Tratamento cirúrgico de sialolitíase em glândula submandibular - relato de caso / Surgical treatment of sialolithiasis in the submandibular gland - case report

A sialolitíase é responsável por metade das patologias que acometem as glândulas salivares e, em função disso, vem sendo tratada e estudada há décadas. Nos últimos anos, com o advento de novos recursos de diagnóstico e métodos de tratamento, propostas terapêuticas vêm sendo continuamente sugeridas para abordagem dos cálculos salivares. Este trabalho apresenta o caso clínico de um paciente de gênero masculino, de trinta e sete anos que procurou atendimento profissional devido aumento volumétrico e dor em região submandibular esquerda com seis meses de evolução. A avaliação clínica associada aos exames de imagem levaram à confirmação diagnóstica de sialolitíase, com o cálculo salivar localizado no ducto da glândula submandibular esquerda. Foi planejada e realizada a remoção cirúrgica por acesso intrabucal do sialolito, de forma que num pós-operatório imediato já se observa funcionamento normal da glândula e de seu sistema secretor. Com base no caso apresentado, este trabalho ainda discute os mais recentes métodos de diagnóstico e tratamento de sialolitíase.

Considering that sialolithiasis is responsible for half of disorders that affect the salivary glands, and therefore it has been studied and treated during decades. Therapeutic alternatives have been suggested to treat salivary calculi over the last years due to development of diagnostic and treatment resources. The aim of this study is to report the case of a male patient, 37 years old, who reported pain and volume expansion in left submandibular region during 6 months. Clinical evaluation combined with radiographic exams confirmed the diagnosis of sialolithiasis with salivary calculus in the duct of left submandibular gland. After definitive diagnostic of sialolithiasis, surgical removal of calculus was planned and performed through intraoral approach of calculus in left submandibular duct. Normal function and drainage recovery was achieved in an immediate postoperative period. According to the present report, this study still discusses the current methods for diagnosis and treatment of sialolithiasis.

Sialoadenite esclerosante crônica (tumor de Kuttner): relato de caso clínico / Chronic sclerosing sialadenitis (Kuttner tumour): clinical case report

A sialoadenite esclerosante (tumor de Kuttner) representa um processo inflamatório crônico incomum de glândula salivar, que acomete com maior freqüência a glândula submandibular. O objetivo deste trabalho é relatar o caso clínico de um paciente que apresentou sialoadenite esclerosante crônica associada a quadro de sialolitíase. Essa entidade patológica é pouco freqüente, clinicamente pode ser confundida com uma neoplasia e, embora seja resolvida com a exérese da lesão, causa transtornos importantes ao paciente, como dor intensa, disfonia e disfagia.

Chronic sclerosing sialadenitis (Kuttner tumour) is an unusual chronic inflammatory process of the salivary gland that affects principally the submandibular gland. The aim of this work is to report a case of chronic sclerosing sialadenits associated with sialolithiasis. Kuttner tumour is an uncommon entity that clinically may not be distinguished from neoplasia and though it can be resolved by surgical excision of the lesion, it causes important upset for the patient, as intense pain, dysphonia and dysphagia.

Immunization of Balb/c mice with modified auto-antigens for induction of autoimmune sialoadenitis

Sjögren's syndrome is an autoimmune disease characterized by sialoadenitis and elevated titers of autoantibodies. To assess whether it is possible to induce inflammatory changes in salivary gland tissues, a series of immunizations in Balb/c mice have been undertaken, using salivary gland extract, modified or not, added to several adjuvants. Mice's humoral immune response to salivary gland antigens was monitored by ELISA. Inflammatory cells infiltrating gland tissue were seen 3 months after immunization with salivary gland extract modified with pepsin (AgGp) and metaperiodate (AgGMp). Although pathological progression was not observed, the histopathological picture was similar to the initial phase of Sjõgren's syndrome. In addition, a monoclonal antibody reactive with 3 gland polypeptides and anhydrase carbonic II was rescued among B cells from immunized mice. Thus, immunizations with modified autoantigens were able to initiate pathological damage to glandular tissue and stimulate the proliferation of auto-reactive B cells.

