Thyroid carcinoma metastasizing to the submandibular gland: Sonographic findings

Metastases to the submandibular gland are extremely rare; a literature search retuned only three previously reported cases from a thyroid gland primary site. Herein, we report two cases of metastatic thyroid carcinoma to the submandibular gland in a 64-year-old woman with PTC and a 70-year-old-woman with medullary thyroid carcinoma (MTC). The metastases were identified on CT and PET/CT in one case and on CT in the other case, but both were diagnosed with ultrasound-guided fine-needle aspiration. Our cases highlight that while rare, both PTC and MTC can metastasize to the submandibular gland.

Metastatic small cell neuroendocrine carcinoma of the submandibular gland from the lung: A case report

RATIONALE

Small cell neuroendocrine carcinoma of the salivary gland is an extremely rare condition. To the best of our knowledge, metastasis of small cell neuroendocrine lung cancer to the submandibular gland has not been reported in the literature.

PATIENT CONCERN

An 87-year-old female complained of a left neck mass that enlarged from one month ago.

DIAGNOSIS

The final diagnosis was diagnosed as a metastatic small cell neuroendocrine carcinoma of the submandibular gland from lung by an immunohistochemistry.

INTERVENTIONS

Left submandibular resection was performed under general anesthesia.

OUTCOMES

We recommended further evaluation and treatment, but the patient and patient family support team rejected further treatment of her condition. It was confirmed that 3 months after this conclusive diagnosis, the patient died as a result of this condition and disease.

LESSONS

Small cell neuroendocrine carcinoma of the salivary gland is an extremely rare condition. We report a case of metastatic small cell neuroendocrine carcinoma of the submandibular gland from the lung.

Metastases to the Submaxillary Gland from Breast Cancer: Case Report

A case of metastases to the submaxillary gland from breast carcinoma is reported. The patient, a 68-year-old female, had been operated for a stage II N+ breast carcinoma 4 years before. She then received six courses of CMF adjuvant program. A literature review is presented concerning the 8 well-documented cases reported.

Metastasizing pleomorphic adenoma of the submandibular gland: a case report

Pleomorphic adenoma (PA), originally called mixed tumour, is the most common neoplasm of the salivary glands. It is usually a benign, slow-growing and well-circumscribed tumour. However, PA may occasionally give rise to metastases that usually occur after a previous recurrence. These tumours display benign histological features in both primary tumours and metastases. Such tumours have been termed metastatic PA or metastatic mixed tumours. We report a case of metastatic PA of the submandibular gland with metastasis to the cervical lymph nodes.

Breast cancer metastatic to the submandibular gland. Case report

Metastatic disease in the major salivary glands is rare and the parotid gland is most frequently involved. Secondary deposits in the submandibular gland are very uncommon. We report a case of a 50-year-old woman who developed a metastasis from breast cancer in the right submandibular gland, 9 years after primary surgery for G3 T1c N0 ipsilateral breast carcinoma. The peculiarity of the case was the unusual site of the metastatic disease and the difficulty in differential diagnosis with primitive ductal salivary carcinoma.

[Papillary carcinoma in a thyroglossal duct cyst: report of two cases]

Thyroglossal duct cyst is the most common congenital anomaly of thyroid gland development. However, papillary carcinoma is described only in 1-2% of cases and the clinical appearance is indistinguishable from a benign thyroglossal duct cyst. We report two females aged 15 and 27 years consulting for a cervical mass. In both, a solid cystic lesion was found and excised using the Sistrunk procedure. The biopsy disclosed a papillary carcinoma in both. The postoperative evolution of both patients was uneventful.

Submandibular Area Metastasis From Prostate Small Cell Carcinoma With Neuroendocrine Differentiation

Neuroendocrine differentiation in prostatic carcinomas generally confers a more aggressive clinical behavior and less favorable prognosis than usual prostatic carcinomas. In this article, we report a case of a 65-year-old man with prostatic carcinoma who had a metastasis of the submandibular area. His serum prostate-specific antigen level was reduced to below the normal range and carcinoembryonic antigen was increased. Pathologic specimens demonstrated a small cell carcinoma with neuroendocrine differentiation by immunohistochemical studies.

