[On the pathogenesis of the Küttner tumor of the submandibular gland -- Analysis of 349 cases with chronic sialadenitis of the submandibular (author's transl)]

Abstract

In view of the etiology and pathogenesis of the so-called Kütter tumor (chronic sialadenitis of the submandibular gland) gland resections of 349 patients (salivary gland register at the Institute of Pathology, University of Hamburg; period 165--1974) were analyzed pathohistologically. In 143 cases (41%) a sialolithiasis of the submandibular gland occurred simultaneously. Regarding the degree of the inflammation 4 stages were distinguished (stage 1 = focal sialadenitis; stage 2= diffuse lymphocytic sialadenitis with salivary gland fibrosis; stage 3 = chronic sclerosing sialadenitis with salivary gland sclerosis; stage 4= chronic progressive sialadenitis with salivary gland cirrhosis). Twenty-five per cent of the cases were classified in stage 1, 19% in stage 2, 38% in stage 3, and 18% in stage 4. A predominance of the male sex (70%) was observed especially in stage 4. The initial stage is characterized by a periductally lymphocytic infiltration, ectasias of the ducts, and alteration of the secret in the duct lumens (spheroliths, microliths). In stages 2--3 an increase of the inflammatory infiltration with lymph follicles, considerable alterations of the ducts (metaplasias, dysplasias, regenerates of the ducts), and a parenchymal reduction were found. This process is combined with an increase of the interstitial connective tissue and a cicatrication of the salivary gland parenchyma. In the final stage, 4, a cirrhotic gland transformation with progressive loss of the parenchyma and considerable duct destruction appeared. From the pathogenetic course of the inflammation and the comparison with other forms of sialadenitis, the conclusion is drawn that two etiologic factors are important in the Küttner tumor: an initial disturbance of secretion with an obstructive electrolyte sialadenitis and an immune reaction of the salivary duct system with the final phase of an obstructive, progressive immunosialadenitis.