New masses in the head and neck region of previously treated patients with cancer are considered suggestive of potential recurrence. Fine-needle aspiration is an excellent primary tool for evaluating these masses but may show atypical squamous cells that mislead clinicians to pursue aggressive treatment. We describe 3 patients in whom submandibular gland masses developed after radiation therapy for squamous cell carcinoma and for whom subsequent excisional biopsy findings showed benign squamous metaplasia. We review distinguishing clinical and histopathologic features that may allow these lesions to be identified. We also propose a treatment algorithm for this uncommon clinical scenario.
Photomicrograph of fine-needle aspirate from submandibular mass in case 1 shows groups of cells with enlarged hyperchromatic nuclei suggesting squamous cell carcinoma (Papanicolaou, original magnification ×1000).
Photomicrograph of tissue section from case 1 shows chronic sialoadenitis with acinar atrophy and squamous metaplasia of the ductal epithelium (hematoxylin-eosin, original magnification ×400).
Photomicrograph of aspirated squamous cell carcinoma from case 2 shows individual cells with irregular hyperchromatic nuclei and a coarse chromatin pattern (Papanicolaou, original magnification ×1000).
Suggested diagnostic algorithm for guiding surgical exploration of submandibular head and neck masses in patients who present with these masses after receiving external beam radiation therapy for squamous cell carcinoma (SCC).
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