Late metastasis of renal cell carcinoma to the submaxillary gland 10 years after radical nephrectomy

Renal cell carcinoma metastasis to the submaxillary gland after tumor nephrectomy has not been previously recorded in the literature. Most reported cases have involved the parotid gland. We report in this article the first case of solitary submaxillary gland metastasis from clear cell renal cell carcinoma in an 83-year-old man who presented 10 years after primary treatment. The submaxillary gland was excised with preservation of the facial nerve.

Percutaneous radio-frequency mandibular nerve rhizotomy guided by CT fluoroscopy

We describe a new method for radio-frequency mandibular nerve rhizotomy under CT fluoroscopy. A patient with cancer had severe intractable and drug-resistant pain in his left mandibular region. Because he had an anatomic deformity due to cancer invasion and radiation therapy, we planned a mandibular nerve rhizotomy under CT fluoroscopic imaging. The needle was advanced to the mandibular nerve just caudal to the foramen ovale under real-time CT fluoroscopy, avoiding the cancer region. Pain scores of the patient were reduced after the nerve rhizotomy, without any complications.

Neck metastasis of a myxoid liposarcoma of the lower extremity

We report the clinical features of two cases presenting metastatic neck tumors (in the anterior neck and submandibular regions) secondary to myxoid liposarcoma of the lower extremity. Both cases underwent repeated resection of primary legions of the lower extremities because of recurrences. Such repeated surgical procedures are thought to be a risk factor for distant metastasis resulting from hematogeneous dissemination of tumor cells, although there is considerable debate about multicentricity versus metastasis in liposarcomas. Where possible, therapy for liposarcomas should initially comprise complete and wide resection of the lesions. Combined therapy consisting of surgery and postoperative radiation and chemotherapy should be investigated in the future.

Bilateral synchronous submandibular lumps in a patient with gastric carcinoma

This case report deals with a patient who was readmitted with a bilateral submandibular swelling after having received primary surgery due to gastric adenocarcinoma 6 months before. After bilateral submandibulectomy both glands were diagnosed histopathologically as metastasis of adenocarcinoma. This is the rare case of a submandibular gland metastasis and the first case of a bilateral synchronous submandibular gland metastasis from gastric carcinoma.

Isolated submandibular gland metastasis from an occult papillary thyroid cancer

A case of an isolated submandibular gland metastasis from a clinically occult papillary thyroid carcinoma is described in a 46-year old lady. Initial surgery was done based on the fine needle aspiration cytology (FNAC) report of adenocarcinoma of the submandibular gland. Histopathologic examination of the specimen suggested a metastatic papillary carcinoma. Occult papillary carcinoma in the thyroid was found by multiple blind FNACs. Subsequently to near-total thyroidectomy, no other site of metastasis was found on radio-iodine scanning.

Metastasis to the submandibular gland in head and neck carcinomas

BACKGROUND

The purpose of this retrospective chart review was to determine whether and how the submandibular gland is involved in metastases of squamous cell carcinoma of the head and neck.

METHODS

We reviewed the records of all patients for whom pathology specimens were available after neck dissection for primary head and neck cancers at two institutions.

RESULTS

One hundred sixty-nine patients were included in the study, 27 underwent bilateral neck dissections, and 196 submandibular glands were resected and sent for pathology. One hundred forty-four glands had normal histologic findings. Normal or benign histologic changes were present in 187 glands. Three submandibular glands showed invasion from a locally involved lymph node, and six had direct extension from a primary lesion. The primary lesions were all ipsilateral to the involved gland and originated from cancers of the floor of the mouth, alveolar ridge, and tongue. No submandibular glands showed pathologic evidence of metastases.

