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Submandibular Oncocytoma with Prominent Contrast Enhancement on Computed Tomograpy

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Submandibular Oncocytoma with Prominent Contrast Enhancement on Computed Tomography

Ji Kang Park'

Jeong Hong Kim'

Gil Chai Lim' lDepartment이Radiology,Jeju NationalUniversilyCollege01Medicine

Depa꺼ment of Ololaryngology-Headand Neck su며ery,Jeju NationalUniversilyCollege이Medi히ne (ReceivedJanu밍γ 27. 2014; RevisedFebruary 3. 2014; AcceptedFebruary 10. 2014)

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Abstract

An oncocytoma is a rare salivary gland neoplasm,and about 11% of oncocytomas of the 5허ivary gland occur in Ihe submandibular gland. This is a case report of an oncocytoma of the submandibular gland that showed strong homogenous contrast enhancemenl on a computed tomography (cn scan. We summarize our case and review the imaging features of prior literature on oncocylomas. The submandibular mass showed relatively high density on the precontrast CT scan [43 Hounsfield unil (H비].There was no remarkable calcification. The mass showed homogenously strong contrast enhancemenl (mean,162 HU; maximum,188 HU; and minimum,130 HU). In the case presented here,the HU levels of the submandibular oncocytoma on a contrast-enhanced CT is remarkably higher than the HU tevels of the sa1ivary gland tumors described in prior Iiterature. If a mass 01 the salivary gland has strong contrast enhancement on a CT scan,the occurrence of an oncocytoma of the salivary gland may be possible_ lhe possibilily 01 Ihe oncocytoma 01 lhe salivary gland may be considered. (J Med Lile 5cl 2014;10(3);233-235)

Key Words ; OncocytlJma.5ubmandibular Gland. Computed Tom。망'aphy. Contrast Media,Doppler ul때sonography

[_ _ _ _ _ _ Introductic>n .

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Cas.e_ Report.m ._. '.

1

A seventy year-old man visited our otolaryngology outpatient clinic due 1.0 a palpable mass in the left-side submandib띠ar area present for a few weeks prior. He did not suffer pain at the mass site and observed postprandial ch밍1ges in the size. In physica1 examinations,there was a soflJy-p외pated and movable mass in the left submandibular area of about 1 cm in size 까1ere was no tendemess during palpation,and there were no abnormal findings at the mouth f1oor. A CT scan was peñonned with a scan delay of 40 seconds after the bolus injection of contrast agent (Ulσavist 370,Bayer Schering,Berlin ,Germany) with an inîection rate of 3 cc/second πle left-side submandibular mass was 1.5crn in size and showed relative1y hi앙1 densit;y on the precontrast CT sc밍1 (43 Hounsfield unit (HU),Fig

lA). There was no rernarkable calcification 만1e mass showed homogenously strong contrast enhancement (mean‘

162 HU; maximum. 188 HU; and minimum. 130 HU; Fig. 18. lC). mtrasound-guided fme-needle aspiration biopsy was performed for 양101。밍c examination,and the cytologic result suggested the presence of a pleomorphic adenoma. The mass was hypoechoic and had a well-defmed smooth An oncocytoma is a rare salivary gland neoplasm that

consists of about 1.6% of all saliv8Jγ gland tumors1) Oncocytomas usual1y occur in the parotid gland. and about

11% of oncocy

mas of the salivary gland occur in the submandib띠와 glandll 맴1ere lS a 5αable amount of prior literature on onc。앙tomas of the saJivary gland. However. a few studies describe the detailed imaging features of onco앙tomas of the parotid gland2",Il. Recentiy. we witnessed

a case of oncocytoma of the submandibular gland which showed sU'ong homogenous contrast enhancement on a computed Iomography (CT) scan‘We will summarize our case and review the imaging features of prior literature on oncocytomas

Correspandenceto : GiI Chai Um

Departme미

f Otolaryngology-Headand Neck su얘ery’Jeju

NationalUniversilyHospital,Jeju NationalUniversityCollege01

싸dicine. 102 Jeμdaehakno,690-756,Jeju,Korea

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nait벼yi081α@gmail

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끼1is researchwas sup

rted by Ihe 2013 scienlificpromotionprogramfunded by Jeju Nati。때University

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233-Ji Kang Park,Jeong Hong Kim. Gil Cho.iLim

margin. Color Doppler ulσ'asound reve어ed prominent centr외

blood flow (Fig. 10). 매e left submandibular gland was completely excised. Dwing surgical excision. a soft mass was palpated on the left submandibu1ar gland which did not invade the swface of the gland. 'There was no spi1lage of the tumor cont.ents during surgical procedures. Grossly. the submandibular gland contained a tan-c010red. 1.2 x 0.8 cm size mass. The mass was ov외-shaped. well-circumscribed

and encapsulaæd (Fig. 2). Pathol。밍cal diagnosis confiπned the presence of an oncocytoma. Four days after the

peration‘the patient was discharged without complications

Figure 2. Gross appearance of the cut surface of the submar펴ib띠ar명외XI하:>ecunen.까1e subm와업ibulargl와‘d αm어lI1S a tan-rolored 뼈w마lτ:ircums떠>edmass.

