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Tissue Diagnosis of Salivary Gland Tumors

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Tissue Diagnosis of Salivary Gland Tumors

  1. 1. Hari Dev2008 MBBS
  2. 2. Salivary Gland tumors Parotid Submandibular Minor salivary glands
  3. 3. Pleomorphic Adenoma Benign Tumor Represent 60% of tumors in parotid – Most common tumor of major salivary glands. Mixed Tumor – Derived from a mixture of Ductal [ epithelial] and myoepithelial cells, showing epithelial and mesenchymal differentiation. Radiation – A risk factor!!
  4. 4. Pleomorphic Adenoma –Gross Rounded , well demarcated Rarely exceed 6cm Pseudo – Encapsulated !! Cut surface shows grey white – Myxoid bluish translucent - Chondroid
  5. 5. Pleomorphic Adenoma -Histology HETEROGENEITY Epithelial cells resembling ductal cells or myoepithelial cells arranged as ducts, acini , tubules, strands, sheets… Dispersed within mesenchyme – loose myxoid tissue of chondroid, foci of bone. There is no epithelial dysplasia/ mitotic activity.
  6. 6. Carcinoma Ex PleomorphicAdenoma Malignant mixed tumor Incidence of malignant transformation increases with duration of tumor. Adenocarcinoma / Undifferentiated carcinoma Overgrows preexisting pleomorphic adenoma. Diagnosis- traces of pleomorphic adenoma must be there. Most aggressive of all salivary gland neoplasms!!!!!
  7. 7. Carcinoma ex pleomorphic adenoma
  8. 8. Warthin’s Tumour Second most common salivary gland neoplasm. Benign tumour Only tumour virtually restricted to parotid. More common in males Smoking - A risk factor!! 10% multifocal , 10% Bilateral.
  9. 9. Warthin’s Tumour - Gross Round to Oval Encapsulated Mostly arises in superficial parotid Cut section – Pale grey surface punctuated by cystic spaces filled with mucinous/ serous secretions.
  10. 10. Warthin’s Tumour -Histology Cystic spaces lined by double layer of neoplastic epithelial cells – surface palisade by oncocytic columnar cells resting on a layer of cuboidal cells these layers rest on a dense lymphoid stroma Papillary projections of lymphoepithelial elements into the cystic spaces Papillary Cystadenoma Lymphamatosum
  11. 11. Mucoepidermoid Carcinoma Malignant tumor Most common form of primary malignant tumour of salivary glands. Variable mixtures of squamous cells, mucus secreting cells, intermediate cells. Divided into Low , intermediate and high grade tumors. Radiation – A Risk factor !!
  12. 12. Mucoepidermoid Carcinoma - Gross • Grow up to 8cms • Though apparently circumscribed, lack well defined margins • On cut section. - Pale and grey white - Small mucin containing cysts.
  13. 13. Mucoepidermoid Carcinoma - Histology Squamous , mucous, intermediate cells Arranged in cords, sheets, cystic spaces. Mucous filled vacoules. Regular benign looking to highly anaplastic cells Hence low, intermediate , high grade.
  14. 14. Adenoid cystic carcinoma•Relatively Uncommon tumor•Most common tumor ofminor salivary glands•Gross – poorly encapsulated, grayish pink on cut section.•Histology – small cells withdark compact nuclei arrangedin tubular, solid , cribriformpattern.
  15. 15. Adenoid cystic carcinoma Tendency to invade perineural spaces!! Stubbornly recurrent!! >50% disseminate to bone, liver ,brain
  16. 16. Acinic cell Carcinoma Relatively uncommon Mostly arise in parotids Sometimes bilateral and multicentric. Gross – small discrete lesions, appears encapsulated. Histology – cells resemble normal serous acinar cells of salivary gland, clear cytoplasm arranged in solid , microcystic , papillary cystic patterns etc..
  17. 17. Acinic cell Carcinoma
  18. 18. Non Hodgkin’s Lymphoma  uncommon tumor  most often occurs in the parotid gland (70%) and belongs to MALT type Lymphoid proliferation of salivary gland REACTIVE MALIGNANTLymphoepithelial sialadenitis of NHL-MALT type cases derived from Sjogren Syndrome lymphoepithelial sialadenitis
  19. 19. Squamous cell carcinoma • True salivary gland primaries of squamous cell carcinoma are very rare • Most tumors of parotid gland are metastases to intraparotid lymph nodes from primaries in oral cavity, upper aerodigestive tract or skin • May represent malignant component of malignant mixed tumor or high grade mucoepidermoid carcinoma • Rapid growth with infiltration of surrounding structures, regardless of origin
  20. 20. To conclude….. Most common tumour 1. Of major salivary glands?? Pleomorphic Adenoma 2. Of minor salivary glands?? Adenoid Cystic Ca 3. Malignant tumour of salivary glands.?? Mucoepidermoid Salivary gland tumour 1. with strong predilection to invade nerves?? Adenoid Cystic Ca 2. associated with smoking?? Warthin’s tumor 3. with double layer of epithelial cells and lymphoid stroma?? Warthin’s tumor

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