MUCUS EXTRAVASATION PHENOMENON HIDING A MUCOEPIDERMOID CARCINOMA IN THE FLOOR OF MOUTH

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Background Mucoepidermoid carcinoma is the most common salivary gland malignancy. Approximately more than half these tumors present in the major salivary glands, the parotid gland being the most frequent location.1 The others occur in the minor salivary glands, primarily in the palate.2 The submandibular gland is rarely involved, about less than 10% of all other major salivary glands.1 This tumor develops over a wide age range—from the second to the seventh decades of life.3 Histologically, mucoepidermoid carcinoma is classified, on the basis of its aggressiveness, into 3 grades: low, intermediate, or high grade.1,2 Clinical and Radiologic Findings A 49-year-old female with a mass on the left side of the floor of the mouth was complaining of neck pain for the last 2 to 3 days and had noticed the mass growing in size and becoming tender to palpation. There was no exacerbation of pain during eating, drinking, or opening of mouth. Clinical examination showed no external signs of infection or inflammation. The patient denied any medical disease or history of surgeries. A multidetector computed tomography (MDCT) scan was made. Definitive Interpretation The radiographic examination revealed a mostly well-defined hypodense area suggestive of mucus extravasation phenomenon (“ranula”), which was corroborated by the clinical findings. The treatment of choice was complete excision of the ranula and the left submandibular salivary gland. The histopathologic examination surprisingly revealed low-grade mucoepidermoid carcinoma. No further treatment was recommended; however, a follow-up was scheduled in 4 months. Discussion/Conclusions This atypical location of mucoepidermoid carcinoma in the floor of the mouth simulated the clinical and radiographic features of a mucus extravasation phenomenon. This case highlights the value and importance of using all the available diagnostic tools and modalities for optimal patient management because histopathologic analysis played an important role in confirming the diagnosis.