How to cite this article: A N Bagate, V V Deshmukh, S L Gaikwad, D S Jadhav, A G Valand. Clinicopathological study of head and neck

lesions in a rural tertiary care centre. MedPulse International Journal of Pathology. October 2017; 4(1): 01-06.

https://www.medpulse.in/Pathology/

Original Research Article

Clinicopathological study of head and neck lesions

in a rural tertiary care centre

A N Bagate1, V V Deshmukh

2*, S L Gaikwad

3, D S Jadhav

4, A G Valand

5

1Associate Professor,

2Tutor,

3,4Associate Professor,

5Professor and Head, Department of Pathology, Swami Ramanand Teerth Rural

Government Medical College Ambajogai, Maharashtra, INDIA.

Email: drvaibhav73@gmail.com

Abstract Background: Head neck lesion is the frequently found presentation of patients seen in clinical practice. The head and

neck pathology is very important as diverse diseases occur in various organs located in close proximity to each other.

Aim: This study is conducted to document the clinicopathological aspects of head and neck lesions, frequency as

compared to other lesions, analyse the data regarding the relative proportion of non neoplastic and neoplastic lesions.

Material Method: Head and neck lesions were divided under nine groups: 1. Thyroid 2.Salivary glands 3.Lymph nodes

4.Nose, paranasal sinuses and nasopharynx 5.Oral cavity and oropharynx Hypopharynx and larynx 6.Ear 7.Eye 8.Skin

and 9. Soft tissue. Information regarding history, clinical findings and diagnosis was collected and studied with gross and

light microscopic findings Result: Out of 370 cases of head and neck region 216 cases were classified as non neoplastic

(58.4%), 83 cases as benign (22.4%), and 71cases as malignant (19.2%). Among all head and neck lesions Females

(54.3%) outnumbered males (45.7%). Non neoplastic lesions contributed 58.4% and neoplastic lesions contributed

41.6%. Benign lesions contributed 53.9% and malignant lesions contributed 46.1% of total number of neoplastic lesions.

Among all benign lesions Females (54.2%) outnumbered Males (45.8 %). Among all malignant lesions Males (52.1%)

outnumbered Females (47.9%) Conclusion: Among all the head and neck lesions, non neoplastic lesions were

predominant with a female preponderance. Benign tumors were in excess of malignant tumors. Malignant tumours were

common in elderly men and benign tumours were common in middle aged females.

Key Words: Clinicopathological, Head, Neck, Rural, Tertiary.

*Address for Correspondence:

Dr. V V Deshmukh, Tutor, Department of Pathology, Swami Ramanand Teerth Rural Government Medical College Ambajogai,

Maharashtra, INDIA.

Email: drvaibhav73@gmail.com

Received Date: 29/07/2017 Revised Date: 14/08/2017 Accepted Date: 27/09/2017

DOI: https://doi.org/10.26611/105411

INTRODUCTION Pathology of head and neck is an easy sounding title for

complex subject matter. The head and neck pathology is

very important as diverse diseases occur in various organs

located in close proximity to each other between base of

skull and thoracic aperture. Thus, “Lesions of head and

neck” constitute wide range of diseases encountered in

the anatomically complex region extending from the

frontal sinuses, orbits, roof of the sphenoidal sinuses and

clivus proximally to the upper borders of the sternal

manubrium, clavicles and first ribs distally. This includes

the ears, eyes, upper aero digestive tract, salivary glands,

dental apparatus, thyroid and parathyroid glands, as well

as all the epithelial, fibrous, fatty, muscular, vascular,

lymphoid, cartilaginous, osseous and neural tissues or

structures related to them. Reason for assembling all these

different organs under head and neck is that the proximity

of the organs makes it difficult for the surgical pathologist

to focus one of these organs and neglect the pathology of

others which are only a centimeter apart. Another reason,

however, is that the upper respiratory tract and the upper

digestive tract, which meet in the larynx, have some basic

diseases in common.1

The most important among these

are malignant neoplasms occurring in several anatomical

sites in head and neck region such as oral cavity, ear,

scalp, nasal cavities, paranasal sinuses, nasopharynx,

Access this article online

Quick Response Code:

Website:

www.medpulse.in

Accessed Date:

04 October 2017

MedPulse International Journal of Pathology, Print ISSN: 2550-7605, Volume 4, Issue 1, October 2017 pp 01-06

