Salivary Gland Neoplasms

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Salivary Gland Neoplasms

  1. 1. SALIVARY GLAND NEOPLASMS
  2. 2. Epidemiology <ul><li>90% of trs arise in parotid </li></ul><ul><li>75% of parotid trs are pleomorphic adenoma </li></ul><ul><li>Muco epidermoid – MC malignancy </li></ul>
  3. 3. Epidemiology <ul><li>1.2% of all neoplasms </li></ul><ul><li>Slow growing masses </li></ul><ul><li>Pain not an indicator of malignancy </li></ul><ul><li>Benign tumors also present with pain </li></ul>
  4. 4. Indications of malignancy <ul><li>Facial nerve involvement </li></ul><ul><li>Indurations / ulceration of skin , mucous membrane </li></ul><ul><li>Lymph node metastasis </li></ul><ul><li>Rapid tumor growth </li></ul>
  5. 5. Classification <ul><li>Epithelial tumors </li></ul><ul><li>Non epithelial tumors </li></ul>
  6. 6. Epithelial tumors <ul><li>Adenoma </li></ul><ul><li>Muco epidermoid tumors </li></ul><ul><li>Acinic cell tumors </li></ul><ul><li>Carcinoma </li></ul>
  7. 7. Adenoma <ul><li>Pleomorphic Adenoma </li></ul><ul><li>Monomorphic Adenoma </li></ul>
  8. 8. Monomorphic Adenoma <ul><li>Adenolymphoma </li></ul><ul><li>Oxyphilic adenoma </li></ul><ul><li>Other types </li></ul>
  9. 9. Carcinoma <ul><li>Adenoid cystic </li></ul><ul><li>Adenocarcinoma </li></ul><ul><li>Epidermoid carcinoma </li></ul><ul><li>Undifferentiated carcinoma </li></ul><ul><li>Carcinoma in pleomorphic adenoma </li></ul>
  10. 10. Non epithelial tumors <ul><li>Hemangioma </li></ul><ul><li>Lymphangioma </li></ul><ul><li>Lipoma </li></ul><ul><li>sarcoma </li></ul>
  11. 11. Investigations <ul><li>FNAC </li></ul><ul><li>CT </li></ul><ul><li>MRI </li></ul>
  12. 12. FNAC <ul><li>95% accuracy </li></ul><ul><li>Differentiate inflamatory from neoplastic in sub mandibular gland </li></ul><ul><li>Controversial in parotid </li></ul>
  13. 13. CT Scan <ul><li>Limited to malignancy </li></ul><ul><li>Tumor extension </li></ul><ul><li>Deep lobe tr from parapharyngeal trs </li></ul>
  14. 14. MRI <ul><li>Superior to CT </li></ul><ul><li>Better clarity of margins </li></ul><ul><li>More sensitive </li></ul><ul><li>Lack of artefact from dental filling </li></ul>
  15. 15. Open biopsy <ul><li>Contraindicated </li></ul><ul><li>Justified only in minor gland trs </li></ul><ul><li>Ulcerated lesions </li></ul>
  16. 16. Benign tumors <ul><li>Painless </li></ul><ul><li>Slow growing </li></ul><ul><li>No facial palsy </li></ul>
  17. 17. Pleomorphic Adenoma <ul><li>Commonest benign tr </li></ul><ul><li>Pseudocapsule </li></ul><ul><li>Pseudopodal extensions </li></ul><ul><li>Not multicentric </li></ul>
  18. 18. Pleomorphic Adenoma <ul><li>Mixed tumor </li></ul><ul><li>Consists of cartilage besides epithelial cells </li></ul><ul><li>Cartilage not of mesodermal origin </li></ul><ul><li>Derived from mucin secreted by epithelial cells </li></ul>
  19. 19. Microscopy <ul><li>Epithelial and myoepithelial components </li></ul><ul><li>Abundant matrix mucoid,myxoid or chondroid supporting tissue </li></ul>
  20. 20. Diagnosis <ul><li>Lobulated , painless swelling </li></ul><ul><li>Long duration </li></ul><ul><li>Neither adherent to skin/ masseter muscle </li></ul><ul><li>Generally firm / variable consistency </li></ul>
  21. 21. Malignant transformation <ul><li>3 – 5 % of cases </li></ul><ul><li>Pain </li></ul><ul><li>Rapid growth </li></ul><ul><li>Hard </li></ul>
  22. 22. Malignant transformation <ul><li>Fixed to masseter </li></ul><ul><li>Fixity to skin </li></ul><ul><li>Lymph nodes </li></ul><ul><li>Restricted jaw movements </li></ul>
  23. 23. Treatment <ul><li>Superficial parotidectmy </li></ul><ul><li>Total parotidectomy </li></ul>
  24. 24. Warthins tumor <ul><li>Papillary cystadenoma lymphamatosum </li></ul><ul><li>5 – 15 % of parotid trs </li></ul><ul><li>Always at the lower pole of the parotid </li></ul><ul><li>Overlies the angle of mandible </li></ul>
