Thyroid carcinoma metastasizing to the submandibular gland: Sonographic findings.

Metastases to the submandibular gland are extremely rare; a literature search retuned only three previously reported cases from a thyroid gland primary site. Herein, we report two cases of metastatic thyroid carcinoma to the submandibular gland in a 64-year-old woman with PTC and a 70-year-old-woman with medullary thyroid carcinoma (MTC). The metastases were identified on CT and PET/CT in one case and on CT in the other case, but both were diagnosed with ultrasound-guided fine-needle aspiration. Our cases highlight that while rare, both PTC and MTC can metastasize to the submandibular gland.

Metastatic small cell neuroendocrine carcinoma of the submandibular gland from the lung: A case report.

RATIONALE: Small cell neuroendocrine carcinoma of the salivary gland is an extremely rare condition. To the best of our knowledge, metastasis of small cell neuroendocrine lung cancer to the submandibular gland has not been reported in the literature. PATIENT CONCERN: An 87-year-old female complained of a left neck mass that enlarged from one month ago. DIAGNOSIS: The final diagnosis was diagnosed as a metastatic small cell neuroendocrine carcinoma of the submandibular gland from lung by an immunohistochemistry. INTERVENTIONS: Left submandibular resection was performed under general anesthesia. OUTCOMES: We recommended further evaluation and treatment, but the patient and patient family support team rejected further treatment of her condition. It was confirmed that 3 months after this conclusive diagnosis, the patient died as a result of this condition and disease. LESSONS: Small cell neuroendocrine carcinoma of the salivary gland is an extremely rare condition. We report a case of metastatic small cell neuroendocrine carcinoma of the submandibular gland from the lung.

Global microRNA profiling of metastatic conjunctival melanoma.

This study aimed to investigate the microRNA (miRNA) profile in primary tumors from conjunctival melanoma with and without subsequent metastatic spread along with their coupled distant metastases to identify miRNAs likely to be involved in metastatic progression. This observational study included 13 patients with metastatic conjunctival melanoma (follow-up: 1-39 years) treated at a Danish referral center. Twenty-five patients with nonmetastatic conjunctival melanoma (follow-up: 5-17 years) were included for comparison. Global miRNA profiling was performed with the Affymetrix GeneChip 4.1 microarray. Taqman qPCR arrays were used for validation. Significant differentially expressed miRNAs were defined as having a false discovery rate of less than 0.05. Primary conjunctival melanoma with and without subsequent metastatic spread clustered separately according to miRNA expression, and 15 miRNAs were found to have significant differential expression. Six miRNAs (hsa-miR-4528, hsa-miR-1270, hsa-miR-1290, hsa-mir-548f-4, hsa-mir-4278, and hsa-miR-34a-3p) were downregulated and nine miRNAs were upregulated (hsa-mir-575, hsa-miR-527, hsa-miR-518a-5p, hsa-miR-6759-5p, hsa-miR-8078, hsa-mir-4501, hsa-mir-622, hsa-mir-4698, and hsa-mir-4654) in primary conjunctival melanoma with subsequent metastatic spread. A comparison of primary conjunctival melanoma with their pair-matched metastases identified six significant differentially expressed miRNAs (hsa-miR-1246 and hsa-miR-302d-5p, hsa-mir-6084, hsa-miR-184, hsa-mir-658, and hsa-mir-4427). qPCR confirmed downregulation of hsa-miR-184 in the distant metastases when compared with the corresponding primary tumor. Primary conjunctival melanoma with and without subsequent metastatic spread separated clearly on the miRNA level when profiled with microarray-based methods. qPCR was able to replicate expression levels of one miRNA (hsa-miR-184) that was downregulated in metastases when compared with corresponding primary tumors.

Metástasis a la glándula submandibular por carcinomas escamosos de cabeza y cuello: ¿mito o realidad? / Metastasis to the submandibular gland in head and neck squamous cell carcinomas: Myth or reality?