CONCLUSIONS

Because the submandibular gland has no intraparenchymal lymph nodes, its involvement in upper aerodigestive tract carcinomas must be through extension from a locally involved lymph node or the primary tumor. Previous work has demonstrated that the submandibular gland can undergo transplantation out of the neck with subsequent reimplantation, as a possible means of protection from the effects of radiation. We demonstrated the submandibular gland to be involved only in cases of ipsilateral oral cavity tumors or metastasis to ipsilateral level I lymph nodes. We conclude that it is oncologically sound to consider transplantation and replantation of the contralateral submandibular gland for patients with head and neck squamous cell carcinoma when level I lymph nodes are unlikely to be involved.

Benign stromal fragments in metastases of squamous cell carcinoma in cytology--a report of two cases

Benign stromal fragments or extracellular matrix can be seen in aspirates of invasive carcinomas. Although well documented on histology, this feature is rarely observed on fine needle aspirates and can create diagnostic difficulties on smears. Only three such cases have been reported so far. We report two more cases where stromal fragments were seen in association with invasive squamous cell carcinoma (SCC). Two cases of biopsy proved invasive SCC of the cheek and of the larynx presented with metastases to the submandibular salivary gland and to the cervical lymph node respectively. Aspirates of the metastatic sites showed two components: one of SCC and the other benign stroma, both in close approximation with one another. Both patients were treated with radiotherapy. Biopsy of the metastatic sites was not done. Benign stromal fragments can be encountered in aspirates of invasive carcinoma. These may be cellular or myxoid. Since such stromal fragments can also be seen in salivary tumours, adnexal tumours, fibroadenoma and phylloides tumour, their presence should be interpreted in the light of clinical findings of the patient, so that an erroneous diagnosis can be avoided.

Distant metastases of adenoid cystic carcinoma of the salivary glands and the value of diagnostic examinations during follow-up

BACKGROUND

Adenoid cystic carcinoma (ACC) accounts for approximately 10% of all neoplasms of the salivary glands. Late distant metastases and local recurrences are responsible for a rather low long-term survival rate.

AIM

To study the metastasizing pattern of ACC of the salivary glands in 51 patients.

METHOD

Fifty-one patients with an ACC in the intraoral/sublingual salivary glands (n = 30), parotid gland (n = 8), submandibular gland (n = 2), maxillary sinus (n = 6), and nasal cavity (n = 5) have been studied. The male-female ratio was 1:1, the mean age was 54.3 (range, 19-81) years. In 30 cases treatment consisted of surgery and radiotherapy. In 13 cases surgery alone was carried out. The average follow-up time was 117.8 (range, 1-171) months.

RESULTS

In 28 cases (54.9%) distant metastases occurred, and in 3 patients (5.8%) regional lymph node metastases occurred. In 12 of the 28 patients with distant metastases (42.8%), only the lungs were involved, whereas in 5 of the 28 patients (17.8%), the distant metastases occurred in other organs (eg, bones and brain). In 11 of the 28 patients (39.2%) metastases were found both in the lungs and other organs. Twenty-four of the 51 patients (47.0%) died because of their tumor. The average time between the occurrence of lung metastases and death was 32.3 months and between the occurrence of metastases elsewhere and death 20.6 months.

CONCLUSION

Distant metastases of ACC of the salivary glands occur most often in the lungs. Although these lung metastases are the first to occur, these patients die later than patients with distant metastases in other organs. The value of annual chest films or other tests for the presence of distant metastases during follow-up after surgical removal of an ACC seems rather questionable.

[Metastasis in submandibular gland from a leiomyosarcoma of the uterus]

Two general types of metastases should be distinguished in metastatic salivary gland tumors: one of them are tumors originating in the head and neck region, and the other are tumors from distant tumor sites. Distant metastasis affecting the submandibular gland are a rare entity. We report a case of the uterus leiomyosarcoma which metastatised in the submandibular gland.