There were few prior studies that described the imaging features of parotid oncocytomas~l π1e common lmagmg feature of the parotid oncocytoma was a well-defmed mass with relatively homogenous contrast enhancement on CT or magnetic resonance ima밍ng (MRD,but this was not spec피c

10 oncocytoma. When large,the parotid oncocytoma had a

“deformable" appe밍1illce와1d a non-e띠1ancing curvilinear

c1eft or cystic

mponent"

Occasionally,on

∞앙

toma of the salivary gland were invisible or vanishing in contrast e피1anced CT or MRl depending on the time of scanning

after conσ'ast enhancement".J

Previous dynamic CT studies revealed the pattem contrast e띠1밍1cement pattems 밍ld HU of tumors of the sa1ivary glandUl. 1n those studies ,the strongest contrast enhancement was seen in a Whartin twnor (96 HU for the early phase: 73-77 00 for the delay phase) 밍1d malignancy (71-84 00 for the early phase: 82-109 00 for the delay phase) 끼lere was no twnor that showed HU levels higher than 150 in those studies. Contrary to those reports. in our case we found a prominent contrast enhancement. The mean,maxunum,뻐d minimum 00 levels were 162,190 and 130,respectively,at a 4Q-second delay efær contrast e띠1ancement π1Ïs hi앙1 HU level was equiva1ent to that of renal oncocytomas. The imaging features of the renal oncocytoma were sirr피ar 10 those of the onc

。‘

~ma of the

sa1ivary gland: relatively homogenous con뼈st enhancement

and an occasional centr,외 scar in 10.7% of cases71 π

e

previous dynamic CT study revealed the HU levels of the Figure J. A 7()-year-。뼈man"얘1 an incidenta1subn딩I엄b띠a잉and

mass.

여)π1e mass has떠ativety뼈,densi\Yon a preron1rast

cr

엎n (43 HU).1bere is no r힌narkable calcification.

æ,C)까,e mass shows homogenouslystrong

n1rast enh뻐잉nent.

까.,

00 lev깅!s of the mass on poslocn1rast

cr

scan are a mean of 162 00,maximumof 188 00,and minimumof 13:>00.

φ) on u1trasonograpl\Y‘the mass is l\YPα

앙、。

c ar퍼뼈5 a

well-defmed sm

thma멍π Color Do띠er없ldy reVeaISa oentrol fE얹ding vess잉

Discussion

Lτj

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-Submandit띠ar Oncocytoma

Nith Prominent Contrast Enhancement on Computed Tomography

i

흉nal oncocytoma: the HU levels were 171.6:t50.3 for the arterial phase and 128.7:t24.3 for the venous phase8l

Although we did not evaluate microvessel density in oUI case ,

we think that this unusually strong contrast enhancement may be associated with microvessel density of the oncyocytoma .In prior literature,the microvessel density (MVD) of the renal oncocytoma was sirnilar or higher than the MVD of various renal cell carcinomas,and MVD was inversely correlated to 벼e size of oncocytom랴 In our case, the size of the tumor was relatively small,and the MVD might be high enough to explain the unusually strong contrast enhancement

In conclusion,we remarked quantitative value of HU in oncoc야。ma of the s니bmanclibular gland

The HU levels after the use of the contrast agent are remarkably rugher thεul that of the salivarγ gland tùmor from prior literature. We earmot conclude that the HU levels

f this case were typical for the oncocytoma of the salivarγ gland due to our 피nited experience. However,we suggest that strong contrast enhancement (about 150 HU) was equivalent to the HU levels of renal oncocytoma. In our

pinion,if a mass of 삼1e salivarγ gland has strong contrast enhancement on CT,the possibility of the presence of oncocytoma of the salivarγ gland may be. consîdered

L

R닫

fergncFs-1) Curtin HD, 30m PM. 3alivary glands: anatomy and pathology. In: Som PM,Brandwein MS (4theds).Curtin HD,30m PM. Head and neck imaging. 3t. 10uis ,Mo Mosby: 2003. p. 2082-2084

2) Kei PL,Tan Tγ CT "invisible" lesion of the major

235

salivarγ glands a diagnostic pitfall of. contrast-enhanced CT. Clinical radiologγ 2009:64(7):744-746

3) Patel ND,van Zante A,Eisele DW,Harnsberger HR, Glastonbuη CM. Oncocytoma: the vanishing parotid mass. AJNR. American journal of neuroradiology 2011:32(9):1703-1706

4)Tan TJ,Tan TY. CT features of parotid gland

ncocytomas: a study of 10 cases and literature review AJNR. American journal of neuroradiology 2010:31(8):1413-1417

5) Choi DS,Na DG,Byun HS,Ko YH,Kim CK,Cho JM,et al. Salivary gland tumors: evaluation with two-phase helieal CT. Racliology 2000;214(1):231-236

6)γ-erli H,Aydin E ,Coskun M,Geyik E ,Ozluoglu LN, Haberal N,et a1. Dynamic multislice computed tomography fmdings for parotid gland tumors,Journ밍of computer assisted tomo밍aphy 2007;31(2):309-316 7) MeGahan JP,Lamba R,Fisher J ,S\arshak P ,Ramsam。이

R,Fitzgerald E,et a1. Is segmental enhancement mverslOn on e띠]잉1ced biphasic :MDCTa reliable si밍1 for

the noninvasive diagnosis of renal oncocytomas? AJR. American j

니rnal of roentgenology 2011;197(4):W674-9

8)Bird VG,Kanagarajah 'P,Morillo G,Caruso DJ, Ayyathurai R,Leveillee R,et a1. Differentiation of

ncocytoma and renal cell carcinoma in small renal masses ((4 cm):, the .role of 4-phase computerized

tomography. World journal of urology 2011;29(6):787-792 9) Okon K,Kawa R. Microvascular network in renal carcinomas. Quantitative and tissue microarray immunorustochemical study. Polish Journal of Pathologγ

fficial journal of the Polish Society of Pathologists 2008;59(2):107-115

수치

Figure 2. Gross appearance of the cut surface of the submar 펴 ib 띠 ar 명외 XI 하 :>ecunen

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