RESUMO
BACKGROUND: As a debilitating syndrome, paraneoplastic cerebellar degeneration (PCD) remains challenging to treat. Further, anti-Yo antibody (directed against human cerebellar degeneration-related protein 2) detection in patients with PCD is associated with unsatisfactory responses to existing therapies. Here, we present the case of a 60-year-old woman who developed PCD with anti-Yo antibodies and a submandibular gland tumor. CASE PRESENTATION: A 60-year-old woman presented with a 5-day history of unsteadiness of gait and inadequate coordination of her extremities, along with truncal instability. Although walking without aid was possible, dysmetria of all four limbs, trunk, and gait ataxia was observed. While routine biochemical and hematological examinations were normal, the patient's blood was positive for anti-Yo antibodies. When the neurological symptoms deteriorated despite administration of intravenous methylprednisolone, fluorodeoxyglucose-positron emission tomography (FDG-PET) and computed tomography (CT) images with contrast enhancement were performed, which showed a tumor in the left submaxillary gland. She underwent total left submandibular gland resection, including the tumor; histological and immunohistochemical results revealed a salivary duct carcinoma. She was administered intravenous methylprednisolone, followed by 10 plasma exchange sessions, intravenous immunoglobulins, and cyclophosphamide therapy. Following treatment, her symptoms were not alleviated, even after the reduction of anti-Yo titers. CONCLUSIONS: Although tumor detection was delayed, early tumor detection, diagnosis, and PCD treatment are essential because any delay can result in the progression of the disorder and irreversible neurological damage. Therefore, we recommend that the possibility of a salivary gland tumor should be considered, and whole-body dual-modality CT, including the head and neck, and FDG-PET should be performed at the earliest for patients with well-characterized paraneoplastic antibodies when conventional imaging fails to identify a tumor.
Assuntos
Degeneração Paraneoplásica Cerebelar , Neoplasias da Glândula Submandibular , Anticorpos Antineoplásicos , Autoanticorpos , Feminino , Fluordesoxiglucose F18 , Humanos , Metilprednisolona , Pessoa de Meia-Idade , Degeneração Paraneoplásica Cerebelar/complicações , Degeneração Paraneoplásica Cerebelar/diagnóstico , Neoplasias da Glândula Submandibular/complicaçõesRESUMO
A 69-year-old man presented with a history of personality change for several years. He was admitted to our hospital due to partial seizure. A cerebrospinal fluid test and an electroencephalogram showed no specific abnormalities, but brain magnetic resonance imaging revealed abnormal findings in the right temporal pole, bilateral amygdala to hippocampus, and insular cortex. He was diagnosed with limbic encephalitis accompanied by partial seizure, and received infusion of an antiepileptic agent and acyclovir. Additional examinations for malignancy and autoimmune disease were performed, and neck CT and MRI revealed a neck tumor. Neck lymph node biopsy suggested lymph node metastasis of a neuroendocrine neoplasm derived from other organs. He did not want aggressive treatment involving surgical resection and chemotherapy, and thus, conservative treatment was chosen by an otorhinolaryngologist and immunotherapy was not used. After discharge, the neck tumor grew gradually. To manage the focal mass effect, chemotherapy and surgical resection followed by chemoradiotherapy were performed by the otorhinolaryngologist on days 244 and 325 of the disease course, respectively. Histology of resected tissues disclosed neck neuroendocrine carcinoma derived from a submandibular gland. His personality change improved temporarily after surgical resection, but then worsened again with regrowth of the tumor. He died on day 723. After death, a blood test revealed the presence of anti-amphiphysin antibody. This case suggests that neck neuroendocrine carcinoma can induce paraneoplastic limbic encephalitis, and in such cases, early surgical resection of the neck tumor with suspected lymph node metastasis is necessary both to control symptoms associated with encephalitis and to exclude carcinoma derived from the neck itself.
