ABSTRACT
Background: Kuttner’s tumour is a condition of the submandibular gland which is underreported as a distinct entity. Also called as the chronic sclerosing sialadenitis it resembles a plasmocytic and lymphocytic inflammatory process and presents as a hard and painful mass which clinically mimics a malignancy and raises significant concerns. The objective of the present study was to evaluate cases of Kuttner’s tumor and discuss its clinical and pathological aspects to distinguish it from a definite malignancy and create a grown acceptance of the presence of such an entity in our setting.Methods: We collected 170 cases of submandibular swellings and evaluated in detail the clinical and pathological aspects of eight cases out of them which were later diagnosed to as Kuttner’s tumour.Results: The age of the patients varied between 23 to 61 years (mean age 42.5 years) with 3 males and 5 females. 6 patients reported with a firm to hard painless submandibular mass (5 left sided; 3 right sided) while 2 patients experienced intermittent discomfort. The mean duration of presentation of symptoms was 5.3 months. Fine needle aspiration cytology was done in 6 cases preoperatively. Following submandibular sialadenectomy histopathology showed salivary gland tissue with preserved lobular architecture, but with marked fibrosis, acinar atrophy, and a dense lymphoplasmacytic infiltrates.Conclusions: Kuttner’s tumor may be pre operatively distinguished from a malignancy with improved imaging and a good image guided FNA Cytology saving the clinician and the patient from a lot of dilemma. However, histopathology and immunohistochemistry would be the key in establishing the diagnosis.
ABSTRACT
Objective @#To explore the clinicopathological features, diagnosis, treatment and prognosis of sclerosing polycystic adenosis (SPA) and provide a reference for clinics.@*Methods @#A case of sclerosing polycystic adenosis of the parotid glands was retrospectively analyzed, and the relevant literature was reviewed.@*Results @# A 57-year-old female patient presented with a tumor, which she had noticed for half a month, on the left side of the lower ear, with occasional paroxysmal numbness and no complaint of other discomfort. Resection of the left submandibular area tumor was performed, and the tumor specimen pathological results showed sclerosing polycystic adenosis of the left parotid gland, with no recurrence after six-months follow-up. Sclerosing polycystic adenosis is rare, occurs in the parotid gland and is characterized by a frequently painless, slow-growing mass of the parotid gland. Imaging examination and fine needle aspiration biopsy can only be used as a reference; the diagnosis must include a pathology examination. Histological manifestations showed that abundant sclerotic collagenous stroma was permeated by ductal and acinar lobules, and cystic dilatation of the duct was accompanied by epithelial hyperplasia and diverse ductal cells. Immunohistochemistry of the ductal and acinar cells showed positive expression of cytokeratin (AE1-3 and CAM5.2) and S100 protein. The ducts filled with hyperplastic and dysplastic epithelium were surrounded by an intact myoepithelial layer that was positive for SMA, p63, and calponin, with a Ki-67 index less than 3%. Treatment comprised mainly surgical resection, with a good prognosis. However, one-third of cases relapse: low-grade malignant tumors may occur, with at least one report of invasive cancer.@*Conclusion@#Sclerosing polycystic adenosis of the salivary gland is rare and has a good prognosis, but patients may relapse easily after surgery. The diagnosis depends primarily on pathological examination. The main treatment is surgical resection, the prognosis is good, and follow-up should be strengthened after surgery.
ABSTRACT
Chronic sclerosing sialadenitis, Mikulicz disease or Kuttner tumor has been recently recognized as a spectrum of IgG4-related sclerosing disease. IgG4-related disease is characterized by a high serum IgG4 level and tissue infiltration of IgG4-positive plasmacytes. We report three cases of chronic sclerosing sialadenitis with variably associated systemic involvement. All patients presented with a submandibular mass or swelling, and all the resected submandibular glands showed diffuse lymphocytic infiltration, lymphoid follicles, and septal fibrosis. Two of the specimens revealed numerous IgG-positive plasma cells, most of which were IgG4-positive on immunohistochemical staining. One of them was associated with dacryoadenitis and hypophysitis. The other patient had ureterorenal lesions. Immunohistochemical study was unavailable in remaining one case, but the histologic features along with elevated IgG level and associated pancreatitis supported the diagnosis. All patients received steroid therapy postoperatively and are doing well. Salivary gland involvement in IgG4-related fibrosclerosis should be recognized in systemic medical pathology.
Subject(s)
Humans , Dacryocystitis , Fibrosis , Immunoglobulin G , Mikulicz' Disease , Pancreatitis , Plasma Cells , Salivary Glands , Sialadenitis , Submandibular GlandABSTRACT
Chronic sclerosing sialadenitis, also known as Kuttner tumor, is a benign chronic inflammatory lesion of the salivary gland. Here, we describe a case of chronic sclerosing sialadenitis with mucinous ductal metaplasia in a parotid gland, which was confused with low-grade mucoepidermoid carcinoma on aspiration cytology.