Sonographic detection of secondary MALT lymphoma of the submandibular gland

This report describes a case of mucosa-associated lymphoid tissue (MALT) lymphoma of the lacrimal glands that recurred in the submandibular salivary glands. Gray-scale sonography showed small hypoechoic nodules, measuring less than 0.5 cm in diameter, in both submandibular glands. The echogenicity and echotexture of the rest of the submandibular glands and of the parotid glands was normal. Power Doppler sonography revealed increased vascularity within the nodules. A sonographically guided aspiration biopsy of the nodules revealed MALT lymphoma. Secondary MALT lymphoma should be considered in the presence of multiple small hypoechoic nodules in the salivary glands in patients with a history of MALT lymphoma at another location.

Metachronous bilateral submandibular gland metastases from carcinoma of the breast

Metastases to the salivary glands from distant neoplasms are unusual, with most reported cases involving the parotid gland. Metastatic deposits in the submandibular gland are extremely rare with bilateral involvement not previously reported. We present the case of a patient with advanced breast carcinoma who has had metachronous involvement of both submandibular glands and review the literature on this subject.

Squamous carcinoma in a major salivary gland: a review of the diagnostic considerations

CONTEXT

Squamous carcinoma in a major salivary gland has several possible sources: (1) high-grade mucoepidermoid carcinoma, (2) metastasis or direct invasion from a primary skin carcinoma, (3) metastasis from a distant primary carcinoma, or (4) a primary malignant neoplasm. The latter is conventionally regarded as a diagnosis of exclusion after a history of squamous carcinoma elsewhere has been obtained or there is a positive mucin stain.

DESIGN

Eleven cases of squamous carcinoma in a major salivary gland are presented and the literature reviewed.

RESULTS

Two cases, 1 metastatic from a histologically identical squamous carcinoma from the ipsilateral tonsil and 1 with in situ squamous carcinoma in a duct, demonstrated positive mucicarmine stains. Two cases were high-grade mucoepidermoid carcinomas, also with positive mucin stains. Five cases represented metastases from cutaneous squamous carcinomas. Only 2 cases were regarded as primary carcinomas. There were no histologic clues as to correct subclassification. Six patients died, 4 from their disease. Three of the 5 still alive had recurrence or metastasis.

CONCLUSION

The occurrence of squamous carcinoma in a major salivary gland exhibits a histologic sameness that precludes accurate subclassification and assignation of origin. Also irrespective of tumor origin, the clinical approach to diagnosis and treatment is similar. Adjuvant therapy (eg, radical neck dissection, radiation, chemotherapy) is not uniformly applied. Most patients present with a sizable (>3-cm) mass for which total excision is attempted. The natural evolution of the tumor is aggressive, irrespective of clinical context. The traditional subclassification of squamous carcinoma in a major salivary gland may not be clinically relevant.

Gastric adenocarcinoma with tonsil and submaxillary gland metastases: case report

Local invasion, hematogenous and lymphatic metastases are the major modes of spreading gastric cancer. The most common sites of metastases in patients with gastric cancer are liver, peritoneum, omentum, lungs and mesentery. Of the two pathological types of gastric cancer, intestinal-type gastric cancer showed preferential metastasis to the liver, whereas the diffuse-type showed a preference for peritoneal involvement and lymph node metastasis. However, metastases of gastric cancer to the head and neck regions are not common. The hematogenous route appears to account for a great majority of metastases to the head and neck regions. Malignant neoplasm metastases to major salivary glands or tonsils are not common. Several patients with cancers from the infraclavicular area have been reported with parotid gland or tonsil metastases. However, metastasis of gastric adenocarcinoma to the tonsils or submandibular glands is rare. We present a patient with recurrent gastric adenocarcinoma with both tonsil and submandibular gland metastases which is even rarer.

Anterior facial vein and submandibular gland together: predicting the histology of submandibular masses with CT or MR imaging

PURPOSE

To test the hypothesis that the relationship of the anterior facial vein to the submandibular salivary gland and a mass in the submandibular fossa could help identify the origin of the mass at computed tomography (CT) or magnetic resonance (MR) imaging.

