Demet YAZICI, Mehmet YALÇIN ÇÖKTÜ, Zekiye GÜNEY, Sanem Okşan ERKAN, ORHAN GÖRGÜLÜ, İLHAMİ YILDIRIM, Osman Kürşat ARIKAN

Differential diagnosis of submandibular gland swellings

Objective: The differential diagnosis of submandibular triangle swellings can be challenging to the clinician. In this study, we retrospectively analyzed clinical and histopathological characteristics of these swellings referred to our clinic and integrated our results with current literature in terms of various diagnostic aspects. Methods: A total number of 64 transcervical submandibular gland extirpations were reviewed and evaluated regarding age, gender, fineneedle aspiration biopsy and specimen reports. Results: This study comprised 34 male (53.1%) and 30 female (46.9%) patients. We classified submandibular triangle swellings clinicopathologically as tumoral and non-tumoral lesions for better evaluation. We had 15 patients with primary epithelial submandibular gland neoplasm, 10 (66.7%) of them were benign cases, all of the benign cases were pleomorphic adenoma with a male to female ratio of 1:2.33 and a mean age of 30.8 years, 5 (33.3%) of them were malignant with a mean age of 55 years. There were also 37(57.8%) patients with chronic sialadenitis associated with sialolithasis, 1 (1.6%) had acute sialedenitis, 2 (3.1%) had granulomatous sialadenitis, 2 (3.1%) had reactive cervical lymphadenopathy and 5 (7.8%) were treated for cystic lesion removal. Ultrasonography and fine needle aspiration cytology were our major diagnostic tools for differential diagnosis. Our institution’s sensitivity of fine-needle aspiration cytology for identifying malignancy was 60% and the specificity was 100%. Conclusion: Submandibular gland excision for primary lesions has relatively low incidence compared with other surgical implications. Although chronic sialadenitis caused by symptomatic sialolithiasisis the most frequent indication for surgery, diverse clinical entities should be ruled out for differential diagnosis of swellings of this region.

Submandibüler bez kitlelerinde ayırıcı tanı

Amaç: Submandibüler üçgen kitlelerinin ayr›c› tan›s› klinisyen aç›s›ndan s›k›nt›l› olabilmektedir. Biz bu çal›ﬂmam›zda, klini¤imize submandibüler bez kitlesi ile baﬂvuran hastalar›n klinik ve histopatolojik bulgular›n› retrospektif olarak analiz ettik ve bulgular›m›z› günümüz literatürü ile karﬂ›laﬂt›rd›k. Yöntem: Transervikal submandibüler bez eksizyonu yap›lan 64 hasta incelendi ve yaﬂ, cinsiyet, ince i¤ne aspirasyon biyopsisi ve spesimen sonuçlar› aç›s›ndan de¤erlendirildi. Bulgular: Bu çal›ﬂmaya 34 erkek (%53.1) ve 30 kad›n (%46.9) hasta dahil edildi. Submandibüler üçgen kitleleri; tümöral ve tümöral olamayan lezyonlar olarak ikiye ayr›ld›. 15 hastada primer epitelyal submandibüler bez neoplazm› mevcuttu, bu kitlelerden 10 tanesi (%66.7) benigndi. Benign olanlar›n hepsi plemorfik adenomdu, hastalar›n ortalama yaﬂ› 30.8 iken, erkek/kad›n oran› ise 1:2.33 idi. Kitlelerden 5 tanesi (%33.3) ise maligndi. Malign olanlar›n ortalama yaﬂ› 55 idi. 37 (%57.8) hastada sialolitasise ba¤l› kronik sialadenit mevcuttu, 1 hastada (%1.6) akut sialadenit, 2 hastada (%3.1) granülomatöz sialadenit, 2 hastada (%3.1) reaktif servikal lenfadenopati mevcuttu. 5 hastada (%7.8) ise kistik lezyon eksizyonu yap›ld›. Ultrasonografi ve ince i¤ne aspirasyon sitolojisi ay›r›c› tan›da en s›k kullan›lan tan›sal yöntemlerdi. Malignansi saptamada ince i¤ne aspirasyon sitolojisinin sensitivitesi %60, spesifitesi %100 idi. Sonuç: Submandibüler bezin primer eksizyonu, di¤er endikasyonlarla karﬂ›laﬂt›r›ld›¤›nda nadirdir. Submandibüler bez eksizyonu en s›k nedeni semptomatik sialolitiasise ba¤l› kronik sialadenit olsa bile, bu bölgenin lezyonlar›n›n ay›r›c› tan›s›nda de¤iﬂik klinik antiteler göz önünde bulundurulmal›d›r.

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