Pathology Of Salivary Gland Tumours

Question 1

What are some reasons for changes in gland size?

Answer 1

Secretion retention - due to mucocele/ duct obstruction
Chronic sialadenitis
Gland hyperplasia - due to sialosis/ Sjögren’s syndrome
Salivary neoplasms

Question 2

What are common viral infections affecting the salivary glands?

Answer 2

Mumps, Epstein Barr virus

Question 3

What are the common features of salivary neoplasms?

Answer 3

Painless
Slow growing
Well defined

Question 4

What are common symptoms of salivary tumours?

Answer 4

Localised swelling
Neurological change (due to facial nerve in parotid)

Question 5

Are most salivary gland tumours benign or malignant?

Answer 5

75% are benign

Question 6

Where is the most common site for malignant salivary gland tumour?

Answer 6

Sublingual and minor glands have largest proportion to malignant tumours (compared to benign)

Question 7

What are the clinical features of a major gland tumour?

Answer 7

Asymmetry/ obstruction/ pain caused by lump in gland

Question 8

What are the diagnostic techniques for salivary gland tumours?

Answer 8

Ultrasound fine needle aspirate
Core biopsy
Incisional biopsy

Question 9

What is fine needle aspirate?

Answer 9

Minimally invasive technique used to obtain a cell sample
Suction is used to collect sample

Question 10

What is a core biopsy?

Answer 10

A technique used to collect a larger tissue sample (usually for breast cancer)

Question 11

What is an incisional biopsy?

Answer 11

Small cut is made in the tissue and a portion of the tumour is removed and tested under microscope

Question 12

What is a pleomorphic adenoma?

Answer 12

75% of all salivary tumours, most common in the parotid
Slow growth
Varied histology - mixed tumour
Capsule may not be complete

Question 13

What is the treatment for pleomorphic adenoma?

Answer 13

Wide local excision (as recurrence is common)

Question 14

How long should a pt with pleomorphic adenoma be reviewed?

Answer 14

For 5 years as recurrence is common

Question 15

What is Warthin’s tumour?

Answer 15

associated with smoking
Most occur in parotid
Histology - cystic, distinctive double layer epithelium, lymphoid tissue

Question 16

What is the treatment for warthin’s tumour?

Answer 16

Excision

Question 17

What is the malignancy potential for pleomorphic adenoma and warthin’s tumour?

Answer 17

Pleomorphic adenoma - 5%
Warthin’s tumour - low

Question 18

What is adenoid cystic carcinoma?

Answer 18

Most common in minor glands, in maxilla
Varied patterns - cribiform or tubular/ solid
Local spread along nerve (peripheral infiltration)

Question 19

What is the prognosis of adenoid cystic carcinoma?

Answer 19

Long term prognosis is poor (at 20 years) as it is difficult to treat and has high recurrence.

Question 20

What is mucoepidermal carcinoma?

Answer 20

Contains squamous and glandular cells.
Either cystic or solid.
Unpredictable behaviour with rare lymphatic spread

Question 21

What is responsible for the possibility for intraosseous mucoepidermal carcinoma?

Answer 21

Jaw bone can contain ectopic salivary glands
Or may be due to the odontogenic epithelium in the lining (can sometimes contain mucous cells).