Salivary disease - Salivary Neoplasms

Question 1

List the benign salivary gland tumours

Answer 1

Pleomorphic adenoma
Warthin tumour
Cystadenoma
Basal cell adenoma
Canalicular adenoma

Question 2

List the malignant salivary gland tumours

Answer 2

Mucoepidermoid carcinoma
Acinic cell carcinoma
Polymorphous adenocarcinoma
Adenoid cystic carcinoma
Carcinoma ex pleomorphic adenoma

Question 3

How are salivary gland tumours classified?

Answer 3

1. Epithelial
   - Adenomas
   - Carcinomas
2. Non-epithelial
   - Soft tissue tumours
   - Malignant lymphomas
   - Secondary tumours
   - Unclassified tumours
   - Tumour like lesions

Question 4

Epidemiology of salivary gland tumours?

Answer 4

1000 malignant salivary gland tumours per yr in UK
70% in parotid gland, 70% pleomorphic adenomas, 90% benign
Only 20% are minor salivary glands
Minor gland tumours are more commonly malignant

Question 5

What percentage of salivary gland tumours are in each major salivary gland and minor salivary glands?

Answer 5

70% parotid
9% submandibular
1% sublingual 
= 80% in major salivary glands
- 80% of tumours in major glands are benign

20% in minor salivary glands
- Palate 55%
- Lips 15% (95% in upper lip)
- Cheek  10%
- Tongue 10%
- Other 10%
50% of tumours in minor glands are malignant

Question 6

Features of pleomorphic adenoma?

Answer 6

Most common salivary gland tumour
Parotid most common
Then palate
30-50yrs old M:F
Benign
May recur

Question 7

Histopathology of pleomorphic adenomas?

Answer 7

Mixed pleomorphic pattern
Islands and strands of epithelial cells 
Ductal structures common 
Myxoid, mucoid or chondroid stroma 
Encapsulated
Often lobular pattern

Question 8

Warthin tumour features?

Answer 8

10% of benign salivary tumours
Always parotid gland
Most common in males 60:40
Sometimes bilateral or multifocal 
Completely benign

Question 9

Where are the most common sites for adenomas?

Answer 9

Parotid
Then upper lip and cheek
= Benign

Question 10

What is the most common malignant salivary gland lesion?

Answer 10

Mucoepidermoid carcinoma

Question 11

Mucoepidermoid carcinoma features?

Answer 11

20% of minor and 5% of major gland lesions
Parotid most common
Palate, cheek, retromolar 
Seen occasionally in children 
Malignant - 10-15% metastasise

Question 12

Histopathology of mucoepidermoid carcinomas?

Answer 12

A mixture of mucous cells and epidermoid (squamous cells)

Lesions are usually multicystic

Question 13

Adenoid cystic carcinoma features?

Answer 13

Second most common malignant tumour
15% of minor and 5% of major gland lesions
Parotid, then cheek, palate, sinuses
Highly malignant
75% of patients die within 20 yrs
Metastasise via blood stream and nerve invasion

Question 14

Adenoid cystic carcinoma?

Answer 14

Infiltrative tumour - No capsule

Multicystic or cribriform pattern - swiss cheese pattern

Question 15

Polymorphous adenocarcinoma features?

Answer 15

Only found intra-orally 
70% palate
30% lips, cheek
3rd most common intra-oral malignancy 
Usually over 50 yrs 
Perineural infiltration typical 
Often misdiagnosed on incisional biopsies as pleomorphic adenoma or adenoid cystic carcinoma
>90% survival at 5 yrs
Metastasise in 10-15%

Question 16

Acinic cell carcinoma features?

Answer 16

5% of salivary gland malignancies
80% in parotid, 15% in minor glands
30% recurrence rate and 15% metastasise

Question 17

Carcinoma ex pleomorphic adenoma features?

Answer 17

10% of pleomorphic adenomas may become malignant
Usually long standing and/or recurrent lesions
Elderly - 60+
History of a long term slow growing lesion with recent increase in size
Histology shows areas of cytological atypia

Question 18

What is sjogrens syndrome?

Answer 18

An autoimmune disorder characterised by lymphocyte mediated destruction of exocrine glands resulting in dry eyes and dry mouth
Primary SS - dry eyes and dry mouth
Secondary SS - dry eyes and/or dry mouth, connective tissue disease (RA, SLE (systemic lupus erythematosus))

Question 19

Clinical features of sjogren’s syndrome?

Answer 19

90% in females
Middle age
Oral symptoms:
- Dry mouth: dry mucosa, lobulated tongue
- Infections: candidosis
- Caries
Dry eyes - keratoconjunctivitis
Parotid swelling in about 20%

Question 20

Pathology of sjogren’s syndrome?

Answer 20

Lymphocytic infiltrates in salivary glands
In minor glands - focal sialodenitis
In major glands - lymphoepithelial lesion

Question 21

Sjogren’s syndrome histopathology?

Answer 21

Gland is replaced by lymphocytes
Acini disappear but ducts proliferate to form epithelial islands
3-5% of cases these lesions may progress to lymphoma