Salivary Gland Tumors - Tehran University of Medical Sciences Gland Tumors.pdf · •Diversity in...
Transcript of Salivary Gland Tumors - Tehran University of Medical Sciences Gland Tumors.pdf · •Diversity in...
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Salivary Gland Tumors
Sasan Dabiri, M.D. - Assistant Professor
Department of Otorhinolaryngology – Head & Neck surgery
Amir A’lam hospital
Tehran University of Medical Sciences
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Epidemiology
• Overall prevalence:
– 3% of Head & Neck neoplasms
– 100 parotid neoplasms
– 10 submandibular neoplasms
– 10 minor salivary gland neoplasms
– 1 sublingual neoplasm
Salivary Gland Tumors
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Epidemiology
• The most common neoplasms:
– Benign in anywhere:Pleomorphic Adenoma
– Malignant in parotid:Mucoepidermoid Carcinoma
– Malignant in others:Adenoid Cystic Carcinoma
– Post radiation, benign: Warthin’s tumor
– Post radiation, malignant: Mucoepidermoid Carcinoma
Salivary Gland Tumors
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Fine Needle Aspiration / Biopsy
• Goals are:
– Differentiation of neoplastic and non-neoplastic mass
– Differentiation of benign and malignant neoplasm
• High specificity (96-98%)
• Good sensitivity (79-96%)
Salivary Gland Tumors
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Fine Needle Aspiration / Biopsy
• Is it Accurate?
– Highest inaccuracy rates in Parotid
• Diversity in pathology ( 11 benign & 24 malignant )
• Other than mixed tumor, are uncommon
• Morphologically complex
• Some carcinomas have not malignant cellular appearance
Lower accuracy for diagnosing malignant tumor
Salivary Gland Tumors
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Frozen Section
• Indications :
– Determination of tumor extension
– Evaluation of surgical margin
– Non-diagnostic FNA
– Incompatible FNA according to clinical judgement
Salivary Gland Tumors
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Imaging
Salivary Gland Tumors
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Imaging
Salivary Gland Tumors
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Imaging
Salivary Gland Tumors
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Imaging
Salivary Gland Tumors
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Imaging
Salivary Gland Tumors
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Imaging
Salivary Gland Tumors
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Imaging
• Differentiation of benign and malignant tumors is not the primary goal of CT and MRI; but:
– Anatomical localization
– Local, Regional (lymph node), and Distant invasion
• Overall
– Low intensity in T1 & T2 malignant (high probable)
Salivary Gland Tumors
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Imaging
• Why MRI is better than CT?
– Well visualized on T1 (especially parotid “fatty gland”)
• Excellent assessment of margins
• Deep extension & Infiltration
– Best mapping on T1+ Gd + Fat suppression• Bone marrow & cortex: hyposignal
invasion, well visualized
• Fatty & bony foramina at skull base: hyposignal
perineural spread: well visualized
• Meningeal invasion
Salivary Gland Tumors
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Imaging
• Perineural invasion for parotid tumor
– Facial nerve
• entire nerve should be assessed all the way
( even if there is no clinical facial paralysis )
– Auriculotemporal nerve
• through a small fat pad along the
medial aspect of the lateral pterygoid muscle and just inferior to the foramen ovale
Salivary Gland Tumors
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Imaging
• Perineural invasion for submandibular tumor
– Hypoglossal nerve
• Tongue movement impairment
– Lingual nerve
• Tongue tingling
Salivary Gland Tumors
MRI visualizes :• enlarged nerve• obliterated fat• enlarged ganglion• atrophy of the masticator muscles
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Imaging
• Radionuclide Scanning (Tc 99m)
–Warthin’s tumor
– Oncocytoma
Salivary Gland Tumors
Helpful for elderly patients with parotid mass
Aldred Scott Warthin1866 - 1931
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Imaging
• Ultrasonography
Pros
– Differentiation of glandular from extraglandular mass
– Guiding the biopsy (FNA)
Cons
– Operator dependent
– Just in superficial masses
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Pleomorphic Adenoma
Salivary Gland Tumors
• Epithelial and
Mesenchymal
components
• 10% risk of
malignancy after
15 years
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Warthin’s tumor
Salivary Gland Tumors
• Papillary Cystadenoma Lymphomatosum
• Only in parotid
• Male & cigarette smoking
• No risk of malignancy
• bilateral
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Mucoepidermoid Carcinoma
Salivary Gland Tumors
• Contains mucoid
and epidermoid cells
• Low, intermediate
and high grade
classification
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Adenoid Cystic Carcinoma
Salivary Gland Tumors
• Perineural invasion
• Grading according
dominant cells:
• Cribriform
• Tubular
• Solid
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Management
• Surgery
– primary management in all new and recurrent cases
Unless :
• Surgery cannot be done (patient’s condition)
• Invasion to skull base
• Invasion to pterygoid plates
• Encase carotid artery
Salivary Gland Tumors
T4b
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Management
• Radiation therapy ± Chemotherapy
– Unable to surgery
– Adenoid cystic carcinoma
– Intermediate or high grade carcinoma
– Close or positive margin
– Perineural or perivascular invasion
– Lymph node metastasis
Salivary Gland Tumors
In cases with complete resection
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Thanks for Your Attention