MedPulse International Journal of Pathology, Print ISSN: 2550-7605, Volume 4, Issue 1, October 2017 Page 2

hypopharynx, oropharynx and salivary glands. They are

characterised by diverse patterns of biological behaviour

and well established association with tobacco and alcohol

use.2

Since many patients first come to medical attention

because of discovery of lump in neck, the proper

diagnostic approach to such lesions is of paramount

importance. Such tumors should always be considered of

utmost gravity until a definite cause is established.3

MATERIAL AND METHOD It is a prospective study of 370 cases belonging to head

and neck at a tertiary care rural hospital and medical

college over a period of 2 years from July 2014 to June

2016. The lesions of head and neck region were selected

on basis of clinical history, examination findings and

clinical diagnosis; which were then subjected to biopsy,

curative surgery and detail gross and histopathological

examination. Head and neck lesions were divided under

following nine groups. 1. Thyroid 2.Salivary glands

3.Lymph nodes 4.Nose, paranasal sinuses and

nasopharynx 5.Oral cavity and oropharynx Hypopharynx

and larynx 6.Ear 7.Eye 8.Skin and 9. Soft tissue. Patients

who were treated conservatively or patients referred to

other hospitals were excluded from this study.

Information regarding history, clinical examination

findings and clinical diagnosis was collected. Surgical

specimens obtained were subjected to histopathological

tissue processing and paraffin blocks were prepared, 3 to

5 micron thick sections were cut from each paraffin block

and stained with hematoxylin and eosin stain.

RESULTS The present study includes a total of 370 head and neck

lesions during study period 2 years Frequency: Out of

total 4764 cases, 370 cases belonged to head and neck

region contributing 7.8%. Age wise distribution:

Maximum numbers of cases were in the age group 21-40

years [159 cases (43%)]. Minimum numbers of cases

were in age group > 60 years [42 cases (11.4%)]. Non

neoplastic lesions of head and neck occurred in all age

groups with peak distribution in the age group of 21-40

years [94 cases (43.5%)]. The youngest patient was 1

years old while the oldest was 88 years of age. Mean age

was 36.2 years. Neoplastic lesions of head and neck

occurred in all age groups with peak distribution in the

age group of 21-40 years [65 cases (42.2%)]. The

youngest patient was 5 years old while the oldest was 86

years of age. Mean age was 44.6 years. Benign tumors of

head and neck occurred in all age groups with peak

distribution in the age group of 21-40 years [37 cases

(44.6%)]. The youngest patient was 5 years old while

oldest was 75 years old. The mean age was 39.5 years.

Malignant head and neck lesions occurred in all age

groups, most commonly in age group of 21-40 years [28

cases (39.4%)], followed by age group 41-60 years[26

cases (36.6%)]. The youngest patient was 20 years old

while the oldest patient was 86 years old. 59.2% of cases

were above 40 years. The mean age was 50.6 years.

Sex wise distribution: Out of 370 cases, females (201

cases) outnumbered males (169 cases) contributing 54.3%

and 45.7% respectively. The M: F ratio was 1:1.2.

Females [122cases (56.5%)] outnumbered males [94

cases (43.5%)] with M: F ratio of 1:1.3 among all non

neoplastic lesions. Females [79 cases (51.3%)]

outnumbered males [75 cases (48.7%)] with M: F ratio of

1:1.1 among all neoplastic lesions. Females [45 cases

54.2%)] outnumbered males [38 cases (45.8%)] with M:

F ratio of 1:1.2 among all benign tumours. Males [37

cases (52.1%)] outnumbered females [34 cases (47.9%)]

with M: F ratio of 1.1:1 among all malignant lesions.

Distribution according to Site: Frequency of head and

neck lesions was maximum in Skin and soft tissue region

[122 cases (33%)] and minimum in hypopharynx and

larynx region [4 cases (1.1%)], second most common

lesions are in thyroid region [91 cases (24.6%)].

Distribution of non neoplastic and neoplastic lesions: Of total 370 cases, 216 (58.4%) were non neoplastic and

154 (41.6%) were neoplastic. Goiter (diffuse and

multinodular) was the most common non neoplastic

lesion [43 cases (19.9%)], followed by nonspecific

inflammatory lesions [40 cases (18.5%)].

Distribution of benign and malignant tumours: Of

total 154 neoplastic cases, 83 (53.9%) were benign and 71

(46.1%) were malignant. Follicular adenoma of thyroid

and Lipoma were the most common benign tumours [11

cases each (13.3%)], followed by Haemangioma [10

cases (12.1%)]. Squamous cell carcinoma at various sites

was the most common malignancy observed, [38 cases

53.5%] followed by papillary carcinoma of thyroid [14

cases (19.7%)].

