Giant neck swelling

Key clinical message

The most common benign salivary gland tumor is pleomorphic adenoma. They can attain giant proportions and weigh several kilograms. They can cause facial disfigurement and, if untreated, could lead malignant transformation. This image depicts a 7.5 kg pleomorphic adenoma of right submandibular gland with malignant change in a 55‐year‐old male.

Quiz

A 55‐year‐old man presented with a giant, firm, nontender neck swelling insidiously growing since 40 years. His only complain was facial disfigurement.

What is your probable diagnosis?

• Thyroid mass

• Lymphoma

• Cystic hygroma

• Submandibular tumor

Legend of Snap‐Shot

A 55‐year‐old man presented with a huge, firm, nontender neck swelling (28 × 25 × 17 cm) and facial disfigurement (Fig. 1). The swelling rapidly increased in size over the past three months with ulceration and bleeding from the advancing “apex”. Fine‐needle aspiration cytology was consistent with pleomophic salivary adenoma. Computerized tomography (Fig. 2) suggested it to be a mass arising from right submandibular gland. The mass was excised under general anesthesia. It weighed 7.5 kg. Postoperative recovery was uneventful. Histopathology revealed carcinoma ex‐pleomorphic adenoma with sarcomatous differentiation. Pleomorphic salivary adenomas are most common neoplasm of major salivary glands 1. Six percent show transformation to carcinoma 2. Sarcomatous degeneration is rare found in 2.5% 3.

Figure 1.

Figure showing giant neck swelling.

Figure 2.

CT image depicting the tumor.

Conflict of Interest

None declared.

Clinical Case Reports 2016; 4(4): 454–455