A 51-year-old man presented with a history of dysphagia and dysarthria. On physical examination, he was found to have a palpable mass in the left submandibular space, extending into the floor of the mouth. Tongue fasciculations and decreased movement of the tongue were also noted. A contrast-enhanced computed tomographic examination demonstrated a hypodense multilobulated mass in the left submandibular space with extension into the floor of the mouth and lateral displacement of the mylohyoid muscle (Figure 1 and Figure 2). Subsequent contrast-enhanced magnetic resonance imaging (MRI) scan demonstrated a T2 hyperintense and enhancing lesion centered in the left submandibular space with extension into the genioglossus and floor of the mouth (Figure 3 and Figure 4). A fine needle aspiration indicated a salivary gland neoplasm. The preoperative differential diagnosis centered on pleomorphic adenoma, while primary malignant lesion, metastatic disease to the submandibular gland and infection were considered less likely.
Viets R, Scherl S, Clain JB, Urken ML, Khorsandi A. Radiology Quiz Case 2. JAMA Otolaryngol Head Neck Surg. 2013;139(5):523. doi:10.1001/jamaoto.2013.2878a