2. INTRODUCTION
Tumors of the salivary glands are-
• Most heterogeneous group of tumours.
• The majority of neoplasms are benign 80% and only 20%
are malignant .
• The various type are distinguished by their histologic
patterns.
7. PLEOMORPHIC
ADENOMA(MIXED
TUMOUR)
• PLE0MORPHIC ADENOMA IS THE MOST
COMMON BENIGN NEOPLASM CONSISTING
OF CELL EXHIBITING ABILITY TO
DIFFERNTIATE INTO EPITHELIAL CELLS
(DUCTAL AND NON DUCTAL CELLS) AND
MESENCHYMAL CELLS
(CHONDROID,OSSEOUS CELLS).
• MOST COMMON NEOPLASM OF SALIVARY
GLAND.
8. CLINICAL
FEATURES
• 1.SITE - MAJORLY OCCUR ON PAROTID GLAND
• LOWER POLE OF THE SUPERFICIAL LOBE OF
GLAND
• MINOR SALIVARY GLAND (6%)
• PALATE(60-65%)
• 2.SEX-FEMALES>MALES
• (6:4)
• 3. SIGNS-PAINLESS, SMALL, QUISCENT
NODULE, LOCAL DISCOMFORT PRESENT
• FACIAL PARALYSIS IS RARE
• 4. AGE – 40 TO 50 YEARS
9. • PAINLESS,SLOW GROWING TUMOUR,FIRM MASS,INITALLY
SMALL IN SIZE AND BEGIN TO INCREASE IN SIZE.
• INITALY MOVABLE BUT CONTINUED GROWTH BECOME
MORE NODULAR.
• SELDOM ULCERATED UNTIL TRAUMATIZED.
• RECURRENT TUMOUR - MULTINODULAR FIXED
ON PALPATION.
11. HISTOLOGIC FEATURES
• MACROSCOPIC FEATURES-
• APPEAR AS IRREGULAR TO OVOID MASS WITH WELL DEFINED
BORDERS.
• NEOPLASM HAVE INCOMPLETE FIBROUS CAPSULE OR ARE
ENCAPSULATED.
• CUT SURFACE IS RUBBERY,FLESHY,M UCOID OR GLISTERING
• AREAS OF HEMORRHAGE AND INFARCTION MAY BE NOTED.
12. MICROSCOPIC
FEATURES-
MICROSCOPICALY ,BENIGN MIXED TUMOURS ARE CHARACTERIZED
BY VARIABLE,DIVERSE,AND STRUCTURAL HISTOLOGIC PATTERNS.
COMBINATION OF GLANDULAR EPITHELIUM AND MESENCHYME LIKE
TISSUE AND PROPRTION OF EACH COMPONENTS VARIES WIDELY
AMONG INDIVIDUAL NEOPLASM. BASED ON THIS NEOPLASM
CATEGORIZED INTO THE FOLLOWING TYPES
1.PRINCIPALLY MYXOID
2.MYXOID AND CELLULAR COMPONENT PRESENT IN EQUAL
PROPRTION
4.EXTREMELY CELLULAR.
13. .
• THE EPITHELIAL COMPONENT FORM DUCTS
AND SMALL CYST THAT MAY CONTAIN AN
ESONIPHILIC COAGULUM.
• THE EPITHELIUM MAY ALSO OCCUR
AS SMALL CELLULAR NESTS ,SHEETS OF
CELLS,ANSTOMOSING CORDS,AND FOCI OF
KERATINISING OR SPINDLE CELLS.
14. • 4.MYOEPITHELIAL CELLS ARE ANGULAR OR
SPINDLE SHAPED .
• .CELLS WITH ECENTRIC NUCLEI AND
HYALINZED ESONIPHILIC
CYTOPLASM (HYALINE CELLS).
• CAUSES CHANGES DUE TO ACCUMULATION
OF MUCOID MATERIALS .
• VACOULAR DEGENERATION RESULT IN
CARTILAGENOUS APPEARANCE .
• FOCI OF HYALINZATION,BONE,EVEN FAT
SEEN
15.
