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Benign tumours of salivary glands


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Benign tumours of salivary glands

  2. 2. PLEOMORPHIC ADENOMA • Most common benign salivary neoplasm consisting of cells exhibiting the ability to differentiate epithelial cells (ductal and nonductal cells) mesenchyme-like cells (chondroid, myxoid or osseous) • This results in different histopathologic patterns in the tumours. Hence the name pleo- (meaning many) morphic (meaning shape, form )
  3. 3. ETIOLOGY • 60% of all salivary gland tumours • 85% of these are found in the parotid gland, 8% in submandibular gland and the remaining in sublingual and minor salivary glands • Histogenesis – Numerous theories have been advanced. Current theory- based on myoepithelial and reverse cells of the intercalated ducts.
  4. 4. CLINICAL FEATURES • Age- 30 to 50 years • Gender- slight female predilection • Location –superficial lobe of parotid > submandiblar gland> palate • Signs and symptoms It is a slow growing and painless mass Rarely ulcerates the overlying skin In parotid gland, the tumour grows in posterior and inferior aspect of superficial lobe measuring a few cms. In the submandibular gland, it is a well defined palpable mass.
  5. 5. CLINICAL FEATURES • When occuring in the parotid, the ear lobe of the affected side might elevate. • When observed in-situ, it is encased in pseudocapsule and exhibits a lobulated surface. • The palatal tumours are smooth-surfaced and dome shaped masses.
  6. 6. Typical appearance of pleomorphic adenoma Removal of palatal tumour
  7. 7. PATHOLOGY • Gross appearance Firm, smooth mass within a pseudocapsule • Histological appearance Has both epithelial and mesenchymal cells Stroma consists of chondroid, myxoid, osseous and fibroid cells There is presence of microscopic projections which are necessary to remove, or they become the cause for recurrence.
  8. 8. Neoplastic cells are seen arranged in ductal patterns, sheets and islands. Stroma is delicately collagenous with myxoid areas. Few cells show vacoular degenartion
  9. 9. Neoplastic cells are seen arranged in ductal patterns, sheets and islands. Stroma is delicately collagenous with myxoid areas. Few cells show vacoular degenartion
  10. 10. DIFFERENTIAL DIAGNOSIS AND TREATMENT • DIFFERENTIAL DIAGNOSIS Adenolymphoma Oncocytoma Adenocarcinoma Warthin’s tumour • TREATMENT Surgical removal of the tumour including adequate margin Superficial parotidectomy, if the tumour is affecting the parotid gland Removal of the entire submandibular gland may be required if the submandibuar gland is affected
  11. 11. PAPILLARY CYSTADENOMA LYMPHOMATOSUM • Also known as Warthin’s tumour. • Second most common benign tumour seen in the parotid gland • It is characterized by proliferation of both luminal and non-luminal cells.
  12. 12. CLINICAL FEATURES • Age- 60 to 70 years • Gender- slight male predilection • Location- parotid most commonly affected, inferior and posterior to the angle of mandible • Signs and symptoms- It is a slow growing, painless nodular mass It is firm in consistency or fluctuant It can occur as a bilateral lesion (unique feature) It is metachronous i.e appearing at different times, not simultaneously. Oncocytes take up technetium and is visible on Tc 99m scintiscans.
  14. 14. PATHOLOGY • Gross appearance- Tumour is smooth and has a well defined capsule. Cut specimen shows cystic spaces filled with thick mucinous material. • Histological appearance- Cyst formation with papillary projections in the cystic spaces. Inner luminal cells are tall, columnar and eoisnophilic with palisaded nuclei. Outer luminal cells are cuboidal or polygonal. There is characteristic lymphocytic infililtration.
  15. 15. DIFFERENTIAL DIAGNOSIS AND TREATMENT • DIFFERENTIAL DIAGNOSIS Pleomorphic adenoma Oncocytoma Parotid lymph node enlargement • TREATMENT Surgical excision involving a margin of normal tissue In cases where a significant amount of superficial lobe is affected, superficial parotidectomy is done. Recurrence and malignant changes are rare
  16. 16. ONCOCYTOMA • Less common benign tumour (<1%) • The name is derived from presence of oncocytes. • These cells resemble the apparently normal cells. • Oncocytic cells are considered as somatic mutants rather than new specific cell lineage. • Oncocytic transformation of epithelial cells is not degenerative but rather a redifferentiation of epithelial cells which develope an increased but unbalanced metabolism.
  17. 17. CLINICAL FEATURES • Age- 50 to 80 years • Gender- female predilection • Location- parotid gland most commonly affected • Signs and symptoms- Discrete, encapsulated, slow growing mass 3-5cm in diameter Painless and firm Diffuse multinodular oncocytoma appears when many nodular masses involve the entire gland Can occur bilaterally Rarely seen intraorally
  18. 18. Oncocytoma, clinical appearance
  19. 19. PATHOLOGY • Gross appearance- Non cystic and firm • Histology- Brown, granular eosinophilic cells with central nuclei and arranged in sheets, nests or cord. Oncocytes concentrate technetium and can be visualized by Tc 99m scintigraphy Malignant oncocytomas can occur and are aggressive.