Assuntos
Carcinoma Neuroendócrino/complicações , Encefalite Límbica/etiologia , Neoplasias da Glândula Submandibular/complicações , Idoso , Autoanticorpos/sangue , Biomarcadores Tumorais/sangue , Carcinoma Neuroendócrino/diagnóstico , Carcinoma Neuroendócrino/patologia , Carcinoma Neuroendócrino/terapia , Terapia Combinada , Evolução Fatal , Humanos , Metástase Linfática , Proteínas do Tecido Nervoso/imunologia , Neoplasias da Glândula Submandibular/diagnóstico , Neoplasias da Glândula Submandibular/patologia , Neoplasias da Glândula Submandibular/terapiaRESUMO
Submandibular gland tumours are relatively uncommon tumours and demonstrate diverse histological types and a variable prognosis. The aim of this study was to analyze our experience with submandibular malignancies over a period of 6 years (January 2009 to December 2015). Patient data from the 6-year period were reviewed retrospectively and 51 patients with submandibular malignancies were identified. Demographic data, clinicopathological details, treatment received, complications, and follow-up were recorded. The mean age of the 51 patients at presentation was 49.1 years. They were followed up for a mean 20.3 months. Nine of 47 patients (19.1%) developed distant metastasis during follow-up, while only three (6.4%) developed local recurrence. Disease-free survival at 2 years was 69.7% and overall survival at the end of 2 years was 77.8%. Actuarial 5-year survival was 57.8% when all subtypes were considered. The overall mean time to recurrence was 10 months (6-24 months). Nodal positivity was the only prognostic factor that was significant on multivariate analysis, while age, sex, perineural invasion, and grade were not. With advances in surgical and radiotherapy techniques, loco-regional control rates have improved greatly; however, effective adjuvant treatment to prevent systemic relapse is still lacking.
Assuntos
Neoplasias da Glândula Submandibular/patologia , Adulto , Idoso , Feminino , Humanos , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Metástase Neoplásica/patologia , Metástase Neoplásica/terapia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Glândula Submandibular/complicações , Neoplasias da Glândula Submandibular/terapia , Taxa de SobrevidaRESUMO
Bazex syndrome (BS) is a rare paraneoplastic syndrome most frequently associated with squamous cell carcinomas of the upper aerodigestive tractand other tumours. Characteristically, cutaneous lesions precede the diagnosis of malignancy. We report a 72-year-old patient with 1-year history of acral dermatitis. The diagnosis of BS was based on the presence of psoriasiform acral dermatitis and the evidence of two simultaneous tumors (prostate adenocarcinoma and undifferentiated carcinoma ofthe submandibular gland). It is important to have this syndrome in mind since cutaneous features usually precede an underlying neoplasm.
Assuntos
Carcinoma Basocelular/patologia , Hipotricose/patologia , Síndromes Paraneoplásicas/patologia , Neoplasias Cutâneas/patologia , Pele/patologia , Adenocarcinoma/complicações , Idoso , Biópsia , Carcinoma Basocelular/etiologia , Humanos , Hipotricose/etiologia , Masculino , Neoplasias Primárias Múltiplas/complicações , Síndromes Paraneoplásicas/etiologia , Neoplasias da Próstata/complicações , Neoplasias Cutâneas/etiologia , Neoplasias da Glândula Submandibular/complicaçõesRESUMO
Las alteraciones recurrentes de las glándulas submaxilares son unos trastornos relativamente frecuentes que se deben, generalmente, a una enfermedad obstructiva de la glándula, entre otras menos frecuentes, como la presencia de neoplasias, enfermedades autoinmunes o degenerativas. El tratamiento quirúrgico habitual consiste en la exéresis de la glándula submaxilar a través de un abordaje cervical. Las ventajas de este abordaje cervical son su sencillez, la visión directa del campo quirúrgico y la rapidez del procedimiento. Las desventajas más relevantes son la cicatriz cervical y la posibilidad de lesión de la rama marginal del nervio facial. Se presenta y discute el abordaje intraoral como acceso a la glándula submaxilar. Su ventaja respecto al abordaje convencional es la eliminación de la cicatriz cervical y el riesgo de lesión de la rama marginal. Sus desventajas fundamentales son la dificultad técnica, la visión reducida, el mayor tiempo quirúrgico empleado y la posibilidad de lesión del nervio lingual. En el Hospital Universitario de Canarias (Tenerife, España), a un total de 6 pacientes, 4 mujeres y 2 varones entre 25 y 60 años, se les realizó una submaxilectomía por abordaje intraoral. En todos los casos los resultados estéticos y funcionales fueron muy satisfactorios, tan solo leves disestesias del nervio lingual autolimitadas en 2 meses. Se presenta una alternativa por vía intraoral al abordaje cervical para la realización de submaxilectomía, con la ventaja principal de eliminar la cicatriz cervical (AU)
