Cavernous hemangiomas rarely arise in the submandibular gland. We report a case of cavernous hemangioma in the submandibular gland that had atypical clinical symptoms and imaging findings.
A 27-year-old man presented with intermittent pain and swelling in the right submandibular region in August 2007. Three years 6 months ago the patient had had colicky pain during a meal and was given a diagnosis of submandibular sialolithiasis at another university hospital. Extraoral examination revealed an elastic soft mass with well-demarcated borders in the right submandibular region. On oral examination, salivation from the right Wharton's duct was normal, and other findings were unremarkable. MRI demonstrated a well-demarcated tumor in the submandibular gland, which showed low-signal intensity on Tl-weighted images and heterogeneous highsignal intensity on T2-weighted images. Enhanced CT showed a poorly-defined intraglandular lesion and enlarged submandibular and upper jugular lymph nodes. On the basis of these preoperative findings, a malignant tumor was included in the differential diagnosis. The submandibular gland was extirpated to remove the tumor with intraoperative frozen section examination in October 2007. The tumor was histopathologically diagnosed as a cavernous hemangioma with chronic sialadenitis.
Factors such as the characteristic blood flow of the cavernous hemangioma and the intraglandular location of the tumor may have caused the atypical features of this case.