Malignant Salivary Gland Tumors

Question 1

Malignant Salivary Gland Tumors

Answer 1

• Mucoepidermoid Carcinoma
• Acinic Cell Carcinoma
• Adenoid Cystic Carcinoma
• Carcinoma ex - Mixed Tumor / Malignant Mixed Tumor
• Polymorphous Adenocarcinoma

Question 2

Clinical Features of Adenocarcinomas

Answer 2

• Infiltrative
• Fixed
• Rapid or slow growth, depending on grade

Question 3

Mucoepidemoid Carcinoma

Answer 3

• Most common SG malignancy
• Most common malignancy SG tumor in children
• Parotid (most common site)
• Minor SG: palate 2nd
• Minor gland: Symptomatic gluctuant swelling; blue or red
• May arise within jaws from odontogenic epithelium of dentigerous cysts
• More commor in mandible than maxilla
• MOLAR RAMUS AREA

mixture of mucus -producting cells and epidermoid or squamous cells

Treatment:

• prognosis if fairly good - 10% of patients die (recurrence)
• Surgical Excision
• Low grade tumors = good prognosis - 90% cured
• High grade - guarded - only 30% survive

Gene Fusion: CRTC1 - MAML2, CRTC3 - MAML2

Question 4

Central Mucoepidermoid Carcinoma – Images

Answer 4

• Mucoepidermoid - is one of the salivary gland malignancies that can occur in bone and when you see a presentation of a large destructive radiolucent lesion in the mandible - mucoepidermoid not common, extremely rare
• small swelling in the palatal region and was neglected - the swelling was very rapid and aggressive growth and it was biopsied and it was determined to Mucoepidermoid

Question 5

Adenoid Cystic Carcinoma

Answer 5

• High grade salivary gland malignancy
• Adults
• Palatal mass; ulcerations
• spead through PERINEURAL INVASIONS
• approx 50% within the minor SG - Palate most common site
• Usually slowly growing mass
• ***** PAIN IS A COMMON AND IMPORTANT EARLY FINDING, OCCASIONALLY OCCURRING BEFORE THERE IS NOTICEABLE SWELLING
• PEARINEURAL INVASION = corresponding to pain

Treatment:

• Excision
• 5-year survival rate high as 70%
• By 20 years, only 20%

Question 6

Acinic Cell Adenocarcinoma

Answer 6

• Occurs predominantly in major SGs
• Found in all age groups, peak incidence in 5-6th grade (YOUNGER)
• All gender
• Malignancy with Serous Acinar Differentiation
• Most common in Parotid
• Variable microsocopic appearance - encapsulated
• BETTER PROGNOSIS THAN SALIVARY GLAND MALIGNANCIES

Question 7

Adenoid Cystic Carcinoma Histology

Answer 7

• Swiss cheese appearance, Cribriform pattern
• Perineural invasion
• Tumor island indicated by blue arrow

Question 8

Polymorphous Adenocarcinoma

Answer 8

• ALMOST EXLUCIVELY in the MINOR SG
• 60% on the hard or soft palate
• 2/3 in females
• Tumor cells have deceptively uniform appearance
• Different growth patterns - polymorphous
• Perineural invasion common
• Wide surgical excision – overall prognosis good - 80% cure rate

Question 9

Pleomorphic Adenoma

Answer 9

• Mean age about 15 years greater than benign counterpart
• MASS PRESENT FOR MANY YEARS WITH RECENT RAPID GROWTH WITH ASSOCIATION PAIN OR ULCERATION

Treatment:

• Wide excision, with local node dissection and radiationi
• Prognosis guarded, with 50% local recurrence or metastases and dying