This lesion has been recognized as a distinct clinicopathological entity in the latest edition of world health organization classification of tumor like lesions of the salivary. Immunoprofile of kuttner tumor chronic sclerosing sialadenitis. Chronic sclerosing sialadenitis kuttners tumour of the. Kuttner described 4 cases of chronic sclerosing sialadenitis css of.
Many causes have been identified like sialolithiasis. Consensus statement on the pathology of igg4related. Kuttner tumor of the submandibular gland american journal of. We report here 7 cases of kuttners tumor that morphologically resemble primary salivary gland marginal zone bcell lymphoma of the mucosaassociated lymphoid tissue malt type. Chronic sclerosing sialadenitis is a part of the spectrum of igg4associated diseases 10, 16.
Kuttners tumor also known as chronic sclerosing sialadenitis was first described in 1896 by kuttner in germany. Kuttner s tumor also known as chronic sclerosing sialadenitis was first described in 1896 by kuttner in germany. Chronic sclerosing sialadenitis kuttner tumor in the sublingual. May 31, 2017 in this chapter, the histopathology as well as pertinent ancillary diagnostic, prognostic, and predictive information of these common tumors and pseudotumors will be discussed. A musthave for any practising surgical pathologist. Relatively rare in occurrence, this condition is benign, but presents as hard, indurated and enlarged masses that are clinically indistinguishable from salivary gland neoplasms or tumors. Chronic sclerosing sialadenitis or kuttner tumor or cirrhosis of submandibular gland, although one of the common disease affecting submandibular gland, is still underrecognised, with only few publications about this entity in the literature6,7. Igg4related disease igg4rd is a recently recognized systemic immunemediated disease that can affect nearly any organ or tissue. Chronic sclerosing sialadenitis kuttner s tumor is a benign and chronic inflammatory condition of the submandibular gland that clinically cannot be easily distinguished from salivary malignant. Features over 3,000 highquality fullcolor illustrations. These lesions recognized as tumorlike lesions of the salivary gland by the world health organization. Histopathology showing preservation of the lobular architecture, dense lymphoplasmacytic infiltration, periductal fibrosis, and loss of acini.
Histopathology of sacral tumors and pseudotumors radiology key. Chronic sclerosing sialadenitis or kuttner tumor is an uncommon benign chronic inflammatory condition affecting submandibular gland. Christopher fletchers renowned reference provides the advanced, expert guidance you need to evaluate and interpret even the most challenging histopathology specimens more quickly and accurately. American society for clinical pathology academy of clinical. Kuttners tumour, also known as chronic sclerosing sialadenitis, is a localised form of igg4 disease which presents as asymptomatic submandibular gland swelling. This two volume set contains the essentials for diagnosis of various tumors from benign to malignant in all organ systems and body parts. The physician thought this was clear cell rcc, but it is simply a mass of histocytes mimicking a tumor. Kt is usually diagnosed by histopathologist when the lesion. Histopathology of kuttner tumor the histopathologic features of kuttner tumor may evolve through four different histologic stages.
This is a great supplement to standard surgical pathology texts and presents the essential and esoteric diagnostic information in a concise formatted discussion using clinical information, gross and microscopic pathologic findings as. Kuttner tumor is a rare tumor like lesion of the salivary gland characterized by chronic inflammatory disease of the submandibular salivary gland. Offer pdf diagnostic histopathology of tumors 3rd edition. Case report unusual involvement of igg4related sclerosing. Kuttner s tumor or chronic sclerosing sialadenitis although described more than a century ago, is relatively rare in occurrence. Benign lymphadenopathy is a common biopsy finding, and may often be confused with malignant lymphoma. Kuttners tumor of bilateral submandibular and parotid glands volume 2 issue 2 2015 umit aydin, 1 omer karakoc, 1 fatih arslan, ali fuat cicek, 2 omer gunhan 1gulhane military medical academy, department of otolaryngolog ty, urkey 2gulhane military medical academy, department of pathology, turkey correspondence. Kuttner reported 4 cases of submandibular gland lesions for the first time in 1896. The histologic feature varies according to stage of evolution and severity of inflammation. Chronic sclerosing sialadenitis or kuttner tumor is an unusual chronic inflammatory.
