Seek the Spindle Tumor in Submandibular Space

Submandibular region is surgically significant in the head and neck field and a mass in this region may have multiple differential diagnoses.

An elderly man came with a single 4×2.5 cm swelling in the neck on the right side, just below the lower jaw, since one month. Ultrasound showed an irregular heterogeneous hypoechoic lesion in the right submandibular space measuring 37×23 mm with mild internal vascularity. The submandibular gland appeared separate but compressed. Fine needle aspiration was suggestive of spindle cell neoplasm. The swelling was excised under general anesthesia. By histopathological examination, the lesion was diagnosed as anaplastic lymphoma kinase-negative inflammatory myofibroblastic tumor (IMT) based on focal immunoreactivity with cyclin D1. The patient then received radiotherapy 60 Gray divided into 30 fractions over 6 weeks. The case had no evidence of recurrence or residual disease six months post-surgery.

Tumefactive spindle-cell lesion in the head and neck can comprise inflammatory conditions, benign and malignant neoplasms or borderline neoplasms, such as nodular fasciitis and IMT. The definitive histologic diagnosis of IMT helps in tailoring the treatment modality based on its locally aggressive biologic potential.