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Chronic Submandibular Gland Sialadenitis: Case Example

last modified on: Tue, 09/25/2018 - 12:10

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Preoperative ultrasound:

 

Preoperative CT-neck:

 

Surgery (left submandibular gland resection):

 

Pathology and ultrasound of Left submandibular gland:

A 71-year-old female presented with a stable in size left submandibular mass for 4 months noticed by the patient without any associated pain. She denies any symptoms of dry mouth or dry eyes. No history of autoimmune diseases. Past surgical history of hip fracture surgery. No history of chronic medication intake. Never smoker. No family history of cancers or salivary gland disease.

Physical examination:palpable, firm, nontender, 2cm mass in the left submandibular gland. No other neck masses or palpable lymph nodes.  

Ultrasound performed (photos below) demonstrated left submandibular gland as having a normal hyperechoic homogeneous posterior aspect. Heterogeneity to a less echogenic mass in the anterior gland measured 13.1 x 7.9 mm (overall size of gland = 20.5 mm x 10.2 mm x 23.3 mm).  Further delineation of the hyperechoic homogeneous mass in the tail showed it to be 13.1 mm x 7.9 mm.  

Fine needle aspiration biopsy under ultrasound guidance was consistent with chronic sialadenitis, but also showed atypical cells (few discohesive spindled to epithelioid cells) with the comment that a 'neoplastic process cannot be excluded'.  

CT-scan (photos below) identified enhancing oval mass in the  left submandibular gland with the radiologist offering the differential diagnosis of pleomorphic adenoma and hemangioma.

The patient elected to proceed with left submandibular gland resection (photos below). see also: Submandibular Gland Resection

Surgical pathology (photos below) demonstrated an isolated segment in the anterior gland with extensive fibrosis and chronic inflammation with multiple lymphoid follicles while rest of the gland is minimally involved.