Salivary neoplasms Flashcards
(39 cards)
Which salivary gland is more prone to development of benign neoplasms?
Parotid gland 80% are benign
Submandibular 50% are benign
Minor glands 10% are benign
Which salivary glands have the highest malignancy rate?
minor salivary glands
What is the classification of salivary neoplasms?
PRIMARY
- > epithelial
- > non-epithelial
- > lymphoepithelial
- > lymphoma
SECONDARY
What is the sub-classification of epithelial salivary neoplasms?
BENIGN (adenoma)
- pleomorphic (most common)
- Wathin’s (monomorphic): papillary cystadenolymphomatosum
- Oxyphil: oncocytoma
MALIGNANT (adenocarcinoma)
- mucoepidermoid
- acinic cell
- adenoid cystic
- squamous cell carcinoma
- carcinoma ex pleomorphic adenoma
- undifferentiated
What are the types of non-epithelial salivary neoplasms?
- hemangioma: most common benign tumor in pediatrics
- lymphangioma
- neurofibroma
Which benign salivary neoplasm occurs mainly in the parotids, & in common with HIV & Sjogren?
Lymphoma (NON-HODGKIN)
Which benign salivary neoplasm occurs mainly in the parotids, & in common with HIV & Sjogren?
Lymphoma (NON-HODGKIN)
What are the types of lymphoepithelial salivary neoplasms?
- Godwin’s tumor: benign & bilateral
- Eskimoma: malignant & rare (affects submandibular)
What are the types of lymphoepithelial salivary neoplasms?
- Godwin’s tumor: benign & bilateral
- Eskimoma: malignant & rare (affects submandibular)
How is a pleomorphic adenoma described grossly & histologically?
GROSS
- lobulated encapsulated
- contains cartilages, cystic spaces, & solid tissues
HISTOLOGICALLY
- epithelial cell, myoepithelial cells, stromal cells
- mucoid material with myxomatous changes
What are the clinical features of a pleomorphic adenoma?
- unilateral single painless smooth firm lobulated
- mobile swelling in front of the parotid with positive CURTAIN SIGN (can never move above zygomatic arch)
- ear lobule is lifted
- facial nerve in not involved
What are the features of malignant transformation?
- recent increase in size
- pain & nodularity
- involvement of skin & ulceration
- involvement of masseter
- involvement of facial nerve
- hard fixed immobile neck lymph nodes
What are the important investigations that should be done to diagnose a pleomorphic neoplasm?
- sonography: initially
- FNAC: diagnostic
- CT & MRI: status of deep lobe, local extension & spread
How should a salivary pleomorphic neoplasm be treated?
- if only superficial lobe: conservative superficial parotidectomy
- if both lobes: total conservative parotidectomy
enucleation is avoided due to high recurrence because of psuedopods (incomplete capsule)
Which tumor is composed of a double layer of columnar epithelium with papillary projections into cystic spaces with lymphoid tissues in the stroma, that only occurs in the parotid gland’s lower pole?
Warthin’s tumor = Adenolymphoma = Papillary cystadenolymphomatosum
DOES NOT TURN INTO MALIGNANCY
What are the clinical features of Warthin’s tumor?
- bilateral non tender
- common in males
- common in old people
- only in lower part of superficial lobe of parotid gland
- slow growing, smooth, soft, cystic, fluctuant swelling
What is the diagnostic method of investigation in case of papillary cystadenolymphomatosum (Warthin’s tumor)?
99TECHNETIUM SCAN -> hot nodule
fnac could be used as well
What is the treatment of papillary cystadenolymphomatosum?
conservative superficial parotidectomy
What tumor is characterized by presences of oncocytes & its red color? How should it be treated?
Oxyphil adenoma (oncocytoma)
Surgical removal
What is the commonest malignant salivary gland tumor?
Mucoepidermoid tumor
What are the types of mucoepidermoid tumor?
low grade: mucus cells mainly
high grade: epidermoid cells mainly
facial nerve involvement is late
What are the clinical features of a mucoepidermoid tumor?
- swelling in parotid or submandibular region
- slowly increasing in size
- attains large size, hard, nodular, with involvement of skin & lymph nodes
Which malignant salivary neoplasm is characteristically soft & cystic but can involve the facial nerve or neck lymph nodes?
Acinic cell tumor
What is the most severe malignant salivary neoplasms & where does it commonly occur?
adenoid cystic carcinoma
- in submandibular & minor salivary glands