Distribution according to clinical presentation: In the

present study the commonest complaint was swelling,

which was present in 296 cases (80%), followed by

ulcerous growth in 22 cases (6%) and ear discharge in 12

cases (3.2%)

Duration of complaints: Duration of complaints was

between 1 months -1 year in 85.4% of cases, less than

1month in 7.6% of cases, 1-3 years in 4.9% of cases, and

>3 years in 2.2% of cases.

Table 1: Age- wise distribution of head and neck lesions

Age in years (Range) No. of cases Percentage (%)

0-20 60 16.2

21-40 159 43.0

41-60 109 29.5

> 60 42 11.4

Total 370 100

A N Bagate, V V Deshmukh

Copyright © 2017, Medpulse Publishing Corporation,

Table 2: Sex- wise distribution of head and neck lesions

Sex No. of cases Percentage (%)

Male 169 45.7

Female 201 54.3

Total 370 100

Table 3: Age and sex wise distribution of non neoplastic and

neoplastic lesions

Non neoplastic Neoplastic

Benign Malignant

Age (Years)

0-20 45 13

21-40 94 37

41-60 63 21

> 60 14 12

Total 216 83

Mean age 36.2 39.5

Sex

M 94 38

F 122 45

Total 216 83

M:F 1:1.3 1:1.2 1.1:1

Table 4: Distribution of head and neck lesions according to site

Sr. Site of lesion Frequency (No

of cases)

1 Thyroid 91

2 Salivary glands 21

3 Lymph nodes 28

4 Nose, paranasal sinuses

and nasopharynx 13

5 Oral cavity and

oropharynx 66

6 Hypopharynx and larynx 04

7 Ear 19

8 Eye 08

9 Skin and soft tissue 122

Total 370

Table 5: Distribution of head and neck lesions according to clinical

presentation

Complaints No. of cases Percentage (%)

Swelling 296

Sore throat 11

Ulcer 11

Ulcerous growth 22

White patch 03

Change in voice 03

Nasal obstruction 08

Ear ache 02

Ear discharge 12

Headache 01

Epiphora 01

Total 370

, V V Deshmukh, S L Gaikwad, D S Jadhav, A G Valand

Copyright © 2017, Medpulse Publishing Corporation, MedPulse International Journal of Pathology, Volume 4, Issue 1

wise distribution of head and neck lesions

Percentage (%)

45.7

54.3

100

Age and sex wise distribution of non neoplastic and

Neoplastic Total

Malignant

01 59

28 159

26 110

16 42

71 370

50.6

37 169

34 201

71 370

1.1:1

Distribution of head and neck lesions according to site

Frequency (No Percentage

(%)

24.6

5.7

7.6

3.5

17.8

1.1

5.1

2.2

33.0

100.0

Distribution of head and neck lesions according to clinical

Percentage (%)

80.0

3.0

3.0

6.0

0.8

0.8

2.2

0.5

3.2

0.3

0.3

100

Table 6: Duration of complaints of head and neck lesions

Duration of head and neck

lesions No. of cases

<1 month

1month-1 year

1-3 years

>3 years

Total

Figure 1: Age-wise distribution of head and neck lesions

Figure 2: Sex- wise distribution of head and neck lesions

Figure 3: Distribution of head and neck lesions according to site

16%

43%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

0-20 21-40p

erc

en

tag

e

age in years

Female54.3%

3.5%

1.1%

5.1%

2.2%

Thyroid

Salivary glands

Lymph nodes

Nose, paranasal sinuses and …

Oral cavity and oropharynx

Hypopharynx and larynx

Ear

Eye

Skin and soft tissue

, Issue 1 October 2017

of complaints of head and neck lesions

No. of cases Percentage (%)

28 7.6

316 85.4

18 4.9

08 2.2

370 100

wise distribution of head and neck lesions

wise distribution of head and neck lesions

Distribution of head and neck lesions according to site

30%

11%

41-60 >60

age in years

Male45.7%

24.6%

5.7%

7.6%

3.5%

17.8%

5.1%

2.2%

33.0%

MedPulse International Journal

MedPulse International Journal of Pathology, Print ISSN:

Figure 4: Distribution of head and neck lesions according to clinical

presentation

Figure 5: Duration of complaints of head and neck lesions

Figure 6: Papillary carcinoma thyroid –photomicrograph showing

papillae lined by single layer of cuboidal cell having Orphan Annie

eyed nuclei. (H and E, 40 X)