Recurrent sub-maxillary gland disorders are relatively common. They are mainly caused by obstructive gland diseases. Other aetiologies are malignancies, autoimmune, or degenerative diseases. The traditional treatment of the submandibular gland is the surgical excision by a cervical approach. The advantages of this approach are: its simplicity, direct surgical vision, and speed of the procedure. The most important disadvantages are: unsightly cervical scar, and injury risk of the marginal branch of the facial nerve. This paper presents and discusses the intraoral approach to the submandibular gland. The advantages over the conventional approach are: the elimination of the scar and the risk of injury to the marginal branch. The main disadvantages are: the technical difficulty, reduced vision, the longer surgical time, and the possibility of lingual nerve injury. A total of 6 patients, 4 women and 2 men aged 25 to 60 years, underwent a sub-maxillectomy by intraoral approach in the Hospital Universitario de Canarias (Tenerife, Spain). In all cases, the aesthetic and functional results were very satisfactory, with only mild self-limited lingual nerve dysesthesia being observed at two months. We present an alternative to the cervical approach for the submandibular glands; the intraoral approach. The major advantage of this technique is to eliminate the cervical scar (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Glândula Submandibular/fisiopatologia , Estética Dentária/classificação , Estética Dentária/estatística & dados numéricos , Estética/classificação , Cirurgia Bucal/normas , Cirurgia Bucal/tendências , Cirurgia Bucal , Neoplasias da Glândula Submandibular/complicações , Neoplasias da Glândula Submandibular/patologia , Neoplasias da Glândula Submandibular/fisiopatologia , Estudos RetrospectivosAssuntos
Doenças dos Nervos Cranianos/etiologia , Nervo Lingual/patologia , Neoplasias da Glândula Submandibular/complicações , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias da Glândula Submandibular/patologia , Tomografia Computadorizada por Raios X , Língua/inervaçãoRESUMO
Surgical excision of the submandibular gland is the treatment of choice for lesions affecting this gland. The data of 87 patients, who underwent a transcervical extirpation of the submandibular gland as a single operation over the past 10 years at a single institution in Germany, were available for analysis. Sialolithiasis (73.5%) was the most common reason leading to excision, followed by benign (18.5%) and malignant tumors (8%). Complications included temporary palsies of the marginal mandibular branch of the facial nerve (5.7%), the lingual nerve (5.7%), and the hypoglossal nerve (1.1%), and wound infections in the form of hematoma (3.4%) and seroma (1.1%).
Assuntos
Carcinoma/cirurgia , Linfoma de Células B/cirurgia , Cálculos das Glândulas Salivares/cirurgia , Neoplasias da Glândula Submandibular/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/complicações , Carcinoma/patologia , Feminino , Humanos , Linfoma de Células B/complicações , Linfoma de Células B/patologia , Masculino , Pessoa de Meia-Idade , Pescoço/cirurgia , Estudos Retrospectivos , Cálculos das Glândulas Salivares/complicações , Cálculos das Glândulas Salivares/patologia , Neoplasias da Glândula Submandibular/complicações , Neoplasias da Glândula Submandibular/patologia , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Sarcomatoid salivary duct carcinoma of the submandibular gland is extremely rare. This paper highlights the impact of surgery and adjuvant radiation therapy on the outcome of this disease. METHODS: A 59-year-old man with human immunodeficiency virus presented with a painless, rapidly growing left neck mass. Biopsy followed by surgical excision of the left submandibular gland revealed sarcomatoid salivary duct carcinoma of the submandibular gland duct with perineural invasion and close margins, for which he underwent adjuvant radiotherapy. Post-operative positron emission tomography and computed tomography revealed no residual or metastatic disease. Pathological analysis of tumour-node-metastasis staging revealed a T2 N0 M0 (stage II) tumour. RESULTS: The patient tolerated his treatment without serious acute or long-term side effects. There was no evidence of disease on comprehensive examination or on positron emission tomography or computed tomography scans at the 4.6-year follow up. CONCLUSION: Surgery followed by adjuvant radiotherapy provided practical locoregional control with acceptable toxicity. Further detailed case reports are warranted to optimise the management of this rare malignancy.