16. TREATMENT AND
PROGNOSIS-
• MOST ACCEPTED IS SURGICAL
EXCISION.
• SUPERFICIAL PAROTIDECTOMY FOR
TUMORS IN SUPERFICIAL LOBE
OF PAROTID GLAND .
• EXTRCAPSULAR EXCISION FOR INTRA
ORAL LESION
• AS THESE ARE RADIORESISTANT
SO RADIOTHERAPY IS NOT
BENIFICIAL.
• PROGNOSIS IS EXCELLENT WITH
ADEQUATE SURGERY WITH A CURE
RATE OF MORE THAN 95%.
17. WARTHINS TUMOUR (PAPILLARY CYSTADENOMA
LYMPHOMATOSUM ADENOLYMPHOMA)
• SECOND MOST COMMON TUMOUR .
• THIS TUMOUR GLAND ALMOST OCCUR IN THE PAROTID
GLAND ,ALTHOUGH ALSO REPRTED IN SUBMAXILLARY GLAND).
• INTRAORAL ACCESORY SALIVARY GLAND RARELY AFFECTED.
18. CLINICAL FEATRURES
1. SEEN IN SIXTH AND SEVENTH DECADES.
2. AGE UPTO 62 YEARS
3. TUMOUR – SUPERFICIAL,LYING BENEATH THE PAROTID CAPSULE OR
PROTRUDES THROUGH IT.
4. LESION IS 3-4 CM IN DIAMETER.
5. PAINLESS,FIRM TO PALPATION AND CLINICALLY DISTINGUISHABLE.
6. SITE –PAROTID GLAND MAINLY BUT SUBMAXIILARY GLAND IS ALSO
INVOLVED.
7. .THIS TUMOUR OCCOUR BILATERALLY
19.
20. HISTOLOGIC FEATURES
• 1 MACROSCOPIC FEATURES-
• SMOOTH ,WELL ENCAPSULATED .
• CONTAIN NUMBER OF CYSTS THAT CONTAIN CLEAR FLUID.
• AREA OF FOCAL HEMORRHAGE IS SEEN.
21. MICROSCOPIC FEATURES
• 1 TUMOUR IS MADE UP OF 2 HISTOLOGICAL COMPONENTS : EPITHELIAL AND
LYMPHOID TISSUES.
• 2 AS THIS LESION IS ADENOMA EXHIBITNG CYST FORMATION,WITH PAPIILARY
PROJECTIONS INTO CYSTIC SPACES AND A LYMPHOID MATRIX SHOWING
GERMINAL CENTERS.
• 3.CYST ARE LINED BY BILAYERED ONCOCYTIC EPITHELIUM.
• THE INNER CELLS ARE TALL COLUMNAR WITH FINE
,GRANULAR,CYTOPLASMIC ESONIPHLIC CYTOPLASM DUE TO PRESENCE OF
MITOCHONDRIA AND SLIGHTLY HYPERCHROMATIC NUCLEI.
• THE OUTER CELLS LAYER ARE ONCOCYTIC TRIANGULAR AND
OCCASIONALLY FUSIFORM BASALOID CELLS
22. • 4.FOCAL AREAS OF METAPLASIA AND MUCOUS CELL PROSOPLAISA IS
SEEN.
• (MUCOUS CELL PROSOPLASIA MEANS TRANSFORMATION OF
SIMPLE SQUAMOUS EPITHELIAL CELL INTO MUCOUS SECRETING CELL)
• 5 CYSTIC SPACES HAVE ESONIPHILIC COAGULUM WHICH APPEAR
AS CHOCOLATE COLOURED FLUID IN GROSS SPECIMEN.
• 6 LYMPHOID COMPONENT EXHIBITNG GERMINAL CENTER IS SEEN.
23. WARTHINS TUMOUR SHOWS CYSTIC SPACES PARTIALLY FILLED WITH
HOMOGENOUS FLUID CIECUMSCIBED B Y DOUBLE ROWS OF
ONCOCYTES HAVIND A STROMA RICHLY INFILTRATED.
24.
