Malignant pleural mesothelioma metastatic to the submandibular salivary gland, simulating glandular hypertrophy, diagnosed by fine-needle aspiration biopsy: a case report and literature review

Our plain-English summary of Malignant pleural mesothelioma metastatic to the submandibular salivary gland, simulating glandular hypertrophy, diagnosed by fine-needle aspiration biopsy: a case report and literature review, by M. Ambroggi, E. Orlandi, R.P. Foroni, et al (World Journal of Surgical Oncology, 2014).

The study

• Authors: M. Ambroggi, E. Orlandi, R.P. Foroni, L. Cavanna
• Journal: World Journal of Surgical Oncology
• Published: 2014;12:129
• Type of article: Case report, Review
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant mesothelioma is a rare neoplasm that generally develops in the pleural or peritoneal cavity. Distant metastases are common; it rarely metastatizes to the head and neck region.

Case Presentation: A 54-year-old white man, a non-smoker, was treated with chemotherapy, surgery and radiation for a malignant pleural mesothelioma. Seven months after the last treatment, he developed a right submandibular enlargement: clinical examination, ultrasound and computerized tomography scans revealed a salivary gland hypertrophy. Anti-inflammatory and antibiotic treatment was then started, without improvement. An ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) showed atypical mesothelial cells with nuclear enlargement and increased chromatin representation. Immunocytochemistry showed positivity for calretinin and WT-1.A diagnosis of right submandibular salivary gland involvement from mesothelioma was established, allowing an adequate treatment.

Conclusion: We report a very rare site of metastasis from malignant pleural mesothelioma. We suggest that US-guided FNAB is a useful, quick, and cheap procedure for a definite diagnosis.

In plain English

This was a case report of one patient plus a review of earlier published cases. A 54-year-old Caucasian man, a non-smoker with no occupational exposure to asbestos, was diagnosed with locally advanced malignant pleural mesothelioma in December 2005. From 2005 to 2012 he had chemotherapy, surgery and radiotherapy; the disease returned in the abdominal wall and chest lymph nodes. In November 2012 his right submandibular salivary gland became swollen. Ultrasound and CT showed only an enlarged gland; it was treated as inflammation, without improvement. A fine-needle aspiration biopsy, in which cells are drawn out through a thin needle, found mesothelioma cells. The gland was then treated with radiotherapy. The authors' literature search found 17 earlier cases of mesothelioma spreading to the head and neck outside the lymph nodes. The tongue was the most frequent site, accounting for 7 of the 17 cases. None were in the salivary glands, and none had been diagnosed by fine-needle aspiration. The authors concluded that this is a very rare site of spread and that fine-needle aspiration allowed a definite diagnosis.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report of one patient with a literature review (MEDLINE, Cancerlit and Embase; English-language papers published before April 2013)
• Who was studied: One 54-year-old Caucasian man, a non-smoker, with malignant pleural mesothelioma diagnosed in December 2005, treated at a hospital in Piacenza, Italy; plus 17 previously published cases of head and neck metastases (excluding lymph nodes) from mesothelioma
• Exposure: The authors stated the patient had no occupational exposure to asbestos; no other exposure information was given
• Main results:
  • After seven cycles of chemotherapy with cisplatin and pemetrexed, a CT scan showed a partial response. The patient then had total right pleuropneumonectomy in December 2006, which showed epithelioid malignant mesothelioma, followed by radiotherapy to the right chest (50.4 Gy, 28 fractions)
  • In June 2009 a 35 × 16 mm nodule in the anterior abdominal wall was found to be metastatic mesothelioma. It was surgically removed and treated with radiotherapy (45 Gy, 15 fractions)
  • In September 2011 a relapse in the mediastinal lymph nodes was treated with six cycles of cisplatin and pemetrexed, with a complete response on PET in February 2012
  • In November 2012 the right submandibular salivary gland became swollen. Ultrasound and CT showed gland enlargement without signs of metastasis, and inflammation was diagnosed. Anti-inflammatory and antibiotic treatment did not help
  • An ultrasound-guided fine-needle aspiration biopsy showed atypical mesothelial cells, positive for calretinin and weakly and focally positive for WT-1. This confirmed spread of epithelioid mesothelioma to the gland
  • A subsequent PET scan was positive for the gland, and the patient was treated with radiotherapy to that site
  • In the literature review, 17 earlier cases of head and neck metastases (excluding lymph nodes) were found: tongue 7, mandible 4, oral mucosa 3, lips 1, conjunctiva 1, thyroid 1. None were in the salivary glands
  • Among the 17 reviewed cases, the tongue was the most frequent single site (7 of 17), followed by the mandible and then the oral mucosa
  • In the reviewed cases, diagnosis was made by incisional or excisional biopsy or surgery. None had been diagnosed by fine-needle aspiration biopsy
• The authors' conclusion: The authors concluded that spread of mesothelioma to the head and neck area outside the lymph nodes, especially to the salivary glands, is very rare. They also concluded that ultrasound-guided fine-needle aspiration biopsy allowed a definite diagnosis in this case, whereas such diagnoses are usually made by surgical biopsy

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Fine-Needle Aspiration, Mesothelioma, Neoplasm, Peritoneal Cavity, Chemotherapy, Ultrasound, Mesothelial Cells.

Related studies

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• Isolated pancreatic metastasis from a malignant pleural mesothelioma diagnosed using endoscopic ultrasonography-guided fine needle aspiration biopsy — Y. Ishikawa-Kakiya, H. Maruyama, et al. (2022)
• Cytopathologic Features of Metastatic Malignant Mesothelioma With SMARCB1 (INI-1) Deficient Diagnosed by Ultrasound-Guided Fine-Needle Aspiration: A Case Report — J. Yang, J. Liu, et al. (2026)
• Thoracic splenosis diagnosed by fine-needle aspiration cytology: a case report — S. Syed, P. Zaharopoulos (2001)
• Advantages of thoracic ultrasound-guided fine-needle aspiration biopsy in lung cancer and mesothelioma — M. Sperandeo, L. Dimitri, et al. (2014)
• Fine-needle aspiration biopsy of axillary lymph nodes — S. Jaffer, M. Zakowski (2002)

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