A unique case of Nodular Fasciitis in the Submandibular gland mimicking pleomorphic adenom

Abstract

— Aim: Nodular fasciitis (NF) is a rare entity responsible for 0.0025% of tumors in the head and neck, to our knowledge; there has been no report in the literature of NF infiltrating the submandibular gland. Through a case of a 29-year-old woman we will discuss the histology and imaging of NF in the submandibular gland and its resemblance to pleomorphic adenoma (PA). Case description: Our patient presented with rapid growth of the right submandibular gland over a 6-month period. Fine Needle Aspiration Cytology suggested PA, nonetheless, mesenchymal origin could not be excluded. MRI strengthened the diagnosis of PA wherein the lesion appeared hyper-intense on T2, hypo-intense on T1 and enhanced with gadolinium. Right submandibulectomy was performed and the histopathological report compatible with NF Conclusion: NF is a self-limited benign process that does not always require surgical removal while PA is a benign tumor treated with surgical resection. Differentiating between these two pathologies is important since surgery can be avoided with a diagnosis of NF. Currently, there is no non-invasive modality that can provide a definite diagnosis of NF in salivary glands. It is important to exhaust our diagnostic possibilities and regard scarcer etiologies in order to achieve the most favorable outcome for the patients.