Introducción: muy pocos estudios se han publicado respecto a la posibilidad de metástasis a la glándula submandibular por carcinomas escamosos de cabeza y cuello.Objetivo: identificar la evidencia científica más reciente respecto a la posibilidad de metástasis a la glándula submandibular por carcinomas escamosos de cabeza y cuello.Métodos: se realizó un estudio metaanalítico mediante una búsqueda retrospectiva de artículos publicados en las bases de datos electrónicas PUBMED, MEDLINE, COCHRANE, HINARI desde 2003 hasta 2013; en las revistas Acta of Otolaryngology, Journal of Otolaryngology, Journal of Laryngology and Otology, Journal of Cranio–Maxillo Surgery, International Journal of Oral and Maxillofacial Surgery, Head and Neck, Annals of Surgical Oncology con los términos: metástasis por carcinomas escamosos de cabeza y cuello, metástasis a glándulas salivales, metástasis a la glándula submandibular, tumores malignos de glándula submandibular sin restricciones idiomáticas. Además de cumplir con estos requisitos se incluyeron solo los artículos cuyo material y método reflejara: cirugía y disecciones linfonodulares cervicales como primer tratamiento oncológico específico; estudio anatomopatológico para concluir el diagnóstico y discusión del estudio donde quedara explícita la opinión de los autores. Se incluyeron artículos publicados durante los últimos 10 años.Análisis e integración de la información: el estudio metaanalítico de 12 series de pacientes con carcinomas de cabeza y cuello conformó una metapoblación de 2 483 pacientes. Solo hubo 3 casos de metástasis a la glándula submandibular, representando (0,12 por ciento del total), o sea, 1 de cada 827 presentó metástasis a esta glándula. Una metamuestra de 848 glándulas se analizó dentro de las series en que fueron reportadas y solo 0,35 por ciento presentó metástasis...(AU)

Introduction: very few studies have been published about the possibility of metastasis to the submandibular gland in head and neck squamous cell carcinomas.Objective: identify the latest scientific evidence about the possibility of metastasis to the submandibular gland in head and neck squamous cell carcinomas.Methods: a meta-analytical study was conducted based on a retrospective search of papers published in the databases PUBMED, MEDLINE, COCHRANE and HINARI from 2003 to 2013, as well as in the journals Acta of Otolaryngology, Journal of Otolaryngology, Journal of Laryngology and Otology, Journal of Cranio-Maxillo Surgery, International Journal of Oral and Maxillofacial Surgery, Head and Neck, and Annals of Surgical Oncology, using the following search terms: metastasis from head and neck squamous cell carcinomas, metastasis to salivary glands, metastasis to the submandibular gland and malignant tumors of the submandibular gland, without any language restrictions. Papers were selected which met the above criteria and referred to the following contents in their materials and methods section: cervical lymph node surgery and dissection as the first onco-specific treatment, anatomopathological study to complete the diagnosis, and a clear statement of the authors' opinions in the discussion of the study. The papers included had been published in the previous 10 years.Data analysis and integration: a meta-analytical study was conducted of 12 series of patients with head and neck carcinomas for a metapopulation of 2 483 patients. Only 3 cases were found of metastasis to the submandibular gland, representing 0.12 percent of the total cases, that is, 1 for every 827 cases. A meta-sample of 848 glands were analyzed within the series in which they were reported, and only 0.35 percent presented metastasis...(AU)

Metástasis a la glándula submandibular por carcinomas escamosos de cabeza y cuello: ¿mito o realidad? / Metastasis to the submandibular gland in head and neck squamous cell carcinomas: Myth or reality?

