DOI: https://doi.org/10.36347/sjmcr.2025.v13i11.056

Pages: 2890-2895

Background: Adenoid cystic carcinoma (ACC) is a rare malignant tumor of the salivary glands, most frequently arising from the minor salivary glands of the palate. Despite its slow growth, ACC is characterized by an insidious course, marked perineural invasion, and a high propensity for local recurrence and distant metastasis. Early diagnosis remains challenging, as palatal lesions may initially mimic benign or inflammatory conditions. Case Presentation: We report the case of a female patient presenting with a painless palatal swelling initially misdiagnosed as a palatal abscess. Imaging revealed a soft-tissue mass with focal bone lysis and extension toward the maxillary sinus and nasal floor. Histopathological analysis confirmed ACC with predominant cribriform and tubular patterns and focal perineural invasion. The patient underwent radical surgical resection with oncologic margins, followed by reconstruction using a para-lateronasal approach and temporalis fascia flap. Discussion: This case illustrates the deceptive clinical presentation of palatal ACC and highlights the importance of advanced imaging in detecting subtle bone and sinus involvement. The histopathological features identified— particularly the cribriform/tubular architecture and perineural invasion—correlate with the known biological behavior of ACC. Radical surgery with postoperative radiotherapy remains the standard of care for resectable lesions, while long-term surveillance is critical due to the high rate of late recurrence and distant metastasis. Conclusion: Any persistent palatal swelling under intact mucosa should prompt consideration of ACC, especially when imaging demonstrates bone erosion or sinus extension. Early recognition, appropriate surgical planning, and vigilant follow-up are essential to optimize outcomes given the tumor’s aggressive and unpredictable behavior.