Introduction

Lung carcinomas are aggressive malignancies, characterized by early metastatic spread and poor prognosis at the time of presentation. Metastasis of non-small cell lung carcinoma to submandibular gland is rare. The diagnosis of a metastatic lesion is challenging, both to the clinician and to the pathologist. This case is a rare condition, in our knowledge it is the fourth of the literature. We present a 57-year-old male patient with lung adenocarcinoma reveleated by a tumefaction of the submandibular gland.

Case Presentation

Our patient is a chronic smoker, presented with a 4-month history of a tumefaction in the left submandibular region that was slowly increasing in size, without any other associated signs. Cervical ultrasound revealed a suspect mandibular mass measuring 20 × 34 mm, without any cervical adenopathy. The patient had a complete excision of the submandibular gland with a lymphadenectomy of group IA. At the histological examination, the diagnosis of an undifferentiated carcinoma of the submandibular gland was retained. A chest radiograph unexpectedly revealed right pulmonary opacity. A thoracic computerized tomography scan (CT) identified a lesional process of the right upper lobe, measuring 72 mm of main axis, without hilar or mediastinal lymphadenopathy (Figure 1). A pulmonary biopsy was recommended. Anatomopathological and immunohistochemical evaluation confirmed the diagnosis of an undifferentiated adenocarcinoma infiltrating bronchopulmonary origin was retained. Comparison was made between the submandibular left lesion and pulmonary carcinoma, we conclude that the patient was suffering from pulmonary adenocarcinoma with a metastasis in the left submandibular gland. The patient underwent an 18 fluorodeoxyglucose-based positron emission tomography scan that showed a large necrotic hyper metabolic mass in the right lower lobe, with hyper metabolic lesion in the left adrenal gland (Figures 2 and 3). The patient underwent a chemotherapy regimen of platinum and navelbine. He received 6 cycles the CT showed progression with brain metastasis, the patient was referred for radiotherapy. He received a dose of 30 Gray to the whole brain and he still in good condition one year after the diagnosis.

Best Regards:
Mary Wilson
Journal Manager
Journal of Tumor Research
Email: tumour@medicalresjournals.com