Salivary Gland  Neoplasms
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Salivary Gland Neoplasms Presentation Transcript

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