Submandibular gland tumours: A clinicopathological review at the Chris Hani Baragwanath and Charlotte Maxeke Johannesburg academic hospital

Abstract

Background: Reports relating to Submandibular gland tumours are sparsely reported in the literature. There are some reports of different patterns of tumour types in black/negroid patients, as compared to Caucasian patients1,2,11. Aim: To provide an audit of the histopathological types and the clinical presentations of submandibular gland tumours at our two academic hospitals. Method: An analytical cross sectional study using retrospective clinical data from in-patient ward registers, patient’s hospital records, operating room/theatre registers and the NHLS databases. The study was conducted in the ENT units at the Chris Hani Baragwanath Academic Hospital and the Charlotte Maxeke Johannesburg Academic Hospital, over a chosen period of 7 years from January 2005 to December 2011. All patients who had a submandibular gland excision by members of the ENT department at the two hospitals were included. A total of 61 patient records were examined, of which 26 met the inclusion criteria. Data collected included age, gender, race and histological diagnosis. Data was analysed using standard statistical methods. Results: Twenty six patients were included in this study, comprising 46% females and 54% males. The ages ranged from 22 to 65 years, with a mean of 42.5 years – the majority being in the 22-40 years age group. There was no statistical difference in the age of males and females (p=0.29), nor in black vs. white patients (p=0.29). Benign disease was found in 65.4% of patients, while 34.6% had malignancy. Black patients had a higher ratio of benign disease than white patients, and black males were more likely to have benign disease (83.33%) than black females (50%). However, there was no statistical difference in the ratio of benign to malignant tumours between blacks and whites. Histopathologically, pleomorphic adenoma was the most common benign tumour (82%), while adenoid cystic carcinoma was the most common epithelial malignancy (22%). There was a high incidence of lymphoma (56% of patients) in the malignant group. Local pain (p=0.03) and peripheral neurological deficit (p=0.05) was found to be significantly associated with malignancy. Conclusion: The rate of malignancy in Black patients was found to be lower than that reported in the Western literature, which is in keeping with other studies in non-Caucasian (Black, Asian and Hispanic) populations1,2,9,11. Additionally, Black patients presented at a younger age. Pain and local/peripheral neurological involvement were clinical indicators of malignant disease.