treatment. Since recurrence rates in low grade MEC are lower than 10%, there is generally no need for Before planning the treatment, degree of extention and presence of distant metastasis should be determined by imaging methods. While the CT demonstrates presence of bone destruction very accurately, and MRI gives information about soft tissue invasion [11]. If there is no bone destruction, large mucosal resection would be sufficient for treatment. Since recurrence rates in low grade MEC are lower than 10%, there is generally no need for additional treatment [4]. We did not detect bone destruction in our case, as a result large mucosal resection was determined to be sufficient. If there is invasion of the bone, bone resection is added to large resection [4]. Furthermore, routine radiotherapy is not recommended during the postoperative period. Due to the adver of radiotherapy on maxillofacial development which is most notably in children. Radiotherapy is recommended only for patients who have a positive surgical border [12]. In addition, radiotherapy should never be regarded as an alternative to surgical treatment in MEC [11].

CONCLUSION
MEC is the most common malignant tumor of the salivary glands, but it rarely seen in childhood. Nonetheless, these lesions should be considered in the differential diagnosis of pain standing masses developing in the oral cavity during childhood.

CONSENT
The patient's parents have given their informed consent for the case report to be published Journal.

ETHICAL APPROVAL
It is not applicable.

COMPETING INTERESTS
Authors have declared that no competing interests exist.
; Article no. BJMMR.25755 additional treatment [4]. We did not detect bone e, as a result large mucosal resection was determined to be sufficient. If there is invasion of the bone, bone resection is added to large resection [4]. Furthermore, routine radiotherapy is not recommended during the postoperative period. Due to the adverse effects of radiotherapy on maxillofacial development which is most notably in children. Radiotherapy is recommended only for patients who have a positive surgical border [12]. In addition, radiotherapy should never be regarded as an cal treatment in MEC [11].

Fig. 4. MRI observed normal
MEC is the most common malignant tumor of the salivary glands, but it rarely seen in childhood. Nonetheless, these lesions should be considered in the differential diagnosis of painless, longstanding masses developing in the oral cavity The patient's parents have given their informed consent for the case report to be published declared that no competing