Keywords malignant peripheral nerve sheath tumor giant cell tumor ewing sarcoma mature teratoma struma ovarii. Carcinoid tumors are the most common tumor of the appendix, accounting for more than half of all appendiceal malignancies and discovered in seven of every 1,000 appendectomy specimens. Kuttner tumor or chronic sclerosing sialadenitis is a benign. Kuttners tumour chronic sclerosing sialadenitis of the. Nov 16, 2016 igg4related disease is a multiorgan immunemediated chronic fibroinflammatory condition characterized by elevated serum igg4 concentrations, tumefaction, and tissue infiltration by igg4positive plasma cells. Kuttner in 1896 reported chronic sclerosing sialadenitis for the first time 1. Igg4related disease is a multiorgan immunemediated chronic fibroinflammatory condition characterized by elevated serum igg4 concentrations, tumefaction, and tissue infiltration by igg4positive plasma cells.
Stage 1 focal sialadenitis stage 2 diffuse lymphocytic sialadenitis with salivary gland fibrosis stage 3 chronic sclerosing sialadenitis with. Plus, more than 50 internationally recognized authorities and over 3,100 fullcolor illustrations provide you with an uptodate account of tumor morphology, the application of modern diagnostic techniques including molecular genetics, and key aspects of differential diagnosis. Although described more than a century ago, this clinical entity which masquerades as carcinoma is underdiagnosed by many surgeons. Chronic sclerosing sialadenitis or kuttners tumour. Chronic sclerosing sialadenitis is a very rare inflammatory lesion of the parotid gland and cannot be easily distinguished from salivary malignant masses. Chronic sclerosing sialadenitis or kuttners tumour is usually misrecognised as it is only after. Histological findings similar to those of kuttners tumour were observed in this case, and dense plasma cell infiltrations suggested immunemediated plasmacytic disease, which has been reported as a potential aetiology of kuttners tumour. It is also known as kuttner tumour kt as it was first described in 1896 by h. It may be separated into major morphologic patterns, each with its own differential diagnosis. Recent reports suggest that certain aspects of sclerosing diseases, including chronic sclerosing sialadenitis or dacryoadenitis, should be classified under im. The treatment proposed was right submandibular salivary gland. Relatively rare in occurrence, this condition is benign, but presents as hard, indurated and enlarged masses that are clinically indistinguishable from salivary gland neoplasms or. Jan 12, 2015 over a third of all pediatric salivary gland disorders are of an inflammatory nature, with either an obstructive or nonobstructive etiology.
Kuttner tumor kt is a benign tumor like lesion predominantly involving the submandibular gland of middle aged individuals. In a lowgrade tumor, the nuclei are small with coarse chromatin. Similarly, the kuttners tumor or chronic sclerosing sialadenitis, characterized by severe swelling of the submandibular glands, was initially considered as an individual disease entity, frequently associated with sclerosing cholangitis and retroperitoneum involvement. Chronic sclerosing sialadenitis kuttners tumour of the parotid gland. Anatomic pathology kuttner tumor of the submandibular gland. Igg4related kidney disease diagnostic histopathology. Chronic sclerosing sialadenitis is a chronic longlasting inflammatory condition affecting the salivary gland. It occurs mainly in the submandibular gland and usually presents as a. Enlargement of the submandibular gland is a condition that raises the alarm for further investigation as the risk of an underlying malignancy is higher in comparison to parotid gland enlargement. Kuttners tumor of bilateral submandibular and parotid glands. Histology of the salivary gland tissue showed chronic sclerosing sialadenitis kuttners tumor with only a few residual ducts persisting, marked fibrosis and foci.
Case of xanthogranulomatous pyelonephritis presenting as a renal tumor. The histopathology of igg4related disease was a specific focus of the international symposium. It is under diagnosed entity since 1896, when kuttner reported four cases of chronic sclerosing sialadenitis kuttners tumor for. Histopathology of sacral tumors and pseudotumors springerlink. Consensus statement on the pathology of igg4related disease. Histopathology with lymphoplasmacytic inflammation and transmural fibrosis. It may be separated into major morphologic patterns, each with its. Diagnose tumors with confidence with diagnostic histopathology of tumors, 4th edition. Kuttner tumor chronic sclerosing sialadenitis sciencedirect.
It is usually a slowgrowing and lowgrade tumor, but metastatic disease is seen more frequently in sacral chordomas than in skull base chordomas. In this chapter, the histopathology as well as pertinent ancillary diagnostic, prognostic, and predictive information of these common tumors and pseudotumors will be discussed. Chronic sclerosing sialadenitis is a chronic inflammatory salivary gland disease. Sclerosing sialadenitis of the sublingual salivary glands. This tumorlike lesion is a chronic inflammatory disease of the salivary gland that causes a firm swelling of the glands with the clinical impression of a neoplasm 2,3. Kuttner tumor, sclerosing, sialadenitis, submandibular gland. Cancer detection in histopathology wholeslide images using conditional random fields on deep embedded spaces farhad ghazvinian zanjani, svitlana zinger. Kuttner tumor mimics a malignant neoplasm clinically because of presentation of hard swelling.