MATERIALS AND METHODS

Thirteen patients with 14 palpable submandibular masses, surgical and histologic confirmation, and contrast material-enhanced CT images (12 patients) or MR images (one patient) that showed the anterior facial vein were identified with review of files from 1985 to 1997. Six patients had submandibular gland disease: three with primary neoplasms, two with metastatic tumor invading the gland, and one with chronic sialoadenitis. Eight patients had masses arising outside the gland (seven with lymphadenopathy, one with a plexiform neurofibroma).

RESULTS

The anterior facial vein did not separate primary tumors, tumors invading the gland, or lobulations of the enlarged gland from the body of the gland. The vein was identified between enlarged lymph nodes and the gland. The vein did not separate the gland from the neurofibroma, but this tumor was medial to the gland; the vein runs lateral to the gland.

CONCLUSION

The anterior facial vein is a useful landmark in determining the origin of a submandibular mass. Primary disease of the gland is never separated from the gland by the vein. The vein does separate lymphadenopathy from the gland and, theoretically, separates the gland from soft-tissue tumors lateral to the gland.

Basal cell carcinoma metastatic to the salivary glands: differential diagnosis in fine-needle aspiration cytology

A disparate group of salivary gland neoplasms is characterized by small, uniform, hyperchromatic, basaloid cells. This "small blue cell" pattern is most common in non-Warthin's types of monomorphic adenoma, or in adenoid cystic carcinoma. Small cell anaplastic carcinoma (primary or metastatic), metastatic basaloid squamous cell carcinoma, basal cell adenocarcinoma, and metastatic nasopharyngeal carcinoma are rarely encountered but may present a cytologically similar appearance. We report one female and two male patients (median age = 84 yr) with cutaneous-type basal cell carcinoma (BCC) aspirated from metastatic deposits in the parotid (2 cases) or the submandibular (1 case) gland. One was correctly classified at the time of aspiration, based on a previous history of multiple facial BCC. One was interpreted as carcinoma, the previous history being unavailable at the time of FNA. Smears in these two cases show necrosis and rare keratotic cells. The third cases was mistaken for pleomorphic adenoma (PA); the smears showed metachromatic fragments of collagenous tumor stroma that were misinterpreted as the matrix material typical PA. Similar material was identified in the other two cases. When the "small blue cell" pattern is encountered in salivary bland cytology, one should consider BCC, especially if necrosis is identified. The desmoplastic tumor stroma of BCC may mimic the chondroid matrix of PA. Careful consideration of previous history is very important.

Cervical metastases from pulmonary epidermoid carcinoma

A patient with a right latero-cervical swelling of three-months history was observed. Fine needle aspiration biopsy showed the presence of metastases of epidermoid carcinoma moderately differentiated. No signs or symptoms of head and neck neoplasm were presents. After instrumental evaluation the primary neoplasm was localised at the left lung and metastases were also localised in the right submandibular gland. Although metastases from pulmonary epidermoid carcinoma are normally bloodborne, in this case lymphatic metastases involving cervical areas were present, probably secondarily the submandibular involvement.

Metastatic renal cell carcinoma involving Wharton's duct: a case report

This article describes a case of renal cell carcinoma that metastasized to the right Wharton's duct of a 73-year-old man. Metastases of renal cell carcinoma to the oral tissues are rare. Involvement of salivary gland tissue appears to be exceedingly rare, and a metastatic focus localized only in the Wharton's duct never has been reported in the literature.

[Uncommon tumor and pseudotumor lesions of the submandibular fossa]

The histological examination of the salivary gland tumors is a very important step in the diagnostic approach of the lesions, on which depends the success of therapeutic outcome. Some surprises may occur; four examples were reported. In one case the lesion was not a tumor but a tuberculous lymphadenitis; another showed a Destombes Rosai Dorfman syndrome. Two other cases were found to be unusual tumors: a carcinosarcoma of the submandibular gland and a metastasis of a Merkel carcinoma in the submandibular gland.