Assuntos
Infecções por HIV/complicações , Neoplasias da Glândula Submandibular/terapia , Terapia Combinada , Humanos , Masculino , Pessoa de Meia-Idade , Glândula Submandibular/patologia , Glândula Submandibular/cirurgia , Neoplasias da Glândula Submandibular/complicações , Neoplasias da Glândula Submandibular/diagnóstico , Neoplasias da Glândula Submandibular/patologia , Neoplasias da Glândula Submandibular/radioterapia , Neoplasias da Glândula Submandibular/cirurgiaRESUMO
First bite syndrome is a well-described sequelae of parapharyngeal space surgery, thought to result from sympathetic denervation of the parotid gland. We describe a case of first bite syndrome caused by an adenoid cystic carcinoma of the submandibular gland. The tumor was not clinically or radiographically apparent until 18 months after initial presentation despite repeated imaging. In patients with first bite syndrome and no surgical history, there must be high suspicion for a malignancy, which may be occult on presentation. The submandibular gland should be considered as a possible site of a lesion.
Assuntos
Carcinoma Adenoide Cístico/complicações , Carcinoma Adenoide Cístico/diagnóstico , Dor Facial/etiologia , Neoplasias da Glândula Submandibular/complicações , Neoplasias da Glândula Submandibular/diagnóstico , Idoso , Biópsia , Carcinoma Adenoide Cístico/patologia , Carcinoma Adenoide Cístico/cirurgia , Meios de Contraste , Diagnóstico Diferencial , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias da Glândula Submandibular/patologia , Neoplasias da Glândula Submandibular/cirurgia , SíndromeRESUMO
Congenital aplasia of the major salivary gland is a rare condition. We report on a case of bilateral aplasia of the submandibular glands associated with a left submandibular hemangioma. A 62-year-old woman came to our department complaining of a 3-year history of left submandibular swelling. She had no notable family or personal medical history. On physical examination of the head and neck region, a 30 mm, non-tender mass was palpated in the left submandibular area. On imaging examinations including ultrasonography and CT, lack of the right submandibular gland and a left submandibular mass with calcification were demonstrated. Fine needle aspiration cytology resulted in blood elements only. Functioning tissue could not be observed in the bilateral submandibular glands on technetium pertechnetate scintigraphy. We performed a left submandibular tumor extirpation. Intraoperatively, the left submandibular gland and duct were missing. On pathologic examination, the tumor was found to be a hemangioma. The parotid and sublingual glands were recognized bilaterally on postoperative MRI. Her postoperative condition was satisfactory. This condition may be due to the dysfunction of several factors, such as fibroblast growth factors, related to gland differentiation.
Assuntos
Hemangioma Cavernoso/complicações , Neoplasias da Glândula Submandibular/complicações , Glândula Submandibular/anormalidades , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
The removal of the submandibular salivary gland for non-neoplastic disease is a common procedure that has well documented risks and postoperative complications. Persistent symptoms of pain and swelling in the floor of the mouth that can occur after excision of the submandibular gland may require removal of the sublingual gland, but a causative association between the two has not, to our knowledge, been comprehensively established. We prospectively studied 77 patients who had had excision of the submandibular gland for benign disease, six of whom (8%) returned to theatre for ipsilateral sublingual sialadenectomy within a 5-year period after the initial operation (mean 24 months). These findings suggest that the association is under-reported, and may need to be considered during the consent process for excision of the submandibular salivary gland.
