Submandibular Mass Research Articles

Fine-needle aspiration cytology in Kimura's disease.

Three patients presenting with parotid, submandibular, and/or lymph node masses were subjected to fine-needle aspiration cytology. Smears showed dissociated and clustered endothelial cells, eosinophils, lymphocytes, and Warthin Finkeldey giant cells. In two cases a diagnosis of Kimura's disease was suggested from the FNA cytologic smears. In the third case the presence of mononucleate cells with prominent nucleoli led to a suspicion of Hodgkin's disease. Excision biopsy and histopathologic study established a diagnosis of Kimura's disease in all three cases.

The importance of thyroid scanning in neck lumps – a case report of ectopic tissue in the right submandibular region

We describe the case of a 50-year-old previously well female, who presented with a slowly growing mass in the right submandibular region. Imaging confirmed the absence of a normally placed thyroid and the presence of a lingual thyroid. The submandibular mass was excised and histological examination confirmed ectopic thyroid tissue. The embryological descent of the thyroid and the Sistrunk procedure are discussed as well as the importance of thyroid scanning in neck lumps.

Primary and metastatic high‐grade carcinomas of the salivary glands: A cytologic‐histologic correlation study of twenty cases

We reviewed the clinical and fine-needle aspiration (FNA) findings in 20 patients with poorly differentiated carcinomas presenting initially as parotid or as submandibular masses. There were 11 primary tumors and nine metastatic malignancies in 14 males and six females ranging in age from 39 to 89 yr (median = 66). The tumor types included three primary carcinomas with oncocytic features, three additional cases of high-grade parotid carcinoma, one case of primary neuroendocrine carcinoma, two examples of malignant mixed tumor, one high-grade mucoepidermoid carcinoma, and a single example of malignant lymphoepithelial lesion. Six patients with metastatic carcinoma had previous diagnoses of malignancy. In the three remaining individuals, primary carcinomas of the lung (two cases), and an unknown primary site presented initially as parotid masses. Five examples of metastatic squamous cell carcinoma, one metastatic basal cell carcinoma, and two metastatic renal cell carcinomas were identified. One parotid lymphoepithelioma was interpreted cytologically as an atypical lymphoproliferative process suggestive of Hodgkin's disease. Nineteen cases (95%) were correctly classified as carcinoma at the time of FNA. High-grade carcinomas aspirated from the parotid may be primary, but are frequently metastatic to either the gland, or to an intraparotid lymph node. Our experience indicates that some metastatic carcinomas present at this site, without a previous history of malignancy. Distinguishing primary from metastatic lesions has important therapeutic implications.

Lipoma Masquerading as a Submandibular Mass

Lipoma Masquerading as a Submandibular Mass

Submandibular swelling as the first manifestation of giant cell arteritis. Report of a case

Giant cell arteritis is a systemic disease with a broad range of clinical signs and symptoms. Although the most frequently involved vessel is the superficial temporal artery, other arteries can be affected. Vasculitic changes in the facial artery usually present as jaw claudication. A report of a case of giant cell arteritis is presented in which facial artery involvement first manifested itself clinically as a submandibular mass. This is a very rare and atypical form of clinical presentation.

良性リンパ上皮性病変の２症例 腺上皮におけるサイトケラチン発現の検討

Two cases of benign lymphoepithelial lesions (BLEL) are reported along with a discussion on the expression of cytokeratin.Case 1: A 46-year-old man was referred to our clinic with a chief complaint of swelling at the right submandibular gland. Computed tomography showed the submandibular gland as a homogeneous high density area. Gallium scintigraphy demonstrated a clear hot spot at the same region. The submandibular mass was extirpated extraorally. Pathologically, there were atrophic changes of the ducts and acini, acompanied by severe lymphoid cell infiltration.Case 2: A 55-year-old man complained of swelling of the right buccal region. Magnetic resonance imaging revealed a homogeneous mass showing low intensity in T1 weighted SE and slightly high intensity in T2 weighted SE at the right lower parotid region. Examination of a specimen of the extraorally excised mass showed severe lymphoid tissue infiltration interspersed with myoepithelial islands in the atrophic parotid gland.Immunohistochemical staining was performed to check for the expression of the cytokeratin in the atrophic salivary gland. All duct-like structures (DLSs) reacted positively against K8.13 and cytokeratin #7 and #18. On the other hand, # 8 was negative especially in small DLSs.