Introducción: muy pocos estudios se han publicado respecto a la posibilidad de metástasis a la glándula submandibular por carcinomas escamosos de cabeza y cuello. Objetivo: identificar la evidencia científica más reciente respecto a la posibilidad de metástasis a la glándula submandibular por carcinomas escamosos de cabeza y cuello. Métodos: se realizó un estudio metaanalítico mediante una búsqueda retrospectiva de artículos publicados en las bases de datos electrónicas PUBMED, MEDLINE, COCHRANE, HINARI desde 2003 hasta 2013; en las revistas Acta of Otolaryngology, Journal of Otolaryngology, Journal of Laryngology and Otology, Journal of Cranio­Maxillo Surgery, International Journal of Oral and Maxillofacial Surgery, Head and Neck, Annals of Surgical Oncology con los términos: metástasis por carcinomas escamosos de cabeza y cuello, metástasis a glándulas salivales, metástasis a la glándula submandibular, tumores malignos de glándula submandibular sin restricciones idiomáticas. Además de cumplir con estos requisitos se incluyeron solo los artículos cuyo material y método reflejara: cirugía y disecciones linfonodulares cervicales como primer tratamiento oncológico específico; estudio anatomopatológico para concluir el diagnóstico y discusión del estudio donde quedara explícita la opinión de los autores. Se incluyeron artículos publicados durante los últimos 10 años. Análisis e integración de la información: el estudio metaanalítico de 12 series de pacientes con carcinomas de cabeza y cuello conformó una metapoblación de 2 483 pacientes. Solo hubo 3 casos de metástasis a la glándula submandibular, representando (0,12 por ciento del total), o sea, 1 de cada 827 presentó metástasis a esta glándula. Una metamuestra de 848 glándulas se analizó dentro de las series en que fueron reportadas y solo 0,35 por ciento presentó metástasis. Conclusión: el presente estudio sugiere que los carcinomas de cabeza y cuello metastizan a la submandibular con una frecuencia casi nula, lo que pudiera sugerir su preservación de la submandibular en las disecciones cervicales linfonodulares(AU)

Introduction: very few studies have been published about the possibility of metastasis to the submandibular gland in head and neck squamous cell carcinomas. Objective: identify the latest scientific evidence about the possibility of metastasis to the submandibular gland in head and neck squamous cell carcinomas. Methods: a meta-analytical study was conducted based on a retrospective search of papers published in the databases PUBMED, MEDLINE, COCHRANE and HINARI from 2003 to 2013, as well as in the journals Acta of Otolaryngology, Journal of Otolaryngology, Journal of Laryngology and Otology, Journal of Cranio-Maxillo Surgery, International Journal of Oral and Maxillofacial Surgery, Head and Neck, and Annals of Surgical Oncology, using the following search terms: metastasis from head and neck squamous cell carcinomas, metastasis to salivary glands, metastasis to the submandibular gland and malignant tumors of the submandibular gland, without any language restrictions. Papers were selected which met the above criteria and referred to the following contents in their materials and methods section: cervical lymph node surgery and dissection as the first onco-specific treatment, anatomopathological study to complete the diagnosis, and a clear statement of the authors opinions in the discussion of the study. The papers included had been published in the previous 10 years. Data analysis and integration: a meta-analytical study was conducted of 12 series of patients with head and neck carcinomas for a metapopulation of 2 483 patients. Only 3 cases were found of metastasis to the submandibular gland, representing 0.12 percent of the total cases, that is, 1 for every 827 cases. A meta-sample of 848 glands were analyzed within the series in which they were reported, and only 0.35 percent presented metastasis. Conclusion: the study suggests that head and neck carcinomas metastasize to the submandibular gland with an almost null frequency, which may point to the preservation of the submandibular gland in cervical lymph node dissections(AU)

Metastasis to submandibular glands in oral cavity cancers: Can we preserve the gland safely?

OBJECTIVE: To analyze submandibular gland (SMG) involvement in cases of oral cavity cancers and decide whether to remove submandibular glands while performing neck dissections for oral cavity cancers to decrease the incidence of xerostomia, a common issue post-operatively. METHODS: Retrospective analysis of 157 neck dissections out of 204 neck dissections performed for oral cavity carcinomas in the Department of Otolaryngology and Head and Neck Surgery from 2008 to 2013 was done. SMG was bilaterally removed in 6 dissections, hence a total of 163 glands were analyzed. Those involved by tumor in histopathology were further studied for the pattern of involvement. RESULTS: 3.68% (6/163) glands showed involvement by the tumor. 9.20% (15/163) showed chronic sialo-adenitic changes. Four of the six involved glands showed direct contiguous spread from primary lesion, one showed extra-capsular spread from level IB lymph nodes and evidence of both modes of spread was seen in one. Evidence of metastasis was not seen in any of the glands (0%). Literature review showed a metastasis rate of 0.096% (2/2074). CONCLUSION: Metastatic involvement of submandibular gland is extremely rare. Submandibular gland preservation, in the absence of evidence of gross contiguous involvement, does not affect survival. Hence, SMG can be safely spared during neck dissections for oral cavity squamous cell cancers except in certain situations such as close proximity of the primary lesion to gland, presence of intra-capsular lymph nodes in radiology, gross intraoperative evidence of invasion of the SMG and in salvage surgeries performed in post-irradiated and recurrent cases.