Assuntos
Complicações Pós-Operatórias , Doenças das Glândulas Salivares/etiologia , Glândula Sublingual/cirurgia , Neoplasias da Glândula Submandibular/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ductos Salivares/patologia , Sialadenite/etiologia , Neoplasias da Glândula Submandibular/complicações , Adulto JovemAssuntos
Fístula Cutânea/cirurgia , Fáscia/transplante , Fístula Bucal/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Transplante de Tecidos/métodos , Adulto , Fístula Cutânea/etiologia , Seguimentos , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Fístula Bucal/etiologia , Complicações Pós-Operatórias/cirurgia , Neoplasias da Glândula Submandibular/complicações , Neoplasias da Glândula Submandibular/patologia , Neoplasias da Glândula Submandibular/cirurgia , Resultado do Tratamento , Cicatrização/fisiologiaRESUMO
Küttner tumor (chronic sclerosing sialadenitis) is a chronic, benign lesion of salivary gland. Its clinical course resamble malignant process. Authors report two typical cases of CSS affecting submandibular gland. We inform, that we start follow up of those cases consist of--us imaging /twice a year/, indication of LE and IgG level, protein electrophoresis.
Assuntos
Sialadenite/patologia , Sialadenite/cirurgia , Neoplasias da Glândula Submandibular/patologia , Neoplasias da Glândula Submandibular/cirurgia , Idoso , Doença Crônica , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Esclerose/complicações , Sialadenite/complicações , Sialadenite/diagnóstico , Glândula Submandibular/patologia , Glândula Submandibular/cirurgia , Neoplasias da Glândula Submandibular/complicações , Neoplasias da Glândula Submandibular/diagnóstico , Resultado do Tratamento , Adulto JovemRESUMO
Cysticercosis is a parasitic infestation caused by the pork tapeworm larval stage, Cysticercus cellulosae. The majority of the cases present in ocular, cerebral, and subcutaneous locations. We report the presence of cysticercosis inside the submandibular gland in association with squamous cell carcinoma of the inferior alveolar ramus of the mandible. To the best of our knowledge, this is the first case report documenting cysticercosis inside a salivary gland. A 65-year-old male presented with complaints of an ulcerative lesion on the inferior alveolar ramus present for 2 months. Histological examination revealed a keratinizing well-differentiated squamous cell carcinoma involving the alveolar margin and mandible. The histopathological examination of the submandibular gland revealed cysticercosis. This case emphasizes the importance of adequate sampling of all the tissues obtained for associated infectious disorders, more so in immunosuppressed patients, which will help the clinician to manage the case appropriately.
Assuntos
Carcinoma de Células Escamosas/complicações , Cisticercose/complicações , Doenças da Glândula Submandibular/complicações , Idoso , Carcinoma de Células Escamosas/patologia , Humanos , Masculino , Doenças da Glândula Submandibular/microbiologia , Doenças da Glândula Submandibular/patologia , Neoplasias da Glândula Submandibular/complicações , Neoplasias da Glândula Submandibular/patologiaAssuntos
Doenças do Aparelho Lacrimal/diagnóstico , Linfoma de Zona Marginal Tipo Células B/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Neoplasias da Glândula Submandibular/complicações , Feminino , Humanos , Doenças do Aparelho Lacrimal/etiologia , Doenças do Aparelho Lacrimal/terapia , Linfoma de Zona Marginal Tipo Células B/terapia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/etiologia , Recidiva Local de Neoplasia/terapia , Neoplasias da Glândula Submandibular/terapiaRESUMO
The occurrence of sialoliths in the submandibular gland is 80% due to the specific anatomy of both the gland and its duct. The diagnosis is rather easy because of the obvious clinical signs of the entity. Imaging studies are always necessary in order to treat the patient as effectively as possible. The stones do not tend to occur within the gland as frequently as in the respective duct. The coexistence of sialoliths and malignant tumors is extremely rare. A 70-year-old woman with intraparenchymal stone was operated in our ENT department. In addition to the sialolith the pathological examination revealed the existence of an adenoid cystic carcinoma (ACC), that extended to the neighboring skeletal muscle. This is the reason why we believe it would be useful to report this case of a large stone (14 mm in diameter) located in the submandibular gland coexisting with ACC. This case report is a very good example illustrating that all available means should be used prior to reaching a conclusion and making a health professional decision.