  20. 20. DIFFERENTIAL DIAGNOSIS AND TREATMENT • DIFFERENTIAL DIAGNOSIS Pleomorphic adenoma Warthins tumour Parotid lymphnode enlargement • TREATMENT Superficial parotidectomy with preservation of the facial nerve, in parotid gland Removal of the gland, in submandibular gland Gland removal with a normal cuff of tissue is the treatment of choice for oncocytomas of minor salivary glands
  21. 21. BASAL CELL ADENOMA • It is an uncommon salivary gland tumour, histopathologically composed of basaloid (resembling basal cells), epithelial cells arranged in solid, trabecular, tubular or membranous patterns. • Hence the name basal cell adenoma • It arises from the neoplastic transformation of reserve cells in intercalated ducts and shows differentiation of both epithelial and myoepithelial elements
  22. 22. CLINICAL FEATURES • Age- 50 to 70 years • Gender- female predilection • Location- 70% in parotid, upper lip (minor salivary gland) • Signs and symptoms- Slow growing, freely movable Painless Less than 3cm in diameter
  24. 24. PATHOLOGY • It is well-encapsulated tumour in major salivary glands whereas in minor salivary glands, the capsule will be ill-defined • Three varieties exist- 1.Solid- islands or sheets of basaloid cells. Normal sized- nuclei and basophilic with minimal cytoplasm. 2.Trabecular-tubular form- cord of epithelium 3.Membranous form- multilocular and 50% cases are encapsulated. It grows in clusters interspersed with normal salivary gland tissue.
  25. 25. DIFFERENTIAL DIAGNOSIS AND TREATMENT • DIFFERENTIAL DIAGNOSIS Canalicular adenoma Sebaceous adenoma Clear cell adenoma • TREATMENT Conservative surgical excision extending to normal tissue. Low recurrence rate, except membranous form maybe.
  26. 26. CANALICULAR ADENOMA • Uncommon neoplasm composed of epithelial cells arranged in a single or double layer forming branching cords in a loose stroma • CLINICAL FEATURES Age- older than 50 years Gender- female predilection Location- 80% cases in the upper lip Symptoms and signs- slow growing, movable and asymptomatic. Well-circumscribed and painless.
  27. 27. HISTOLOGY • Long columns or cords of cuboidal columnar cells in a single layer • These layers are parallel, form long canals • Sometimes, row of cells are loosely approximated and appear as a double row of cells • The supporting stroma is loose, fibrillar and highly vascular. • The cystic spaces are filled with eosinoplhilic material.
  28. 28. MYOEPITHELIOMA • Uncommon salivary gland tumour (<1%) • Occurs in the parotid gland and in minor salivary glands of the palate. • No gender predilection. • Average age group affected is in the sixth decade of life. • Clinically, it is a well-circumscribed, asymptomatic, slow-growing mass.
  29. 29. PATHOLOGY • Consists of spindle-shaped, plasmacytoid cells, or a combination of the two • Diagnosis is based on identification of myoepithelial cells and must be differentiated from other benign and malignant epithelial and mesenchymal tumours for treatment planning. • Growth patterns vary from solid to a loose stroma formation with myoepithelial cells. • This tumour is epithelial in origin however, it functionally resembles smooth muscle and is demonstrated by immunohistochemical staining for actin cytokeratin and S-100 protein.
  30. 30. TREATMENT • Standard surgical excision, including a border of normal tissue, is recommended. • Recurrence is uncommon.
  31. 31. SEBACEOUS ADENOMA • A rare benign tumour derived from sebaceous glands located within salivary gland tissue • Parotid gland is most commonly involved • Age group affected – 22 to 90 years, mean age at initial clinical presentation is 58 years. • The tumour is more common in men. • CLINICAL PRESENTATION Encapsulated or sharply circumscribed tumour that varies in color from grayish white to pinkish white to yellow or yellowish grey.
  32. 32. PATHOLOGHY AND TREATMENT • PATHOLOGY • These are composed of sebaceous cell nests with minimal atypia and pleomorphism and no tendency to invade • Sebaceous glands vary in size and are usually embedded in a fibrous stroma. • TREATMENT Conservative excision. No recurrences.
  33. 33. DUCTAL PAPILLOMA • They include three rare benign salivary gland neoplasms which exhibit papillary projections i.e. showing surface projections, histologically. • The unique features of this tumour are- 1.Papillar projections 2.All three tumours arise from the excretory duct 3.Commonly affects the minor salivary gland • Three benign tumours include- 1.Intraductal papilloma 2.Sialadenoma papilliferum 3.Inverted ductal papilloma
  34. 34. SIALADENOMA PAPILLOMA • CLINICAL FEATURES Age- 30 to 70 years Male predilection Most commonly seen on palate and buccal mucosa minor glands. Well-circumscribed, painless, papillary exophytic growth • HISTOLOGY Epithelium lined papillary projections supported by fibrovascular connective tissue, forming a series of clefts within the lesion
  35. 35. INVERTED DUCTAL PAPILLOMA • CLINICAL FEATURES Age- 30 to 60 years. Male predilection Buccal mucosa, lower lip and vestibule of lower jaw. Asymptomatic, firm, submucosal nodule <1.5cm Occurs near the orifice of salivary gland ducts. • HISTOLOGY • Resembles sialadenoma • Consists of projections of ductal epithelium that proliferate to surrounding tissues, forming clefts.
  36. 36. TREATMENT • Surgical excision • Recurrence is rare.

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