A case of carcinosarcoma arising in the submandibular gland.

A 54-year-old man presented with an 8-year history of a hard asymptomatic mass of the left submandibular area. Total excision of the left submandibular gland with radical neck dissection was performed under a diagnosis of a submandibular tumor, probably a malignant mixed tumor. The pathologic diagnosis was carcinosarcoma consisting of carcinomatous and sarcomatous elements. The epithelial component was composed of squamous cell carcinoma, undifferentiated carcinoma, and adenocarcinoma. The nonepithelial component was composed of chondrosarcoma, osteosarcoma, spindle cell sarcoma, rhabdomyosarcoma, and liposarcoma. In the central area of the tumor, a few remnants of benign pleomorphic adenoma were identifiable. The finding suggested that in our patient, the carcinosarcoma arose from a preexisting pleomorphic adenoma. In view of the expected aggressive nature of the tumor, the patient was treated with postoperative radiotherapy of 60 Gy total, in 30 daily fractions of 2 Gy, and chemotherapy. He currently remains well and free of disease 24 months after treatment.     

A traumatic fistula of the submandibular gland.

A salivary fistula of a submandibular gland was successfully treated by excision of that gland.     

Extra-skeletal Ewing's sarcoma of the submandibular gland.

Extra-skeletal Ewing's sarcoma (EES) is an uncommon malignancy, especially in the head and neck region that may arise in various extra-osseous tissues. We report a 22-year-old male with an EES of the submandibular gland, which to the best of our knowledge, has not been described previously. The patient who underwent combined treatment with surgical resection and chemo-irradiation was disease free for 22 months but succumbed to multi-organ metastases 14 months later. This case highlights the combined diagnostic role of immunohistochemical, cytogenetic and radiological evaluation of EES. EES is an aggressive cancer that requires multidisciplinary management with wide surgical excision and adjunctive chemo-irradiation for the best outcome.     

Sialolipoma of the submandibular gland in a child

Sialolipoma is a new variant of salivary gland lipoma that was first proposed by Nagao et al (Histopathology 2001;38:30-36). Three cases of submandibular gland sialolipoma have been previously reported in the English literature, all of which were in adults. We report an unusual case of sialolipoma of the submandibular gland in a 3-year-old boy. This is the first reported case of submandibular gland sialolipoma in a child.     

Schwannoma of the submandibular gland

Neurilemmomas (schwannomas) are solitary neurogenic tumors that arise from cells of the neural sheath. They are slow growing and represent a proliferation of Schwann cells. Extracranial neurogenic tumors of the head and neck are uncommon, with benign tumors occurring with greater frequency than malignant tumors. These tumors often mimic primary or metastatic disease in the head and neck. Schwannoma of the salivary gland is a particularly rare form of an extracranial neurogenic tumor, with most presenting in the parotid gland originating from a peripheral branch of the facial nerve. An unusual case of neurilemmoma of the submandibular gland is presented, and the literature concerning this subject is reviewed. We believe this tumor originated in an autonomic nerve of the submandibular gland. The mass was discrete and well demonstrated on CT scan. Total excision of the gland resulted in complete resolution of symptoms with no cranial nerve deficits.     

Morbidity study of submandibular gland excision.

Submandibular gland excision is an operation frequently performed by many different surgical specialists. It is often associated with a variety of postoperative complications, the commonest being neurological deficits related to damage to the marginal mandibular, lingual or hypoglossal nerves. Other patients develop further problems at a later date due to the development of calculi from gravel retained in the duct remnant. This study aims to discuss how these complications can be avoided.     

Choristoma of the submandibular gland: a rare cause of cervical swelling.

A case of choristoma of the submandibular gland excised from a 4-week-old female infant is reported. The differential diagnosis is discussed and suggestions are made for the possible etiology of the lesion.     