The role of suprahyoid block dissection in carcinoma of the floor of the mouth

The efficacy of suprahyoid block dissection combined with radiotherapy, in the management of neck nodal disease was evaluated in 15 patients with carcinoma of the floor of mouth (abutting on the mandible) between 1983 and 1989. Ten males and 5 females had a mean age of 60.3 years. Suprahyoid block dissection was performed in 10 patients as initial treatment. Nine of these presented with a submandibular mass and one patient with a T4NO lesion had a prophylactic block performed. Suprahyoid block dissection was performed in five patients who developed a submandibular mass after completion of surgery and radiotherapy. Wound sepsis occurred in three patients, but resolved with conservative treatment. Clinical assessment of the suprahyoid mass was accurate in 65% of patients. Nodal recurrence occurred in one patient. Seven patients are alive and disease free after a mean of 64.5 months. Two other patients are alive, one with lung metastases, and one with a supraclavicular mass. Six patients have died, two of whom developed local recurrence, one who developed a supraclavicular mass, one after nodal recurrence, one with lung metastases, and one of an unrelated cause. Suprahyoid block dissection combined with radiotherapy is effective treatment for nodal control of patients with carcinoma of the floor of mouth. This procedure is associated with a low morbidity.

Primary Adenoid Cystic Carcinoma of Salivary Gland with Metastatic to the Lung

A 22-year old female visited CNUH due to palpable neck mass. Cytologic examination of a fine needle aspiration was performed and the result was Pap class II. Routine chest x-ray shows solitary pulmonary nodule. For rule-out malignancy, FNA at neck mass was repeated and pathologic finding was dysplasia. She was admitted to MI department for evaluation of solitary pulmonary nodule and percutaneous needle aspiration was done. Pathologic diagnosis was adenoid cystic carcinoma. Thereafter, the lesions were treated by excisional biopsy of submandibular gland mass with left supraomohyoid neck dissection and wedge resection of right lower lobe at ENT department and thoracic and cardiovascular surgery department, respectively. Final diagnosis was adenoid cystic carcinoma arising in submandibular gland with solitary lung metastasis. According to TMN staging system, surgical staging is stage IV of T2N0M1. Clinical follow-up to postoperative 13 months in this case showed that she is alive and well without evidence of recurrence.

顎下部に発生した毛髪嚢腫症例

A 52-year-old female was admitted to our hospital with a complaint of left submandibular mass. Ultrasound echo, CT-scanning and MRI-scanning revealed a cystic lesion. The mass was resected and diagnosed as a trichilemmal cyst pathologically.All the reports of trichilemmal cyst have been presented b y dermatologists in Japan, and a trichilemmal cyst in the submandibular region is very rare. This is the first report of a trichilemmal cyst by an otorhinolaryngologist

RESIDENTS PAGE: PATHOLOGY

Pathologie Quiz Case 1 A 14-month-old black girl was referred for evaluation of a slowly enlarging left submandibular mass that had been present for 3 weeks. A tuberculin skin test was nonreactive, and the mass enlarged despite 10 days of amoxicillin–clavulanate therapy. The patient was otherwise healthy, without fever, cough, or other systemic complaints. Her head and neck examination was remarkable only for a 3X3-cm mass in the left submandibular triangle, which was firm but not fixed. The mass was neither warm nor tender, and no changes were present in the overlying skin. No other significant adenopathy was found on head and neck and general physical examinations. Computed tomography with intravenous contrast showed a submandibular mass with low attenuation centrally and some rim enhancement (<b>Figure 1</b>[arrow indicates the mass]). Fine-needle aspiration was performed, revealing a polymorphous population of mononuclear cells and occasional large reactive histiocytes containing intact lymphocytes (<b>Figure 2</b>).

顎下腺の腺へん平上皮癌例

A 70-year-old man was admitted to the hospital because of a large left submandibular mass, 7×5×5cm. The tumor but it had been growing slowly for 50 years, enlarged suddenly, so we removed it together with adjacent lymph nodes. The pathohistological examination showed adenosquamous cell carcinoma accompanied by specific hyalinization. The hyalinization was considered to be related to the enlargement of the tumor and to the development of squamous cell carcinoma. Three years after the first operation, squamous cell carcinoma recurred. The adenosquamous cell carcinoma should be treated more vigorously at the initial stage.

A large submandibular space mass

In the case presented, we have a 57-year-old well-nourished man who had a tooth removed for an unknown cause. The second event in the history was persitent pain and swelling of the left submandibular region after the extraction

Associated carotid body tumour and pharyngeal pouch

Paragangliomas are rare tumours which most commonly present as an asymptomatic neck mass. A small percentage of patients may have associated dysphagia. A 63-year-old male presented with a ten-month history of dysphagia. Physical examination revealed a pulsatile submandibular triangle neck mass. Computed tomography and angiography were diagnostic of a carotid body tumour. Barium swallow illustrated a hypopharyngeal pouch. He was treated by surgical excision of both lesions and cricopharyngeal myotomy. The simultaneous occurrence of both lesions has not been described before and highlights the need to find an alternative cause for dysphagia in patients with chemodectomas who fail to demonstrate oropharyngeal compression or lower cranial nerve palsies.

