PMC10170660_01
Clinical examination.
. 
A = yellowish nodule covered by normal mucosa located in the midline of the floor of mouth; B = close association of the lesion with the orifice of the left submandibular duct; C = the lesion shows transition to a diffuse bluish cystic swelling posteriorly.
jomr-14-e5-g001.jpg
PMC10170660_01_jomr-14-e5-g001.jpg
fig1
Clinical examination revealed a soft, fluctuating, non-pedunculated, yellowish nodule covered by normal mucosa with a prominent vasculature (Figure 1A), in close association with the orifice of the left submandibular duct (Figure 1B), posteriorly transitioning to a diffuse bluish cystic swelling (Figure 1C).
Ultrasonographic imaging.
. 
A = an irregularly shaped cystic lesion of 5 mm maximum diameter; B = 13 mm craniocaudal length.
jomr-14-e5-g002.jpg
PMC10170660_01_jomr-14-e5-g002.jpg
fig2
Ultrasound evaluation revealed an irregularly shaped cystic lesion with a maximum diameter of 5 mm and maximum craniocaudal lenght of 13 mm (Figure 2A, 2B).
Intraoperative pictures: (A) anterior round lesion in continuity with a more diffuse cystic lesion (B), exhibiting significant posterior extension towards the submandibular gland (C).
jomr-14-e5-g003.jpg
PMC10170660_01_jomr-14-e5-g003.jpg
fig3
The latter exhibited a significant posterior extension towards the submandibular gland as an elongated cylindrical dilatation (Figure 3). 
Gross examination: (A) oval-shaped cystic nodule containing whitish creamy material (anteriorly), transitioning to a brownish cystic process posteriorly (B).
jomr-14-e5-g004.jpg
PMC10170660_01_jomr-14-e5-g004.jpg
fig4
In summary, an oval shaped cystic nodule containing whitish creamy material was observed in the anterior aspect of the surgical specimen, transitioning posteriorly to another cystic lesion (Figure 4).
Histopathologic examination (haematoxylin and eosin stain, original magnification x20).
. 
A = two large cystic spaces with epithelial lining; B = anteriorly, a keratin-filled cystic cavity with squamous epithelial lining; C = posteriorly, a cystic cavity with columnar or cuboidal cells in the epithelial lining.
jomr-14-e5-g005.jpg
PMC10170660_01_jomr-14-e5-g005.jpg
fig5
Histopathologic examination revealed two cystic spaces in close proximity, both showing epithelial lining (Figure 5A). The anterior lesion was a large, well-delineated, keratin-filled, cystic cavity lined by orthokeratinized stratified squamous epithelium with absence of dermal appendages in the fibrous cystic wall (Figure 5B), while posteriorly, a dilated salivary duct lined by single columnar, cuboidal or pseudostratified epithelium, partially containing amorphous eosinophilic material, was observed (Figure 5C).