Malignant pleural mesothelioma metastatic to the submandibular salivary gland, simulating glandular hypertrophy, diagnos
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WORLD JOURNAL OF SURGICAL ONCOLOGY
CASE REPORT
Open Access
Malignant pleural mesothelioma metastatic to the submandibular salivary gland, simulating glandular hypertrophy, diagnosed by fine-needle aspiration biopsy: a case report and literature review Massimo Ambroggi1, Elena Orlandi1, Raoul P Foroni2 and Luigi Cavanna1*
Abstract Background: Malignant mesothelioma is a rare neoplasm that generally develops in the pleural or peritoneal cavity. Distant metastases are common; it rarely metastatizes to the head and neck region. Case presentation: A 54-year-old white man, a non-smoker, was treated with chemotherapy, surgery and radiation for a malignant pleural mesothelioma. Seven months after the last treatment, he developed a right submandibular enlargement: clinical examination, ultrasound and computerized tomography scans revealed a salivary gland hypertrophy. Anti-inflammatory and antibiotic treatment was then started, without improvement. An ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) showed atypical mesothelial cells with nuclear enlargement and increased chromatin representation. Immunocytochemistry showed positivity for calretinin and WT-1. A diagnosis of right submandibular salivary gland involvement from mesothelioma was established, allowing an adequate treatment. Conclusion: We report a very rare site of metastasis from malignant pleural mesothelioma. We suggest that US-guided FNAB is a useful, quick, and cheap procedure for a definite diagnosis. Keywords: Mesothelioma, Salivary gland metastasis, Fine needle aspiration
Background Malignant mesothelioma is a rare neoplasm with an incidence rate of 1 per 100,000 (both sexes, United States) [1]. Approximately 80% of cases of mesothelioma develop in the pleural cavity, whereas the other 20% arise in the peritoneum; the pericardium is affected very rarely [2]. Metastases from malignant mesothelioma are common, usually to the local lymph nodes, pleurae of the contralateral lung, bone, liver and brain [3]. However, metastases to the head and neck region are uncommon but the jaw bones, particularly the mandibular molar * Correspondence: [email protected] 1 Department of Oncology and Hematology, Oncology Unit, Azienda Ospedaliera ‘Guglielmo da Saliceto’, Via Taverna 49, 29100 Piacenza, Italy Full list of author information is available at the end of the article
area, are more likely to be the site of metastases than the perioral region [4-19]. We present a 54-year-old man, a non-smoker, with no occupational exposure to asbestos with malignant pleural mesothelioma, previously treated with surgery, radiotherapy and chemotherapy. He presented with right submandibular salivary gland enlargement, diagnosed using US and computerized tomography (CT) scan imaging techniques, as salivary gland hypertrophy, while a fine-needle aspiration biopsy (FNAB) showed metastasis from malignant mesothelioma.
Case presentation A 54-year-old Caucasian man underwent right pleural biopsy in December 2005 for recurrent pleural effusion and locally advanced malignant
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