[Extension study and evaluation of the therapeutic response in a patient with metastatic lung adenocarcinoma using sequential study with ¹8F-FDG PET-CT and ¹8F-fluoride PET-CT]. / Estudio de extensión y valoración de la respuesta terapéutica en un paciente con adenocarcinoma pulmonar metastásico mediante estudio secuencial con (18)F-FDG PET-TC y (18)F-fluoruro PET-TC.

We report a case of a patient with lung adenocarcinoma and bone and extraosseus metastases studied with (18)F-FDG PET-CT, (99m)Tc-HMDP and (18)F-fluoride PET-CT. It assesses the usefulness of (18)F-FDG PET-CT for initial staging of the disease and monitoring response to therapy. For the study of the sclerotic bone metastases it shows the superiority of 99mTc-HMDP bone scintigraphy and (18)F-fluoride PET-CT over (18)F-FDG PET-CT, and (18)F-fluoride PET-CT over bone scintigraphy. It also shows the usefulness of (18)F-fluoride PET-CT for monitoring the bone metastases.

Extra-prostatic transgene-associated neoplastic lesions in transgenic adenocarcinoma of the mouse prostate (TRAMP) mice.

Male transgenic adenocarcinoma of the mouse prostate (TRAMP) mice are frequently used in prostate cancer research because their prostates consistently develop a series of preneoplastic and neoplastic lesions. Disease progression in TRAMP mouse prostates culminates in metastatic, poorly differentiated carcinomas with neuroendocrine features. The androgen dependence of the rat probasin promoter largely limits transgene expression to the prostatic epithelium. However, extra-prostatic transgene-positive lesions have been described in TRAMP mice, including renal tubuloacinar carcinomas, neuroendocrine carcinomas of the urethra, and phyllodes-like tumors of the seminal vesicle. Here, we describe the histologic and immunohistochemical features of 2 novel extra-prostatic lesions in TRAMP mice: primary anaplastic tumors of uncertain cell origin in the midbrain and poorly differentiated adenocarcinomas of the submandibular salivary gland. These newly characterized tumors apparently result from transgene expression in extra-prostatic locations rather than representing metastatic prostate neoplasms because lesions were identified in both male and female mice and in male TRAMP mice without histologically apparent prostate tumors. In this article, we also calculate the incidences of the urethral carcinomas and renal tubuloacinar carcinomas, further elucidate the biological behavior of the urethral carcinomas, and demonstrate the critical importance of complete necropsies even when evaluating presumably well characterized phenotypes in genetically engineered mice.

Squamous Cell Carcinoma of the Caruncle.

Squamous cell carcinoma (SCC) of the lacrimal caruncle is a rare entity. The authors report the management and outcomes of 3 cases of caruncle SCC. Case 1 underwent wide margin surgical excision with adjuvant topical chemotherapy for a poorly differentiated SCC. He later developed regional lymph node metastasis and required modified radical neck dissection. Case 2 underwent wide margin surgical excision with cryotherapy and adjuvant topical chemotherapy for an invasive moderately differentiated SCC. She later developed a recurrence and underwent orbital exenteration. Case 3 was a moderately differentiated SCC treated with wide margin excision alone and had no recurrence during 5-year follow up. Careful surveillance of caruncle SCC is required, given the observed propensity for local recurrence and/or regional metastasis.

Submandibular gland involvement in early stage oral cavity carcinomas: can the gland be left behind?

OBJECTIVE: To determine the frequency of submandibular gland involvement in early oral cavity tumors. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: ENT Department, CMH, Rawalpindi, from January 2008 to December 2011. METHODOLOGY: Data of 110 oral cavity tumors operated over 2008 - 2011 was retrieved from ENT OPD, tumor registry in AFIP and from Head and Neck Oncology Forum Registry. Cases of oral cavity tumors that had undergone elective neck dissections were retrospectively studied for invasion of the submandibular gland, TNM Staging, perineural, perivascular, lymphovascular invasion, site specific frequency of oral cavity tumors and frequency of lymph node metastasis. RESULTS: Tumors of tongue were the most common constituting 42%, squamous cell carcinoma was the histological diagnosis in 90% cases. Sixty eight (61.8%) cases were node negative. Selective neck dissection was done in 55.5% of the cases. Submandibular gland was involved in 2 cases (1.8%). CONCLUSION: Submandibular gland metastasis from early oral cavity tumors is rare; any neoplastic involvement of the gland usually occurs via direct spread.

