Unusual Localization of an Adenoid Cystic Carcinoma Subsequent to Superficial Parotidectomy for a Benign Lesion

Abstract

Salivary gland tuberculosis is a rare pathology and does not always have the diagnostic guidelines led by previous tubercular localizations. Tubercular bacillus can reach the salivary gland in different ways, but the condition that most frequently causes a tubercular infection is the decay of the human organism defensive capacity toward the germ.A 15-year-old Romanian boy presented with a swelling in the left submandibular region. Normal extraoral, intraoral examination, and routine diagnostic examinations were performed. In order to make a final diagnosis, we performed a surgical left submandibular gland sialo-adenectomy operation to enable a histologic examination of the withdrawn tissue. Microscopic examination of the gland and lymph nodes showed a chronic necrotizing phlogosis of tubercular type. Previous routine examinations have been important only after final diagnosis to confirm that the submandibular tubercular localization was a primary infection. Diagnosis of this kind of disease is extremely difficult and is made with certainty only with the histologic examination, as happened in our case.

Adenoid Cystic Carcinoma ex Pleomorphic Adenoma of the Parotid Gland

“…Among seven cases of AdCC ex PA with sufficient data [10, 13–17], five tumors arose in association with a primary PA including a long-standing (>50 years) lesion [13–16], whereas the remaining two developed as a recurrent tumor at the site of a previously excised PA [10, 17]. It is acknowledged that PA and AdCC are composed of variable proportions of ductal and myoepithelial type cells [19–22].…”

“…Unfortunately, the universally accepted grading system for de novo AdCC, i.e., the proportion of the tumor with a solid pattern, has not yet been used in any case of AdCC ex PA. Judging from the photomicrographs and/or descriptions, most of the previously reported cases of AdCC ex PA were low-grade [6, 8, 11, 13–15, 17]. The present AdCC component was regarded as Grade III and the solid growth pattern was predominant in two remaining cases that developed metastasis [9, 16].…”

“…[9]. Our literature search disclosed six additional cases of pure AdCC ex PA described by name [13–17]. The following is a rare emergence of AdCC from a primary PA in the parotid gland which pursued an unpredictable aggressiveness on behavioral basis.…”

Primary tuberculosis of submandibular salivary gland

“…[2] The tuberculous disease is impossible to distinguish clinically from other diffuse diseases of salivary glands if glandular secretions from Wharton's duct or saliva are negative for AFB. [23] Most forms of sialadenitis are resolved by a surgical procedure. However, a cure for tuberculosis of submandibular salivary gland requires adequate and prolonged ATT.…”

“…[3] Diagnosis of tuberculous sialadenitis may be difficult. Clinically salivary gland tuberculosis is indistinguishable from a neoplasm of the gland, although benign neoplasms of the gland tend to grow slowly over years rather than over a few months, as in case of tuberculous involment.…”