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Salivary gland neoplasms comprise approximately __% of all head and neck neoplasms



how many cases of salivary gland neoplasms are diagnosed each year? who is at the greatest risk?

A) Uncommon, but not rare, with 4,000 new cases diagnosed each year in U.S.

B) May be a slight female sex predilection

C) Vast majority of these lesions arise during adulthood


which salivary glands are most likely to be effected with neoplasms?

Parotid- 61-80%
Submandibular- 8-11%
Sublingual- less than 1%
Minor glands- 9-28%


what is the most common INTRAORAL site of involvement for salivary neoplasms?

Palate (50%)

- 20% are found on lips, 15% on buccal mucosa


Minor salivary gland neoplasms typically effect what intraoral site?



what salivary gland has the highest risk for malignant transformation of salivary neoplasms?

Sublingual gland


what is the prevalence of MALIGNANCY in salivary gland neoplasms in the parotid/sublingual/submandibular/minor glands?

A) parotid = 15-32%

B) submandibular = 26-45%

C) sublingual = 70-95%

D) minor = 45-50%


which intraoral sites are most likely to present with malignancies?

A) Retromolar- 90%
B) Tongue - 80%
C) Lower lip - 60%
D) Palate & Buccal mucosa - 45%
E) Upper lip - 15%


______________ are also known as “benign mixed tumor”

Pleomorphic Adenomas


T/F: Pleomorphic Adenomas are a relatively rare form of salivary neoplasms


- PA's are the most common salivary gland neoplasm


what does the naming of "pleomorphic adenomas" refer to?

the combination of neoplastic ductal epithelial and myoepithelial cells that often show a variety of histologic patterns


___% of all Pleomorphic Adenomas are found in the parotid gland

PA's account for ___% of all parotid tumors

80% of all PA's are in the parotid

PA's make up 63% of all parotid tumors


___% of Pleomorphic Adenomas are found in the submandibular gland

PA's account for ___% of all submandibular tumors

10% - submandibular (60% of all submandibular tumors)


___% of Pleomorphic Adenomas are found intraorally

PA's account for ___% of all intraoral salivary gland tumors

10% - intraoral (40% of all intraoral salivary gland tumors)


what is the clinical presentation of a salivary gland Pleomorphic adenoma?

In the major glands, a slow-growing, painless, freely moveable mass will be detected

Rubbery firm on palpation


in what location of the mouth would you NOT expect a pleomorphic adenoma to be mobile?

Posterior Hard Palate


T/F: PA's are typically non-ulcerated, and are NOT bilateral in presentation


A) Palatal lesions are usually to one side of the midline
B) Usually non-ulcerated, but ulceration may be present secondary to trauma


When a Pleomorphic Adenoma lesion is small, it's usually round, but it typically becomes ___________ as it grows larger



intraorally, where are pleomorphic adenomas most likely to be found?

palate is most frequent (54%), followed by upper lip (22%) and buccal mucosa (15%)


T/F: For Pleomorphic Adenomas, the encapsulated proliferation of ductal epithelial cells and myoepithelial cells vary in proportions from lesion to lesion



what are the histological features of Pleomorphic Adenomas?

1) The myoepithelial cells may appear spindled or plasmacytoid

2) myoepithelial cells have the ability to produce a myxoid stroma, hyaline material, cartilaginous material or even osteoid


what is the treatment protocol for Pleomorphic Adenomas?

Tx: Depends on location:
1) Parotid - remove the lesion with the involved lobe
2) Submandibular - remove the lesion and the involved gland
3) Hard palate - remove the lesion, including overlying oral mucosa, down to periosteum
4) Soft palate, labial and buccal mucosa - enucleation


a pleomorphic adenoma in what location has the highest rate of reoccurance?

what is the risk for malignancy in PA's?

A) reoccurance = parotid gland

B) 5% of PA's will undergo malignant transformation


Papillary Cystadenoma Lymphomatosums are also known as "_____________"

Warthins tumors


what is the histogenesis of Warthins tumors (PCL)?

Probably arises from salivary duct epithelium entrapped in parotid lymph nodes during development


Prevalence of Warthins tumors (PCL):

Comprises 5% of all salivary gland neoplasms and 5-22% of parotid gland neoplasms


Papillary Cystadenoma Lymphomatosums are almost always found in what location?

- Found almost exclusively in parotid gland


Risk factors for Papillary Cystadenoma Lymphomatosum (Warthins tumor):

- More common in MALES
- May be caused by cigarette smoking
- Average age is 55-60 years


Clinical presentation of Warthins tumors (PCL):

(Papillary Cystadenoma Lymphomatosum)

A) Presents as a non-tender, slowly growing freely moveable mass of the parotid region

B) In 10% of cases, synchronous or (mostly) metachronous lesions are observed, may be bilateral or unilateral

C) Grossly, encapsulated with cystic spaces containing serous, milky or chocolate-syrup-like fluid


Histology of PCL's (warthins tumors)

(Papillary Cystadenoma Lymphomatosum )

- Encapsulated collection of lymphoid tissue that usually exhibits typical germinal center formation

- Contained within this tissue are dilated cystic spaces into which project papillary infoldings that are lined by a double row of columnar to cuboidal oncocytes (altered ductal epithelial cells)