case_images: PMC8407638_01
case_images: (a and b) Extraoral photograph showing a left submandibular swelling
case_images: AMS-11-183-g001.jpg
case_images: PMC8407638_01_AMS-11-183-g001.jpg
case_images: F1
case_images: Extraoral examination revealed a soft-to-firm nontender swelling in the left submental and submandibular region [Figure 1].
case_images: Intraoral photograph showing a single, smooth, sessile swelling elevating the tongue
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case_images: PMC8407638_01_AMS-11-183-g002.jpg
case_images: F2
case_images: On intraoral examination, a localized, smooth, well-defined, nontender swelling approximately of size 4 cm x 2 cm in the floor of the mouth extending from 31 to 38 region was noticed [Figure 2].
case_images: (a-c) Mandibular occlusal radiograph and computed tomography axial section showing flecks of calcification in the left sublingual region with intact mandibular cortex
case_images: AMS-11-183-g003.jpg
case_images: PMC8407638_01_AMS-11-183-g003.jpg
case_images: F3
case_images: Mandibular occlusal radiograph and computed tomography scan showed flecks of calcifications medial to the left mandibular cortex [Figure 3] that suggested "chronic sialadenitis secondary to sialolith." As tumours from floor of the mouth could also obstruct submandibular duct and cause retro-obstructive sialadenitis, ultrasonogram was performed which showed the swelling was of salivary origin.
case_images: (a and b) Ultrasonographic evaluation showing hypervascular masses with multifocal calcification and altered echotexture in level I and II left side lymph nodes and normal echo in the right side
case_images: AMS-11-183-g004.jpg
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case_images: F4
case_images: The findings such as hypervascular masses with multifocal calcification and altered echotexture with nodal involvement [Figure 4] and also increased clear cell changes in incisional biopsy were more in favor of malignancy.
case_images: (a and b) Surgical excision of the deep lobe of submandibular salivary gland and sublingual salivary gland through extraoral and intraoral approach under general anaesthesia
case_images: AMS-11-183-g005.jpg
case_images: PMC8407638_01_AMS-11-183-g005.jpg
case_images: F5
case_images: H and E, stained section showing clear cell changes, mucous cells, intermediate cells, epidermoid cells (a and b), and areas of cystic degeneration (c)
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case_images: F6
case_images: The final diagnosis was "intermediate grade MEC with clear cell changes" [Figure 6].