Pleomorphic adenoma of the submandibular gland

Pleomorphic adenomas of the submandibular glands are exceedingly rare tumors in the pediatric practice. Patients usually present with a painless and mobile mass without any other associated symptoms. Radiologic studies are usually unable to differentiate benign from malignant tumors in most cases. Recurrences are rare with complete en bloc excision of the tumor and the submandibular gland. Except for the rare cases of malignant transformation, the prognosis is excellent.     

Endo-robotic resection of the submandibular gland in a cadaver model

BACKGROUND: By means of a prospective, nonrandomized investigation, we evaluated the feasibility of performing endo-robotic resection of the submandibular gland in a cadaver model and compared the results of robotically enhanced endoscopic surgery with those from a conventional endoscopic technique. METHODS: Procedural times were recorded in a consecutive series of 11 endoscopic submandibular gland resections using the daVinci Surgical System (Intuitive Surgical, Sunnyvale, CA) and a modified endoscopic surgical approach previously developed in a porcine model. The presence of neurovascular injury was assessed postoperatively, and the specimens were examined histologically. RESULTS: Eleven endo-robotic submandibular gland resections were successfully performed in six cadavers (no conversions to open resection were necessary). The median duration of the procedures was 48 minutes (range, 33-82 minutes). Creation of the operative pocket took an average (+/-SD) of 12.2 +/- 5.3 minutes, assembly of the robot required 9.3 +/- 4.1 minutes, and the mean time for submandibular gland resection was 29.4 +/- 8.9 minutes. The time required for robotic assembly was offset by the reduced operative time necessary compared with conventional endoscopic resection. Histologic examination confirmed the presence of normal glandular architecture, without evidence of excessive mechanical or thermal injury. There were no cases of apparent neurovascular injury. CONCLUSIONS: Robotically enhanced endoscopic surgery in the neck is feasible and offers a number of compelling advantages over conventional endoscopic neck surgery. Clinical trials will be necessary to determine whether these advantages can be achieved in clinical practice.     

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.     

Mixed tumour of submandibular salivary gland. Case report

The authors present the case of 14 years male child with tumour located on submandibular salivary glands. It was proceeded the biopsy and tumour excision, the tissue fragments being further processed at paraffin, sectioned and than stained HE, PAS, Alcian-Blue, Van Gieson and Gordon-Sweet. The first biopsy performed from the latero-cervical ganglion revealed the presence of an benign tumour of salivary gland. Totally excision of the tumour emphasized the presence of a salivary gland encapsulated tumour, sized 2.5/2.5/2 cm, nodule shaped, white colored, hard consistency. Histopathologic examination revealed the existence of a proliferating encapsulated tumor, well separated from the normal adjacent tissue. The small sized tumour cells with moderate cytoplasm induce formation of glandular lumens, some of them with cystic dilatation, with mucous content. Other tumour cells form small cords or nests. The tumour stroma forms mucoid areas, some with osteoid appearance. We have presented a case of a 14 years aged child with pleomorphic adenoma with rare location within the submandibular salivary gland. The post biopsy rapid increase of the tumour imposed the totally surgical gland excision.     

Trans-oral robotic submandibular gland removal

Submandibular gland excision is traditionally performed via a trans-cervical approach. While generally regarded as a relatively simple surgical procedure, several complications are possible, including injury to the marginal mandibular branch of the facial nerve, lingual nerve, hypoglossal nerve, facial artery and a visible unsightly neck scar or keloid. The trans-oral route has the ability to eliminate a cervical scar and decrease risk of injury to several structures. Coincident with the development of the trans-oral approach, robotic surgery has been gaining popularity in the operative management of early oral cavity, tonsil, and tongue base malignancies. A 51-year-old female presented to our institution with a 15-year history of recurrent left submandibular gland sialoadenitis. She previously underwent a rhytidectomy with cervicoplasty and was interested in a trans-oral approach to avoid a neck incision. Here we present a novel application of the da Vinci Surgical Robot for trans-oral removal of the submandibular gland.