2.97

2.97

5.95

0.81

0.81

2.16

0.54

3.24

0.27

0.27

0 20 40 60

Swelling

Sore throat

Ulcer

Ulcerous growth

White patch

Change in voice

Nasal obstruction

Ear ache

Ear discharge

Headache

Epiphora

percentage

0

10

20

30

40

50

60

70

80

90

<1 month 1month-1 year 1-3 years

Pe

rce

nta

ge

Duration

Journal of Pathology, Print ISSN: 2550-7605, Volume 4, Issue 1, October 2017 pp 01

ISSN: 2550-7605, Volume 4, Issue 1, October 2017

Distribution of head and neck lesions according to clinical

and neck lesions

photomicrograph showing

papillae lined by single layer of cuboidal cell having Orphan Annie

Figure 2: Mucoepidermoid carcinoma

mucous, squamous, and intermediate cells. Mucin filled spaces

can be clearly seen. (H

Figure 3: Lymphoma (DLBCL)- Clinical photograph of a 75 year old

female patient presented with right submandibular swelling since

6 month

Figure 3a: Lymphoma (DLBCL) - Photomicrograph showing areas of

sinus histio-cytosis admixed with darkly stained small to large

undifferentiated cells.(H

80

80 100

>3 years

2017 pp 01-06

Page 4

Mucoepidermoid carcinoma-Photomicrograph showing

squamous, and intermediate cells. Mucin filled spaces

can be clearly seen. (H and E, 10X)

Clinical photograph of a 75 year old

female patient presented with right submandibular swelling since

Photomicrograph showing areas of

cytosis admixed with darkly stained small to large

undifferentiated cells.(H and E, 40X)

A N Bagate, V V Deshmukh

Copyright © 2017, Medpulse Publishing Corporation,

Figure 4: Tuberculous lymphadenitis- Photomicrograph showing

shows langhans giant cells, caseous necrosis and epitheloid cells.

(H and E, 40X)

DISCUSSION The present study was carried out in the Department of

Pathology of Government Medical College and Hospital

during a period from July 2014 to June 2016

head and neck lesions were studied. They formed

all the lesions. Of these 216 cases were non

cases were benign and 71 cases were malignant

contributing 58.4%, 22.4% and 19.2% respectively.

percentage of non neoplastic lesions [216 cases (58.4%)]

in our study was relatively more than that in study by

Popat VC et al (2010)4

[26 cases (24.3%)] and the

percentage of benign lesions in study by Popat VC

(2010)4 [43 cases (42.7%)]

was relatively more than that

in our study [83 cases (22.4%)]. Age wise distribution of

head and neck lesions in our study was comparable with

study by Popat VC et al (2010)4. In the present study,

females outnumbered males with M: F ratio of 1:1.2.

Males had slight preponderance in a study by Popat VC

al (2010)4

with M: F ratio of 1.01:1, which can be

explained by difference in the sample size. In our study

the most common site of occurrence of head and neck

lesions is Skin and soft tissue [120 cases (3

study by Popat VC et al (2010)4

most common site of

lesion was thyroid [32 cases (31.06%)] which is second

most common site of lesion in our study [91 cases

(24.6%)], this difference can be explained with variation

in sample size and rural setup of our study The

descending order of occurrence of head and neck lesion at

various sites was Skin and soft tissue > Thyroid > Oral

cavity and oropharynx > Lymph nodes > Salivary glands

> Ear > Nose, paranasal sinus and nasopharynx > Eye >

Hypopharynx and larynx. The frequency of occurrence of

thyroid lesions in our study [91 cases (24.6%)] was

comparable with study by Popat VC et al

reported one case of Diffuse large B cell lymphoma

(DLBCL) in salivary (submandibular) gland.

diagnosis of Diffuse large B cell lymphoma confirmed on

, V V Deshmukh, S L Gaikwad, D S Jadhav, A G Valand

Copyright © 2017, Medpulse Publishing Corporation, MedPulse International Journal of Pathology, Volume 4, Issue 1

Photomicrograph showing

necrosis and epitheloid cells.

