Kuttners tumor of bilateral submandibular and parotid glands. Chronic sclerosing sialadenitis kuttner tumor in the sublingual. Dec 04, 2009 chronic sclerosing sialadenitis is a chronic inflammatory salivary gland disease. Immunoprofile of kuttner tumor chronic sclerosing sialadenitis.
Kuttner tumor of the submandibular gland fineneedle aspiration. Chronic sclerosing sialadenitis kuttners tumour of the parotid gland. Enlargement of the submandibular gland is a condition that raises the alarm for further investigation as the risk of an underlying malignancy is higher in comparison to parotid gland enlargement. Chronic sclerosing sialadenitis kuttners tumour of the. Cytologic features of epithelioid hemangioendothelioma. They account for 5% of gi carcinoids and are more common in women than men.
Recent reports suggest that certain aspects of sclerosing diseases, including chronic sclerosing sialadenitis or dacryoadenitis, should be classified under im. Chronic sclerosing sialadenitis or kuttner tumor is an uncommon benign chronic inflammatory condition affecting submandibular gland. Histopathology of kuttner tumor the histopathologic features of kuttner tumor may evolve through four different histologic stages. Chronic sclerosing sialadenitis or kuttners tumour. It is a chronic inflammatory condition affecting the salivary gland. Features over 3,000 highquality fullcolor illustrations. The tumor cells are separated by fibrous septa, which give rise to the lobulated appearance and are embedded in abundant extracellular myxoid matrix.
Kuttner tumor, sclerosing, sialadenitis, submandibular gland. Kuttner s tumor also known as chronic sclerosing sialadenitis was first described in 1896 by kuttner in germany. Chronic sclerosing sialadenitis kuttner s tumor is a benign and chronic inflammatory condition of the submandibular gland that clinically cannot be easily distinguished from salivary malignant. Case report unusual involvement of igg4related sclerosing. The exact etiology of igg4related disease remains unclear with no known role of the igg4 molecule itself being identified.
Chronic sclerosing sialadenitis or kuttner tumor is an unusual chronic inflammatory. Christopher fletchers renowned reference provides the advanced, expert guidance you need to evaluate and interpret even the most challenging histopathology specimens more quickly and accurately. These lesions recognized as tumorlike lesions of the salivary gland by the world health organization. American society for clinical pathology academy of clinical. Sclerosing sialadenitis of the sublingual salivary glands. Benign lymphadenopathy is a common biopsy finding, and may often be confused with malignant lymphoma. Epithelioid hemangioendothelioma ehe is a vascular tumor of intermediate malignancy that may occur in a variety of sites, including soft tissues, 1,2 bone, 3,4 lung, 5 liver, 6 pleura and peritoneum, 7,8 skin, 2,9 lymph nodes, 10,11 stomach, 12 and brain. Bilateral kuttner tumor of submandibular glands introduction. Chronic sclerosing sialadenitis of the submandibular. Carcinoid tumors are the most common tumor of the appendix, accounting for more than half of all appendiceal malignancies and discovered in seven of every 1,000 appendectomy specimens.
In a highgrade tumor, the nuclei may become larger, pleomorphic and with greater mitotic activity. Kuttners tumour chronic sclerosing sialadenitis of the. The histologic feature varies according to stage of evolution and severity of inflammation. We report here 7 cases of kuttners tumor that morphologically resemble primary salivary gland marginal zone bcell lymphoma of the mucosaassociated lymphoid tissue malt type. These lesions recognized as tumor like lesions of the salivary gland by the world health organization. Clinical examination showed an enlarged submandibular. In this chapter, the histopathology as well as pertinent ancillary diagnostic, prognostic, and predictive information of these common tumors and pseudotumors will be discussed. The most common manifestation in the kidney is igg4related tubulointerstitial nephritis igg4tin, which can present as renal insufficiency, renal mass lesions, or both. Igg4related disease is a multiorgan immunemediated chronic fibroinflammatory condition characterized by elevated serum igg4 concentrations, tumefaction, and tissue infiltration by igg4positive plasma cells. A musthave for any practising surgical pathologist. Kuttner tumor chronic sclerosing sialadenitis sciencedirect. Kuttner reported 4 cases of submandibular gland lesions for the first time in 1896.
Kuttner in 1896 reported chronic sclerosing sialadenitis for the first time 1. Consensus statement on the pathology of igg4related. It may be separated into major morphologic patterns, each with its own differential diagnosis. Kuttner described 4 cases of chronic sclerosing sialadenitis css of. Igg4related kidney disease diagnostic histopathology. Kuttner tumor kt is a benign tumorlike lesion predominantly involving the submandibular gland of middle aged individuals. The diagnosis is usually based on histopathology and immunohistochemistry. It is usually a slowgrowing and lowgrade tumor, but metastatic disease is seen more frequently in sacral chordomas than in skull base chordomas. Over a third of all pediatric salivary gland disorders are of an inflammatory nature, with either an obstructive or nonobstructive etiology. Kuttner tumor or chronic sclerosing sialadenitis is a benign.
