title: Unilateral submandibular gland aplasia masquerading as cancer nodal metastasis.
abstract: OBJECTIVE
  Five reports have examined unilateral submandibular gland aplasia. The purposes of this report are to demonstrate submandibular gland aplasia leading to contralateral gland hypertrophy in the setting of oral cavity cancer and to discuss the corresponding diagnostic and management challenges.
  
  
  METHODS
  This study is a case report of a 60-year-old male who presented with pain on the right side of the mobile tongue.
  
  
  METHODS
  This report uses literature review.
  
  
  RESULTS
  A 60-year-old male presented with pain on the right side of the mobile tongue. Subsequent results of punch biopsy revealed squamous cell carcinoma in situ with foci of microinvasion of the tongue. Head and neck examination revealed no abnormalities. The patient underwent a wide-local excision of the tongue lesion. Postoperative computed tomographic (CT) scan showed an asymmetric mass on the ipsilateral side of the cancer in the region of the submandibular gland. The gland was noted to be abnormally large. A diagnosis of contralateral submandibular gland aplasia was made. The patient is cancer-free at 2 years postlocal excision. Salivary gland aplasia is an extremely rare disorder and is often associated with various congenital syndromes. Unilateral submandibular gland aplasia is even rarer with ours representing the sixth reported case. Aplasia is believed to stem from a regional disturbance in early fetal development. Common symptoms can include dysphagia, dry mouth, decreased taste, and tooth decay. In the presence of a history of oral cavity cancer, unilateral submandibular gland aplasia poses a challenge during postoperative cancer follow-up.
  
  
  CONCLUSIONS
  Unilateral submandibular gland aplasia in the setting of oral cavity cancer poses a unique challenge for cancer follow-up. Hypertrophy of the submandibular gland on the other side can masquerade as nodal metastasis. Head and neck examination as well as CT scan can be inconclusive. Regular confirmatory tests such as fine needle aspiration biopsy and positron emission tomography/CT for cancer detection is extremely useful for detecting recurrence.
authors.affiliation: Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Taha Z
authors.initials: TZ
authors.lastname: Shipchandler
authors.forename: Robert R
authors.initials: RR
authors.lastname: Lorenz
mesh_terms: D044963:Biopsy, Fine-Needle; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D035583:Rare Diseases; D018570:Risk Assessment; D013363:Submandibular Gland / Q000002:abnormalities* / Q000473:pathology; D014062:Tongue Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery