PMC5253503_01
Diagnostic ultrasound of the left submandibular gland and neck.
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Ultrasound of the swelling on the left side of her neck reported a 1.9 x 0.9 x 0.9 cm hypoechoic mass involving the left submandibular gland (Figure 1).
Axial T2 MRI of the head and neck at initial presentation illustrating the left submandibular gland mass (arrowhead).
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MRI of the neck revealed a 1.4 x 1.1 x 1.9 cm enhancing lesion within the left submandibular gland near the anterior aspect of the gland (Figure 2).
Pathology demonstrated moderate to marked atypical small lymphoid proliferation, involving the parotid gland parenchyma and ducts, composed of predominantly small lymphoid cells on low-power (a) and high-power (b) H&E. Immunohistochemistry demonstrated that the B cells were positive for CD20 (c) and PAX 5 (d), consistent with a MALT.
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BCL-2, prominent CD23, and positive dendritic network, while they were negative for CD3, CD5, CD10, MUM1, BCL-6, cyclin D1, and CD23, with a low proliferative fraction of 10-20%. Based on these pathology findings, the diagnosis of extranodal marginal zone lymphoma of MALT type in the submandibular gland was established (Figure 3). Bone marrow biopsy was found to be negative.
Coronal (a) and axial (b) images of radiation therapy treatment IMRT plan to 30 Gy.
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The patient received radiation to the left submandibular gland surgical bed and adjacent draining lymph nodes using IMRT (Figure 4) to 30 Gy in 15 fractions.