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Juxtaoral Organ of Chievitz, an Obscure Anatomical Structure Masquerading

as Perineural Invasion of Mucoepidermoid Carcinoma: Case Report and
Review of Literature

Article  in  International Journal of Surgical Pathology · January 2015

DOI: 10.1177/1066896915568991 · Source: PubMed

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research-article2015
IJSXXX10.1177/1066896915568991International Journal of Surgical PathologySancheti et al

Pitfalls in Pathology
International Journal of Surgical Pathology

Juxtaoral Organ of Chievitz, an Obscure

1­–3
© The Author(s) 2015
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DOI: 10.1177/1066896915568991

Perineural Invasion of Mucoepidermoid ijs.sagepub.com

Carcinoma: Case Report and Review of

Literature

Sankalp Mahendra Sancheti, MD1, Satyakam Sawaimoon, MD1,

and Mohammed Abdul Lateef Zameer, MD1

Abstract
The juxtaoral organ was first described by Chievitz in 1885. This is typically located deep to the medial pterygoid muscle
(unilaterally or bilaterally) in the pterygomandibular space. Juxtaoral organ of Chievitz (JOOC) is usually incidentally
detected in biopsies or resection specimen of other tumors but exceptionally, it can present as mass lesions. Awareness
of this normal anatomic structure is important, because the epithelial islands in this area could be misinterpreted as
an invasive carcinoma, mucoepidermoid carcinoma, an odontogenic tumor such as ameloblastoma or adenomatoid
odontogenic tumor, or a perineural invasion by carcinoma. When a portion of the juxtaoral organ of Chievitz is
accidentally exposed by frozen biopsy, there is an even higher risk of mistaking these cells for an invasive cancer or
a perineural invasion of carcinoma. We report this to create awareness about this obscure structure and to draw
attention to its differential diagnosis

Keywords
juxtaoral organ of Chievitz, mucoepidermoid carcinoma, perineural invasion

Clinical Details squamoid cells with a peripheral rim of cuboidal basal

A 50-year-old woman presented with a cystic lesion in the
left retromolar trigone. The lesion was excised at an out-
side hospital and the patient presented to our hospital for
further management. The outside biopsy slides were
reviewed, which showed low-grade mucoepidermoid car-
cinoma of minor salivary gland. Since the status of mar-
gins of excision could not be ascertained from the reviewed
slides and because the post biopsy computed tomography
scan showed an asymetrically increased soft tissue in the
region of left retromolar trigone, a marginal mandibulec-
tomy with wide excision of the biopsy scar was performed
to remove any residual tumor.
Histopathology
The sections from the previous healed scar and indurated
area in the left retromolar trigone showed mucosa lined
by orderly maturing stratified squamous epithelium with
submucosal fibrosis and mild chronic inflammation.
Deep in the submucosal tissue, closely packed nests of
cells were seen. These nests were intimately intermingled
with nerves, vessels and mature adipocytes. There were
foci of calcification within these islands. The histomor-
phology of these nests in association with neurovascular
structures raised a suspicion of perineural invasion/lym-
pho vascular tumor emboli of mucoepidermoid carci-
noma (Figures 1-3). However mucin containing cells,
nuclear pleomorphism, mitosis, necrosis or any other
definite evidence of malignancy were not found. Because
of its classical location and its histomorphological fea-
tures (revealed by literature review) a diagnosis of
Juxtaoral organ of Cheivitz (JOOC) was made. Multiple
sections from the specimen did not reveal any residual
mucoepidermoid carcinoma.
1
Tata Medical Center, Kolkata, India
Corresponding Author:
Mohammed Abdul Lateef Zameer, Tata Medical Center, New Town,
Kolkata 700156, India.
Email: lateefzameer@gmail.com

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2 International Journal of Surgical Pathology 
Figure 1.  Juxtaoral organ of Chievitz: Cord-like epithelial
structure with a focus of dystrophic calcification (hematoxylin
and eosin, 100×).
Figure 2.  Juxtaoral organ of Chievitz intimately associated
with nerve-like fibers with wavy nuclei mimicking neural
invasion (hematoxylin and eosin, 400×).
Discussion
The juxtaoral organ was first discovered in human embryos
by Chievitz and he thought these structures involute prena-
tally.1 It was Zenker2 who reported that JOOC persists well
into adulthood. The incidence of the JOOC has been
reported to be variable. Tschen and Fechner3 observed
JOOC in 14 of 25 consecutive adult autopsies, whereas
Leibl et al4 noted only 1 case in 100 autopsies. The forma-
tion of head and neck structures results from precise in-
utero events where molecular signaling and interactions
between components of different germ layers result in
coordinated histomorphological changes. While most
embryonic structures undergo continuous and progressive
changes that lead to fully developed tissue types, others
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Figure 3.  Juxtaoral organ of Chievitz with focal whorling
surrounded by an artifactual space mimicking nests of
intermediate cells of mucoepidermoid carcinoma in a vascular
space (hematoxylin and eosin, 400×).
persist for defined periods of time and then involute. Some
embryologic structures persist well into adulthood and are
commonly seen in and around the oral cavity. Examples of
such structures of epithelial origin include dental lamina
rests, rests of Malassez, nasopalatine duct remnants, and
JOOC.5 Typically, JOOC is located deep to the medial
pterygoid muscle (unilaterally or bilaterally) in the ptery-
gomandibular space. JOOC starts as an epithelial thicken-
ing of the stomodeum, which invaginates into the subjacent
mesenchyme. This epithelial bud then detaches from the
oral epithelium, becomes innervated by a buccal nerve
branch and receives vascular supply from the buccal
artery.6 Although the exact function is not known, a possi-
ble mechanoceptor function due to close approximation of
JOOC to structures resembling Pacinian corpuscles has
been proposed.7 JOOC is characterized at the microscopic
level by the presence of distinct epithelial and connective
tissue structures. The epithelial component consists of cir-
cumscribed nests of nonkeratinizing squamous, columnar
(glandular-like) and occasionally, basaloid epithelial cells.
Occasionally, epithelial islands demonstrate focal areas of
dystrophic calcification The connective tissue is rich in
nerves and encases the epithelial islands.8,9 JOOC carries
no risk for malignant transformation. It rarely may present
as a mass lesion. There is no recurrence after its removal.10
The importance of recognizing this structure lies in
separating it from its mimics. The JOOC can be differenti-
ated from malignancy by its benign cytological features,
showing no pleomorphism, abnormal mitosis, or necrosis.
The basement membrane is destroyed in carcinoma, but
the basement membrane of the JOOC remains intact.
Carcinoma has more disorganized and desmoplastic
stroma usually with an associated inflammatory reaction,
 Sancheti et al 3
while the JOOC shows organized envelopment of loose
and dense connective tissue stroma without inflamma-
tion.7 At times, the glandular-like epithelial cells of JOOC
can mimic a mucoepidermoid carcinoma. However, the
typical mucous cells, intermediate and squamous cells
with characteristic histopathologic findings as seen in
mucoepidermoid carcinoma are not present. A JOOC may
occasionally have glandular foci filled with tissue fluid,
which is negative for mucin stains. This characteristic is
distinctive from adenocarcinoma or mucoepidermoid
carcinoma.11,12
We expect that this report will play a role in increasing
awareness of this obscure structure and thereby decreasing
the chance of a misdiagnosis and possibly an unnecessary
therapeutic intervention.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
References
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Speicheldrusen. Arch Anat Physiol. 1885;9:401-436.
Downloaded from ijs.sagepub.com by guest on January 28, 2015
View publication stats
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Organ), ein nervös epitheliales Organ beim Menschen. Anat
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