PMC6159206_01
Fused 18Fluoro-Deoxy-glucose axial PET CT image demonstrates increased uptake in the left submandibular gland (B). The normal right submandibular gland is shown at this level (A).
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f1
This detected FDG avid uptake in the left submandibular gland (Figure 1).
Colour Doppler ultrasound image corresponding to the FDG-avid region on PET-CT. Ill-defined hypoechoic mass within the medial left submandibular gland (calipers), avascular and heterogeneous features those of malignancy though non-specific in differentiating primary from secondary neoplasm.
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f2
An ultrasound scan confirmed a poorly defined mass within the left submandibular gland suspicious for malignancy (Figure 2).
Left submandibular gland, H-E, x40.
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f3
Microscopic appearances (Figures 3 and 4) were compatible with metastatic infiltration of the left submandibular gland from the known moderately differentiated oesophageal adenocarcinoma (CK7 and CDX-2 positive/CK-20 negative on immunohistochemistry).
Left submandibular gland, CDX-2 immunostain, x40. Core biopsies showing normal salivary gland tissue (Figure 3, arrowed a), and infiltration by a proliferation of irregular glands containing intraluminal mucinous secretion and surrounded by desmoplastic stroma (Figure 3, arrowed b). The tumour cells show diffuse nuclear immunoreaction for CDX-2, which indicates intestinal phenotype shown in the Figure 4, arrowed. The immunohistological features are compatible with metastasis of known moderately differentiated invasive tubular adenocarcinoma of the gastro-oesophageal junction.
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Microscopic appearances (Figures 3 and 4) were compatible with metastatic infiltration of the left submandibular gland from the known moderately differentiated oesophageal adenocarcinoma (CK7 and CDX-2 positive/CK-20 negative on immunohistochemistry).