Salivary Gland Carcinoma Presentation

8/8/2019 Salivary Gland Carcinoma Presentation

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Salivary Gland Tumours

MOHAMMED SANWAR

HUSSAIN


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Risk Factors

nutritional deficiency exposure to ionizing radiation UV exposure genetic predisposition EBV


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Epidemiology

Salivary tumors 7% of ead and neck tumors!arotid tumors "#x more common ten

su$mandi$ular and "##x more common ten lingual

!arotid #% $enign &pleomorpic adenoma'Su$mandi$ular (#% malignantSu$lingual ma)ority &*(+%' are malignantE,ual incidence $et-een sexes


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Staging system for major

salivary gland cancer • Tx Primary tumor cannot be assessed• T0 No evidence of primary tumor • T1 Tumor < 2cm in greatest dimension• T2 Tumor 2-4 cm in greatest dimension• T3 Tumor 4-6 cm in greatest dimension

• T4 Tumor > 6 cm in greatest dimension

• ll categories are subdivided! "a# no local e$tension% "b# locale$tension&

• 'ocal e$tension is clinical or macroscopic invasion of s(in) soft tissue)bone) or nerve&

•

*icroscopic evidence alone is not a local e$tension for classificationpurposes&• T+e merican ,oint ommission on ancer &see also +andouts&


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Staging

." / 0cm and no extraparencymal extension

.0 1 0cm $ut not 12cm -itout extraparencymalextension

.3 12cm and or extraparencymal extension.2a invades skin4 mandi$le4 ear canal and5or facial

nerve

.2$ invades skull $ase and or pterygoid plates andor encases carotid artery


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Structural elements of t+e

salivary gland unit&• pleomorp+ic adenomas originate from t+eintercalated duct cellsand myoepit+elial cells

• oncocytic tumors

originate from t+estriated duct cells

• acinous cell tumors originate from t+e acinarcells)

• *ucoepidermoidtumors and s.uamouscell carcinomas developin t+e e$cretory ductcells&


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Pathology

/ Benign Tumors

0 PleomorphicAdenomas

/ Malignanttumors 0 Parotid –

mucopidermoidmost common– low grade,slow growingcured bysurgery alone

Submandibularand minorsalivary –adenoid cysticmost common.


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Pleomorp+ic denoma


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Pleomorp+ic denoma


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Pleomorphic Adenoma

• pleomorp+ic

adenoma contains

bot+ epit+elial "1#

and stromal "S#components&


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Pleomorphic Adenoma

• 1pit+elial omponents – Tubular and cord-li(e arrangements

– ells contain a moderate amount of cytoplasm

–*itoses are rare

• Stromal or mesenc+ymal3 omponents – an be .uite variable

– ttributable to t+e myoepit+elial cells –

*ost tumors s+o c+ondroid "cartilaginous#differentiation

– 5sseous metaplasia not uncommon

– elatively +ypocellular and composed of pale blueto slig+tly eosinop+ilic tissue&


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Pleomorphic Adenoma

• T+e diverse microscopic patternof t+is lesion is one of its mostc+aracteristic features&

• 7slands of cuboidal cellsarranged in ductli(e structuresis a common finding&

• 'oose c+ondromy$oid stroma)+yalini8ed connective tissue)cartilage"arros# and evenosseous tissue are observed&

• T+is neoplasm is typicallyencapsulated) alt+oug+ tumorislands may be found it+in t+e

