tumors of Salivary glands

7/28/2019 tumors of Salivary glands

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1. Benign Neoplasms1.1 Pleomorphic Adenoma

- also known as Mixed Tumor

- most common tumor of the majorand minor salivary glands

- parotid gland 85%

submandibular gland 8%

intraoral minor salivary gland 7%

- constitute about 50% of all intraoralminor salivary gland tumors


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Location: hard palate most common

intraoral siteupper lipbuccal mucosa

Age: occurs at any ageprevalent from 4th to 6th decades of life

Gender: males


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Clinical features:

- generally mixed tumors are mobile except

in the hard palate

- appear as firm, painless swellings- do not cause ulceration of the overlying

mucosa

- when it arises within the parotid gland,

generally mixed tumors are painless andslow growing and located below the ear

and posterior to the mandible


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Gross pathologySmoothWell-demarcatedSolidCystic changesMyxoid stroma


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Histopathologic features:

- demonstrate a wide spectrum of

histologic features- pleomorphic patterns and variable ratios

of ductal to myoepithelial cells gave rise to

the other term Pleomorphic Adenoma


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Treatment:- Surgical excision treatment of choice

- Enucleation not advisable because ofrisk of recurrence due to extension of

tumor through capsular defects

Prognosis:

- Inadequate removal may result in

recurrence.- With recurrence there is an increase

possibility of malignant transformation


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1.2 Monomorphic Adenomas

Classifications (based on histologic

pattern)

1.2.1 Basal Cell Adenoma

- constitute about 1% to 2% of all

salivary gland adenomas

- 70% are found within the parotidgland


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Location: in minor salivary glands, mostoccurs in upper lip, followed by the palate,

buccal mucosa, and lower lip

Age: between 35 and 80 years

mean age: 60 years

Gender: male


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Clinical features:

- generally slow growing tumor and

painless- clinically distinct on palpation, but it can be

multifocal and multinodular


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Histopathological features:- forms of basal cell adenoma

1. solid variety of monomorphicadenoma islands or sheets of

basaloid cells shows palisadingpattern

2. trabecular-tubular form exhibits

trabecular cords of epithelial cells

3. Membranous adenoma grows in anodular fashion with variable-sizedislands of tumor tissue


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Solid- Most common- Solid nests oftumor cells- Uniform,hyperchromatic,round nuclei,indistinctcytoplasm- Peripheral nuclearpalisading


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Trabecular Cells in elongated

trabecular pattern Vascular stroma


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Tubular Multiple duct-likestructures Columnar celllining Vascular stroma


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MembranousThick eosinophilic

hyaline membranessurrounding nestsoftumor cellsjigsaw-puzzleappearance


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Treatment: Conservative surgical excisionincluding a margin of normaluninvolved tissue

Prognosis: For membranous adenoma,monomorphic adenoma

good prognosis/rarely recur

For membranous form of basal cell

adenoma- has significant rate ofrecurrence


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1.2.2 Canalicular Adenoma

Location: upper lip most common

site

Gender: Female

Age: older than 50 years old


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Clinical features:

- freely movable

- asymptomatic

- size: from few millimeter to 2 to 3 cm

Histopathologic features: showed bilayer

strands of basaloid cells

- cells are cuboidal to columnar


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- Well-circumscribed- Multiple foci-Tubular structures line by columnar or cuboidalcells- Vascular stroma


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Treatment:

Surgical excision

- include cuff of clinically

normal tissue


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1.2.3 Myoepithelioma- benign salivary gland tumorscomposed entirely of myoepithelialcells called as myoepitheliomas

Location: arises within the parotidgland

Age: 3rd to 9th decade of life

Mean age: 53 years old


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Gender: no gender predilection

Clinical features: present as circumscribed

painless masses

Histopathologic features: composed of

either plasmacytoid (20%) or

spindle cells (70)%


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Spindle cell- More common-

Parotid- Uniform, centralnuclei- Eosinophilic granular

or fibrillar cytoplasm


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Plasmacytoid cell- Polygonal- Eccentric oval nuclei


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Treatment: Conservative excision includinga thin rim of surrounding

normal tissue

Prognosis: Excellent


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1.2.4 Oncocytoma

- also known as Oxyphilic adenoma

- rare lesion

Location: seen predominantly in the

parotid gland

Age: 6th decade of life


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Gender:

Clinical features:

- solid, ovoid encapsulated lesions- less than 5 cm in diameter

- in some cases, bilateral occurrence

may be noted

- rarely seen intraorally


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- oncocytoma cells are polyhedral

with granular eosinophiliccytoplasm

- nuclei are centrally placed and are

typically vesicular


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Cords of uniformcells and thin fibrousstroma Large polyhedralcells Distinct cellmembrane Granular,eosinophiliccytoplasm Central, round,vesicular nucleus


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Treatment: Conservative with superficialparotidectomy

Prognosis: GoodRecurrence is rarely noted


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1.2.5 Papillary Cystadenoma Lymphomatosum

