Presentation
Mildly painful, slowly growing left neck swelling for 5 months. No fever or skin color changes.
Patient Data
Multilocular tubular cystic structure measuring approximately 3.2 x 5.7 cm in the left submandibular region. No calcifications, solid component or internal vascularity is appreciable in it.
Well-defined lobulated tubular cystic lesion having an average density of 19 HU, in the left submandibular region, just anterior to the submandibular gland. No calcifications, solid component or internal enhancement is appreciable in it. Average size thyroid gland with a few heterogeneous nodules.
Lobulated multiseptated cystic lesion, low signal on T1 and high signal on T2-weighted images, in the left submandibular region, extending anteriorly into the sublingual space. No fat, hemorrhage or solid component is noted in it. The lesion has thin walls which show mild enhancement on the post-contrast study. No associated cervical lymphadenopathy.
Multilocular tubular cystic structure in the left submandibular region; a few possibilities can be plunging ranula, cystic hygroma/lymphangioma, or less likely a cystic/necrotic lymph node.
Case Discussion
The left submandibular cystic lesion was excised.
Gross description: Specimen consists of partially opened cyst with removal of its content. It measures 4 cm in maximum diameter. The wall of the cyst is focally thickened and measures 0.3 cm. The external surface is irregular and covered by fatty tissue and the internal surface is focally irregular.
Diagnosis: Features consistent with a ranula. Immunostains performed showed negativity of the lining layer of the cyst by CD34 and CD31, excluding the diagnosis of cystic lymphangioma.