Kuttner’s tumour: chronic sclerosing sialadenitis- a mimicker of malignancy

Abstract

Background: Kuttner’s tumour is a condition of the submandibular gland which is underreported as a distinct entity. Also called as the chronic sclerosing sialadenitis it resembles a plasmocytic and lymphocytic inflammatory process and presents as a hard and painful mass which clinically mimics a malignancy and raises significant concerns. The objective of the present study was to evaluate cases of Kuttner’s tumor and discuss its clinical and pathological aspects to distinguish it from a definite malignancy and create a grown acceptance of the presence of such an entity in our setting.Methods: We collected 170 cases of submandibular swellings and evaluated in detail the clinical and pathological aspects of eight cases out of them which were later diagnosed to as Kuttner’s tumour.Results: The age of the patients varied between 23 to 61 years (mean age 42.5 years) with 3 males and 5 females. 6 patients reported with a firm to hard painless submandibular mass (5 left sided; 3 right sided) while 2 patients experienced intermittent discomfort. The mean duration of presentation of symptoms was 5.3 months. Fine needle aspiration cytology was done in 6 cases preoperatively. Following submandibular sialadenectomy histopathology showed salivary gland tissue with preserved lobular architecture, but with marked fibrosis, acinar atrophy, and a dense lymphoplasmacytic infiltrates.Conclusions: Kuttner’s tumor may be pre operatively distinguished from a malignancy with improved imaging and a good image guided FNA Cytology saving the clinician and the patient from a lot of dilemma. However, histopathology and immunohistochemistry would be the key in establishing the diagnosis.

T Cell Roles and Activity in Chronic Sclerosing Sialadenitis as IgG4-Related Disease: Current Concepts in Immunopathogenesis

“…It is a relatively uncommon lesion that is considered an IgG4-RD because of its histologic features and elevated serum IgG4 levels [ 4 , 95 ]. Moreover, it is characterized by dense lymphocytic infiltration, dilated ducts, progressive periductal fibrosis, lymphoid follicle formation, acinar atrophy, and eventually marked sclerosis of the affected gland [ 100 , 101 ].…”

“…CD4 + SLAMF7 + CTL cells are found in the parafollicular zone of germinal centers and in interfollicular areas of the affected gland, especially near ducts and between acini that are intimately close to the epithelial cells [ 101 , 103 , 105 , 108 ]. The infiltrated populations of CD4 + CTLs show monoclonal and oligoclonal expansion [ 103 , 108 , 126 ].…”

“…The presence of cytotoxic T cells intimately close to the ductal epithelial cells indicates that IgG4-RS may be the consequence of an immune process triggered by intraductal epithelial agents [ 101 , 103 , 105 , 108 , 127 ].…”