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<p class="ql-align-justify">Core biopsy fragments totally effaced by a severe, chronic inflammatory process. There is numerous well-formed, non-necrotizing granulomas composed of cohesive clusters of plump epithelioid histiocytes. These granulomatous nodules are deeply embedded within a dense, reactive background infiltrate consisting predominantly of mature lymphocytes and plasma cells, which occasionally organize into distinct lymphoid aggregates. There is no evidence of a biphasic epithelial and myoepithelial proliferation, chondromyxoid stroma, or cellular atypia; no features of pleomorphic adenoma or malignancy are identified.</p>
<p class="ql-align-justify">3x2 cm solid, hypoechoic nodule in the right submandibular gland with associated non-specific cervical lymphadenitis, highly suspicious for a pleomorphic adenoma.</p>
<p>Tissue cores up to 1.5 cm, totally embedded.</p>
<p><strong><em><u>Right submandibular gland, core needle biopsy:</u></em></strong></p><ul><li>Severe chronic granulomatous sialadenitis.</li><li>Negative for pleomorphic adenoma or evidence of malignancy.</li></ul><p><br></p><p><strong>Comment</strong></p><h5 class="ql-align-justify">The histological findings demonstrate an extensive granulomatous inflammatory process replacing the submandibular salivary gland parenchyma. In a 3-year-old patient, this pattern strongly favors an infectious etiology, most notably atypical (non-tuberculous) mycobacterial infection or cat-scratch disease (<em>Bartonella henselae</em>). There is no morphological evidence to support the ssuspicion of a pleomorphic adenoma. Clinical correlation with targeted microbiological cultures, molecular testing (PCR), and appropriate serology is strongly recommended to identify the definitive causative organism.</h5>
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