Metastasizing pleomorphic adenoma of the submandibular gland: a case report.

Pleomorphic adenoma (PA), originally called mixed tumour, is the most common neoplasm of the salivary glands. It is usually a benign, slow-growing and well-circumscribed tumour. However, PA may occasionally give rise to metastases that usually occur after a previous recurrence. These tumours display benign histological features in both primary tumours and metastases. Such tumours have been termed metastatic PA or metastatic mixed tumours. We report a case of metastatic PA of the submandibular gland with metastasis to the cervical lymph nodes.

Salivary neoplasms presenting with radiologic venous invasion: an imaging pearl to diagnosing metastatic renal cell carcinoma.

We report the case of a 64-year-old otherwise healthy woman who presented with left facial swelling. Imaging of the neck revealed multiple masses in the salivary and thyroid glands. The mass in the left parotid gland was associated with an intravenous extension into the retromandibular, facial and internal jugular veins in the left neck. Based on multiplicity of these masses and the presence of radiologic venous invasion, the diagnosis of metastatic renal cell carcinoma (RCC) was suggested on imaging, which was subsequently confirmed on systemic workup and pathology findings. Although RCC metastasizes to the salivary glands, the primary presentation of RCC with both salivary and thyroid gland masses is extremely rare, with only a few reports. The above feature and its imaging diagnosis based on local venous invasion are the highlights of this report.

Malignant pleural mesothelioma metastatic to the submandibular salivary gland, simulating glandular hypertrophy, diagnosed by fine-needle aspiration biopsy: a case report and literature review.

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.

Late solitary metastasis of renal cell carcinoma to the submandibular gland.

Metastatic renal cell carcinoma to the head and neck is rare. Most reported cases of metastases to the head and neck involve the thyroid and parotid glands. Metastasis to other salivary glands is exceedingly rare. This report describes a case of a solitary metastasis of renal cell carcinoma to the submandibular gland 9 years after nephrectomy. To the authors' knowledge, this is the first case successfully diagnosed preoperatively using a combination of fine-needle aspiration and clinical history. The patient subsequently underwent a submandibular gland resection with preservation of the facial nerve branches. For the 3 years since resection of the submandibular gland, the patient has been free of disease.

Oral cavity squamous cell carcinoma metastasis to the submandibular gland.

INTRODUCTION: This study aimed to evaluate the incidence of submandibular gland metastases in cases of oral cavity squamous cell carcinoma. METHODS: Sixty-nine patients treated between 1 January 2004 and 30 June 2009 were retrospectively reviewed. Patients were treated with wide local excision of the primary tumour, plus simultaneous neck dissection and reconstruction if required. RESULTS: Of 69 submandibular glands from 46 men and 23 women (mean age, 58 years), 43 (62.3 per cent) had advanced, tumour stage three or four lesions. Histopathological reappraisal of all submandibular glands demonstrated an absence of metastatic spread. Only 2/69 (2.9 per cent) submandibular glands demonstrated ipsilateral contiguous tumour involvement. CONCLUSION: This study demonstrated an absence of metastasis to the submandibular gland from oral cavity squamous cell carcinoma. Patients with early stage oral cavity squamous cell carcinoma and with a pre-operative node stage zero neck may be candidates for preservation of the submandibular gland during neck dissection.

Pulmonary blastoma with submandibular, scrotum and adrenal metastases: case report.

A 62-year-old patient diagnosed with pulmonary blastoma with submandibular, scrotum and adrenal metastases was admitted to Sotiria General Hospital in Athens. No other such case has been published to date. The patient started receiving chemotherapy, but the scrotum metastasis grew rapidly and erupted. This led to sepsis despite surgical excision of infected and necrotic tissues and intravenous antibiotics. Treatment strategy in pulmonary blastoma should be defined by a multidisciplinary team, and surgical treatment should be considered as quickly as possible when such a tumor is suspected.

