Adult T cell lymphoma first occurring in the submandibular region

Abstract

Adult T cell lymphoma in the head and neck region is very rare, however so-called midline lymphomas are almost of the T cell type. Lymphoma in the submandibular gland is extremely rare. A T cell lymphoma occurring in the submandibular region is presented in this article. A 70-year-old woman was referred to our clinic for surgical treatment of a swelling in the left submandibular gland. The gland was indurated and fixed with the surrounding tissues. By palpation, no swelling of the lymph nodes was detected. The gland was extirpated with suspicion of a malignancy, and histological examination of the frozen sections was performed during the surgery. Malignant lymphoma (diffuse, pleomorphic type) was suspected, and neck dissection was avoided. About 1 year after the surgery with adjuvant chemoradiotherapy, lymphadenopathy occurred in the neck and axilla, with the patient dying of the disease in spite of steroid therapy for 4 months. Immunohistochemical stainings revealed tumor cells were positive for CD 3, CD 4 and CD 25. Human T-cell leukemia virus type-1 genome was detected in the PCR-augmented DNA substracted from the extirpated gland. However, the viral DNA was not proven by in situ hybridization. These findings appear to indicate that T cell transformation first occurred in the submandibular region.