Benign salivary gland tumor part 1 / dental crown & bridge courses

Benign tumors of
Salivary Gland Tumors
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

OBJECTIVES
• At the end of the lecture student should be able to understand
the:
 Histological classification of salivary gland tumors.
 Etiology, clinical features, histopathological features of:
• Pleomorphic adenoma
• Basal cell adenoma

Histological Classification of Salivary Gland Tumors
1) Adenomas
a. Pleomorphic Adenoma
b. Myoepithelioma
c. Basal cell Adenoma
d. Warthin’s Tumor (Adenolymphoma)
e. Oncocytoma (Oncocytic Adenoma)
f. Canalicular Adenoma
g. Sebaceous Adenoma

h. Ductal Papilloma :
a. Inverted Ductal Papilloma
b. Intraductal Papilloma
c. Sialadenoma Papilleferum
i. Cystadenoma
a. Papillary cystadenoma
b. Mucinous Cystadenoma

2) Carcinomas
a. Acinic cell carcinoma
b. Mucoepidermoid carcinoma
c. Adenoid cystic carcinoma
d. Polymorphous low grade adenocarcinoma
(Terminal duct Adenocarcinoma)
e. Epithelial myoepithelial carcinoma

f. Basal cell adenocarcinoma
g. Sebaceous carcinoma
h. Papillary Cystadenocarcinoma
i. Mucinous Cystadenocarcinoma
j. Oncocytic Carcinoma
k. Salivary duct Carcinoma
l. Adenocarcinoma

m. Malignant myoepithelioma (Myoepithelial carcinoma)
n. Carcinoma in pleomorphic adenoma ( Malignant mixed
tumor)
o. Squamous cell carcinoma
p. Small cell carcinoma
q. Undifferentiated carcinoma
r. Other carcinomas

3) Non Epithelial Tumors
4) Malignant Lymphomas
5) Secondary Tumors
6) Unclassified Tumors
7) Tumor Like Lesions:
a. Sialadenosis
b. Oncocytosis
c. Necrotizing Sialometaplasia (Salivary gland infarction)
d. Benign Lymphoepithelial tumors
e. Salivary Gland cyst
f. Chronic sclerosing sialadenitis of submandibular gland (Kuttner tumor)
g. Cystic Lymphoid hyperplasia in AIDS

Pleomorphic Adenoma (Benign Mixed Tumor)
 Most common
 53-77% - Parotid gland
 44- 68% - Submandibular gland
 38- 43% - Minor glands
 Derived from a mixture of ductal and myoepithelial elements

 That is reserve cells in intercalated duct
 Intercalated duct reserve cell differentiate into ductal and
myoepithelial cell
 Myoepithelial cell can undergo mesenchymal metaplasia and
gives rise to morphologic diversity of this tumor
 Not truly a mixed neoplasm

• Clinical Features
 Parotid gland is most common site
 4th to 6th decade female predilection i.e. 6:4
 Also common in young adults, children.
 Small, painless quiescent nodule
 Slowly grow and increase in size
 Sometimes show intermittent growth

 Do not show fixation to deeper tissue or the overlying skin
 It is an irregular nodular lesion that is firm in consistency.
 Areas of cystic degeneration may be palpated if superficial.
 Skin seldom ulcerates.
 Pain is not a common symptom.
 Local discomfort is frequently present

 Most pleomorphic adenomas of parotid gland occur in the
superficial lobe
 It present as a swelling overlying the mandibular ramus in
front of ear
 Facial palsy in rare
 Tumor initially is mobile, but becomes less mobile as it grows
larger

• Intraoral Tumors
 < 1- 2 cm in diameter
 Palate is the most common site for minor gland followed by
upper lip and buccal mucosa
 Causes difficulty in mastication, talking a breathing
 Palatal Tumors – on posterior lateral aspect
 Present as smooth surfaced, dome shaped mass
 If traumatized – ulcerates
 Appear fixed to underlying bone but is noninvasive

• Histopathology
 Well circumscribed encapsulated tumor
 Capsule may be incomplete/ show infiltration
 Commonly seen in minor gland tumors tumor is composed of
mixture of glandular epithelium and myoepithelial cells in
mesenchyme like background

 The epithelium after forms ducts and cystic structures or may
from islands or sheets of cell.
 Keratinizing sq. cells i.e. mucous producing cells can also be
seen.
 Myoepithelial Cells – Present in large number
 Have variable morphology – angular/ Spindle

 Some are rounded ; eccentric nucleus and hyalinized
eosinophilic cytoplasm; resembling plasma cell.
 Characteristically; plasmacytoid appearance of myoepithelial
cell is seen in minor gland tumors.
 Stromal change is produced by the myoepithelial cells.
 Collection of mucoid material in tumor cells result in
myxomatous background

 Vacuolar degeneration of cells produce chondroid appearance.
 At places eosinophilic hyalinized change
 At times, fibrous, fat or osteoid is seen
 Presence of entirely myoepithelial cell as myoepitheliomas

Benign Salivary Gland Tumors

• Treatment
 Surgical Excision
 In Parotid – The tumor and involved lobe of the gland is
removed.
 Submax gland tumors are treated by removal of gland and
tumor in continuity
 Intraoral – by extracapsular excision
 Palatal tumor- excised overlying mucosa
 Lining mucosa enucleation/ extracapsular excision

• Monomorphic Adenoma
Benign salivary gland tumor showing a more uniform
histopathologic pattern
• Basal cell Adenoma
Basal cell Adenoma is a benign salivary tumor that is
composed of basaloid appearance of the tumor cells.
Uncommon neoplasm 1-2% of all salivary tumors
First reported by Kleinasser and Klein in 1967
Batsakis reported intercalated duct/ reserve cell is the
histogenetic source. www.indiandentalacademy.com

• Clinical Features
Primarily in major salivary gland particularly the parotid
gland.
Painless, slow growth, freely movable
5:1 male predilection
<3cm in diameter
Usually located within the superficial lobe of parotid
gland.

• Histopathology
Well defined C.T. capsule
Multiple island and cords of epithelial cells
Cells are isomorphic and basaloid in appearance
Nuclei are basophilic round to oval
Cytoplasm is scanty and ill-defined

Histopathology
Well defined C.T. capsule
Multiple island and cords of
epithelial cells
Cells are isomorphic and
basaloid in appearance
Nuclei are basophilic round
to oval
Cytoplasm is scanty and ill-
defined

Peripheral cells are
hyperchromatic and
palisaded
Scanty stroma present
between the nests of
tumor cells.
Electron microscopy
show that the cells bear
similarity with secretory
cells of the intercalated
duct.

According to morphologic appearances four
subtypes
Solid
Tubular
Trabecular
Membranous

MembranousTrabecular

Peripheral cells are hyperchromatic and palisaded
Scanty stroma present between the nests of tumor cells.
Electron microscopy show that the cells bear similarity with
secretory cells of the intercalated duct.
• Treatment and Prognosis
 Excision
 Recurrence is rare

SUMMARY
At the end of lecture student should know:
 Histological classification of salivary gland tumors.
 Etiology, clinical features, histopathological features of:
• Pleomorphic adenoma
• Basal cell adenoma

Benign salivary gland tumor part 1 / dental crown & bridge courses

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