SALIVARY GLAND

INTRODUCTION
DEFINITION:
• SALIVARY GLANDS ARE COMPOUND, TUBULOACINAR,
MEROCRINE, EXOCRINE GLANDS THE DUCTS OF WHICH
OPEN INTO ORAL CAVITY.
• THE ORAL CAVITY IS KEPT MOIST BY A FILM OF FLUID
CALLED SALIVA THAT COATS THE TEETH AND
MUCOSA.
• SALIVA IS A COMPLEX FLUID PRODUCED BY THE
SALIVARY GLANDS.

ANATOM
Y
Salivary glands are the exocrine glands that are responsible for secretion of
the saliva. There are two groups of salivary glands:
1. Major salivary glands: Major salivary glands consist of pair of parotid
glands, submandibular glands and sublingual salivary glands.
2. Minor salivary glands: There are large number of minor salivary glands
in the mucosa of the oral cavity, nasal sinuses, larynx and bronchial tree.

 Parotid glands are mainly serous glands. Each gland weighs about 15–25
gm.
• The parotid gland is situated in the angle of mandible.
• The gland is divided into superficial and deep compartment and facial
nerve with its branches passing in between these two compartments.
 Submandibular salivary gland is located in the submandibular triangle
which is bounded anteriorly by anterior belly of digastric, posteriorly by
posterior belly of digastric and superiorly by mandible.
• This is a seromucous gland and weighs 7–8 gm.
• The gland has two lobes: (1) superficial and (2) deep lobes.
• The secretion of the gland flows through the Wharton’s duct that opens
into the floor of the mouth.
 The sublingual gland is the smallest salivary gland and weighs only 3 gm.
• This is a mucinous gland.
• The gland is located in the sublingual fossa and the secretion of the
gland flows through multiple excretory ducts to open into the oral cavity.

HISTOLOGY
• The major salivary gland is composed of secretory part and duct part.
• The secretory part is made of acini which are lined by serous, mucinous or
mixed (seromucinous) type of cells.
• The cells in acini are arranged as lobules encircled by myoepithelial cells.
• Each acini opens into the intercalated ducts that further joins with each
other and forms larger excretory duct.

 Main function of Salivary Gland-secretion of
saliva
 Daily secretion -800 to 1500 ml
 pH :6-7
PHYSIOLOGY
COMPOSITION
:

 Control of secretion
• Parasympathetic stimulation- profuse secretion of watery
saliva
• Sympathetic stimulation- scanty viscid secretion
.Sympathetic supply comes from cervical sympathetic chain
along the blood vessels
 Functions of Saliva
 Keep the mouth moist
 Aids in swallowing
 Aids in speech
 Keeps the mouth and teeth
clean
 Antimicrobial action
 Digestive function

SPECIMEN COLLECTION FOR CYTOLOGICAL
EXAMINATION
Indications: Any palpable swelling of the salivary gland.
Advantages:
• Rapid
• Safe
• High sensitivity and specificity
• Cheap
• Avoids any unnecessary surgery
• Helps in planning of surgery in case of neoplasm
• Various ancillary investigations can be done: Microbiological examination,
flow cytometry, cell block
INDICATIONS OF FINE NEEDLE ASPIRATION CYTOLOGY OF THE SALIVARY
GLANDS
• FNAC is indicated in any space occupying lesion of the salivary glands
 Fine needle aspiration cytology of the salivary gland is done preferably
by thin needle with 23 gauze diameter & both May-Grünwald-Giemsa
(MGG) and Papanicolaou’s stains should be done.

COMPLICATIONS AND CONTRAINDICATIONS
Complications:
• Hemorrhage
• Facial pain
• Infection
Contraindications:
• Bleeding diathesis
• Severe skin infection
• No swelling

NORMAL SALIVARY GLAND CELLS
Fine needle aspiration cytology of the normal salivary gland usually yields
scanty material.
 Benign ductal cells:
• Ductal cells are usually present in tight small clusters or
honeycombed like monolayered sheets.
• The individual cells are round with scanty cytoplasm having
monomorphic round nuclei.
 Acinar cells :
• These cells are commonly present as loose grape-like clusters or
discretely.
• The individual cells are pyramid in shape with abundant foamy
cytoplasm and small eccentrically placed round nuclei.
• Due to cytoplasmic fragility, the acinar cells often present as bare
nuclei and these cells should be distinguished from the
background lymphocytes.
ROUND TO OVAL
MONOMORPHIC BENIGN
DUCTAL CELLS [MAY-
GRÜNWALDGIEMSA (MGG)
STAIN × MEDIUM POWER (MP)]
LOOSE GRAPE LIKE CLUSTER
OF BENIGN SALIVARY ACINAR
CELLS [HEMATOXYLIN AND
EOSIN (H & E) STAIN × MP)

 Myoepithelial cells: Myoepithelial cells are oval to spindle
shaped with scanty indistinct cytoplasm.
• Oval plasmacytoid myoepithelial cells may also be seen.
Other Components Fragments of fibrous and adipose tissue may also be
seen in the background of the normal salivary aspirate.
• Due to the presence of intraparotid lymph node, lymphoid cells are
often noted in the normal salivary aspirate..