25. • DIAGNOSIS CAN BE MADE BY -
• 1.SIALOGRAPHY
• 2.SCINTIGRAM
• TREATMENT -
• MOST ACCEPTED IS SURGICAL EXCISION
26. BASAL CELL ADENOMA
• BASAL CELL ADENOMA IS A NEOPLASM OF A UNIFORM POPULATION OF BASALOID EPITHELIAL
CELLS ARRANGED IN SOLID,TRABECULAR,TUBULAR OR MEMBRANOUS PATTERNS.
• CLINICAL FETAURES
1 SITE-PRIMARLILY IN MAJOR SALIVARY GLAND ,PARTICULARLY IN PAROTID GLAND.
2 TUMOR IS PAINLESS AND OF SLOW GROWTH. APPEARS AS FIRM SWELLING ,WHICH MAY BE
CYSTIC AND COMPRESSIBLE.
3 OCCUR MAINLY IN ADULTS .
4 SEX PREDILECTION – 2:1.
5.CLINICALLY DISTINGUISHABLE FROM PLEMORPHIC ADENOMA AND DIMENSION IS USUALLY LESS
THAN 3 CM.
27.
28. MACROSCOPIC FETAURES
• SIMPLE WELL DEFINED NODULE.
• TUMORS IN SALIVARY GLAND MAY HAVE WELL DEFINED NODULE
WHEREAS IN INTRORAL TUMOURS ARE LESS DEFINED.
• CUT SURFACE IS HOMOGENOUS WITH GRAY TO BROWN IN COLOR,
MAY HAVE CYSTIC AREAS.
29. HISTOLOGIC FEATURES
• BASAL CELL MAKE THIS LESION UNIFORM AND REGULAR.
• 2 MORPHOLOGICAL FORM IS SEEN - ONE IS SMALL WITH SCANTY
CYTOPLASM AND DEEPLY ROUND BASOPHIOLIC NUCLEUS.
• OTHER CELL IS LARGE WITH ESONIPHILIC CYTOPLASM AND AN OVOID PALE
SATINING NUCLEUS.
• BASED ON MORPHOLOGY CAN BE DIVIDED INTO 4 SUBTYPES
• 1.SOLID
• 2. TUBULAR
• 3.TRABECULAR
• 4.MEMBRANOUS
30. 1.SOLID-
• MOST COMMON.
• BASALOID CELL FORMS ISLANDS AND CORDS.
• ROUNDED AND LOBULAR PATTERN.
2.TUBULAR TYPE-
.MULTIPLE SMALL DUCT LIKE PATTERNS.
LINED BY 2 LAYER OF CELLS INNER CUBOIDAL ND OUTERBASALOID CELL.
LEAST COMMON .
31. 3.TRABECULAR PATTERN-
.SAME CYTOLOGICAL FEATURES AS SOLID
TYPE.
.EPITHELIAL ISLAND ARE NARROWER AND
CORD LIKE.
4 MEMBRANOUS TYPE-
CLINICAL SUBTYPE , CHRACTERIZED BY
PRESENCE OF ABUNDANT, THICK ESONIPHILIC
HYALINE LAYER THAT SURROUNDS ANS
SEPARATE EPITHELIAL ISLANDS.
EPITHELIAL ISLANDS RESEMBLE JIGSAW
PUZZLE PATTERN
35. MALIGANT TUMOURS OF SALIVARY GLAND.
MUCOEPIDERMOID CARCINOMA-
•MALIGANT EPITHELIAL TUMOUR.
•CONSIST OF MUCUS SECRETING CELLS AND
EPIDERMOID TYPE CELL.
36. CLINICAL FEATURES
• 1.AGE- 3rd to 5th DECADE UPTO 47 YEARS OF AGE.
• 2.SEX-FEMALE> MALE
• 3.SITE-PAROTID, PALATE (55%).
• INTRAORALLY- TOUNGE, BUCCAL MUCOSA, RETROMOLAR AREAS.