This two volume set contains the essentials for diagnosis of various tumors from benign to malignant in all organ systems and body parts. Kuttner tumor of the submandibular gland american journal of. The treatment proposed was right submandibular salivary gland. Igg4related disease igg4rd is a recently recognized systemic immunemediated disease that can affect nearly any organ or tissue. Chronic sclerosing sialadenitis or kuttners tumour is usually misrecognised as it is only after. Kuttner tumor may be mainly due to t lymphocyte immune reaction and of itself is a benign lesion, but it may provide a state in which a malignant lesion arises. In the present study, the immunoprofile of chronic sclerosing sialadenitis, also known as kuttner tumor, was analyzed.
Relatively rare in occurrence, this condition is benign, but presents as hard, indurated and enlarged masses that are clinically indistinguishable from salivary gland neoplasms or tumors. Case of xanthogranulomatous pyelonephritis presenting as a renal tumor. Histology of the salivary gland tissue showed chronic sclerosing sialadenitis kuttners tumor with only a few residual ducts persisting, marked fibrosis and foci. This lesion has been recognized as a distinct clinicopathological entity in the latest edition of world health organization classification of tumor like lesions of the salivary. Histopathology with lymphoplasmacytic inflammation and transmural fibrosis. Kuttners tumor or chronic sclerosing sialadenitis of the. An unusual presentation of chronic sclerosing sialadenitis of. An unusual presentation of chronic sclerosing sialadenitis.
A 33yearold woman presented with acuteonset pain and swelling in the right submandibular region. May 31, 2017 in this chapter, the histopathology as well as pertinent ancillary diagnostic, prognostic, and predictive information of these common tumors and pseudotumors will be discussed. Chronic sclerosing sialadenitis css is an uncommon, benign, fibroinflammatory disease of the salivary gland commonly affecting submandibular gland. Kuttners tumor also known as chronic sclerosing sialadenitis was first described in 1896 by kuttner in germany. In 1896, kuttner first described the tumor that carries his name. Chordoma is the most common primary malignancy occurring in sacrum arising from notochordal rests. Jan 12, 2015 over a third of all pediatric salivary gland disorders are of an inflammatory nature, with either an obstructive or nonobstructive etiology. Although it is mainly located in the base of the skull, 29. Chronic sclerosing sialadenitis or kuttner tumor or cirrhosis of submandibular gland, although one of the common disease affecting submandibular gland, is still underrecognised, with only few publications about this entity in the literature6,7. Offer pdf diagnostic histopathology of tumors 3rd edition. Review article chronic sclerosing sialadenitis kuttner.
May 18, 2012 the histopathology of igg4related disease was a specific focus of the international symposium. Kt is usually diagnosed by histopathologist when the lesion. Kuttners tumor of salivary glands resembling marginal zone b. Histopathology of sacral tumors and pseudotumors radiology key. We report case of 35yrs old male presented with left submandibular kuttner tumor. Relatively rare in occurrence, this condition is benign, but presents as hard, indurated and enlarged masses that are clinically indistinguishable from salivary gland neoplasms or. An important aspect of kt is its clinical resemblance to a salivary gland neoplasm. The histopathology of igg4related disease springerlink.
Cancer detection in histopathology wholeslide images. Many causes have been identified like sialolithiasis. Among lesions of the major salivary glands parotid, submandibular, and sublingual glands, those with a prominent lymphoid component are encountered frequently in the surgical pathology laboratory and range from reactive lesions to benign and malignant neoplasms. Keywords malignant peripheral nerve sheath tumor giant cell tumor ewing sarcoma mature teratoma struma ovarii. It may be separated into major morphologic patterns, each with its. Kuttners tumor of bilateral submandibular and parotid glands volume 2 issue 2 2015 umit aydin, 1 omer karakoc, 1 fatih arslan, ali fuat cicek, 2 omer gunhan 1gulhane military medical academy, department of otolaryngolog ty, urkey 2gulhane military medical academy, department of pathology, turkey correspondence. Consensus statement on the pathology of igg4related disease. A majority of these lymphoid lesions have a comingled epithelial component, which also ranges from benign to malignant. Chronic sclerosing sialadenitis is a very rare inflammatory lesion of the parotid gland and cannot be easily distinguished from salivary malignant masses. Chronic sclerosing sialadenitis is a part of the spectrum of igg4associated diseases 10, 16. The primary purpose of this statement is to provide practicing pathologists with a set of guidelines. It occurs mainly in the submandibular gland and usually presents as a. Although described more than a century ago, this clinical entity which masquerades as carcinoma is underdiagnosed by many surgeons.
