52 years male patient c / o swelling over left side of palate since 8 months gradually increase in size soft in consistency non tender...suggest ur opinions regarding diagnosis and treatment plan

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Dear From the PIC. given it is confirmed that it involves most part of soft palate and in soft palate 80% tumours are Scca and thus need biopsy to rule out the malignancy. Therefore I think biopsy is a valuable tool for confirmation of diagnosis.

this is palatal tumor . minor salivary gland origin. may be pleomorphic adenoma or adenoidcystic ca. or any other minor salivary gland malignant tumor. first u should do FNAC than Radiology than plan for surgery.

Other name for Lipoma is universal tumor. It can be seen anywhere in the body. Cases have been reported in the literature. CPCJ:INTERNATIONAL JOURNAL of cleft lip and palate. A demographic survey for associated anomalies in orofacial cleft patients. Out of sample size of 3468 patient, 7 cases were reported after histopathological confirmation.

lipoma is a soft tissue origin with nature of fatty tissue and never seen on hard palate, where the palatal mucose is tightly packed. In oro facial cleft, the growth are commonly tags seen is syndromic patients and they are not lipoma. FNAC is a reasonable diagnostic aids with a simple occlusal radiography. clinically the lesion doesn't appear to have a cortical expansion. the D/D can be as simple as pleomorphic or nasty minor salivary gland tumor, however I would suggest have a simple radiography done to rule out possibility of any hemangiomas which may give u a sleep less night during fnac.

the non tender nature of the swelling coupled with its soft consistency is indicative of cystic growth. An X-ray to measure the extent of proliferation followed by an FNAC would be the right protocol for diagnosis.

First advise FNAC and Biopsy......diagnosis become easy.

Please go for a regional CECT first. Or at least a transoral sonography. Than an FNAC. Teeth of the patient are suggestive of use of betel nut and tobbaco a known carcinogen for oral CA. . But the look of the swelling per se doesn't necessarily point towards malignancy and also there are no other features of premalignant changes in the visible adjoining oral cavity. As told by you that it is non tender soft lump my most probable diagnosis will be Lipoma. But still proper work up is needed before definitive treatment.

Thanks a lot Dr. Nitin Sharma for the link and support for the differential of Lipoma on hard palate. I suppose the end to this discussion lies in the hands of our beloved pathologists. With due respect to all the contributors in this discussion I take the liberty to request Dr Wahab On behalf of all of us that please do update us about the climax of this interesting chapter.

Thanks a ton Dr. Chander Shekhar for sharing the link. A very interesting article which I came across is worth to highlight the features of intraoral lipoma especially on hard palate. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3918111/

why biopsy is not indicated?

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