Salivary gland tumours are a relatively rare and morphologically diverse group of lesions. So here are slides containing information about salivary gland tumours with images.

1. NEOPLASMS OF
SALIVARY GLANDS
Presented by KARTHIK K
ESIC MEDICAL COLLEGE & PGMISR BANGALORE

2. SALIVARY GLANDS
MAJOR SALIVARY GLANDS
Parotid glands
Submandibular glands
Sublingual glands
Other locations include
lateral margin of
tongue, palate, lips,
buccal mucosa

3. The fundamental structure of all salivary glands is the acinar-ductal unit.
Acini are variably composed of serous or mucous or both
Ductal unit
Intercalated duct
Striated duct
Excretory duct
The ducts are lined by ductal epithelial cells
Acini and intercalated ducts are surrounded by myoepithelial cells.
Myoepithelial cells are physiologically and functionally modi
fi
ed epithelial cells that has
smooth muscle like contractile properties.
One among the many functions of this myoepithelial cell is to contract and help secrete
saliva from end pieces to duct.

4. Myoepithelial cells

5. INTRODUCTION
Tumours of salivary glands are
Most heterogenous group of tumours.
Greatest diversity of morphological feature.
- relatively uncommon
The tumours of major or minor salivary glands are either from epithelial or
mesenchymal tissues.
Larger the size of salivary gland, more are the chances of a tumour being benign. Eighty per
cent of parotid, 50–60% of submandibular and only about 25% of other minor salivary gland
tumours are benign. In other words, chances of malignant tumours in minor salivary glands
are higher.

6. EPIDEMIOLOGY
Salivary gland tumours are rare in children, however the frequency of
malignancy is higher in children compared to adults. About 35% of all
salivary gland tumours in children are malignant; the most common malignant
neoplasms are mucoepidermoid carcinomas.
Salivary gland tumours account for only 3% of all tumours in the
body and it is estimated that about 1% of all head and neck
malignant neoplasms arise in the salivary glands

7. ETIOLOGY AND RISK
FACTORS
Viruses - EBV,
CMV, Polyoma
virus
Ionizing
radiation
Cigarette
smoking
Genetic
predisposition
Chemical carcinogens
Increased occupational risks-
asbestos, nickel compound or silica
dust

8. CLASSIFICATION OF SALIVARY GLAND TUMOR
Benign
Epithelial
• Pleomorphic adenoma
• Adenolymphoma (Warthin tumour)
• Oncocytoma
• Other adenomas
Mesenchymal
• Haemangioma
• Lymphangioma
• Lipoma
• Neuro
fi
broma
Malignant
Epithelial
• Mucoepidermoid carcinoma
• Adenoid cystic carcinoma (cylindroma)
• Acinic cell carcinoma
• Adenocarcinoma
• Malignant mixed tumour
• Squamous cell carcinoma
• Undifferentiated carcinoma
Mesenchymal
• Lymphoma
• Sarcoma

9. Both benign and malignant salivary gland masses show considerable
overlap with regard to imaging appearance such as tumour margins and
homogeneity. Malignancy is suggested if deep infiltration into the
parapharyngeal space, muscles or bone and perineural spread is present;
these findings are not observed in benign lesions.

10. Salivary gland tumours
BENIGN MALIGNANT
PAROTID 90% 10%
SUBMANDIBULAR 50% 50%
SUBLINGUAL 20% 80%
MINOR SALIVARY 10% 90%

11. CLINICAL FEATURES
BENIGN MALIGNANT
No pain Pain
Slow growing Fast growing
Soft, rubbery Hard
Smaller in size Larger in size
Facial nerve not involved
commonly
Facial nerve is commonly
involved
Ulceration not common Ulceration common
Local invasion
Spread to lymph nodes and
metastasis to lung, liver, brain
and bones are common

12. PLEOMORPHIC ADENOMAS
Benign neoplasm consisting of cells exhibiting the ability to differentiate to
epithelial(ductal and non ductal) cells and mesenchymal (chondroid, myxoid,
osseous) cells
Salivary gland tumour origin: EPITHELIAL
Also called MIXED TUMOR - contains both epithelial and mesenchymal elements.
It sends pseudopod like extension into surrounding tissue.
Malignant transformation is 10% if observed for more than 15 years.

13. Rule of 80’s
80% of parotid tumors are benign.
80% of parotid tumors are Pleomorphic adenomas.
80% of salivary gland Pleomorphic adenomas occur in the parotid
80% of parotid Pleomorphic adenomas occur in the super
fi
cial lobe.
80% of untreated Pleomorphic adenomas remain benign.