Is it oncologically safe to leave the ipsilateral submandibular gland during neck dissection for head and neck squamous cell carcinoma?

AIM: To investigate the incidence of metastasis to the submandibular gland in patients with head and neck squamous cell carcinoma. METHODS: We retrospectively evaluated histological reports of neck dissections for upper respiratory tract carcinoma (performed 2002-2009), recording: primary tumour site, tumour-node-metastasis stage, level Ib involvement, previous radiotherapy, perineural invasion, lymphovascular invasion, extracapsular spread, and the presence of malignant disease in the submandibular gland. RESULTS: We evaluated 107 cases. The most common primary site was the oral cavity (49 per cent) followed by the supraglottis (21 per cent), glottis (14 per cent), oropharynx (9 per cent) and hypopharynx (6 per cent). Forty-eight per cent of patients had advanced local disease, with 21 per cent at tumour stage 3 and 27 per cent at tumour stage 4. Fifty-six per cent had cervical lymph node metastasis, and 8 per cent received pre-operative radiotherapy. Forty-eight per cent had perineural invasion, 46 per cent lymphovascular spread, 27 per cent extracapsular spread and 8 per cent level Ib metastasis. Only one patient had submandibular gland involvement, due to direct spread (a case with prior radiotherapy and macroscopic submandibular gland involvement evident peri-operatively). CONCLUSION: Submandibular gland metastasis from head and neck primary squamous cell carcinoma is extremely rare. Preservation of the ipsilateral submandibular gland during neck dissection is oncologically safe, except in patients with prior surgery or radiotherapy, or a primary tumour in close relation to the gland.

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.

Isolated submandibular metastasis from a contralateral thyroid papillary microcarcinoma: an unusual case.

Papillary carcinoma is the most common form of thyroid cancer. It is a relatively indolent disease, which commonly remains clinically silent until its incidental histological diagnosis in surgical material or at autopsy. A tumour less than 10 mm in size is termed a papillary microcarcinoma. Papillary microcarcinoma may present with clinical symptoms, most commonly jugulodigastric and pretracheal lymphadenopathy with or without palpable thyroid nodules. Isolated submandibular metastases are rare. We present the case of a submandibular metastasis arising from a solitary 3 mm papillary microcarcinoma of the thyroid on the contralateral side in a 46-year-old woman. We describe the ultrasound and MRI characteristics of the submandibular mass. The ultrasound findings in particular were suggestive of a thyroid malignancy and prompted detailed examination of the thyroid gland. Clinical and radiological examination of the thyroid was normal. To the best of our knowledge, we present the first report of a papillary microcarcinoma of the thyroid presenting as a contralateral and isolated submandibular mass.

Evaluation of metastases in the submandibular gland in head and neck malignancy.

BACKGROUND: : Either excision of the submandibular gland during neck dissection or having the submandibular gland in radiation field can result in xerostomia, leading to reduced quality of life. The purpose of this study was to evaluate the prevalence of metastasis to the submandibular gland and to identify potential risk factors leading to the presence of metastases into the gland. PATIENTS AND METHODS: : Of 376 patients with head and neck malignancy who were treated between 1999 and 2008, 130 patients underwent a neck dissection, and in total, 171 submandibular glands were removed. The average age was 61.1 years. RESULTS: : Twenty-three patients (17.7%) revealed some type of pathology in the submandibular gland such as chronic sialadenitis (15), atrophy (5), tumor infiltration (5), and intraglandular lymph node (1). In the group with sialadenitis, the mean age was 57.7 years. Forty-four percent had a pretreatment (radiation, 9%; local resection, 13%; or combined therapy, 22%) before neck dissection. Of the sialadenitis group, 9 of 12 patients had the primary tumor in the lower jaw, floor of mouth, or tongue. CONCLUSIONS: : One needs to be aware of the possibility of occult metastases in level I in oral cavity carcinomas, whereas oropharynx carcinoma constitutes a lower risk for involvement of lymph node metastases at level I. The excision of the submandibular gland should be performed in cases with positive lymph nodes at level I and in tumor sites with a high risk of occult metastasis at level I.