CLINICAL IMAGE
Giant neck swelling Utpal De, Mintu Mohon Nandi & Pranoy Kabiraj Department of Surgery, Bankura Sammilani Medical Colege, Kenduadih, Bankura, West Bengal 722102, India
Correspondence Utpal De, L-4/9, Phase – 3, Dankuni Housing Complex, Dankuni, Hooghly 712311, India. Tel: +91 9434156664; Fax: 03242-251324; E-mail: ][email protected] Funding Information No sources of funding were declared for this study.
Key clinical message The most common benign salivary gland tumor is pleomorphic adenoma. They can attain giant proportions and weigh several kilograms. They can cause facial disfigurement and, if untreated, could lead malignant transformation. This image depicts a 7.5 kg pleomorphic adenoma of right submandibular gland with malignant change in a 55-year-old male. Keywords
Received: 28 September 2015; Revised: 10 November 2015; Accepted: 16 December 2015
Carcinoma ex pleomorphic submandibular tumor.
adenoma,
giant
pleomorphic
adenoma,
Clinical Case Reports 2016; 4(4): 454–455 doi: 10.1002/ccr3.490
Quiz A 55-year-old man presented with a giant, firm, nontender neck swelling insidiously growing since 40 years. His only complain was facial disfigurement. What is your probable diagnosis? • Thyroid mass • Lymphoma • Cystic hygroma • Submandibular tumor
Legend of Snap-Shot A 55-year-old man presented with a huge, firm, nontender neck swelling (28 9 25 9 17 cm) and facial disfigurement (Fig. 1). The swelling rapidly increased in size over the past three months with ulceration and bleeding from the advancing “apex”. Fine-needle aspiration cytology was consistent with pleomophic salivary adenoma. Computerized tomography (Fig. 2) suggested it to be a mass arising from right submandibular gland. The mass was excised under general anesthesia. It weighed 7.5 kg. Postoperative recovery was uneventful. Histopathology revealed carcinoma ex-pleomorphic adenoma with sarcomatous differentiation. Pleomorphic salivary adenomas are most common neoplasm of major salivary glands [1].
454
Figure 1. Figure showing giant neck swelling.
Six percent show transformation to carcinoma [2]. Sarcomatous degeneration is rare found in 2.5% [3].
Conflict of Interest None declared.
ª 2016 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
U. De et al.
giant submandibular gland tumour
Figure 2. CT image depicting the tumor.
References 1. Perumal, C. J., M. Meyer, and A. Mohamed. 2012. A giant pleomorphic adenoma of the submandibular salivary gland: a case report. Craniomaxillofac. Trauma Reconstr. 5:185–188. 2. Gupta, M., and N. Chaudhary. 2011. Giant presentation of pleomorphic adenoma in major salivary gland. BMJ Case
ª 2016 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
Rep. 2011. published online 4 July 2011, doi:10.1136/ bcr.04.2011.4098. 3. Tian, Z., L. Li, L. Wang, Y. Hu, and J. Li. 2010. Salivary gland neoplasms in oral and maxillofacial regions: a 23-year retrospective study of 6982 cases in an eastern Chinese population. Int. J. Oral Maxillofac. Surg. 39:235–242.
455
Giant neck swelling Utpal De, Mintu Mohon Nandi & Pranoy Kabiraj Department of Surgery, Bankura Sammilani Medical Colege, Kenduadih, Bankura, West Bengal 722102, India
Correspondence Utpal De, L-4/9, Phase – 3, Dankuni Housing Complex, Dankuni, Hooghly 712311, India. Tel: +91 9434156664; Fax: 03242-251324; E-mail: ][email protected] Funding Information No sources of funding were declared for this study.
Key clinical message The most common benign salivary gland tumor is pleomorphic adenoma. They can attain giant proportions and weigh several kilograms. They can cause facial disfigurement and, if untreated, could lead malignant transformation. This image depicts a 7.5 kg pleomorphic adenoma of right submandibular gland with malignant change in a 55-year-old male. Keywords
Received: 28 September 2015; Revised: 10 November 2015; Accepted: 16 December 2015
Carcinoma ex pleomorphic submandibular tumor.
adenoma,
giant
pleomorphic
adenoma,
Clinical Case Reports 2016; 4(4): 454–455 doi: 10.1002/ccr3.490
Quiz A 55-year-old man presented with a giant, firm, nontender neck swelling insidiously growing since 40 years. His only complain was facial disfigurement. What is your probable diagnosis? • Thyroid mass • Lymphoma • Cystic hygroma • Submandibular tumor
Legend of Snap-Shot A 55-year-old man presented with a huge, firm, nontender neck swelling (28 9 25 9 17 cm) and facial disfigurement (Fig. 1). The swelling rapidly increased in size over the past three months with ulceration and bleeding from the advancing “apex”. Fine-needle aspiration cytology was consistent with pleomophic salivary adenoma. Computerized tomography (Fig. 2) suggested it to be a mass arising from right submandibular gland. The mass was excised under general anesthesia. It weighed 7.5 kg. Postoperative recovery was uneventful. Histopathology revealed carcinoma ex-pleomorphic adenoma with sarcomatous differentiation. Pleomorphic salivary adenomas are most common neoplasm of major salivary glands [1].
454
Figure 1. Figure showing giant neck swelling.
Six percent show transformation to carcinoma [2]. Sarcomatous degeneration is rare found in 2.5% [3].
Conflict of Interest None declared.
ª 2016 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
U. De et al.
giant submandibular gland tumour
Figure 2. CT image depicting the tumor.
References 1. Perumal, C. J., M. Meyer, and A. Mohamed. 2012. A giant pleomorphic adenoma of the submandibular salivary gland: a case report. Craniomaxillofac. Trauma Reconstr. 5:185–188. 2. Gupta, M., and N. Chaudhary. 2011. Giant presentation of pleomorphic adenoma in major salivary gland. BMJ Case
ª 2016 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
Rep. 2011. published online 4 July 2011, doi:10.1136/ bcr.04.2011.4098. 3. Tian, Z., L. Li, L. Wang, Y. Hu, and J. Li. 2010. Salivary gland neoplasms in oral and maxillofacial regions: a 23-year retrospective study of 6982 cases in an eastern Chinese population. Int. J. Oral Maxillofac. Surg. 39:235–242.
455
