L10: Salivary Gland Neoplasm

Question 1

Incidenece of Salivary Neoplasm

Answer 1

• Around 1.2% of all neoplasms of the body & 5% of head and neck tumors.
• 85% are benign & 15 % are malignant.

Question 2

What age group is affected by salivary neoplasm?

Answer 2

• Benign usually appear after the age of 40 y,
• Malignant after the age of 60y.
• Salivary tumors are rare in children, and mostly are malignant.

Question 3

Site of Salivary Neoplasm

Answer 3

• 80% arise in the parotid glands.
• 10-15% arise in the submandibular glands.
• Remainder arises in the sublingual and minor salivary glands

Question 4

Percentage of Benign & Malignant Tumors in salivary galnds

Answer 4

Question 5

Origin of Salivary Neoplasm

Answer 5

These tumors may arise from the secretory tissue, the duct system, or from the stromal tissue (mainly lymphoid tissue).

Question 6

Types of Salivary Neoplasm

Answer 6

Question 7

Etiology of Salivary Neoplasm

Answer 7

Question 8

Incidence of Pleomorphic adenoma

Answer 8

• Represent 75% of parotid and 50% of submandibular gland neoplasms.
• Males = females.

Question 9

Origin of Pleomorphic adenoma

Answer 9

Arises from epithelial, myoepithelial, and stromal components.

Question 10

Pathology of Pleomorphic adenoma

Answer 10

• Exhibit wide variations in cellular and architectural morphology.
• The capsule may be incomplete with the extension of tumor tissue into the surroundings.

Question 11

Complications of Pleomorphic adenoma

Answer 11

• It grows slowly without infiltration of the facial nerve.
• Long-standing (more than 10 years) pleomorphic adenoma rarely turns malignant.

Question 12

Why is Pleomorphic adenoma Called by this name?

Answer 12

Question 13

what is another name of Adenolymphoma (Warthin’s tumor)?

Answer 13

Warthin’s tumor (benign papillary cystadenoma lymphomatosum)

Question 14

Incidence & Side of Adenolymphoma (Warthin’s tumor)

Answer 14

• The second most common benign tumor of the parotid gland.
• It accounts for 2-10% of all parotid gland tumors.
• Bilateral in 10% of the cases.

Question 15

Origin of Adenolymphoma (Warthin’s tumor)

Answer 15

Arises from epithelial, myoepithelial, and stromal components.

Question 16

Pathology of Adenolymphoma (Warthin’s tumor)

Answer 16

• Epithelial Component
• Lymphoid Component
• Both lymphoid and oncolytic epithelial elements must be present to diagnose Warthin’s.

Question 17

Investigations for Adenolymphoma (Warthin’s tumor)

Answer 17

Question 18

Epithelial Comonent of Adenolymphoma (Warthin’s tumor)

Answer 18

Question 19

Lymphoid Component of Adenolymphoma (Warthin’s tumor)

Answer 19

Question 20

what are types of Benign Salivary Neoplasm?

Answer 20

• pleomorphic adenoma
• Warthin’s tumor

Question 21

What are types of malignant salivary Neoplasm?

Answer 21

• Mucoepidermoid carcinoma
• Adenoid cystic carcinoma

Question 22

Incidence of Mucoepidermoid carcinoma

Answer 22

The commonest malignant salivary tumor → usually affects the parotid.

Question 23

Origin of Mucoepidermoid carcinoma

Answer 23

Arises from the ductal epithelium.

Question 24

Grades of Mucoepidermoid carcinoma

Answer 24

Three grades are → low, intermediate, and high-grade tumors.

Question 25

Characters of Low Grade Mucoepidermoid carcinoma

Answer 25

Question 26

Incidence of **Adenoid cystic carcinoma**

Answer 26

The commonest malignancy affecting the minor salivary glands.

Question 27

Origin of **Adenoid cystic carcinoma**

Answer 27

Arises from ductal and myoepithelial cells.

Question 28

Pathology & Growth of **Adenoid cystic carcinoma**

Answer 28

- It has a slow rate of growth. - It may grow in different patterns: tubular, cribriform, and/or solid.

