Lymphoma in the Submandibular Gland
Yes, lymphoma can occur in the submandibular gland, most commonly as mucosa-associated lymphoid tissue (MALT) lymphoma or follicular lymphoma, though it is relatively rare.
Types of Lymphoma in Submandibular Glands
- MALT lymphoma can present as small hypoechoic nodules (less than 0.5 cm in diameter) within the submandibular gland, detectable by ultrasound 1
- Follicular lymphoma can also arise in the submandibular gland, sometimes with a sclerosing variant that may resemble Küttner tumor (chronic sclerosing sialadenitis) 2, 3
- Secondary involvement can occur when lymphoma from other sites metastasizes to the submandibular region 1
Diagnostic Considerations
- Ultrasound is valuable for initial detection, showing hypoechoic nodules with increased vascularity on Power Doppler 1
- MRI with contrast provides superior soft tissue contrast resolution and can better delineate lymphoma involvement in salivary glands 4
- Biopsy (often ultrasound-guided) is essential for definitive diagnosis 1
- Immunohistochemistry is crucial for proper characterization, including markers such as CD20, CD10, CD5, CD23, cyclin D1, and IgD 4
Distinguishing Features
- Lymphoma in the submandibular gland must be differentiated from:
- Primary salivary gland tumors (which account for 3-5% of all head and neck neoplasms) 4
- Metastatic squamous cell carcinoma, which typically involves the gland through direct extension rather than true metastasis 5
- Küttner tumor (chronic sclerosing sialadenitis), which can mimic the sclerosing variant of follicular lymphoma 2
Clinical Significance
- The submandibular gland is the second most common site for salivary gland tumors after the parotid gland 4
- The risk of malignancy in salivary glands is inversely proportional to gland size, making submandibular gland lesions more concerning than parotid lesions 4
- Unlike metastatic squamous cell carcinoma which requires direct extension or invasion from adjacent structures, lymphoma can arise primarily within the gland tissue 5
Important Considerations
- Intraglandular lymph nodes are extremely rare or absent within the submandibular gland itself, making primary lymphoma development unique compared to lymphatic spread of other cancers 6, 5
- When lymphoma is suspected in the submandibular region, comprehensive staging should be performed to determine if it's a primary occurrence or part of systemic disease 4
- Expert pathological review is recommended for diagnostic confirmation of marginal zone lymphomas, including those affecting salivary glands 4
The presence of lymphoma in the submandibular gland, while uncommon, should be considered in the differential diagnosis of submandibular masses, particularly in patients with a history of lymphoma at other sites 1.