  25. 25. Warthins tumor <ul><li>More in white races </li></ul><ul><li>Not seen in negroes </li></ul><ul><li>Encapsulated lesions </li></ul><ul><li>No malignant transformation </li></ul>
  26. 26. Warthins tumor <ul><li>Only salivary neoplasm more in males </li></ul><ul><li>Elderly males </li></ul><ul><li>Slow growing </li></ul><ul><li>painless </li></ul>
  27. 27. Warthins tumor <ul><li>Surface is smooth </li></ul><ul><li>Well defined </li></ul><ul><li>Distinct margins </li></ul><ul><li>Soft in consistency with fluctuation </li></ul><ul><li>Not tansilluminant </li></ul>
  28. 28. Microscopy <ul><li>Cystic / glandular spaces </li></ul><ul><li>Lined by columnar epithelium </li></ul><ul><li>Within abundant lymphoid tissue with germinal centres </li></ul>
  29. 29. Investigations <ul><li>FNAC </li></ul><ul><li>Tc99 scan – hot spot </li></ul>
  30. 30. Treatment <ul><li>Superficial parotidectmy </li></ul><ul><li>Enucleation </li></ul>
  31. 31. Oncocytoma <ul><li><1% of salivary trs </li></ul><ul><li>Exclusively in parotid </li></ul><ul><li>Hot spot on Tc 99 scan </li></ul>
  32. 32. Hemangioma <ul><li>MC benign parotid tr in children </li></ul><ul><li>Soft, compressible and fluctuant </li></ul><ul><li>Typical bluish hue </li></ul>
  33. 33. Malignant tumors <ul><li>Commonest site –minor glands </li></ul><ul><li>Palate </li></ul><ul><li>MC in females </li></ul><ul><li>7 th decade </li></ul><ul><li>Previous irradiation </li></ul>
  34. 34. Mucoepidermoid carcinoma <ul><li>MC </li></ul><ul><li>Parotid &minor glands </li></ul><ul><li>Slow growing tr </li></ul><ul><li>Recurs locally </li></ul>
  35. 35. Mucoepidermoid carcinoma <ul><li>LN mets in 30% </li></ul><ul><li>Lung, bone, brain -15% </li></ul><ul><li>Graded based on cellular content </li></ul>
  36. 36. Adenoid cystic <ul><li>Cylindroma </li></ul><ul><li>Rare in parotid </li></ul><ul><li>60% in sublingual gland </li></ul>
  37. 37. Adenoid cystic <ul><li>Perineural invasion </li></ul><ul><li>Nerve palsy even before mass </li></ul><ul><li>Also spread along haversian system and neural canals of bone </li></ul><ul><li>Mets LN –direct spread </li></ul>
  38. 38. Acinic cell tumor <ul><li>Mainly in parotid </li></ul><ul><li>3% are malignant & bilateral </li></ul><ul><li>Slow growing painless mass </li></ul>
  39. 39. Acinic cell tumor <ul><li>Local recurrence </li></ul><ul><li>Mets to lung, vertebra </li></ul><ul><li>5yr survival – 85% </li></ul>
  40. 40. Adenocarcinoma <ul><li>Rare </li></ul><ul><li>Mainly parotid </li></ul><ul><li>80% as adherent masses </li></ul>
  41. 41. Squamous cell Ca <ul><li>< 1% </li></ul><ul><li>Firm, indurated mass fixed to other </li></ul><ul><li>Exclude –high grade mucoepidermoid,secondaries to parotid,squamous metaplasiawithin the gland </li></ul>
  42. 42. Lymphoma <ul><li>40% of nonepithelial trs </li></ul><ul><li>Mainly NHL </li></ul><ul><li>Arise from LN within parotid </li></ul>
  43. 43. <ul><li>Pain </li></ul><ul><li>Facial palsy </li></ul><ul><li>Palpable mass </li></ul>
  44. 44. Secondaries <ul><li>Lymphatic spread </li></ul><ul><li>Melanoma & SCC -40% </li></ul><ul><li>Melanoma –paraglandular LN </li></ul><ul><li>SCC – intra glandular LN </li></ul>
  45. 45. Staging <ul><li>T 1 < 2cm </li></ul><ul><li>T 2 2-4 </li></ul><ul><li>T 3 4-6 </li></ul><ul><li>T 4 >6 </li></ul>
  46. 46. Treatment <ul><li>Total parotidectomy </li></ul><ul><li>Radical neck dissection –involved nodes </li></ul>
  47. 47. RT <ul><li>Residual tr </li></ul><ul><li>Positive margin </li></ul><ul><li>Advnced primary tr stage </li></ul><ul><li>Lymphoma </li></ul><ul><li>Secondaries in parotid </li></ul>
  48. 48. Thank you

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