Submandibular gland metastasis of breast carcinoma: a case report and review of the literature

We report a female patient who developed a solitary metastasis in the submandibular salivary gland 2 years after primary surgery for a grade II T1 N0 M0 breast cancer. A review of the literature shows that metastases in the submandibular gland are uncommon but when they arise the site of the primary tumour is more likely to be distant than in the head and neck region. In female patients, breast tumours predominate.

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.

[Metastasis of pancreatic adenocarcinoma to the submandibular gland]

Metastases are rarely found in salivary glands. They are exceptional in the submaxillary gland. The authors report a case of a metastatic tumour in the submaxillary gland. The primitive tumour was found in the pancreatic head.

[Primary pulmonary lymphoma diagnosed by transbronchial biopsy and bronchoalveolar lavage findings]

A 45 year-old male was admitted to Tokyo University Hospital because of a submandibular tumor. Biopsy specimen of the tumor showed medium-sized non-Hodgkin's lymphoma of follicular type and immunoperoxidase staining of frozen sections demonstrated an overwhelming predominance of B lymphocytes with IgM, lambda chain. In the meanwhile, chest X-ray taken on admission showed an ill-defined consolidation with a tumor-like appearance in the right middle lung field. Transbronchial biopsy of this lesion revealed massive infiltrations of small and medium sized lymphocytes, having the same markers as those of submandibular tumor (IgM, lambda chain) and an analysis of bronchoalveolar lavage showed a significant increase of CD19-positive B lymphocytes. Reviewing of check-up X-ray films showed the lung lesion to have preceded the submandibular tumor and to have increased its size in several years. On the basis of the similarity of histological and immunohistochemical findings between pulmonary and submandibular tumor, and considering the time course of the appearance of these tumors, we concluded that these tumors were of the same histological nature and had originated in the lung and metastasized to submandibular gland. This is a relatively rare case of pulmonary lymphoma metastasizing to the submandibular gland, in which transbronchial biopsy specimen and analysis of lymphocytes in bronchoalveolar lavage were helpful in establishing the diagnosis.

Carcinosarcoma of the submandibular gland. An autopsy case

We present a rare case of submandibular gland carcinosarcoma occurring in a 45-year-old male patient. His clinical history revealed that the carcinosarcoma had developed from a carcinoma ex mixed tumor in three years. In spite of repeated resection, intensive chemotherapy and irradiation, the tumor recurred and grew rapidly, and the patient died of hemothorax caused by rupture of a pulmonary metastatic tumor. The fourth recurrent tumor and autopsy specimens showed features of carcinosarcoma consisting of three tumor components, i.e., undifferentiated carcinoma, and chondrosarcomatous and osteosarcomatous growth. The metastatic nodules in both lungs and pulmonary hilar lymph nodes showed the same pattern. Immunohistochemically, the chondrosarcomatous cells were positive for vimentin and S-100 protein, and for epithelial markers such as epithelial membrane antigen (EMA) and cytokeratin (MA-902). Undifferentiated carcinoma cells, on the other hand, were partially positive for muscle actin other than cytokeratin (KL 1). Ultrastructurally, desmosome-like structures were seen in the chondrosarcomatous cells. These findings suggest that the sarcomatous lesions might have originated from epithelial cells.

[Submandibular swelling and its differential diagnosis]

The lump in the submandibular area is not too unusual. Nonmalignant swelling may be caused by mumps, sialadenitis, Sjögren syndrome, cysts and infections. Submandibular lymphadenopathy may also result from infections of teeth, upper respiratory track, sinuses and tonsils or infections mononucleosis and cut scratch disease. The neoplastic growths in the submandibular area may include in most of the case tumors of the submandibular gland, the tail of the parotid gland, the Hodgkin's disease and non-Hodgkin's lymphomas. However, since the greatest cause of asymmetric submandibular enlargement, especially in people elder than 40 years old is the metastatic disease, the physician should always first seek to eliminate a primary site in the head, face and mouth area. Possible origin from other parts of the body should also be ruled out. In this article we are presenting representative cases of submandibular swelling.

