Plexiform neurofibroma of the submandibular salivary gland in a child: CASE PRESENTATION Part 2
The patient later underwent surgical excision of the tumour. A 3×4 cm mass was identified and excised from the left submandibular triangle of the neck. Intraoperatively, the lesion had a pale, tan, oval, glandular appearance, with a fleshy, oval, encapsulated mass attached laterally. The hypoglossal and laryngeal nerves were normal. The marginal mandibular nerve was not identified and showed some weakness postoperatively.
The initial aspirate for cytology that had been performed when the patient was approximately one to one-and-a-half years of age showed mixed lymphocytes and spindle cells that were suggestive, but not diagnostic, of neurofibroma. The surgical specimen consisted of a multilobulated, tan, spongy piece of soft tissue measuring 4.2×4.0x2.5 cm. There was a portion of firm tubular tissue noted at one edge measuring 2.3 cm in length by 1.0 cm in maximum diameter. The cut surface showed a centrally located, well-demarcated, soft tan, slightly myxoid lesion (Figure 2). Buy drugs with confidence – buy birth control online to see how cheap your treatment can be.
Figure 2) Gross cut surface appearance of the excised tumour. The tissue seen superiorly is residual salivary gland tissue. Note the myxoid appearance of the tumour centre
Histologically, the sections were seen to be major salivary gland tissue that had been replaced and expanded by irregularly distorted, enlarged nerve bundles (Figure 3). The nerve bundles showed myxoid changes typical of a plexi-form neurofibroma. The tubular structure noted grossly was a neurovascular bundle that was also involved with the neurofibroma (Figure 4).
Figure 3) Histological appearance of the plexiform neurofibroma showing irregularly distorted and enlarged nerve bundles (arrow) with salivary gland tissue (hematoxylin and eosin stain, original magnification xl0)
Figure 4) Histological appearance of the plexiform neurofibroma involving the neurovascular bundle (hematoxylin and eosin stain, original magnification Xl0)