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.

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.

Hydatid disease of the submandibu;ar gland

Echinococcosis is a tissue infection of the human caused by the larval stage of Echinococcus granulosus or E. multilocularis. Hydatid cyst of the head and neck region is uncommon and the involvement of salivary glands, especially the submandibular gland, is very rare. A case of submandibular gland hydatid cyst is reported in this article, in a patient who was presented with swelling of this area of three months' duration. Examination revealed a soft, non-tender, mobile mass measuring 6x4 cm. Chest X-ray and abdominal ultrasonography were normal. Excision of the whole mass was performed and pathological examination confirmed the fine needle aspiration cytology report. A 7 years old female child was admitted in ENT unit, Lady Reading Hospital, Peshawar, with a swelling on the right side of her neck in the submandibular region of a duration of three months, prior to which the patient had no complaints. The swelling had increased in size, but had remained painless and without any other significant problem. She had a course of conservative management, but there was no response. No history of cough, hemoptysis or jaundice was reported, and examination revealed her to be afebrile. The skin overlying the mass was soft, non-tender, mobile and showed no redness or warmth. The size of the mass was 6x4 cm and intraoral examination revealed no stones in the right submandibular gland duct. Milking of the submandibular glands showed decreased saliva production on the involved side, which was clear and examinations of her chest and abdomen proved normal. X-ray of the submandibular region, however, showed a soft mass with no radiopaque shadow or erosion of the mandible. Ultrasonography of the submandibular area revealed a large non-vascular predominantly cystic mass having some internal solid components with a few enlarged lymph nodes. Fine needle aspiration cytology [FNAC] of the mass showed many scolyces and hooklets along with some inflammatory cells. Complete blood count and sedimentation rate were normal except mild eosinophilia. The tuberculin test [PPD] was also normal. With the impression of hydatid cyst of right submandibular gland, surgery was performed via a horizontal incision about 4 cm below the lower edge of the mandible. After dissection of the surrounding tissue, the submandibular gland was exposed and completely removed without rupturing the cyst. The submandibular gland was incised and a 4x4 cm sized cyst containing a whitish-yellow fluid was seen. The patient was discharged from the hospital with no complications.5 The pathologic report showed a hydatid cyst. Periodic check-ups, including abdominal ultrasonography and x-ray examination, were performed during the first six months postoperatively which revealed no pathological findings

Unresolving submandibular swelling following enucleation of dermoid cyst in mouth floor

A young patient, who had enucleation of dermoid cyst in the floor of mouth more than seven years ago, developed postoperative complications like persistent bulging out of submandibular region on right side, increase in size of swelling and discomfort during meal and intermittent swelling and pain in throat. He was completely eased after removal of Surgical gauze tightly packed and left erroneously in the submandibular space during surgical procedure in the past. A 32 years old male with beard presented with persistent swelling at the angle of mandible on right side with throat pain, dysphagia, saltish taste and foul smell in mouth. In the past, he was operated through an extra-oral approach by a transverse incision in the submental region for dermoid cyst. Patient developed a huge neck swelling just after surgery which was considered a postoperative hematoma. On 13th postoperative day, stitches were removed and on squeezing the swollen area, pus was drained out through infected wound. Patient was discharged and advised follow-up. Patient repeatedly consulted the operating surgeon as well as other doctors for unresolved persistent postoperative swelling but could not get permanent relief except that the change of medicines sometimes helped to reduce the pain. On extra-oral examination, enlarged right submandibular salivary gland was palpable, while right side of floor of the mouth was found elevated and edematous on intra-oral examination. Bimanual palpation of the floor of the mouth or affected side did not feel as soft as the other side. External approach by upward pushing of the floor of the mouth on affected side, yielded a whitish creamy material of slightly thick consistency discharge through sinus located in the retromolar region. Dental probe was inserted through the sinus opening to evaluate the depth and nature of the sinus tract. It was felt that the probe stucked up in a mass which caused hindrance in its free movement inside the sinus. When probe was pulled back a soft smooth whitish mass, caught by the probe tip, came out smoothly through the sinus. This whitish mass was 'surgical gauze' which was then completely removed and the patient got great relief. Enlargement of submandibular gland and other symptoms also subsided within two weeks

Hydatid disease of the submandibular gland

Echinococcosis is a tissue infection of the human caused by the larval stage of Echinococcus granulosus or E. multilocularis. Hydatid cyst of the head and neck region is uncommon and involvement of the salivary glands, especially the submandibular gland, is very rare. In this article, a case of submandibular gland hydatid cyst is reported in a patient who presented with swelling of this area of 5 months' duration. Examination revealed a soft, nontender, mobile mass measuring 7x5 cm. Chest x-ray and abdominal ultrasonography were normal. Excision of the mass was performed and pathologic examination revealed a hydatid cyst of the submandibular gland

Lesão linfoepitelial benigna / Benign lymphoepitelial lesion

A lesão linfoepitelial benigna é uma patologia rara que afeta particularmente as glândulas salivares e lacrimais, provocando seu aumento de volume, sem sintomatologia dolorosa. Há poucos casos relatados na literatura e em indivíduos jovens a lesão é ainda mais incomum. O presente relato mostra os achados clínicos e histopatológicos em uma criança de onze anos que apresentou comprometimento bilateral das glândulas salivares submandibulares sem manifestação sistêmica de doença auto-imune