A CHALLENGING DIAGNOSIS OF IDIOPATHIC VOLUMETRIC GROWTH IN THE SUBMANDIBULAR REGION

Abstract

A 2-year-old white girl, accompanied by her mother, presented with a swelling in her face and 4 days of the same asymptomatic spontaneous volumetric growth. The mother denied comorbidities or weight loss. The extra-oral exam showed a 4-cm node in the right jaw angle progressing to the submandibular region, steady and painless during palpation. The intra-oral exam revealed normal features. The patient was referred to the hospital with hypothetical diagnosis of infantile cortical hyperostosis, lymphoma, and osteosarcoma. The hemogram showed neutrophilia and thrombocytopenia. Magnetic resonance imaging revealed hyperintensity in the submandibular lymph nodes of the jaw angle and normal aspects of the bones. The fine-needle aspiration of the submandibular region showed bacteria, neutrophils, and simple cuboidal and columnar epithelium-like salivary gland duct. The final diagnosis was lymphadenomegaly secondary to acute sialadenitis. The patient was treated with 7 days’ of oral amoxicillin/clavulanate. On the 14th day, we observed a complete tumoral remission. A 2-year-old white girl, accompanied by her mother, presented with a swelling in her face and 4 days of the same asymptomatic spontaneous volumetric growth. The mother denied comorbidities or weight loss. The extra-oral exam showed a 4-cm node in the right jaw angle progressing to the submandibular region, steady and painless during palpation. The intra-oral exam revealed normal features. The patient was referred to the hospital with hypothetical diagnosis of infantile cortical hyperostosis, lymphoma, and osteosarcoma. The hemogram showed neutrophilia and thrombocytopenia. Magnetic resonance imaging revealed hyperintensity in the submandibular lymph nodes of the jaw angle and normal aspects of the bones. The fine-needle aspiration of the submandibular region showed bacteria, neutrophils, and simple cuboidal and columnar epithelium-like salivary gland duct. The final diagnosis was lymphadenomegaly secondary to acute sialadenitis. The patient was treated with 7 days’ of oral amoxicillin/clavulanate. On the 14th day, we observed a complete tumoral remission.