Histological findings similar to those of kuttners tumour were observed in this case, and dense plasma cell infiltrations suggested immunemediated plasmacytic disease, which has been reported as a potential aetiology of kuttners tumour. This is a great supplement to standard surgical pathology texts and presents the essential and esoteric diagnostic information in a concise formatted discussion using clinical information, gross and microscopic pathologic findings as. A majority of these lymphoid lesions have a comingled epithelial component, which also ranges from. It is also known as kuttner tumour kt as it was first described in 1896 by h. Chronic sclerosing sialadenitis is a chronic longlasting inflammatory condition affecting the salivary gland. Diagnostic approach to lymphoid lesions of major salivary. Cancer detection in histopathology wholeslide images using conditional random fields on deep embedded spaces farhad ghazvinian zanjani, svitlana zinger. There is a wide range of viral infections that can involve the salivary glands coxsackie a and b3, parainfluenza b, echo type 9, and epsteinbarr. Nov 16, 2016 igg4related disease is a multiorgan immunemediated chronic fibroinflammatory condition characterized by elevated serum igg4 concentrations, tumefaction, and tissue infiltration by igg4positive plasma cells. Kuttner tumor is a rare tumor like lesion of the salivary gland characterized by chronic inflammatory disease of the submandibular salivary gland.
Historically, histopathology and cytopathology have been the main tools utilised in the diagnosis of cancer. Kuttner tumor kt is a benign tumor like lesion predominantly involving the submandibular gland of middle aged individuals. Chronic sclerosing sialadenitis kuttners tumour is a condition that has been defined in humans. Diagnose tumors with confidence with diagnostic histopathology of tumors, 4th edition. Stage 1 focal sialadenitis stage 2 diffuse lymphocytic sialadenitis with salivary gland fibrosis stage 3 chronic sclerosing sialadenitis with salivary gland sclerosis. Anatomic pathology kuttner tumor of the submandibular gland. Two cases that occurred in the submandibular gland of male patients were submitted to immunohistochemical reactions to different antibodies. The physician thought this was clear cell rcc, but it is simply a mass of histocytes mimicking a tumor. Similarly, the kuttners tumor or chronic sclerosing sialadenitis, characterized by severe swelling of the submandibular glands, was initially considered as an individual disease entity, frequently associated with sclerosing cholangitis and retroperitoneum involvement. Update in rheumatology 2014 jonathan graf, md associate professor of medicine, ucsf. Chronic sclerosing sialadenitis is a chronic inflammatory salivary gland disease. Kuttner tumor, known descriptively as chronic sclerosing sialadenitis, is a benign chronic. Kuttners tumour, also known as chronic sclerosing sialadenitis, is a localised form of igg4 disease which presents as asymptomatic submandibular gland swelling. Chronic sclerosing sialadenitis kuttner tumor in the.
Histopathology showing preservation of the lobular architecture, dense lymphoplasmacytic infiltration, periductal fibrosis, and loss of acini. Kuttner tumor mimics a malignant neoplasm clinically because of presentation of hard swelling. This tumorlike lesion is a chronic inflammatory disease of the salivary gland that causes a firm swelling of the glands with the clinical impression of a neoplasm 2,3. Stage 1 focal sialadenitis stage 2 diffuse lymphocytic sialadenitis with salivary gland fibrosis stage 3 chronic sclerosing sialadenitis with. Article information, pdf download for immunoprofile of kuttner tumor chronic sclerosing sialadenitis open. The histopathology of igg4related disease was a specific focus of the international symposium. Kuttner tumor involving minor salivary glands in a patient. It is under diagnosed entity since 1896, when kuttner reported four cases of chronic sclerosing sialadenitis kuttners tumor for.
Kuttner s tumor or chronic sclerosing sialadenitis although described more than a century ago, is relatively rare in occurrence. Introduction chronic sclerosing sialadenitis is a relatively uncommon and underrecognized cause of salivary gland enlargement that characteristically affects the submandibular salivary gland. The aim of the case report is to highlight the role of histopathology in early diagnosis and stress on this rare, under diagnosed tumor mimic. Chronic sclerosing sialadenitis, also known as kuttner tumor, is a chronic inflammatory disease of the salivary glands that is reported in a few cases in medical literature. In a lowgrade tumor, the nuclei are small with coarse chromatin.
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