Salivary disease - Salivary Neoplasms Flashcards
List the benign salivary gland tumours
Pleomorphic adenoma Warthin tumour Cystadenoma Basal cell adenoma Canalicular adenoma
List the malignant salivary gland tumours
Mucoepidermoid carcinoma Acinic cell carcinoma Polymorphous adenocarcinoma Adenoid cystic carcinoma Carcinoma ex pleomorphic adenoma
How are salivary gland tumours classified?
- Epithelial
- Adenomas
- Carcinomas - Non-epithelial
- Soft tissue tumours
- Malignant lymphomas
- Secondary tumours
- Unclassified tumours
- Tumour like lesions
Epidemiology of salivary gland tumours?
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
What percentage of salivary gland tumours are in each major salivary gland and minor salivary glands?
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
Features of pleomorphic adenoma?
Most common salivary gland tumour Parotid most common Then palate 30-50yrs old M:F Benign May recur
Histopathology of pleomorphic adenomas?
Mixed pleomorphic pattern Islands and strands of epithelial cells Ductal structures common Myxoid, mucoid or chondroid stroma Encapsulated Often lobular pattern
Warthin tumour features?
10% of benign salivary tumours Always parotid gland Most common in males 60:40 Sometimes bilateral or multifocal Completely benign
Where are the most common sites for adenomas?
Parotid
Then upper lip and cheek
= Benign
What is the most common malignant salivary gland lesion?
Mucoepidermoid carcinoma
Mucoepidermoid carcinoma features?
20% of minor and 5% of major gland lesions Parotid most common Palate, cheek, retromolar Seen occasionally in children Malignant - 10-15% metastasise
Histopathology of mucoepidermoid carcinomas?
A mixture of mucous cells and epidermoid (squamous cells)
Lesions are usually multicystic
Adenoid cystic carcinoma features?
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
Adenoid cystic carcinoma?
Infiltrative tumour - No capsule
Multicystic or cribriform pattern - swiss cheese pattern
Polymorphous adenocarcinoma features?
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%
Acinic cell carcinoma features?
5% of salivary gland malignancies
80% in parotid, 15% in minor glands
30% recurrence rate and 15% metastasise
Carcinoma ex pleomorphic adenoma features?
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
What is sjogrens syndrome?
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))
Clinical features of sjogren’s syndrome?
90% in females Middle age Oral symptoms: - Dry mouth: dry mucosa, lobulated tongue - Infections: candidosis - Caries Dry eyes - keratoconjunctivitis Parotid swelling in about 20%
Pathology of sjogren’s syndrome?
Lymphocytic infiltrates in salivary glands
In minor glands - focal sialodenitis
In major glands - lymphoepithelial lesion
Sjogren’s syndrome histopathology?
Gland is replaced by lymphocytes
Acini disappear but ducts proliferate to form epithelial islands
3-5% of cases these lesions may progress to lymphoma
