How Can Radiological Limitations in Atypical Clinical Submandibular Gland Küttner Tumor (IgG-4 Disease) Mimic an Atypical Occurrence of a Solid Salivary Gland Tumor?

In the lateral neck area (LNA), the parotid glands and submandibular glands can be diagnosed with various lesions, especially cysts and tumors of different etiology. In the submandibular area, many lesions are related to salivary stones and some inflammations, causing a secondary gland enlargement. When no sialolithiasis is present, a close relation to other local inflammation causes, IgG4, or related chronic sclerosing disease should be estimated. Ultrasound evaluation seems to be sufficient to indicate any occurrence of salivary retention, inflammation, dilatation of ducts, and gland swelling, and to confirm the initial diagnosis of sialolithiasis or sialadenitis. Any possible tumor formation or tumor-like solid mass evaluation requires adequate computed tomography or magnetic resonance imaging. A very important question should be raised if clinical symptoms like neck asymmetry, submandibular swelling, and solid-mass formation always correspond with radiological as well as some worrisome oncological symptoms. On the other hand, when radiological imaging is insufficient or lacking, a fine needle biopsy would be useful. Problems arise when any signs of potential disease or other tumor-like lesions are inconclusive or indicate inflammation, and possible treatment options are limited. Secondly, when patient anamnesis and blood examination are normal, but a worrisome tumor-like appearance progresses in time, a serious question about improved diagnostics and scheduling for surgery should be raised. Not all cases of elevated serum IgG4 levels correspond with IgG4 lesions and the typical spectrum of those diseases, and therefore histopathological examination of excised lesion provides the scope of the following disease intensity. In the following interesting images, it is worth noticing that radiological, clinical, needle biopsy, and cytological examinations do not always correlate with each other, and in some cases, an open surgery should be considered to improve the diagnosis.