14. Most common tumour
Rate of occurrence :
- 60-70% parotid glands
- 40-60% submandibular glands
- 40-70% minor salivary glands
- rarely sublingual glands
CLINICAL FEATURES
Age: 30-50 years
More common in females>male (3:1-4:1)
Involves super
fi
cial lobe of parotid (usually)

15. CLINICAL PRESENTATION
Painless, slow growing,
fi
rm mass,
initially small in size and begins to
increase in size.
Initially movable but with continued growth become
more nodular and less movable.
Palate - intraorally common site.
Classical sign of parotid tumour - swelling +
elevation of ear lobule

17. DIAGNOSIS
FNAC
Extent of swelling - MRI & CT scan
MANAGEMENT
Surgical excision
Super
fi
cial parotidectomy with preservation of the facial nerve.
RECURRENCE RATE
High recurrence rate
Reason- The growing end of tumour have
fi
nger like projection.
During surgery if the
fi
nger like projection are left behind
RECURRENCE

18. WARTHIN TUMOR
Warthin's tumor, also known as papillary
cystadenoma lymphomatosum, is a benign cystic
tumor of the salivary glands containing abundant
lymphocytes and germinal centers

19. PAPILLARY
CYSTADENOMA
LYMPHOMATOUSUM

20. SYMPTOMS
Because Warthin tumour is a typically slow growing tumour, it can take a
bit of time before the symptoms are detected.
Most of symptoms are related to physical mass pushing up against other
anatomical structures
Eg: nerves which can cause problem like facial paralysis.
Most common symptom is a bump or swelling in front of or below the ear,
which is typically painless

21. CLINICAL FEATURES
- Warthin tumours occur bilaterally, 5% to 14% of cases
- bilateral tumours do not occur simultaneously but are metachronous.
- In rare instances, submandibular glands or minor salivary glands.
Age: 60-80 years
Lower in blacks than whites
Sex: male>female
Warthin tumours have been associated with smoking. This association with smoking
also may help explain the frequent bilaterality of the tumour because any
carcinogenic effects of smoking might be manifested in both parotid.

22. CLINICAL PRESENTATION
- appears as a slowly growing, painless, nodular
mass, of the parotid glands
-
fi
rm or
fl
uctuant to palpation.
- occurs in the tail of the parotid near the angle of
the mandible.

23. DIAGNOSIS
FNAC
Extent of swelling: MRI & CT scan
MANAGEMENT
Super
fi
cial parotidectomy or
extracapsular dissection
RECURRENCE RATE
Recurrences very rare

24. MUCOEPIDERMOID CARCINOMA
Mucoepidermoid carcinoma (MEC) of the salivary
gland is believed to arise from pluripotent reserve
cells of the excretory ducts that are capable of
differentiating into squamous, columnar, and mucous
cells.
It is the most frequently diagnosed malignancy of the
salivary gland. Among the major salivary glands, the
parotid gland is most commonly involved.

25. CLINICAL FEATURES
Age: 3rd- 5th decade
Sex: females>male
Site: Parotid is most commonly affected
Intraorally: palate
Most common salivary gland neoplasm in children

26. CLINICAL PRESENTATION
Low grade- slowly enlarging, painless mass,
rarely exceeds 5cm in diameter in low grade
- not completely encapsulated, often contain
cysts
fi
lled with viscoid, mucoid material
High grade- grows rapidly, facial nerve paralysis.
- ulceration, draining from the ear, dysphagia.
- Metastasis to regional lymph node, lung bone,
brain, subcutaneous tissue.

27. Blue pigmented mass of the
posterior lateral hard palate.
Mucoepidermoid carcinoma
of tongue

28. Surgical treatmen
t
Low-grade tumours of the parotid are treated by super-
fi
cial or total parotidectomy, depending on the location of
the tumour. Facial nerve is preserved
.
High-grade tumours being more aggressive are treated by
total parotidectomy. Facial nerve may be sacri
fi
ced if
invaded by the tumour.
DIAGNOSIS
FNAC
MRI & CT scan
MANAGEMENT

29. ADENOID CYSTIC CARCINOMA
Slow growing but aggressive malignant tumour with a remarkable
capacity of reoccurrence accounting for 10% of salivary gland tumours
AdCC occur both in minor salivary glands (50-60%) and major salivary
glands (parotid - common)
Adenoid Cystic Carcinoma is a tumor consisting of
epithelial and myoepithelial cells in variable morphological
con
fi
gurations, including cribriform, cystic and solid
patterns

30. CLINICAL FEATURES
Age: 5th- 7th decade
Sex: females>male
Site: 50-60% within minor salivary glands- palate>tongue>buccal mucosa
It also invades peri neural spaces and lymphatics and
thus causes pain and VIIth nerve paralysis.

31. CLINICAL PRESENTATION
- slow growing mass
- Pain is a common and important
fi
nding
- Patient often complain of a constant, low-grade, dull
ache, which gradually increases in intensity.
- Facial nerve paralysis may develop with parotid
tumours.
- Palatal tumours can be smooth or ulcerated surface
- Tumour arising in the palate may show radiographic
evidence of bone destruction

32. Adenoid Cystic Carcinoma of
hard palate

33. - surgical excision - radical parotidectomy
- Adjuvant radiation therapy which may
slightly improve patient survival in some
cases
- Poor prognosis
TREATMENT AND PROGNOSIS

34. Thank You