The present study was carried out in the Department of

Pathology of Government Medical College and Hospital

July 2014 to June 2016.Total 370

They formed 7.8% of

all the lesions. Of these 216 cases were non-neoplastic, 83

cases were benign and 71 cases were malignant

, 22.4% and 19.2% respectively. The

percentage of non neoplastic lesions [216 cases (58.4%)]

elatively more than that in study by

[26 cases (24.3%)] and the

percentage of benign lesions in study by Popat VC et al

was relatively more than that

in our study [83 cases (22.4%)]. Age wise distribution of

head and neck lesions in our study was comparable with

In the present study,

females outnumbered males with M: F ratio of 1:1.2.

had slight preponderance in a study by Popat VC et

with M: F ratio of 1.01:1, which can be

explained by difference in the sample size. In our study

the most common site of occurrence of head and neck

lesions is Skin and soft tissue [120 cases (32.4%)]. In

most common site of

[32 cases (31.06%)] which is second

most common site of lesion in our study [91 cases

(24.6%)], this difference can be explained with variation

of our study The

descending order of occurrence of head and neck lesion at

various sites was Skin and soft tissue > Thyroid > Oral

cavity and oropharynx > Lymph nodes > Salivary glands

> Ear > Nose, paranasal sinus and nasopharynx > Eye >

larynx. The frequency of occurrence of

thyroid lesions in our study [91 cases (24.6%)] was

20104. We also

reported one case of Diffuse large B cell lymphoma

(DLBCL) in salivary (submandibular) gland. The

Diffuse large B cell lymphoma confirmed on

immunohistochemistry with large lymphoid cells

positive for Cd20/Bcl2/MUM1/Bcl6 with focal immunore

activity for c-myc. The large lymphoid cells are

immunonegative for CD3/CD10.The Ki67 proliferative

index was approximately 95%.In a study by

Faur et al(2009)5, the frequency of occurrence of

lymphoma among salivary gland neoplasm is 0.98%( 2

cases out of 204 neoplastic salivary gland lesions) while

in our study it is 8.3% [1 case out of 12

salivary gland lesions]. The difference is due to variation

in sample size and rarity of the lesion.

case of Rosai Dorfman disease in a 35 years female

presented with single, non- tender neck lymph node

enlargement. Riyaz N. et al 2005

unusual case of multifocal Rosai Dorfman Disease in a 25

year male presented with asymptomatic skin lesions and

multiple neck swellings. Bhat GM

S et al 20088

also reported similar cases in their studies.

In present study the commonest complaint was swelling

[296 cases (80%)] followed by ulcerous growth [22 cases

(6%)], ear discharge [12 cases (3.2%)], sore throat and

ulcer [11cases (3%) each], nasal obstruction [8 cases

(2.1%)], white patch and change in

each], earache [2cases(0.5%)], ear discharge and

headache [1 case(0.3%) each].In a study

al (2010)4, 75 cases (72.8%) presented with swelling and

other common presentations included dysphagia,

odynophagia, hoarsness of voice(change in voice). The

findings of study by Popat VC

with our study. According to Chavan SS

of 147 cases of benign nasal masses studied nasal

obstruction and nasal drainage were the most common

symptoms observed [83 cases (56.46%)]. According

Misra V et al (2009)10

, who studied sections from 776

lesions of oral cavity, the lesions commonly presented as

white patches in leukoplakia and oral submucosal

fibrosis, and as a growth in squamous cell pap

squamous cell carcinoma.

CONCLUSION Among all the lesions, head and neck lesions contribute a

noticeable percentage. Among all the head and neck

lesions, non neoplastic lesions were predominant with a

female preponderance. Goiter was the most c

neoplastic lesion and usually middle aged females were

affected more. Most of the patients presented with the

complaint of swelling in head and neck region. Benign

tumors were in excess of malignant tumors. The most

common benign tumours were fol

thyroid and lipoma followed by haemangioma. The most

common malignant tumor was squamous cell carcinoma

at various sites and then followed by papillary carcinoma

of thyroid. Malignant tumours were common in elderly

, Issue 1 October 2017

immunohistochemistry with large lymphoid cells immune

positive for Cd20/Bcl2/MUM1/Bcl6 with focal immunore

The large lymphoid cells are

immunonegative for CD3/CD10.The Ki67 proliferative

was approximately 95%.In a study by Alexandra

the frequency of occurrence of

lymphoma among salivary gland neoplasm is 0.98%( 2

cases out of 204 neoplastic salivary gland lesions) while

[1 case out of 12 neoplastic

salivary gland lesions]. The difference is due to variation

in sample size and rarity of the lesion. We reported a rare

case of Rosai Dorfman disease in a 35 years female

tender neck lymph node

20056

also reported an

unusual case of multifocal Rosai Dorfman Disease in a 25

year male presented with asymptomatic skin lesions and

multiple neck swellings. Bhat GM et al 20047

and Kharrat

also reported similar cases in their studies.