• 4.SIGNS- LOW GRADE,SLOWLY ENLARGING,PAINLESS MASS NOT COMPLETELY ENCAPSULATED, FILLED WITH
NISCOID MATERIAL.
• PALATAL MUCOEPIDERMOID CARCINOMA MISTAKEN AS MUCOCELE.
• HIGH GRADE MALIGANCY GROW RAPIDLY AND DOES PRODUCE PAIN AS EARLY SYMPTOMS.
• FACIAL NERVE PARALYSIS IS FREQUENT.
• PATIENT MAY COMPLAINT ULCERATIONS ,DRAIN FROM EAR.
38. HISTOPATHOLOGY
• CHARACTERISED BY DIFFERENT CELL TYPES,GROWTH PATTERN.
• COMPOSED OF DIFFERENT TYPE OF CELLS AND GROWTH PATTERN.
•
1.MUCOUS
SECRETING CELLS-
FOAMY CYTOPLASM
MUCIN STAINS
POSITIVE
POSITIVE FOR PAS
STAINS
2.EPIDERMOID
CELL
SQUAMOUS
FEATURE
POLYGONAL
SHAPE
CELL.INTERCELLUL
AR BRIDGES AND
RARELY
KERATINIZATION.
3.INTERMEDI
ATE CELL
LARGER THAN
THE BASAL
CELL
4.COLUMNAR
OR CLEAR CELL.
LARGER,POLYG
ONAL,DEFINED
CYTOPLASMIC
BORDERS.
39. GRADES OF MUCOEPDERMOID CARCINOMA
• GRADES ARE BASED ON THE CYST FORMATION.
• RELATIVE NUMBER OF MUCOUS,EPIDERMOID,INTERMEDIATE CELLS
LOW GRADE
PROMINENT
CYTSIC
STRUCTURES.
MUCOUS CELLS
PRESENT
INTERMEDIATE
GRADE
LARGE,SOLID
ISLAND OF
TUMOURS MITOTIC
FIGURE.
HIGH GRADE
SOLID CELLILAR
PROLIFERATION O
F EPIDERMOID,
INTERMEDIATE
CELL.
40.
41. TREATMENT
• CONSERVATIVE EXCISION WITH PRESERVATION OF FACIAL NERVE.
• FOR TUMOUR IN SUBMANIBULAR GLAND SURGICAL REMOVAL IS
DONE
• FOR MINOR SALIVARY GLAND SURGICAL EXCISION
• METASTASIS IS 12%.
43. CLINICAL FEATURES
• SITE –PAROTID,SUB MAXILLARY GLAND, ACCESORY GLAND OF
TOUNGE,PALATE
• FEMALE>MALE.
• EARLY MANIFESTATIONS ARE PAIN, PARATHESIA,FACIAL NERVE
PARALYSIS
44.
45. HISTOLOGY
• DIFFERENT ARRANGEMENT OF
CELL.
• COMPOSED OF MYOEPITHELIAL
CELLS AND DUCTAL CELLS.
• 3 GROWTH PATTERNS ARE SEEN.
• CRIBIFORM
• TUBULAR
• SOLID
• CRIBIFORM CONSIST OF BASALOID
CELLS HAVING SWISS CHEESE OR
HONEYCOMB APPERANECE
46. • TUBULAR HAS TUBULAR STRUCTURE LINED BY STRATIFIED CUBOIDAL
EPITHELIUM.
• SOLID CONSIST OF GROUP OF CUBOIDAL CELLS.
• PERINEURAL INVASION AND PERIPHERAL NERVE INVASION SEEN
49. POLYMORPHOUS
LOW GRADE
ADENOCARCINOMA
• MALIGANT EPITHELIAL TUMOUR.
• CHARACTERIZED BY BLAND AND
UNIFORM FEATURES DIVERSE
BUT CHARACTERISTIC
ARCHITECTURE,INFILTRATIVE
GROWTH AND PERINEURAL
INFILTRATION.
50. CLINICAL
FEATURES
IN MINOR GLANDS TWICE FREQUENT AS ADENOID
CYSTIC CARCINOMA.
AVERAGE AGE IS 59 YEARS.
