SALIVARY GLAND

NEOPLASMS
Epidemiology

• 90% of trs arise in parotid

• 75% of parotid trs are

pleomorphic adenoma

• Muco epidermoid – MC
malignancy
Epidemiology
• 1.2% of all neoplasms

• Slow growing masses

• Pain not an indicator of

malignancy

• Benign tumors also present with

pain
Indications of
malignancy
• Facial nerve involvement

• Indurations / ulceration of skin ,

mucous membrane

• Lymph node metastasis

• Rapid tumor growth

Classification

• Epithelial tumors

• Non epithelial tumors

Epithelial tumors

• Adenoma

• Muco epidermoid tumors

• Acinic cell tumors

• Carcinoma
Adenoma

• Pleomorphic Adenoma

• Monomorphic Adenoma
Monomorphic Adenoma

• Adenolymphoma

• Oxyphilic adenoma

• Other types
Carcinoma
• Adenoid cystic

• Adenocarcinoma

• Epidermoid carcinoma

• Undifferentiated carcinoma

• Carcinoma in pleomorphic adenoma

Non epithelial tumors

• Hemangioma

• Lymphangioma

• Lipoma

• sarcoma
Investigations

• FNAC

• CT

• MRI
FNAC

• 95% accuracy

• Differentiate inflamatory from

neoplastic in sub mandibular
gland

• Controversial in parotid
CT Scan

• Limited to malignancy

• Tumor extension

• Deep lobe tr from

parapharyngeal trs
MRI

• Superior to CT

• Better clarity of margins

• More sensitive

• Lack of artefact from dental

filling
Open biopsy

• Contraindicated

• Justified only in minor gland trs

• Ulcerated lesions
Benign tumors

• Painless

• Slow growing

• No facial palsy
Pleomorphic Adenoma

• Commonest benign tr

• Pseudocapsule

• Pseudopodal extensions

• Not multicentric
Pleomorphic Adenoma

• Mixed tumor

• Consists of cartilage besides

epithelial cells

• Cartilage not of mesodermal origin

• Derived from mucin secreted by

epithelial cells
Microscopy

• Epithelial and myoepithelial

components

• Abundant matrix mucoid,myxoid

or chondroid supporting tissue
Diagnosis
• Lobulated , painless swelling

• Long duration

• Neither adherent to skin/

masseter muscle

• Generally firm / variable

consistency
Malignant
transformation
• 3 – 5 % of cases

• Pain

• Rapid growth

• Hard
Malignant
transformation
• Fixed to masseter

• Fixity to skin

• Lymph nodes

• Restricted jaw movements

Treatment

• Superficial parotidectmy

• Total parotidectomy
Warthins tumor
• Papillary cystadenoma
lymphamatosum

• 5 – 15 % of parotid trs

• Always at the lower pole of the

parotid

• Overlies the angle of mandible

Warthins tumor

• More in white races

• Not seen in negroes

• Encapsulated lesions

• No malignant transformation
Warthins tumor

• Only salivary neoplasm more in

males

• Elderly males

• Slow growing

• painless
Warthins tumor

• Surface is smooth
• Well defined
• Distinct margins
• Soft in consistency with
fluctuation
• Not tansilluminant
Microscopy

• Cystic / glandular spaces

• Lined by columnar epithelium

• Within abundant lymphoid

tissue with germinal centres
Investigations

• FNAC

• Tc99 scan – hot spot

Treatment

• Superficial parotidectmy

• Enucleation
Oncocytoma

• <1% of salivary trs

• Exclusively in parotid

• Hot spot on Tc 99 scan

Hemangioma

• MC benign parotid tr in children

• Soft, compressible and

fluctuant

• Typical bluish hue

Malignant tumors
• Commonest site –minor glands

• Palate

• MC in females

• 7th decade

• Previous irradiation
Mucoepidermoid
carcinoma
• MC

• Parotid &minor glands

• Slow growing tr

• Recurs locally
Mucoepidermoid
carcinoma
• LN mets in 30%

• Lung, bone, brain -15%

• Graded based on cellular

content
Adenoid cystic

• Cylindroma

• Rare in parotid

• 60% in sublingual gland

Adenoid cystic

• Perineural invasion

• Nerve palsy even before mass

• Also spread along haversian system

and neural canals of bone

• Mets LN –direct spread

Acinic cell tumor

• Mainly in parotid

• 3% are malignant & bilateral

• Slow growing painless mass

Acinic cell tumor

• Local recurrence

• Mets to lung, vertebra

• 5yr survival – 85%

Adenocarcinoma

• Rare

• Mainly parotid

• 80% as adherent masses

Squamous cell Ca

• < 1%

• Firm, indurated mass fixed to

other

• Exclude –high grade

mucoepidermoid,secondaries to
parotid,squamous
metaplasiawithin the gland
Lymphoma

• 40% of nonepithelial trs

• Mainly NHL

• Arise from LN within parotid

• Pain

• Facial palsy

• Palpable mass
Secondaries

• Lymphatic spread

• Melanoma & SCC -40%

• Melanoma –paraglandular LN

• SCC – intra glandular LN

Staging

• T 1 < 2cm
• T 2 2-4
• T 3 4-6
• T 4 >6
Treatment

• Total parotidectomy

• Radical neck dissection –

involved nodes
RT

• Residual tr
• Positive margin
• Advnced primary tr stage
• Lymphoma
• Secondaries in parotid
Thank you