Malignant salivary gland tumors i/ dental courses

Malignant Salivary Glands
Tumors-I
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

LEARNING OBJECTIVES
At the end of the lecture student be able to
•Describe etiology, clinical features,
histopathological features of
• Adenoid cystic carcinoma
• Mucoepidermoid carcinoma

Adenoid Cystic Carcinoma
(Cylindroma)
Histologically similar lesions occur in the
intraoral accessory salivary glands, lacrimal
glands, paranasal sinuses, pharynx, trachea,
skin an breast.
Malignant Salivary Gland Tumors

Palate is most common site
Also found in parotid & submadibular gland.
Mostly in middle aged adults- 5th and 6th
decade.
Equal sex predilection (slight female
predilection)
Clinical Features

Pain is a common & imp.
finding
Constant low-grade dull
ache
Facial nerve paralysis in
parotid tumors.
Fixation to deeper structure
and local invasion.
Palatal tumors- smooth
surfaced and ulcerated

Composed of myoepithelial cells and ductal
cells,showing varied arrangement
Morphologically arranged in 3 major pattern
1) Cribriform
2) Tubular
3) Solid
Histopathology

Cribriform
Most classic & best
recognized.
Islands of basaloid
epithelial cells contain
multiple cylindric,
cystlike spaces
resembling Swiss
cheese or honey
comb pattern

Spaces often contain
mildly basophilic mucoid
material,a hyalinized
eosinophilic material,or
a combination i.e.
mucoid hyalinized
appearance.
Characteristic-stromal
connective tissue
becomes hyalinized and
surrounds the tumor
cells. This form
(cribriform pattern) the
cylindrical pattern…
derived the name
Cylindroma.
Mucoid material

Sometimes tumor islands are embedded in this
hyalinized stroma.
Tumor cells are small & cuboidal = deep
basophilic nucleus & little cytoplasm.
Cells are uniform.
Mitotic activity is rare.

Tubular Pattern
Tumor cells are similar.
Arranged in multiple small ducts / tubules in a
hyalinized stroma.
Tubular lumina may be lined by one to several
layers of cells.
Sometimes both ductal cells & myoepithelial
cells can present in layers.

Solid Variant
Larger islands of
sheets of tumor cells.
Little tendency towards
duct / cyst formation.
Cellular pleomorphism
and mitotic activity;
focal necrosis in the
center of tumor island
is present.
Uncommon in
cribriform and tubular
pattern.
Cellular pleomorphism

Perineural invasion
Swirling arrangement
around nerve bundles.
Responsible for pain.
Malignant cells
Nerve tissue

Treatment
Surgical excision & radiotherapy.
Prognosis
Site of occurrence & histologic pattern of the
tumor.
Solid variant have poorer prognosis than
cribriform and tubular.

Mucoepidermoid Carcinoma
One of the most common salivary gland
malignancies.
Composed of both mucous secreting cells and
epidermoid type cells in varying proportions.

Clinical Features
E/O in parotid gland.
I/O accessory glands may also be involved
(Palate)
Wide age ranged: 2nd to 7th decade of life.
Common salivary gland malignancy in children.
Slight female predilection.

Some gives H/O previous radiotherapy to head
and neck.
Pain/ facial nerve palsy may develop usually
with high grade tumors.
Slowly enlarging, painless mass simulate
pleomorphic adenoma , but seldom exceed 5cm
in diameter.

Often contain cysts, filled with a viscid, mucoid
material
High grade malignancy grows rapidly and may
produce pain as early symptom.
Facial paralysis present in parotid tumors.

Mucoepidermoid carcinoma is not encapsulated
Infiltrate to surrounding tissue.
Metastasis to regional lymph nodes.
Distant metastasis to lung, bone, brain and
subcutaneous tissue is common.

Histopathology
Composed of
Mucus- secreting cells
Epidermoid type cells
Intermediate cells

Mucous cells
Mucous cells vary in
shape contains
abundant foamy
cytoplasm, that stain
+ve for mucin.
Mucous cells

Intermediate cells
Intermediate cells are basaloid and are larger
than basal cells & smaller than squamoid cells.
Believed to be progenitor cell for mucous and
epidermoid cells.

Epidermoid cells
Epidermoid cells are
characterized by
squamoid feature.
Polygonal in shape,
show intercellular
bridges & rarely
keratinization.
• Epidermoid cells

Clear cells
Some tumors show
clear cells in
abundance.
These clear cells are
mucin and glycogen
free.
Clear cells

Histopathologic grades based on
Amount of cyst formation
Degree of cytologic atypia
Relative no. of mucous, epidermoid ,&
intermediate cells
HISTOPATHOLOGICAL GRADES
Low grade
Intermediate grade
High grade

Low grade
In low grade tumor all
3 types of cells are
present.
Mucus secreting cells
predominate.
Well formed glandular
structures.
Prominent cyst
formation.
Minimal cellular atypia.
Mucoid material

Intermediate grade
Solid areas.
All 3 types of cells are
present.
Intermediate cells
predominate.
Cyst formation is less
prominant
Intermediate cells

High grade
Solid islands of
intermediate &
epidermoid cells.
Prominent nuclear
pleomorphism &
mitotic activity.
Cyst formation is very
less.
Surgical excision followed by radiotherapy
TREATMENT

SUMMARY
Etiology, clinical features, histopathological
features
Adenoid cystic carcinoma
Mucoepidermoid carcinoma

BIBLIOGRAPHY
• Text book of oral pathology Shafer's, 5 & 6th
edition
• Surgical Pathology of Salivary Glands Ellis 1st
Edition
• Color Atlas of Oral Diseases Cawson, R. 2nd
edition
• Oral and Maxillofacial Pathology Neville, Brad W.
2nd
• Lucas’s Pathology Of Tumor’s of the Oral Tissues
• Cawson, R. A., Bennie, W. H 5th edition

Malignant salivary gland tumors i/ dental courses

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