An 80-year-old woman presented to the clinic with a 2-month history of a submandibular painless tumor of the left submandibular gland with progressive growth and increased consistency.
It is not accompanied by constitutional syndrome.
The patient had renal lithiasis and hypertension as the only antecedents.
The physical examination revealed a left submandibular mass of approximately 4 cm in diameter, hard consistency, adhered to deep planes, which did not cause pain on palpation.
No alterations in cervical mobility or facial expression were observed.
In the intraoral examination there is no inflammation of the mouth floor or Wharton's duct.
An ultrasound-guided needle aspiration biopsy (FNAB) was performed and reported as a rare entity.
MRI is requested, which report is compatible with a heterogeneous left submaxillary mass, with internal necrosis of 3 × 4 × 3 cm, which imprints on the floor of the left mouth, without conclusive signs of mandibular suprahyoid muscles.
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With the diagnosis of malignant tumor of the submandibular gland, a functional left cervical dissection type III was performed, including the hypoglossal nerve, the digastric muscle and the marginal branch of the left facial nerve.
Histological analysis of the piece shows a proliferation of thickening agents, which grows fixed and cords, consisting of cytoplasmic cells and epithelium morphology.
The nuclei are atypical with moderate pleomorphism, prominent nucleolus and 11 mitosis/10 high-power fields.
Cells are available within a hyalinized stroma.
Extensive areas of necrosis and foci of scaly differentiation are observed.
Ductal structures are not observed.
The immunohistochemical study showed positivity for CKAE1/AE3, actin, calponin, p63, S-100 protein and GFAP, being negative for CEA.
Proliferative index (Ki67) is 25%.
The tumor is completely resected and the distance to the nearest resection margin is less than 1 mm. Lymph nodes are negative for malignancy.
This report is compatible with the diagnosis of submandibular gland myoepithelial carcinoma pT3-N0, MX.
It was decided, after a multidisciplinary consensus, the application of postoperative radiotherapy.
The total dose received is 60 Gy radiotherapy, administered in 30 sessions.
The patient is being followed up in the outpatient clinic 3 years after surgery and, after performing serial MRI and computed tomography control, no signs of tumor recurrence or metastasis are seen.