A Síndrome de Sjögren é uma doença auto-imune caracterizada por desenvolvimento de sialoadenite e títulos elevados de auto-anticorpos. Com o objetivo de induzir alterações inflamatórias no tecido das glândulas salivares foram realizadas várias imunizações em camundongos BALB/c utilizando extratos de glândulas salivares, modificados ou não, em vários adjuvantes. A resposta humoral para antígenos salivares foi monitorada por ELISA. Células inflamatórias infiltrando o tecido glandular foram vistas 3 meses pós-imunização com extrato de glândula salivar modificado com pepsina (AgGp) e metaperiodato (AgGMp). Embora a evolução patológica não tenha sido observada, o quadro histopatológico foi semelhante à fase inicial da Síndrome de Sjõgren. Também foi possível notar, a partir das células B dos animais imunizados, a produção de anticorpos monoclonais reativos com 3 polipeptídeos glandulares e anidrase carbônica II. Assim, a imunização com auto-antígenos glandulares modificados foi capaz de iniciar o processo patológico no tecido glandular e induzir a proliferação de células B produtoras de auto-anticorpos.

A study of fine needle aspiration cytology of salivary gland lesions with histopathological corroboration.

The diagnostic utility of fine needle aspiration cytology as initial work up of salivary gland enlargement was assessed in one hundred and eighty-five salivary gland specimens over three years period and corroborated with histopathology, whenever feasible. All smears were evaluated according to cell size, amount of cytoplasm, cytologic atypia and presence of lymphocytes. (a) Variable cytologic appearances of pleomorphic salivary adenoma were observed. (b) Cellular pleomorphic adenoma and adenoid cystic carcinoma showed basaloid cell features. (c) Tumours with intermediate size cells and bland cytology included low grade muco-epidermoid carcinoma and cystic lesions. (d) Warthin's tumour, oncocytoma, salivary duct carcinoma and high grade muco-epidermoid carcinoma revealed large cells and abundant cytoplasm with or without atypia. A major diagnostic categories were inflammatory lesions (n = 7 5), cystic lesions (n = 9), benign tumours (n = 81), malignant neoplasms (n = 1 8) and normal acinar pattern (n = 2). Malignant tumours included muco-epidermoid carcinoma (n = 5), adenoid cystic carcinoma (n = 3), acinic cell carcinoma (n = 2), adenocarcinoma (n= 2), squamous cell carcinoma (n = 1), undifferentiated carcinoma (n= 4) and malignant lymphoma (n = 1). Histopathological correlation was possible in 40% of benign and 80% of malignant neoplasms. The overall sensitivity, specificity and diagnostic accuracy were very high. So it can be concluded that fine needle aspiration cytology can play important role in early diagnosis and subsequent therapeutic planning of salivary gland lesions.

Bilateral Kuttner tumor of submandibular glands; a case report and review of the literature.

Kuttner tumor is a relatively uncommon disease of the salivary gland. It is also known as chronic sclerosing sialadenitis or cirrhosis of the submandibular gland. The examination of the submandibular gland characterizes clinically by a firm swelling of the gland, and histologically by progressive periductal sclerosis, dense lymphocytic infiltration with lymphoid follicle formation, reduction of the secretory gland parenchyma and fibrosis. Clinical, cytologic, histopathologic and immunohistopathologic features with briefly reviewed relevant literature describing 231 cases are discussed. The patients with the mean age of 44 years (range 13-81 years) had submandibular masses known to be present for 1 week to 55 years (mean 23.2 years). There is a slight predilection for occurrence in men. This is the first reported description of bilateral Kuttner tumor of submandibular glands in Thailand. It was initially diagnosed as a primary submandibular gland neoplasm that fine needle aspiration revealed to be chronic sialadenitis.