BENIGN SALIVARY GLAND NEOPLASMS

BENIGN SALIVARY GLAND NEOPLASMS

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Salivary glands are common source of benign pathology both inflammatory and neoplastic.

Salivary glands are common source of benign pathology both inflammatory and neoplastic.

Neoplasms arising in the salivary glands are principally a disease of adult population and account < 10% of all head and neck tumors in children

The frequency of individual neoplasms varies according to the gland affected – most common is in the parotid gland

In children most salivary gland lesions are inflammatory or vascular in origin

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Rule of 80’s

Rule of 80’s

80% of all salivary gland tumours will be benign

out of which 80% will be pleumorphic adenoma

out of which 80% will be found in the parotid gland

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Etiology

Etiology

Some genetic explanation: Molecular ( p55 , K1-67 )

Radiation induced ( MECs, WTs )

Viruses: EBV ( WTs )

From existing benign: Ex-pleomorphic adenoma

Neuroectodermal Ags persistence

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Pleomorphic adenoma

Pleomorphic adenoma

most common salivary gland neoplasm consisting of cells exhibiting the ability to differentiate to epithelial cells ( ductal or non ductal) as well as mesenchymal ( chondroid, myxoid or osseous)

This gives different histopathological patterns

Thus many forms(pleo-morphic)

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60% of salivary gland tumors

60% of salivary gland tumors

85% in the parotid gland

8% submandibular gland

The rest in sublingual and minor salivary gland

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Clinical features

Clinical features

Age 30 to 50 years

Slightly has female predilection

Location: Commonly located superficial lobe of the parotid gland followed by submandibular gland, intraorally palate is common site

Slow growing painless mass

Rarely ulcerated the underlying mucosa or skin

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On the palate it occurs as a smooth surfaced swelling which is dome shaped

In parotid gland it grows in the posterior and inferior aspect of superficial lobe, ear lobe of the affected side is elevated

On the palate it occurs as a smooth surfaced swelling which is dome shaped

Has a pseudo capsule

One characteristic of a pleomorphic adenoma is the presence of microscopic projections of tumor outside of the capsule

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Smooth, round and mobile

Smooth, round and mobile

On palpation it is firm not soft

No facial nerve involvement thus no facial nerve paralysis

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note

note

If these projections are not removed with the tumor, the lesion will recur.

Recurrence is possible in rare occasions, as well as a small risk of malignant trans-formation to a carcinoma ex pleomorphic adenoma.

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Image parotid

Image parotid

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Image palate

Image palate

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Slide 13

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Treatment

Treatment

Surgical removal of the tumor including adequate margins

Superficial parotidectomy tumor in parotid

Sailodectomy in case of submandibular gland

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WARTHIN TUMOUR

WARTHIN TUMOUR

Also called papillary cystadenoma lymphomatosum

Second common benign tumour of parotid

It is believed that some intraoral lesions may arise in an area of reactive lymphoid hyperplasia secondary to chronic inflammation

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CLINICAL FEATURES

CLINICAL FEATURES

Age 60-70 years

Gender : male predilection

Location :tail od parotid gland , inferior and posterior to angle of mandible

Slow growing painless nodular mass

On palpation soft or fluctuant in consistency

10% occurs bilateral, unique feature

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Image

Image

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histoPathology

histoPathology

Gross appearance: Tumour is smooth with well defined capsule

Cystic space filled with mucin like material or solid

Papillary projection within the cyst

Lymphocytic infiltration in solid type (b lymphoctes)

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Two forms : cystic and solid

Two forms : cystic and solid

Treatment

Surgical excision

Recurence and malignant changes are very rare

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ONCOCYTOMA

ONCOCYTOMA

Less common benign tumour

Presence of oncocytes thus the name oncocytoma

Theses cells resemble apparent normal cells

Oncocytes are considered somatic mutants rather than mew specific cell lineage

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oncocytes are redifferentiated epithelial cells with increased metabolism

An oncocyte is an epithelial cell characterized by an excessive amount of mitochondria, resulting in an abundant acidophilic, granular cytoplasm.

oncocytes are redifferentiated epithelial cells with increased metabolism

Also known as oxyphil cell adenoma

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Clinical features

Clinical features

Age 50- 80 years

Gender common in female

Parotid gland commonly affected

Slow capsulated painless growing mass

Firm or cystic in consistency

Can occur bilaterally

Rearely seen intraorally

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Diffuse multi nodulated oncocytoma appear when many nodular masses involve the entire gland

Diffuse multi nodulated oncocytoma appear when many nodular masses involve the entire gland

Treatment

Surgical excision

Sialodectomy

Malignant transformation is rare

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hemangioma

hemangioma

Occurs in over half of childhood salivary gland lesions

F> M

Usually diagnosed during the 1st year

Soft, painless mass

The parenchyma (interstitial space) is replaced by vasoformative elements (But normal glandular lobulation is maintained)

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BASAL CELL ADENOMA

BASAL CELL ADENOMA

Uncommon salivary gland tumour

Histopatholigically composed of cells resembling basal cells

Cells are arranged in solid, trabecular, tubular or membraneous patterns

Arises from neoplastic transformation of reserve cells in intercalated ducts and show both epithelial and myoepithlial elements

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Age 50-70 year

Age 50-70 year

Common in female

70% in parotid, minor salivay glands

Slow growing painless mass

Mobile

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Image

Image

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Complication of salivary gland surgery

Complication of salivary gland surgery

Facial nerve paralysis

Xerostomia

Lingual nerve damage

Saliva fistula

Infections

Damage to marginal mandibular nerve

Frey’s syndrome

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