Pediatric Dermatology Vol. 31 No.

1 e36–e37, 2014

Salivary Gland Choristoma (Heterotopic

Salivary Gland Tissue) on the Anterior Chest
Wall of a Newborn

Abstract: Salivary gland choristoma (heterotopic

salivary gland tissue) is a rare condition typically seen
in the newborn period. This developmental heterot-
opia is generally nonprogressive, with little risk of
malignant transformation. We present the second
known reported case of a salivary gland choristoma
located on the anterior chest wall. Knowledge of this
rare entity will allow for accurate diagnosis and
management of this benign anatomic variant.

Figure 1. A solitary 2- to 3-mm flesh-colored exophytic

papule present at the supersternal notch.
We report a case of a well-developed infant girl with
androgenetic alopecia born via vaginal delivery at
39 + 2 weeks gestation to a 33-year-old G2P1001
mother. Past medical history was significant for a
discoordinated suck reflex at birth, with difficulty
feeding and excessive oral secretions.
Physical examination at birth revealed a midline
2- to 3-mm flesh-colored to pink exophytic papule at
the suprasternal notch (Fig. 1). A pediatric otolaryn-
gologist was consulted, and an ultrasound revealed no
internal abnormalities. The mass was identified as a
skin tag by ultrasound and was removed using deep
shave biopsy at 10 months of age. Histopathology
revealed normal-appearing ectopic salivary glands
within the dermis (Fig. 2), consistent with the diag-
nosis of salivary gland choristoma.

DISCUSSION
In 1789, Hunczonky first described heterotopic sali-
vary gland tissue in the lower neck (1). Salivary gland
heterotopia is the existence of salivary tissue in areas
outside the major and minor salivary glands of the
oral cavity (2). Other documented locations include
the middle ear, mandible, hypopharynx, lower neck,
sternoclavicular joint, and brain and along the
thyroglossal duct (3). In the neck, nearly all heterot-
opias have been described along the anterior border of
DOI: 10.1111/pde.12159
Figure 2. Higher power view of ectopic salivary glands
showing ducts attached to both serous (basophilic) and
mucinous (clear) acini within the dermis.
the sternocleidomastoid muscle near the sternoclavic-
ular joint and are associated with a draining sinus.
The differential diagnosis for heterotopic salivary
gland tissue (HSGT), also known as salivary gland
choristoma, is branchial cleft or sinus anomalies,
acrochordon, thyroglossal duct cyst, bronchogenic
cyst or sinus, neurofibroma, and accessory salivary
gland. It is important not to mistake branchial cleft

e36 © 2013 Wiley Periodicals, Inc.


anomalies and their associated salivary tissue with
HSGT (1). In contrast to HSGT, branchial cleft
anomalies present with copious amounts of lymphoid
tissue and are treated much more aggressively (1). An
accessory salivary gland should also not be confused
with HSGT. The former are located in the anterior
periparotid area, with sinus tracts draining into the
parotid duct, and are the entrapment of salivary tissue
within lymph nodes or the floor of the oral cavity
during embryonic development (4).
The exact mechanism of HSGT is uncertain. The
case we present on the anterior chest wall suggests an
association with the precervical sinus that develops in
the lower neck between the second and third branchial
arches and later migrates to the upper thoracic region
(4). At the sixth week of gestation, the ectodermal
lining within the remnants of the precervical sinus of
His develops into salivary gland tissue that subse-
quently migrates to the anterior chest wall (4).
Although the potential for neoplastic transforma-
tion has been documented in a few cases of HSGT
found in the neck, this important complication should
be considered when evaluating a patient (4). Ultra-
sound or computed tomography should be performed
with any troubling feature. Biopsy and excision are
recommended as first-line treatment (5). HSGT is
generally thought of as a nonprogressive, develop-
mental heterotopia with little risk of malignant
transformation. This is the second known reported
case of HSGT located in the anterior chest wall. Our
Brief Report e37
aim is for others to avoid unnecessary examination or
surgical exploration in the newborn period.
REFERENCES
1. Shin C, Kim SS, Chwals WJ. Salivary gland choristoma
of the anterior chest wall. J Pediatr Surg 2000;35:1506–
1507.
2. Lee DK, Kim JH, Cho YS et al. Salivary gland choris-
toma of the middle ear in an infant: a case report. Int J
Pediatr Otorhinolaryngol 2006;70:167–170.
3. Hinni M, Beatty CW. Salivary gland choristoma of the
middle ear: report of a case and review of the literature.
Ear Nose Throat J 1996;75:422–424.
4. Ludmer B, Joachinms HZ, Ben-Arie J et al. Adenocar-
cinoma in heterotopic salivary tissue. Arch Otolaryngol
1981;107:547–548.
5. Toros SZ, Egeli E, Kiliçarslan Y et al. Salivary gland
choristoma of the middle ear in a child with situs inversus
totalis. Auris Nasus Larynx 2010;37:365–368.
Janelle L. Aby, M.D.*
Mayha Patel, B.S.†
Uma Sundram, M.D.‡
Latanya T. Benjamin, M.D.¶
*Department of Pediatrics, Stanford University School of
Medicine, Stanford, California, †Western University of
Health Sciences, Pomona, California, ‡Department of
Pathology, Stanford University School of Medicine,
Stanford, California, ¶Department of Dermatology,
Stanford University School of Medicine,
Stanford, California
Address correspondence to Mayha Patel, B.S., 4939 Kilburn
Court, Oak Park, CA 91377, or email: mkpatel@westernu.edu.