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(a and b) Pre-operative photographs of the patient
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Clinically, the lesion measured 10 cm x 8 cm x 6 cm in size extending posteriorly to the sternocleidomastoid (SCM) muscle, anteriorly crossing the midline, superiorly overlapping the lower border of mandible and inferiorly at the level of cricoids [Figure 1a and b].
(a-d) Pre-operative CECT and MRI images. CECT = Contrast-enhanced computed tomography; MRI = Magnetic resonance imaging
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Contrast-enhanced computed tomography (CECT) neck and corroborating magnetic resonance imaging (MRI) findings [Figure 2a-d] were suggestive of a benign submandibular salivary gland cystic lesion with well-capsulated outline and well-maintained outer fatty layer.
Surgical photographs
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Written informed consent of the patient was taken for surgical excision under general anaesthesia, which was carried out using upper cervical crease incision [Figure 3].
(a and b) Atypical cells with nuclear hyperchromatism and invasion in H and E stain at x100 and x400
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Postoperative definitive HPE also confirmed the lesion to be epidermoid cyst of submandibular gland with malignant transformation into SCC [Figure 4a and b].