In present study the commonest complaint was swelling

[296 cases (80%)] followed by ulcerous growth [22 cases

(6%)], ear discharge [12 cases (3.2%)], sore throat and

ulcer [11cases (3%) each], nasal obstruction [8 cases

(2.1%)], white patch and change in voice [3cases (0.8%)

each], earache [2cases(0.5%)], ear discharge and

[1 case(0.3%) each].In a study by Popat VC et

75 cases (72.8%) presented with swelling and

other common presentations included dysphagia,

hoarsness of voice(change in voice). The

Popat VC et al were comparable

Chavan SS et al (2012)9, out

of 147 cases of benign nasal masses studied nasal

obstruction and nasal drainage were the most common

ptoms observed [83 cases (56.46%)]. According to

who studied sections from 776

lesions of oral cavity, the lesions commonly presented as

white patches in leukoplakia and oral submucosal

fibrosis, and as a growth in squamous cell papilloma and

Among all the lesions, head and neck lesions contribute a

noticeable percentage. Among all the head and neck

lesions, non neoplastic lesions were predominant with a

female preponderance. Goiter was the most common non

neoplastic lesion and usually middle aged females were

affected more. Most of the patients presented with the

complaint of swelling in head and neck region. Benign

tumors were in excess of malignant tumors. The most

common benign tumours were follicular adenoma of

thyroid and lipoma followed by haemangioma. The most

common malignant tumor was squamous cell carcinoma

at various sites and then followed by papillary carcinoma

Malignant tumours were common in elderly

MedPulse International Journal of Pathology, Print ISSN: 2550-7605, Volume 4, Issue 1, October 2017 pp 01-06

MedPulse International Journal of Pathology, Print ISSN: 2550-7605, Volume 4, Issue 1, October 2017 Page 6

men and benign tumours were common in middle aged

females. The histopathological pattern of various head

and neck lesions ranges from simple nonspecific

inflammatory lesions to highly malignant fatal lesions.

Hematoxylin and Eosin staining remain the best for the

primary histopathological diagnosis.

Immunohistochemistry is very helpful in accurate

categorization of lesion when there is dilemma in

histopathological diagnosis. The results of our study were

comparable with the most of the other similar studies.

The drawback of this study was that the present data

being hospital generated cannot be regarded as

representative of the incidence of head and neck lesions

in the general population.

REFERENCES 1. Cardesa A slootweg P. Pathology of head and Neck. New

York: Springer Verlang Berlin Heidelberg; 2006.

2. Adeyemi BF, Adekunle L V, Kolude BM, Akang EEU,

Lawoyin JO. Head and neck cancer-a clinicopathological

study in a tertiary care center. J Natl Med Assoc.

2008;100(6):690–7.

3. Freund HR. Principles of Head and Neck Surgery. 2nd

ed. New York. Appleton-Century-Crofts; 1979.

4. Popat VC, Vora D, Shah H. Clinico – Pathological

Correlation Of Neck Lesions – A Study Of 103 Cases.

Internet J Head Neck Surg [Internet]. 2010;4(2):1–12.

Available from: https://ispub.com/IJHNS/4/2/4131#

5. Faur A, Lazar E, Cornianu M, Dema A, Lazureanu C,

Muresan A, et al. Primary malignant non-Hodgkin ’ s

lymphomas of salivary glands. Rom J Morphol Embryol.

2009;50(4):693–9.

6. Riyaz N, Khader A, Sarita S. Rosai-Dorfman syndrome.

Indian J Dermatol Venereol Leprol. 2005;71(5):342–4.

7. Bhatt JV, Shah JM, Shah F. Clinico-Pathological Profile

of Cervial Lymphadenopathy.

8. Kharrat S, Sahtout S, Oukhai M, Mekni E, Trabelsi S,

Haouet S,Besbes G. Multifocal Rosai-Dorfman disease: a

case report. Fr ORL. 2008;94: 395-8.

9. Chavan SS, Deshmukh S, Pawar V, Sarvade K, Kirpan

V, Kumbhakarna NR SM. Case Study of

Clinicopathological Correlation of Benign Sinonasal

Masses. World Artic Ear, Nose Throat. 2012;5(1).

10. Misra V, Singh PA, Lal N, Agarwal P, Singh M.

Changing Pattern of Oral Cavity Lesions and Personal

Habits Over a Decade: Hospital Based Record Analysis

from Allahabad. Indian J Community Med. 2009 Oct

9;34(4):321–5.

Source of Support: None Declared

Conflict of Interest: None Declared