Primary Leiomyosarcoma of the Submandibular Gland: A Case Report

Mohamed Reda El Ochi; Hafsa Chahdi; Issam Rharrassi; Abderrahman Albouzidi; Mohamed Oukabli


BMC Clin Pathol. 2015;15(22) 

In This Article

Case Presentation

Clinical History

A 65 year-old white woman, without clinical antecedents, presented with a history of progressive right submandibular swelling which had grown over a period of 8 months. Clinical examination showed a submandibular painless, mobile and hard mass measuring 4 × 2 cm without cervical lymphadenopathy.

Radiologic and Histopathologic Findings

Ultrasonography and computed tomography revealed a solid and heterogeneous mass measuring 4 x 2 cm involving the right submandibular gland. There was no cervical lymphadenopathy. A resection of the right submandibular gland was performed.

Macroscopically, the specimen measured 6 x 4 x 2 cm. The tumor appeared as a grey white, hard mass and 4 × 2 cm in dimension. Histological examination showed intersecting fascicles of spindle cells (Fig. 1) with ample amount of eosinophilic cytoplasm and elongated nuclei with dispersed chromatin. The cells presented high mitotic activity (5 per 10 high-power fields) and foci of severe atypia without necrosis (Fig. 2). The adjacent salivary parenchyma was infiltrated by tumoral cells (Fig. 3). No areas of epithelial component were identified despite extensive sampling. Immunoreactivity with anti smooth muscle actin and H-caldesmon (Fig. 4) antibodies was found. Desmin, S-100 protein, CD34, CD31, CD117, and pancytokeratin were all negative. Thus, a diagnosis of leiomyosarcoma of the submandibular gland grade I FNCLCC (French Fédération Nationale des Centres de Lutte Contre le Cancer) was established. The post-operative course was uneventful. The thoracoabdominal computed tomography, performed subsequently, showed no distant tumor. The patient is dowing well without any evidence of recurrences or metastases after two months of follow-up.

Figure 1.

Salivary parenchyma harboring a well-circumscribed, fascicular proliferation of spindle shaped cells (hematoxylin and eosin stain, original magnification × 25)

Figure 2.

Tumor cells infiltrating the adjacent parenchyma (hematoxylin and eosin stain, original magnification × 200)

Figure 3.

Tumor cells showing mild nuclear atypia with multinucleated giant cells and mitosis (hematoxylin and eosin stain, original magnification × 400)

Figure 4.

H-caldesmon positivity of the tumor cells (original magnification × 400)