Dermatopathology
Heterotopic salivary gland tissue in the neck

https://doi.org/10.1016/j.jaad.2007.11.009Get rights and content

Heterotopic salivary gland tissue (HSGT) consists of salivary tissue outside of the major and minor salivary glands and typically presents as a draining sinus and/or asymptomatic nodule of the neck along the lower anterior sternocleidomastoid muscle. There are a limited number of case series exploring this rare entity. To further delineate the clinicopathologic characteristics of this lesion, we present 11 cases of HSGT in the neck, many with cutaneous involvement. Anatomic pathology files from Lifespan-affiliated hospitals (Rhode Island Hospital and Miriam Hospital) were retrospectively reviewed for all cases meeting criteria for HSGT from 1983 through 2005, and 11 patients were identified: 4 female and 7 male, ages 5 months to 64 years, with 8 patients younger than 18 years; 7 patients presented with a draining sinus. Of note, 8 of 11 cases occurred on the right side. In general, microscopic examination revealed mucinous and serous salivary glandular structures with an associated duct; no cytologic atypia was observed. All cases stained positive for smooth muscle actin and calponin, highlighting a myoepithelial layer similar to that seen in minor and major salivary glands. As in our series, most cases of cervical HSGT occur near the anterior sternocleidomastoid muscle with a right-sided predilection. Cases generally present by early childhood, although 3 cases in our series were diagnosed in adulthood. Although cancers arising in these lesions are fairly uncommon, most clinically apparent foci of HSGT are excised. This entity should be considered in the dermatologist's differential diagnostic considerations for a draining sinus and a lateral, especially right-sided, neck mass.

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Methods

After approval of the institutional review board at Lifespan-affiliated hospitals (Rhode Island Hospital and Miriam Hospital), a large tertiary care center, anatomic pathology files were searched for all cases containing “ectopic salivary” in the final diagnosis, from 1983 through 2005. Fourteen cases were identified for possible inclusion in this retrospective case series; after an initial review, 3 cases were excluded: one branchial cleft cyst containing salivary rests, one accessory gland,

Results

The clinical and pathologic findings for the 11 cases are summarized in Table I. There were 4 female and 7 male patients, with age range at surgery from 5 months to 64 years (median 5 years). In 5 of the cases, the lesion was noted within the first month of life. Patients presented with sinuses that had intermittent drainage, localized nodules, or a dimple. In one case ectopic salivary tissue was an incidental finding related to a parathyroidectomy. Eight cases occurred on the right side of the

Discussion

HSGT of the neck should remain within the dermatologist's differential diagnosis for draining sinus for all age groups. Although most lesions in this series were noted at birth or early in childhood, identification may not occur until later in life because of the small size of the draining orifices3 and the relative rarity of pain and infection compared with that associated with branchial cleft fistulas13, 14; one patient delayed treatment until 64 years of age in spite of the congenital nature

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Funding sources: None.

Conflicts of interest: None declared.

Previously partially presented as a poster at the American Academy of Dermatology Summer Academy Meeting, Chicago, Ill, July 21-3, 2005.

Reprints not available from the authors.

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