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<p><em><u>TUMOR SUMMARY:</u></em></p><ul><li><strong>Tumor Site:</strong> Left Maxilla</li><li><strong>Histologic Type:</strong> Papillary adenocarcinoma.</li><li><strong>Histologic Grade:</strong> Low grade.</li><li><strong>Tumor Size:</strong> 4.3 cm (greatest dimension).</li><li><strong>Tumor Extension:</strong> Tumor <strong>does not</strong> infiltrate underlying bone.</li></ul><p><strong><u>MARGINS:</u></strong></p><ul><li>Microscopic Margin Status<strong>:</strong> <strong>Margins are positive for invasive carcinoma</strong>.</li><li>Lateral Margin<strong>:</strong> <strong>Uninvolved.</strong></li><li>All Other Margins<strong>: Involved.</strong></li><li>Lymphovascular Invasion (LVI)<strong>: Present. </strong></li><li>Perineural Invasion<strong> </strong>(PNI)<strong>: Not identified.</strong></li><li>Regional Lymph nodes<strong>: Not submitted.</strong></li></ul>
<p class="ql-align-justify">A well-defined, progressively enlarging mass covered by normal-appearing mucosa within the left posterior maxillary alveolar bone, localizing to the molar-bearing region. The lesion reportedly emerged following a recent dental extraction at the affected site.</p>
<p class="ql-align-justify">The specimen consists of multiple fragments of soft tissue and associated bone, measuring in aggregate 8.8 x 7 x 1.6 cm, with the largest tissue fragment measuring 5.3 x 3 x 1.6 cm. Largest fragment reveals an ulcerated mass measuring 4.3 x 2.7 x 1.5 cm away, 0.1 cm from the deep margin, 0.8 cm from the lateral margin, 0.1 cm from the posterior margin, and 0.1 cm from the inferior margin. The tumor grossly reaches the medial margin.</p>
<p class="ql-align-justify"><strong><em><u>Left maxillary mass, Left Hemimaxillectomy:</u></em></strong></p><ul><li class="ql-align-justify"><strong>Papillary adenocarcinoma. </strong></li><li class="ql-align-justify"><strong>Recommended for metastatic work up and marker study. </strong></li></ul><h5 class="ql-align-justify"><strong><u>COMMENT</u></strong></h5><h6 class="ql-align-justify">Given the striking papillary architecture in this anatomical location, the primary differential diagnosis lies between a metastasis from a distant site versus a primary neoplasm of the minor salivary glands.</h6><h4 class="ql-align-justify"><strong><em><u>Differential Diagnosis:</u></em></strong></h4><h6 class="ql-align-justify">1-<strong> Metastatic Carcinoma:</strong> Most notably <strong>Metastatic Papillary Thyroid Carcinoma (PTC)</strong>, given the prominent true papillae and nuclear features. Other less likely primary sites with papillary features (e.g., lung, breast, kidney) should be considered if thyroid markers are negative.</h6><p class="ql-align-justify"><br></p><p class="ql-align-justify"><br></p><p class="ql-align-justify"><br></p><p class="ql-align-justify"><br></p><p class="ql-align-justify"><br></p><p class="ql-align-justify"><br></p><p class="ql-align-justify"><br></p><p class="ql-align-justify"><br></p><h6 class="ql-align-justify">2-<strong> Primary Minor Salivary Gland Malignancy: </strong>Papillary Cyst adenocarcinoma.</h6><h6 class="ql-align-justify"><br></h6><h5 class="ql-align-justify"><strong><u>RECOMMENDED IMMUNOHISTOCHEMISTRY (IHC) MARKERS;</u></strong></h5><h5 class="ql-align-justify"><strong>• </strong>To definitively classify this neoplasm and guide appropriate clinical staging and management, the following primary IHC panel is strongly recommended:</h5><h5 class="ql-align-justify"><strong>• To rule out Thyroid Metastasis (Primary suspect based on morphology):TTF-1</strong> (Thyroid transcription factor-1) & <strong>PAX8.</strong></h5><h5 class="ql-align-justify"><strong>• To evaluate for Salivary/Epithelial Origin (If thyroid markers are negative): CK7 and CK20:</strong> To help establish the primary site of origin. <strong>p63 / p40 / S100:</strong> To evaluate for basal/myoepithelial cells, which are typically absent in metastatic thyroid carcinoma but can highlight specific patterns in salivary gland tumors.</h5><h5 class="ql-align-justify"><br></h5><h5 class="ql-align-justify"><strong>Additional Metastatic Workup (If the above are inconclusive): GATA-3</strong> (Breast) & <strong>Napsin A</strong> (Lung).</h5>
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