FEMALE TO MALE RATIO IS 2:1.
SITE- PALATE(60%),BUCCAL MUCOSA (16%), AND
12% IN UPPER LIP.
TUMOUR PRESENT AS A FIRM,NON TENDER
SWELLING INVOLVING THE MUCOSA OF HARD
PALATE AND SOFT PALATE,CHEEK OR UPPER LIP.
DISCOMFORT ,BLEEDING,TELANGIECTASIA(CONDITI
ON CHRACTERIZED BY DILATION OF CAPILLARIES
WHICH RESULT IN SPIDEY APPEARENCE) OR
ULCERATION OF UNDERLYING MUCOSA.
51.
52. HISTOLOGY
• MICROSCOPICALLY CHRACTERIXED BY INFILTRATIVE
GROWTH WITH DIVERSE MORPHOLOGY AND UNIFORM
CYTOLOGICAL FEATURES.
• TUMOURS ARE WELL CIRCUMSCRIBED BUT
UNCAPSULATED .
• DUE TO POLYMORPHIC NATURE LESION REFER TO
VARIETY OF STRUCTURES WHICH
INCLUDESSOLID,DUCTAL,CYSTIC,AND TUBULAR PATTERN.
• TUMOUR IS COMPOSED OF CUBOIDAL TO COLUMNAR
ISOMORPHIC CELLS THAT HAVE UNIFORM OVOID OR
SPINDLE SHAOED NUCLEI.
• TUMOR STROMA VARIES FROM MUCOID TO HYALINE.
• PERINEURAL INVASION IS COMMON.
55. ACINIC CELL
CARCINOMA(
ACINAR CELL
CARCINOMA)
• MALIGANT EPITHELIAL NEOPLASM.
• CYTOLOGICAL DIFFERNTIATION TOWARD
ACINAR SEROUS CELL WHOSE
CHRACTERSTICS FEATURE IS CYTOPLASMIC
PAS POSITIVE ZYMOGEN TYPE SECRETORY
GRANULES.
56. CLINICAL
FEATURES
• OCCUR MAINLY IN PAROTID GLAND (90-
95%).
• INTRORAL SITES-LIPS AND BUCCAL MUCOSA.
• OCCUR IN MIDDLE AGED ADULTS.
• WOMEN TO MEN RATIO 3:2.
• TUMOR IS SLOW GROWING SOMETIMES
NODULAR MOBILE OR FIXED MASS .
• USUALLY ASYMPTOMATIC ,PAIN OR
TENDERNESS IS SEEN IN OVER ONE
THIRD OF THE PATIENTS.
57.
58. HISTOLOGIC
FEATURES
NEOPLSTIC CELLS ARE MADE UP OF ACINAR OR
DUCT CELL AND EXHIBIT CLEAR CYTOPLASM. SOME
MAY BE SHOW ONCOCYTIC OR HOBNAIL
APPERAENCE.
4 TYPE OF GROWTH PATTERNS ARE SEEN
DESCRIBED MAINLY SOLID,PAPILLARY
CYSTIC,FOLLICULAR AND MICROCYSTIC.
THE MOST CHRACTERSTICS CELL SEEN HAS THE
FEATURES OF SEROUS ACINAR CELLLS WITH
ABUNDANT GRANULAR CYTOPLASMIC AND A
ROUNDLY DARKLY STAINED ECCENTRIC NUCLEUS.
59. CELLS ARE PRESENT ARE INTERCALATED
DUCT WHICH ARE SMALLER AND THE
VACOULATED CELLS,WHICH SEEM TO BE
UNIQUE TO ACINIC CELL CARCINOMA.
CONNECTIVE TISSUE STROMA IS DELICATELY
FIBROVASCULAR COLLAGENOUS TISSUE.
60.
61. TREATMENT
• MOST CASES IS SURGICAL.
• LYMPH NODE DISSECTION IS
INDICATED ONLY IN PRESENCE OF CLINICAL
INVOLVEMENT.
• INTRAORAL TUMOURS ARE TREATED BY
SURGICAL EXCISION.