Resident's Page

<h3>PATHOLOGIC QUIZ CASE 1</h3> Jed A. Kwartler, MD, Anjali Limaye, MD, Newark, NJ A 36-year-old man presented with a nontender, indurated, nondraining mass in the left submandibular area of three weeks' duration. His history was significant for cigarette smoking and intravenous drug abuse. He denied any history of blunt trauma to the area, but did admit to attempted drug injections in the region of the mass. He denied any recent dental work. Physical examination revealed a 6 × 4-cm firm, nontender, left submandibular mass. Oral examination did not demonstrate any mucosal lesions, and the dentition appeared intact. Clear saliva could be milked from Wharton's duct. An aspiration biopsy was performed and revealed the mass to be cystic. A large amount of foul-smelling purulent material was evacuated and was sent for culture and cytologic examination. What is your diagnosis? <h3>PATHOLOGIC QUIZ CASE 2</h3> Howard K. Nam, MD; Miriam L. Christ, MD;

Distinction between metastatic melanoma and primary parotid gland carcinoma using monoclonal HMB 45 antimelanoma antibody: Report of a case

A case of malignant melanoma primary of the facial skin presenting with pre-auricular and submandibular masses, both thought to be metastatic melanoma, is reported. The case illustrates the practical application of a recently developed and commercially available specific anti-melanoma monoclonal antibody, HMB 45, which is useful in distinguishing between metastatic melanoma to a submaxillary lymph node and a synchronous primary parotid, poorly differentiated adenocarcinoma. The value of specific anti-melanoma antibody in conjunction with an antibody panel that includes S100, keratin, and epithelial membrane antigen in the distinction of melanomas from anaplastic carcinomas is discussed.

Granulomatous angiitis masquerading as a mass lesion: Magnetic resonance imaging and stereotactic biopsy findings in a patient with occult Hodgkin's disease

Granulomatous angiitis is a frequently fatal central nervous system vasculitis of unknown pathogenesis sporadically associated with Hodgkin's disease, mixed cellularity type. We describe a 58-year-old woman presenting with headaches, progressive spastic paraparesis, equivocal computed tomography findings, and magnetic resonance imaging findings of increased signal intensity biparietally on T 2-weighted imaging in à relatively discrete pattern. Magnetic resonance imaging-directed serial stereotactic biopsies revealed granulomatous angiitis throughout the right parieto-occipital region and splenium. Simultaneous biopsy of an enlarged submandibular mass revealed Hodgkin's disease, lymphocyte-predominant type. This case shows that granulomatous angiitis may be associated with magnetic resonance imaging findings suggesting a mass lesion in lymphoctye-predominant as well as mixed cellularity Hodgkin's disease.

Submandibular gland excision.

A review of 107 submandibular gland excisions was made to determine the relative frequency of neoplastic versus non-neoplastic disease. The results show a preponderance of non-neoplastic pathology. Benign tumors were found in 6% of glands, primary glandular and metastatic carcinoma in 3%. Timely treatment of a submandibular gland mass is indicated due to the relatively aggressive behavior of malignancies originating in this location.

Plunging Ranula in an Infant

This unusual case extends the age range of persons with plunging ranula to include those with congenital neonatal submandibular masses. The congenital nature of plunging ranula has not been widely discussed. Clinical diagnosis can be reinforced by diagnostic imaging (CT, MRI) if the mass extends into or abuts the sublingual space. Definitive treatment (generally excision) leads to resolution of the mass and prevention of recurrence.

The use of sialodochoplasty in the treatment of benign inflammatory obstructive submandibular gland disease.

One of the most common causes of submandibular gland enlargement is benign inflammatory disease. The usual cause is ductal outflow obstruction due to either a calculus or stenosis allowing stasis and retrograde movement of the saliva into the acinar structures leading to an inflammatory response and gland enlargement. Faced with a submandibular mass, a work-up that will rule out neoplastic causes of submandibular enlargement is instituted. This includes clinical assessment, probing of the gland, radiocontrast sialography, and CT scanning. The treatment should reflect the obstructive nature of the disease. Plastic reconstruction of the duct allows the removal of calculi, shortening of the duct, and enlargement of the outflow opening preventing recurrence and allowing healing of the gland. The procedure is performed intraorally as an outpatient, does not disrupt oral functioning, or subject the patient to the risks of gland removal or loss of that organ's function. Our experience with 27 patients over a 7-year period is presented with a detailed description of the technique and an analysis of the results. The procedure was successful in 22 of the 27 patients.

Food induced granuloma—An unusual cause of a submandibular mass with observations on the pathogenesis of hyaline bodies

A case of a submandibular mass due to a granulomatous reaction to vegetable matter of dietary origin is presented. The histology of the lesion and its pathogenesis are described. It is compared with previous reports of ‘hyaline bodies’ in relation to chronic mandibular periostitis.