Question 28

Complications of **Adenoid cystic carcinoma**

Answer 28

- Great tendency for perineural invasion, thus it usually invades the facial nerve. - It has a high frequency of local and distant recurrence and poor long- term prognosis.

Question 29

Characters of **Adenoid cystic carcinoma**

Answer 29

Question 30

Type of Patient of **Benign Neoplasm**

Answer 30

Male = female & age around 40yr

Question 31

Characters of Benign Neoplasm

Answer 31

Slowly growing, Painless swelling.

Question 31

Signs of **Benign Neoplasm**

Answer 31

Question 32

Type of Patient in Malignant Neoplasm

Question 33

Characters of **Malignant Neoplasm**

Answer 33

Question 34

Signs of **Malignant Neoplasm**

Answer 34

Question 35

DDx of Salivary Neoplasm

Answer 35

Question 36

Spread of **Salivary Neoplasm**

Answer 36

Question 37

Complications of **Salivary Neoplasm**

Answer 37

Question 38

Prognosis of **Salivary Neoplasm**

Answer 38

Question 39

Investigations for **Salivary Neoplasm**

Answer 39

Question 40

Low growing parotid tumors should not be subjected to biopsy for 2 reasons:

Answer 40

1) Injury to the facial nerve. 2) Seeding of tumor cells in the subcutaneous plane which causes recurrence in about 40-50% of cases.

Question 41

FNAC **Investigtions of Salivary Neoplasm**

Answer 41

- It is done to confirm the diagnosis and rule out malignancy. - FNAC of the LNs that are palpable in the neck in malignancy cases of the parotid gland.

Question 42

Radiological **Investigtions of Salivary Neoplasm**

Answer 42

- CT - MRI - X-Ray

Question 43

Indication of CT Scan **Investigtions of Salivary Neoplasm**

Answer 43

Done for tumor arising from the deep lobe. It helps to: 1) Define the extraglandular spread, 2) The extent of parapharyngeal disease, 3) Cervical lymph nodes and bony infiltration.

Question 44

MRI **Investigtions of Salivary Neoplasm**

Answer 44

- MRI is a better investigation. However, it is expensive, - CT scan and MRI lack specificity for differentiating between benign and malignant lesion.

Question 45

X-Ray **Investigtions of Salivary Neoplasm**

Answer 45

X-ray of the bones (mandible and mastoid process) to look for bony resorption if malignancy is suspected.

Question 46

Radioactive Isotope scan **Investigtions of Salivary Neoplasm**

Answer 46

Question 63

General Considerations in TTT of salivary neoplasm

Question 64

Superficial Conservative Parotidectomy **TTT of Salivary Neoplasm**

Question 65

Simple enuculation **TTT of Salivary Neoplasm**

Question 66

Total Conservative Parotidectomy **TTT of Salivary Neoplasm**

Question 67

TTT of Facial Nerve Injury **TTT of Salivary Neoplasm**

Question 68

Operation of choice in Benign tumors of the submandibular

Question 69

Procedure in Benign tumors of the submandibular

Question 70

Cautions during TTT in Benign tumors of the submandibular

Question 71

Confirmation of Diagnosis in malignant neoplasm

Question 72

Examples of **Low grade salivary tumors**

Question 73

Procedure of **Low grade salivary tumors**

Question 74

Operation in Low grade salivary tumors in case of parotid gland

Question 75

TTT in case of High grade tumors in case of parotid gland

Question 76

How to deal with LNs in salivary tumors?

Question 77

Managment of inoperable salivary gland cases

Question 78

complications of parotidectomy

Question 79

Cause of **Frey's syndrome**

Question 80

Incidence of **Frey's syndrome**

Question 81

Symptoms of **Frey's syndrome**

Question 82

pathophysiology of **Frey's syndrome**

Question 83

TTT of **Frey's syndrome**

Question 84

Identification of facial nerve

Question 85

Comparison between pleomorphic adenoma and adenolymphoma

Question 86

Comparison between submandibular and parotid tumors

Question 87

The commonest malignancy in adult

Question 88

The commonest malignancy in Children

Question 89

The commonest malignancy in parotid

Question 90

The commonest malignancy in submandibular

Question 91

Differential diagnosis of swelling in parotid region

Question 92

Differential diagnosis of swelling in sabmandibular region

Question 93

Done