Assuntos
Carcinoma Adenoide Cístico/complicações , Cálculos das Glândulas Salivares/complicações , Neoplasias da Glândula Submandibular/complicações , Idoso , Feminino , HumanosRESUMO
No disponible
Ôhe occurrence of sialoliths in the submandibular gland is 80% due to the specific anatomy of both the gland and its duct. The diagnosis is rather easy because of the obvious clinical signs of the entity. Imaging studies are always necessary in order to treat the patient as effectively as possible. The stones do not tend to occur within the gland as frequently as in the respective duct. The coexistence of sialoliths and malignant tumors is extremely rare. A 70-year-old woman with intraparenchymal stone was operated in our ENT department. In addition to the sialolith the pathological examination revealed the existence of an adenoid cystic carcinoma (ACC), that extended to the neighboring skeletal muscle. This is the reason why we believe it would be useful to report this case of a large stone (14 mm in diameter) located in the submandibular gland coexisting with ACC. This case report is a very good example illustrating that all available means should be used prior to reaching a conclusion and making a health professional decision
Assuntos
Feminino , Idoso , Humanos , Carcinoma Adenoide Cístico/complicações , Cálculos das Glândulas Salivares/complicações , Neoplasias da Glândula Submandibular/complicaçõesRESUMO
Sjögren syndrome is one of the most prevalent autoimmune diseases in which the body's immune system mistakenly attacks its own moisture producing glands. Although Sjögren syndrome occurs in all age groups in both women and men, women in their fourties are the most affected. Sjögren's syndrome can occur alone or in the presence of another connective tissue disease, respectively called primary and secundary Sjögren syndrome. When two of the three clinical hallmarks: keratoconjunctivitis sicca, xerostomia or connective tissue disease are present, Sjögren 's syndrome should be considered. To confirm the diagnosis of Sjögren's syndrome several tests are required. e.g. blood tests, ophthalmologic tests and oral tests. Rheumatologists have the primary responsibility for managing Sjögren's syndrome. Other specialists can treat the related symptoms. The incidence of lymphoma is higher in patients with Sjögren's syndrome than in the general population. Therefore patients must be monitored carefully for the development of related autoimmune diseases, lymphoma and other complications. Sjögren's syndrome is serious but generally not fatal if complications are diagnosed and treated early.
Assuntos
Doenças Autoimunes/diagnóstico , Síndrome de Sjogren/diagnóstico , Doenças Autoimunes/complicações , Doenças Autoimunes/terapia , Diagnóstico Diferencial , Evolução Fatal , Seguimentos , Humanos , Linfoma de Zona Marginal Tipo Células B/complicações , Linfoma de Zona Marginal Tipo Células B/diagnóstico , Masculino , Pessoa de Meia-Idade , Síndrome de Sjogren/complicações , Síndrome de Sjogren/terapia , Neoplasias da Glândula Submandibular/complicações , Neoplasias da Glândula Submandibular/diagnóstico , Xerostomia/diagnóstico , Xerostomia/terapiaRESUMO
A case of 42 years-old man with bilateral big sized (12 x 5 cm and 10 x 4,5 cm) oncocytoma in submandibular glands was presented. Oncocytoma is a rare benign neoplasm observed in numerous of organs. In the case described besides submandibular glands tumours, accessory oncocytic tumours in both kidneys were diagnosed. It was the reason of earlier unilateral nephrectomy. Surgical treatment was applied. The comparison of the both tumours histology allowed to establish proper diagnosis. The case is presented because of the explicitly of the oncocytoma location especially in the both submandibular glands simultaneously with tumour of the same histology in distant organs.