PMC8407638_01
(a and b) Extraoral photograph showing a left submandibular swelling
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F1
Extraoral examination revealed a soft-to-firm nontender swelling in the left submental and submandibular region [Figure 1].
Intraoral photograph showing a single, smooth, sessile swelling elevating the tongue
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F2
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].
(a-c) Mandibular occlusal radiograph and computed tomography axial section showing flecks of calcification in the left sublingual region with intact mandibular cortex
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F3
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.
(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
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F4
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.
(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
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F5
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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F6
The final diagnosis was "intermediate grade MEC with clear cell changes" [Figure 6].