chronic sclerosing sialadenitis

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Küttner tumor (KT) refers to a chronic sclerosing sialadenitis. Despite the term tumor, it is a non neoplastic condition. It is classically described in relation to the submandibular gland but less commonly can also affect the other salivary glands and occasionally also the lacrimal gland .

Clinical presentation

Clinically, it produces a firm swelling of the glands and may mimic neoplasia . Patients may experience recurrent pain and swelling that is often associated with food ingestion. Some patients may have an asymptomatic hard swelling of the submandibular gland.

Pathology

It is sometimes considered as part of IgG4 related sclerosing disease .

Histological classification

These lesion are can be classified according to four histological stages :

stage I - lymphocytic infiltration around the salivary ducts
stage II - diffuse lymphocytic infiltration and severe periductal fibrosis
stage III - prominent lymphocytic infiltration, parenchymal atrophy and periductal sclerosis
stage IV (end stage) - marked parenchymal loss and sclerosis (likened to that of liver cirrhosis).

Associations

sialolithiasis - thought to be associated in ~30 to 80% of cases although it is still unclear whether the sialolithiasis is the cause or result of the underlying inflammatory process

Radiographic features

MRI

T1: slightly hypointense
T2, STIR and DWI: slightly hyperintense

Treatment and prognosis

Many authors advocate excision of the lesion although there are also several reports of conservative management - e.g steroids.

History and etymology

It is named after H Küttner, German physician, who described a series of patients with a unilateral, hard, tumor-like mass of submandibular gland in 1896 .