In March, 2009, a 69-year-old white woman presented with a 3-month history of a slowly enlarging, painful, right-sided palatal swelling. She had been seen by several dentists and unsuccessfully treated with root canal therapy of the right maxillary first molar for what was believed to be an odontogenic infection. 10 years earlier, she had been treated for breast cancer with lumpectomy, radiation, and tamoxifen. Intraoral examination showed a right palatal mass (figure A). She described malaise and had lost 7. 1 kg over 1 month because of local pain and lack of appetite. No cervical lymphadenopathy was detected. Periapical and panoramic radiography showed an ill-defined radiolucent lesion in the right posterior maxilla associated with soft tissue expansion and partial loss of the floor of the maxillary antrum. Differential diagnosis included malignant minor salivary gland neoplasm, lymphoma, and metastatic neoplasm. An incisional biopsy was done under local anaesthesia.
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