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© 2010 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 29:111-115 • 0278-4297

Case Series

The Tortoiseshell Pattern in One or Both Sides of the Submandibular Glands in Mucosa-Associated Lymphoid Tissue Lymphoma Is Related to Chromosomal Aberrations and the Disease Extent

Satomi Asai, MD, PhD, Kenji Okami, MD, PhD, Naoya Nakamura, MD, PhD, Yoshiaki Ogawa, MD, PhD, Yoshihide Ohta, DDS, PhD, Yoko Ogase, Guilan Jin, Hiromichi Matsushita, MD, PhD and Hayato Miyachi, MD, PhD

Departments of Laboratory Medicine (S.A., G.J., H.Ma., H.Mi.), Otolaryngology (K.O.), Pathology (N.N.), Internal Medicine, Section of Hematology (Y.Ogawa), and Dentistry and Oral Surgery (Y.Oh.), Tokai University School of Medicine, Isehara, Kanagawa, Japan; and Clinical Laboratory Center, Tokai University Hospital, Isehara, Kanagawa, Japan. (Y.Ogase).

Address correspondence to Satomi Asai, MD, PhD, Department of Laboratory Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan., E-mail: sa{at}is.icc.u-tokai.ac.jp

Objective. Lesions of mucosa-associated lymphoid tissue (MALT) lymphoma in the submandibular glands are localized or a part of systemic involvement in association with chromosomal aberrations. This series was undertaken to investigate the sonographic features of MALT lymphoma in the submandibular glands and their relationships with chromosomal aberrations and the disease extent. Methods. A total of 5 patients with MALT lymphoma without Sjögren syndrome in the submandibular glands were enrolled in this series. Patients underwent sonography of the submandibular glands with a high-resolution transducer before surgical biopsy of the main lesion. Sonographic characteristics of the lesions were described for their location, presence of a posterior echo, texture, and presence of an internal echo. Results. Sonography in all cases showed hypoechoic and solid masses with increased posterior echo enhancement. There was an arrangement of hypoechoic small compartments demarcated by hyperechoic contour lines, which had a tortoiseshell pattern. This pattern was classified into 2 types according to its location: a lesion in the right or left side and lesions in both sides of the submandibular glands, found in 3 and 2 patients, respectively. The latter 2 cases had chromosomal aberrations of t(11;18)(q23;q23) and t(12;18)(q22;q21), respectively, and were revealed as secondary organ involvement. Conclusions. The sonographic appearance of MALT lymphoma in the submandibular glands was characterized by the tortoiseshell pattern in both primary and secondary lesions. Detection of this pattern in both sides of the submandibular glands can be an indicator of chromosomal aberrations and systematic involvement of the disease.

Key Words: chromosomal aberration • infiltration • mucosa-associated lymphoid tissue lymphoma • sonography • submandibular glands

Abbreviations: MALT, mucosa-associated lymphoid tissue

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