L10: Salivary Gland Neoplasm Flashcards
Incidenece of Salivary Neoplasm
- Around 1.2% of all neoplasms of the body & 5% of head and neck tumors.
- 85% are benign & 15 % are malignant.
What age group is affected by salivary neoplasm?
- 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.
Site of Salivary Neoplasm
- 80% arise in the parotid glands.
- 10-15% arise in the submandibular glands.
- Remainder arises in the sublingual and minor salivary glands
Percentage of Benign & Malignant Tumors in salivary galnds
Origin of Salivary Neoplasm
These tumors may arise from the secretory tissue, the duct system, or from the stromal tissue (mainly lymphoid tissue).
Types of Salivary Neoplasm
Etiology of Salivary Neoplasm
Incidence of Pleomorphic adenoma
- Represent 75% of parotid and 50% of submandibular gland neoplasms.
- Males = females.
Origin of Pleomorphic adenoma
Arises from epithelial, myoepithelial, and stromal components.
Pathology of Pleomorphic adenoma
- Exhibit wide variations in cellular and architectural morphology.
- The capsule may be incomplete with the extension of tumor tissue into the surroundings.
Complications of Pleomorphic adenoma
- It grows slowly without infiltration of the facial nerve.
- Long-standing (more than 10 years) pleomorphic adenoma rarely turns malignant.
Why is Pleomorphic adenoma Called by this name?
what is another name of Adenolymphoma (Warthinβs tumor)?
Warthinβs tumor (benign papillary cystadenoma lymphomatosum)
Incidence & Side of Adenolymphoma (Warthinβs tumor)
- 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.
Origin of Adenolymphoma (Warthinβs tumor)
Arises from epithelial, myoepithelial, and stromal components.
Pathology of Adenolymphoma (Warthinβs tumor)
- Epithelial Component
- Lymphoid Component
- Both lymphoid and oncolytic epithelial elements must be present to diagnose Warthinβs.
Investigations for Adenolymphoma (Warthinβs tumor)
Epithelial Comonent of Adenolymphoma (Warthinβs tumor)
Lymphoid Component of Adenolymphoma (Warthinβs tumor)
what are types of Benign Salivary Neoplasm?
- pleomorphic adenoma
- Warthinβs tumor
What are types of malignant salivary Neoplasm?
- Mucoepidermoid carcinoma
- Adenoid cystic carcinoma
Incidence of Mucoepidermoid carcinoma
The commonest malignant salivary tumor β usually affects the parotid.
Origin of Mucoepidermoid carcinoma
Arises from the ductal epithelium.
Grades of Mucoepidermoid carcinoma
Three grades are β low, intermediate, and high-grade tumors.
Characters of Low Grade Mucoepidermoid carcinoma
Incidence of Adenoid cystic carcinoma
The commonest malignancy affecting the minor salivary glands.
Origin of Adenoid cystic carcinoma
Arises from ductal and myoepithelial cells.
Pathology & Growth of Adenoid cystic carcinoma
- It has a slow rate of growth.
- It may grow in different patterns: tubular, cribriform, and/or solid.
Complications of Adenoid cystic carcinoma
- 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.
Characters of Adenoid cystic carcinoma
Type of Patient of Benign Neoplasm
Male = female & age around 40yr
Characters of Benign Neoplasm
Slowly growing, Painless swelling.
Signs of Benign Neoplasm
Type of Patient in Malignant Neoplasm
Characters of Malignant Neoplasm
Signs of Malignant Neoplasm
DDx of Salivary Neoplasm
Spread of Salivary Neoplasm
Complications of Salivary Neoplasm
Prognosis of Salivary Neoplasm
Investigations for Salivary Neoplasm
Low growing parotid tumors should not be subjected to biopsy for 2 reasons:
1) Injury to the facial nerve.
2) Seeding of tumor cells in the subcutaneous plane which causes recurrence in about 40-50% of cases.
FNAC
Investigtions of Salivary Neoplasm
- 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.
Radiological
Investigtions of Salivary Neoplasm
- CT
- MRI
- X-Ray
Indication of CT Scan
Investigtions of Salivary Neoplasm
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.
MRI
Investigtions of Salivary Neoplasm
- MRI is a better investigation. However, it is expensive,
- CT scan and MRI lack specificity for differentiating between benign and malignant lesion.
X-Ray
Investigtions of Salivary Neoplasm
X-ray of the bones (mandible and mastoid process) to look for bony resorption if malignancy is suspected.
Radioactive Isotope scan
Investigtions of Salivary Neoplasm
General Considerations in TTT of salivary neoplasm
Superficial Conservative Parotidectomy
TTT of Salivary Neoplasm
Simple enuculation
TTT of Salivary Neoplasm
Total Conservative Parotidectomy
TTT of Salivary Neoplasm
TTT of Facial Nerve Injury
TTT of Salivary Neoplasm
Operation of choice in Benign tumors of the submandibular
Procedure in Benign tumors of the submandibular
Cautions during TTT in Benign tumors of the submandibular
Confirmation of Diagnosis in malignant neoplasm
Examples of Low grade salivary tumors
Procedure of Low grade salivary tumors
Operation in Low grade salivary tumors in case of parotid gland
TTT in case of High grade tumors in case of parotid gland
How to deal with LNs in salivary tumors?
Managment of inoperable salivary gland cases
complications of parotidectomy
Cause of Freyβs syndrome
Incidence of Freyβs syndrome
Symptoms of Freyβs syndrome
pathophysiology of Freyβs syndrome
TTT of Freyβs syndrome
Identification of facial nerve
Comparison between pleomorphic adenoma and adenolymphoma
Comparison between submandibular and parotid tumors
The commonest malignancy in adult
The commonest malignancy in Children
The commonest malignancy in parotid
The commonest malignancy in submandibular
Differential diagnosis of swelling in parotid region
Differential diagnosis of swelling in sabmandibular region
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