NON MALIGNANT CONDITIONS(Benign Neoplasm):
 Pleomorphic Adenoma
• Pleomorphic adenoma is the most common tumor of the salivary gland and constitutes about 60% of
all tumors of the salivary gland.
• About 80% cases of PA develop in parotid gland, 10% in submandibular gland and the rest 10% cases
in the paranasal sinuses, oral cavity, upper respiratory tract and skin.
ROUND TO OVAL CELLS WITH MODERATE
AMOUNT OF CYTOPLASM IN PLEOMORPHIC
ADENOMA. THE CELLS ARE EMBEDDED IN
THE STROMAL MATERIAL
[PAPANICOLAOU’S STAIN × HIGH POWER
(HP)]
Cytology:
• Pinkish fibrillar chondromyxoid matrix
material with frayed indistinct margins.
• Clusters of round, ovoid or plasmacytoid
epithelial cells
• Moderate amount of dense cytoplasm.
• Central to eccentric monomorphic nucleus
• Bland chromatin.
• Clusters and discrete spindle shaped
myoepithelial cells embedded in mesenchymal
stroma.

 Warthin Tumor
WARTHIN TUMOUR-THE ONCOCYTIC CELLS
HAVE
ABUNDANT CYTOPLASM WITH ECCENTRIC
NUCLEI. WHICH ARE ROUND AND
MONOMORPHIC (H & E STAIN × HP)
Clinical
• Second common tumors of
salivary gland tumors
• Mean age 62 years
• Exclusively within the parotid
gland
• One-fifth cases are bilateral
• Doughy feel on palpation
• Probably developmental, not
neoplastic
Cytology
• Thin dirty mucoid or greenish-
brown fluid

 Basal Cell Adenoma
• BCA accounts for 1–3% of all salivary gland tumors.
• It predominantly affects older individuals.
• Majority of the BCAs (more than 75%) occur in the parotid gland and
rarely other salivary glands are involved.
• This tumor usually presents as solitary, firm, well-defined, mobile
nodules. MULTIPLE CLUSTERS OF BASALOID CELLS
WITH SCANTY CYTOPLASM AND ROUND
MONOMORPHIC NUCLEI IN BASAL CELL
ADENOMA (MGG STAIN × MP)
• Cohesive groups of cells
• Peripheral palisading arrangement
• Round nucleus, bland nuclear
chromatin and scanty cytoplasm
• Squamous morules
• Scanty homogenous acellular stromal
material
 Cytolog
y:

 Oncocytoma
• Oncocytoma represents 1% of all salivary gland tumors.
• This tumor is rarely seen below the age of 50 years
• More than 80% of the tumor arises from the parotid gland and the rest of
the tumor develops from the submandibular gland.
• The tumor predominantly presents as well-circumscribed painless mobile
mass.
• Polygonal cells
• Fine chromatin
• Small nucleoli
• Three-dimensional clusters of oncocytes
• Abundant densely granular eosinophilic
cytoplasm
• Monomorphic round nucleus
 cytology LARGE, POLYGONAL CELLS WITH ABUNDANT
DENSELY GRANULAR EOSINOPHILIC
CYTOPLASM AND WELL-DEFINED CELL
BORDER OF ONCOCYTES IN ONCOCYTOMA
(MGG STAIN × OIL IMMERSION

 Myoepithelial Tumors
• Myoepithelial tumor is a rare benign neoplasm .
• The mean age of the patient is 44 years.
• Myoepithelioma may occur both in major and minor salivary gland.
• The patients usually present with a slow growing painless mass.
 Cytology
• Rich in cells
• Lack of chondromyxoid stroma
• Spindle cell type
• Cohesive clusters and dissociated spindle cells
• Elongated nuclei, fine nuclear chromatin and inconspicuous
nucleoli
• Nuclear grooves
• Scanty pale cytoplasm
• Plasmacytoid (hyaline) myoepithelial cells
• Dissociated round to oval cells.
• Plasmacytoid cells with abundant cytoplasm and eccentric
nucleus
• Fine nuclear chromatin.
INDIVIDUAL CELL MORPHOLOGY OF
MYOEPITHELIAL CELLS IS BETTER VIEWED
IN HIGHER MAGNIFICATION IN
MYOEPITHELIAL TUMOR (H & E STAIN ×
HP)