- also known as Whartins tumor- accounts approximately 7% of

epithelial neoplasms of salivary gland- intraorally, the lesion is rare- positive correlation with smoking- thought to arise within lymphnodes as a

result of entrapment of salivary gland

elements in early develeopment


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Location: majority of the cases occurs

within the parotid gland

Age: between 5th and 8th decades of life

Gender: Male


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Clinical features:

- when it occurs in the parotid gland,it is present as doughy to cystic

mass

- encapsulated and has smooth to

lobulated surface and a roundoutline


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- presence of numerous cystic spacesof irregular outline contain papillary

projections lined by columnar

eosinophilic cells (oncocytes)


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Treatment: Surgical excision

Prognosis: Fair


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1.3 Ductal Pappilomas- these rare tumors are thought to

arise within the interlobular and

excretory duct portion of the

salivary gland unit

- 3 types;

1. Sialadenoma papilliferum

2. Inverted ductal papilloma3. Intraductal papilloma


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Sialadenoma papilliferum- an unusual benign salivary gland tumor

Location: majority of cases have been

found intraorally- most common sites:

buccal mucosa and palate

Age: between 5th

& 8th

decades of life

Gender: common in male


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Clinical features:- usually present as a painless exophytic

papillary lesion


- appears to originate from the superficial

portion of the salivary gland excretory

duct


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Treatment: Conservative surgery

Prognosis: Good


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Inverted ductal papilloma- a rare entity that presents a nodular

submucosal mass resembling a fibroma

or lipoma

- seen in adult and has equal gender

distribution

- histopatholgically, a marked proliferation

of ductal epithelium is seen subjacent tointact mucosa


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1.4 Salivary Lymphoepithelial Lesion- also known as Benign LymphoepithelialLesion (BLEL)

- an uncommon cause of major salivary

gland enlargement- present as a persistent, non-painful, firm,

unilateral or bilateral mass in a major

salivary gland

- histophatologically, presence of denseinfiltrate of lymphocytes and plasma cells


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Intraductal papilloma- a rare lesion that arises from a greater

depth within the ductal system

- histopathologically, a single or doublelayer of cuboidal or columnar epithlium

covers several papillary fronds that

project into a duct

- treatment: simple excision- prognosis: fair


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1.5 Sjogrens Syndrome- expression of autoimmune process that

results principally in dry eyes

(keratoconjunctivitis sicca) and dry mouth

(xerostomia). Rheumatoid arthritis may

also be seen in this syndrome

Etiology: unknown


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Racial predilection: occurs in all ethnic andracial groups

Age: peak age 30 years old

children and teenagers may be

affected

Gender: Female


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Clinical features:- chief complaint xerostomia

causing difficulty in speaking

and eating. Greater risk for

dental caries, periodontal

disease and oral candidiasis

- parotid gland enlargement


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Histopathologic features: a benignlymphocytic infiltrate replaces majorsalivary gland parynchema

Treatment: Symptomatic treatment- artificial saliva and tears

Preventive oral measures

Prognosis: Complicated by an associationwith malignant transformationto lymphoma


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2. Malignant Neoplasm

2.1 Carcinoma Ex-Mixed Tumor

Malignant Mixed Tumor

Metastasizing Mixed Tumor

Carcinoma Ex-Mixed Tumor

- arises in a pre-existing mixed

tumor- metastasis occurs only in the

malignant component


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- more common than malignant mixedtumor

Malignant Mixed Tumor

- malignant transformation on bothepithelial and malignant components

Metastasizing Mixed Tumor

- characterized by benign mixed tumorwhich metastasizes while retaining itsbland appearance histologically.


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Carcinoma Ex-Mixed Tumor

Location: parotid gland 68%

intraoral minor salivary gland 18%

Age: average age when becomes evident

60 years old

20 years beyond the age noted forbenign mixed tumors


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Clinical features:- fixation of the mass surrounding thetissues

- ulceration

- regional lymphadenopathy

Treatment: Surgical with radical neckdissection

Prognosis: Fair to Good


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2.2 Adenoid Cystic Carcinoma

- 23% of all salivary gland carcinomas

- a high-grade malignancy that has fair 5-

year survival rate but a dismal 15-year

survival rate


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Location: 50% to 70% occurs in minor

salivary gland of the head

and neck

- parotid gland is the most affected

major salivary gland

Age: 5th to 7th decades of life

Gender: no gender predilection


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Clinical features:- usually unilobular mass which is

firm on palpation

- occasionally with some pain

- characterized by slow growth rate

- present for several years before the

patient seek treatment

- facial nerve weakness or paralysismay occur

- bone invasion may occur


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- distant spread to the lungs is morecommon than metastasis to regional

lymph nodes

- intraoral lesions

- palate ulceration of the mucosa

- help to distinguish this

lesion from benign mixed

tumor


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Histopathologic features:- ductal structures are lined by

cuboidal cells with uniform nuclei

Treatment: Surgery / Radiation

Wide resection when parotid

gland is involved

Prognosis: 15-20 years survival rate

tumors of Salivary glands

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