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Cervical CT images of Case 1. Bilateral swelling of the submandibular glands (arrows).
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A computed tomography (CT) scan showed that the submandibular gland was bilaterally enlarged to approximately 30 mm (Figure 1).
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FDG-PET images of Case 2. (a) Intense uptake (SUV: 6.24) in the right submandibular gland (arrows). (b) Intense uptake in the right submandibular gland (thick arrows) and the deep interior cervical area (thin arrows).
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18-fluorodeoxyglucose positron emission tomography (FDG-PET) showed a high and slightly heterogeneous increase in accumulations of FDG in the right submandibular region (standardized uptake value, SUV: 6.24), with a slight increase in accumulations in the upper dorsal to the right submandibular region, the right cervical regions, and the supraclavicular fossa (Figure 2).
Histopathological examination of Case 2. (a) Small-sized gland ducts with plasma cell and eosinophilic leukocyte infiltrations (H&E stain  x40). (b) IgG4-positive plasma cells (stained with IgG4 monoclonal antibody  x40). Mouse monoclonal antibody to human IgG4 (clone, HP6025; dilution, 1 : 100; Zymed Laboratories Inc., Calif, USA).
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Plasma cell and eosinophilic leukocyte infiltrations, relatively high-degree fibrosis, and many IgG4-positive plasma cells were also observed (Figure 3).
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