High-grade malignant mucoepidermoid tumour of tongue. A case report

Mucoepidermoid tumours of the minor salivary glands of the tongue are rarely encountered. A case of a high-grade malignant type is reported here. Merits of subdivision of the mucoepidermoid tumour on the basis of its malignant potential are outlined, and variations of histological presentation of the present tumour at its primary and nodal sites are discussed.

Metastatic tumors to the parotid and submandibular glands--analysis and differential diagnosis of 108 cases

The distinction between primary salivary gland tumors and metastases of other primary tumors in salivary glands is of special importance for therapy and prognosis. In the files of the Salivary Gland Register, 10,944 cases were collected during 1965 and 1985. Among these cases, there were 108 cases of metastatic tumors to the parotid and submandibular gland. The pathohistological analysis of these tumors revealed the following data: 47 cases (43%) of metastatic tumors were localized in the parenchyma of the parotid gland (37 cases) or of the submandibular gland (10 cases). 61 cases (57%) displayed metastases in the lymph nodes of the parotid gland (38 cases) or of the submandibular gland (23 cases). The sublingual gland was free of metastatic tumors. 65 metastatic tumors originated from primary tumors in the neighborhood (head and neck). 32 tumors were carcinomas of the skin, 17 tumors were melanomas, and 13 tumors were nasopharyngeal cancers. Metastases of thyroid cancers were found in 3 cases. The relative frequency of metastases in the lymph nodes of the salivary glands is due to the intense drainage with lymph vessels and the presence of many lymph nodes which are localized especially in the gland parenchyma or around the parotid gland. 21 metastatic tumors originated from primary tumors distant from the head and neck region. There were metastases of lung cancers (7 cases), renal cancers (6 cases), mammary cancers (6 cases), colonic cancer (1 case) and uterus cancer (1 case). Clear cell carcinomas in salivary gland tissue should always be checked for a metastasis of a primary renal cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Renal carcinoma presenting as a primary submandibular gland tumor

An unusual case of metastatic renal cell carcinoma presenting as a submandibular salivary gland tumor is presented, and its differentiation from a primary clear cell neoplasm of salivary origin is discussed.

Renal cell carcinoma with metastasis to the submandibular and parotid glands. A case report

Differential diagnosis between acinic cell carcinoma and renal cell carcinoma is an oft-quoted problem. A case is presented of a 60-year-old woman with metastatic lesions from a renal cell carcinoma to the parotid as well as the submandibular gland. Appropriate diagnosis was delayed due to lack of clinical information.

Metastasis to the submandibular gland as the initial presentation of small cell ("oat cell") lung carcinoma

A 45-year-old man had a submandibular mass, which was resected. Histopathologic evaluation and the subsequent course revealed it to be a metastasis from a small cell carcinoma of the lung. This is the first case in which a metastatic lesion in the submandibular gland was the presenting manifestation of an extrasalivary neoplasm, predating discovery of the primary tumor. Metastases to the salivary glands in general and to the submandibular gland in particular are discussed, as is the differential diagnosis with primary salivary gland carcinoma.

Papillary adenocarcinoma of minor salivary gland origin in a child

A papillary adenocarcinoma with metastasis occurred in a 5-year-old child. The neoplasm arose on the anterolateral sublingual aspect of the tongue and metastasized to a submandibular lymph node. Histologically, the tumor contained broad glandular papillary projections. The tumor cells were cuboidal and had vesicular, "ground glass" nuclei. Colloidlike material was found within the stroma and lumen of the glands. To determine whether the papillary adenocarcinoma was of minor salivary gland or ectopic thyroid in origin, ultrastructural, histochemical, and immunohistochemical techniques were applied to make this clinically important distinction. Ultrastructural and immunohistochemical studies did not indicate the site of origin. Histochemical methods, however, demonstrated the colloidlike material to be sulfated mucopolysaccharide, which was nonreducible by ferric ferrocyanide. These histochemical properties and the anterolateral location identified the tumor as salivary gland in origin.