The most common manifestation in the kidney is igg4related tubulointerstitial nephritis igg4tin, which can present as renal insufficiency, renal mass lesions, or both. A 33yearold woman presented with acuteonset pain and swelling in the right submandibular region. Chronic sclerosing sialadenitis kuttners tumour is a condition that has been defined in humans. It is a chronic inflammatory condition affecting the salivary gland.
An unusual presentation of chronic sclerosing sialadenitis. Kuttner tumor may be mainly due to t lymphocyte immune reaction and of itself is a benign lesion, but it may provide a state in which a malignant lesion arises. The primary purpose of this statement is to provide practicing pathologists with a set of guidelines. Cytologic features of epithelioid hemangioendothelioma. The aim of the case report is to highlight the role of histopathology in early diagnosis and stress on this rare, under diagnosed tumor mimic.
Bilateral kuttner tumor of submandibular glands introduction. The diagnosis is usually based on histopathology and immunohistochemistry. A majority of these lymphoid lesions have a comingled epithelial component, which also ranges from. Kuttner tumor of the submandibular gland fineneedle aspiration. Introduction chronic sclerosing sialadenitis is a relatively uncommon and underrecognized cause of salivary gland enlargement that characteristically affects the submandibular salivary gland. Although it is mainly located in the base of the skull, 29. Diagnostic approach to lymphoid lesions of major salivary. Chronic sclerosing sialadenitis kuttner tumor in the. Chronic sclerosing sialadenitis css is an uncommon, benign, fibroinflammatory disease of the salivary gland commonly affecting submandibular gland. A majority of these lymphoid lesions have a comingled epithelial component, which also ranges from benign to malignant. Kuttner tumor involving minor salivary glands in a patient. Dec 04, 2009 chronic sclerosing sialadenitis is a chronic inflammatory salivary gland disease. In the present study, the immunoprofile of chronic sclerosing sialadenitis, also known as kuttner tumor, was analyzed.
The exact etiology of igg4related disease remains unclear with no known role of the igg4 molecule itself being identified. We report case of 35yrs old male presented with left submandibular kuttner tumor. Kuttner tumor, known descriptively as chronic sclerosing sialadenitis, is a benign chronic. These lesions recognized as tumor like lesions of the salivary gland by the world health organization. Chronic sclerosing sialadenitis, also known as kuttner tumor, is a chronic inflammatory disease of the salivary glands that is reported in a few cases in medical literature. The tumor cells are separated by fibrous septa, which give rise to the lobulated appearance and are embedded in abundant extracellular myxoid matrix. There is a wide range of viral infections that can involve the salivary glands coxsackie a and b3, parainfluenza b, echo type 9, and epsteinbarr. Historically, histopathology and cytopathology have been the main tools utilised in the diagnosis of cancer. Review article chronic sclerosing sialadenitis kuttner. Stage 1 focal sialadenitis stage 2 diffuse lymphocytic sialadenitis with salivary gland fibrosis stage 3 chronic sclerosing sialadenitis with salivary gland sclerosis. Over a third of all pediatric salivary gland disorders are of an inflammatory nature, with either an obstructive or nonobstructive etiology.
The histopathology of igg4related disease springerlink. Kuttners tumor or chronic sclerosing sialadenitis of the. Chronic sclerosing sialadenitis, also known as kuttners tumour kt, is a benign tumourlike lesion predominately affecting the submandibular gland first recognised by kuttner in 1896. In a highgrade tumor, the nuclei may become larger, pleomorphic and with greater mitotic activity. Update in rheumatology 2014 jonathan graf, md associate professor of medicine, ucsf. Epithelioid hemangioendothelioma ehe is a vascular tumor of intermediate malignancy that may occur in a variety of sites, including soft tissues, 1,2 bone, 3,4 lung, 5 liver, 6 pleura and peritoneum, 7,8 skin, 2,9 lymph nodes, 10,11 stomach, 12 and brain. Chronic sclerosing sialadenitis of the submandibular.
They account for 5% of gi carcinoids and are more common in women than men. May 18, 2012 the histopathology of igg4related disease was a specific focus of the international symposium. Among lesions of the major salivary glands parotid, submandibular, and sublingual glands, those with a prominent lymphoid component are encountered frequently in the surgical pathology laboratory and range from reactive lesions to benign and malignant neoplasms. Clinical examination showed an enlarged submandibular. Two cases that occurred in the submandibular gland of male patients were submitted to immunohistochemical reactions to different antibodies. In 1896, kuttner first described the tumor that carries his name.
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