MALIGNANT TUMOUR
 Adenoid Cystic Carcinoma
• Adenoid cystic carcinoma is a slow growing tumor .
• It comprises about 10–20% of salivary gland malignancies.
• ACC commonly affects parotid, submandibular gland and minor salivary glands in
the palate.
• ACC may also occur in nasal cavity and sinuses, tongue, buccal mucosa and lip.
CRIBRIFORM APPEARANCE OF
ADENOID CYSTIC CARCINOMA ON
CYTOLOGY
SMEAR (MGG STAIN × MP)
• Multiple variables sized globular, spherical or tubular
homogenous, acellular magenta colored matrix material
• Globules are surrounded by cells
• Clusters and dissociated small cells
• Scanty cytoplasm
• Round monomorphic nuclei
• Hyperchromatic
• Coarse chromatin
 CYTOLOGY

 Acinic Cell Carcinoma
• About 80–90% of tumor arises in the parotid gland and a small group of tumor develops from the
minor salivary glands.
• The patient classically presents as a single, mobile and painless mass. The duration of the symptoms
is usually few months.
• Females are slightly more affected by acinic cell carcinoma than male and the peak incidence of the
tumor is in third decades of life.
• Abundant cohesive clusters of acinar cells
• Acinar like arrangement
• Large polygonal cells
• Abundant finely vacuolated cytoplasm
• Naked tumor nuclei
• Occasionally lymphocytes and psammoma bodies
• Clean background
 CYTOLOG
Y
HIGHER MAGNIFICATION OF THE ACINIC CELL CARCINOMA
SHOWING ABUNDANT EOSINOPHILIC CYTOPLASM AND
ROUND CENTRAL TO ECCENTRIC NUCLEI (MGG STAIN ×
OIL IMMERSION)

• This tumor represents 17% of all salivary gland malignancies
and predominantly involves the parotid gland.
• The tumorcells exhibits ductal differentiation.
• FNAC smears show recognizable malignant cells with features of
adenocarcinoma but there is lack of definitive evidence of other
specific
subtypes.
Adenocarcinoma
ADENOCARCINOMA OF THE PAROTID
GLAND(H&E-40X)

 Mucoepidermoid Carcinoma
• Mucoepidermoid carcinoma is the commonest malignant tumors of the salivary gland
• MEC occurs in age groups from children to old age, and mean age of the patient is 45
years.
• About 50% of MEC arises from the major salivary gland and rest of the tumor arises
from buccal mucosa and palate.
• The patients usually present with painless, firm, fixed, mass.
• Clusters and dissociated cells with vacuolated
cytoplasm
• Intermediate squamous cells
• Gradual transition of squamoid to mucus producing
cells
• Dirty background produced by debris and mucus
• Histiocytes and background lymphocytes
• Mucus secreting cells are positive for mucicarmine
or Alcian blue stain.
 CYTOLOG
Y
EPIDERMOID CELLS WITH ENLARGED
HYPERCHROMATIC NUCLEI IN
MUCOEPIDERMOID CARCINOMA (H & E STAIN ×
HP)

 Polymorphous Low-grade Adenocarcinoma
• Females are more commonly affected than male. The age range of the patient varies from second
decade to ninth decade.
• However, majority of the patients are in between 50 years and 70 years of age. Mean age of the
patient is 59 years.
• PLGA commonly affects the minor salivary glands and 60% of the tumor develops in palate.
 Cell arrangement:
• Papillary
• Ductal
• Trabecular
• Discrete
 Morphology:
• Scanty to moderate pale cytoplasm
• Round to oval nucleus
• Fine stippled nuclear chromatin
• Inconspicuous nucleoli
• Scanty matrix material
LONG PAPILLARY LIKE
CLUSTER IN POLYMORPHOUS
LOW GRADE
ADENOCARCINOMA (MGG
STAIN × MP)

 Epithelial-Myoepithelial Carcinoma
• Majority of the epithelial-myoepithelial carcinomas (60–80%) arise in the parotid
gland and rest of the tumors arise in the minor salivary glands of the oral cavity.
• The patient usually presents as painless slowly growing mass in the parotid gland
for months to even years.
Biphasic pattern
• Myoepithelial cells:
– Loose cohesive cluster
– Large polygonal clear cell
– Round, monomorphic nuclei
– Mild nuclear enlargement
– Fine chromatin
• Epithelial cells:
– Scanty
– Small cuboidal
– High N/C ratio
• Stromal material:
– Spherical hyaline globules
– Acellular
LARGE POLYGONAL CLEAR
CELL OF EPITHELIAL-
MYOEPITHELIAL
CARCINOMA (H&E STAIN -
HP)
 Cytology:

 Carcinoma Ex-pleomorphic Adenoma
• History of pre-existing Pleomorphic adenoma
• It is also known as malignant mixed tumor.
• High-grade carcinoma of ductal type
• Metachromatic fibrillar matrix with myoepithelial cells
• Ca Ex-PA commonly involves the parotid
gland.
• The patient usually presents with
history of a sudden rapid enlargement of
a longstanding swelling of theparotid gland.
CARCINOMA EX-
PLEOMORPHIC
ADENOMA(H&E STAINED-
HP)