fibrous capsule&


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Warthin's Tumor

• 9art+in:s tumor "benignpapillary cystadenomalymp+omatosum#

• t+e second most

common benign tumorof t+e parotid gland

• 7t accounts for 2-;= ofall parotid gland tumors

•

ilateral in ;= of t+ecases• may contain mucoid

bron fluid


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Warthin’s Tumor

• Mid Power

• T+oug+t to arise

from salivary gland

inclusions it+inlymp+ nodes&


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Warthin’s Tumor

• Epithelial omponent – onsists of papillary fronds +ic+

demonstrate 2 layers of oncocytic epit+eilal

cells – ytoplasm stains deep pin( and s+os

granularity b?c of an abundance ofmitoc+ondria

– 5ccasionally undergoes s.uamousmetaplasia "may mista(enly diagnoseSa #


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Warthin’s Tumor

• !"mphoid omponent – n abundance of t+is is present

– 5ccasional germinal centres ill be seen

– 'ymp+oid tissue forms t+e core or papillary

structures

• ot+ l"mphoid and oncoc"tic

epithelial elements must be present todiagnose 9art+in@s


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Warthin’s Tumor

• #i$h Power

• 'ymp+ocytc

infilterates&

• ilayer of epit+ilium&


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9art+in@s Tumor


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Warthin’s Tumor

• 1lectron microscopy s+os atremendous number ofmitoc+ondria in t+e epit+elialcells) +ic+ are responsible forits granular eosinop+ilicappearance&

• *itoc+ondria-ric+ oncocytes arefound in 9art+in@s tumors &

• 5ncocytes selectivelyincorporate tec+netium Tc AAmand appear as +ot spots on aradionucleotide scan&


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Monomorphic Adenoma

• Similar to Pleomorp+ic denoma e$cept nomesenc+ymal stromal component – Predominantly an epit+elial component

• *ore common in minor salivary glands "upper lip#

• ;2= bilateral• are malignant potential• Types!

– asal ell denoma – anicular denoma

– *yoepit+elioma denoma – lear ell denoma – *embranous denoma – Blycogen-ic+ denoma


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%asal ell

Adenoma• monomorp+ic adenoma• 7t is composed of uniform

&asaloid epithelial cells it+ amonomorp+ous pattern&

• T+e arrangement of tumor cells

may be trabecular) tubular orsolid&

• Cistologically) t+ese tumors aredistinguis+ed from pleomorp+icadenomas by t+eir absence ofc+ondromy$oid stroma and t+epresence of a uniform epit+elial

pattern&


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Mali$nant ali(ar" )land

Tumors


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Mucoepidermoid

arcinoma • *1s contain to

major elements!• mucin-producing cells

and epit+elial cells oft+e epidermoid variety

• "1pidermoid and*ucinous

components#&• *1 is divided intolo-grade "elldifferentiated#&

• Cig+-grade "poorly

differentiated#&


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*ucoepidermoid arcinoma


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Mucoepidermoid arcinoma

• *ucoepidermoid carcinoma "*1# is t+emost common malignant tumor of t+e parotidgland and t+e second-most common

malignancy "adenoid cystic carcinoma ismore common# of t+e submandibular andminor salivary glands&

• Stained Dve by musicarmine&

•*1s constitute appro$imately EF= ofsalivary gland malignancy) and G= to A=of *1s occur in t+e parotid gland&


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Adenoid "stic arcinoma

• denoid cysticcarcinoma it+ wisscheese pattern&

• 7t is t+e second-most

common malignanttumor of t+e salivaryglands&

• is t+e mostcommon malignanttumor found in t+esubmandibular)sublingual) and minorsalivary glands&


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Adenoid "stic arcinoma

• Nerve "N# invaded

by adenoid cystic

carcinoma

"t+e blue areasurrounding t+e

nerve#&

• Spread may occur

by emboli along t+e

nerve lymp+atics


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denoid ystic arcinoma


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Acinic ell

arcinoma • The acinic cell adenocarcinomaoccurs mainl" in the parotid$land* also +nown as &lue dottumor ,

• lassic multic"stic pattern,• tained &" PA,

• ells hea(il" stained,


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cinic ell arcinoma

• T+is lesion is c+aracteri8ed by a benign+istomorp+ologic picture but by occasionalmalignant be+avior&

• T+ese lesions are treated by surgical e$cision

• ilateral involvement occurs in E= ofpatients) ma(ing acinic cell carcinoma t+esecond-most common neoplasm) after

9art+in@s tumor) to e$+ibit bilateralpresentation&


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#od$+in's !"mphoma

• Codg(in:s disease

involving t+e parotid

gland&

• Note t+e eed-

Sternberg cell& "Hine

needle aspiration) Pap)

6E$#


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ali(ar" )land Tumors

•


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Salivary Gland Carcinoma Presentation

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