Salivary Gland Neoplasms Flashcards
Salivary gland neoplasms comprise approximately __% of all head and neck neoplasms.
3%
Are salivary gland neoplasms more common in males or females? Childhood or adulthood?
- females
- adulthood
What are salivary glands are most involved in the extraoral salivary gland neoplams?
- parotid (61-80%)
- minor (9-28%)
- submandibular (8-11%)
- sublingual (
What are the sites of involvement in the intraoral salivary gland neoplasms?
- palate (50%)
- lips (20%)
- buccal mucosa (15%)
What are the salivary glands that are most likely to be malignant if a salivary gland neoplasm is found there?
- sublingual (70-95%)
- minor (45-50%)
- submandibular (26-45%)
- parotid (15-32%)
What are the intraoral sites that are most likely to be malignant if a salivary gland neoplasm is found there?
- retromolar (90%)
- tongue (80%)
- lower lip (60%)
- buccal mucosa (45%)
- palate (45%)
- upper lip (15%)
What is the most common salivary gland neoplasm?
pleomorphic adenoma
What is pleomorphic adenoma also known as? Why does it have its name?
- “benign mixed tumor”
- named because of the combination of neoplastic ductal epithelial and myoepithelial cells that often show a variety of histologic patterns
Where is pleomorphic adenoma often found?
- 80% in parotid (makes up 63% of all parotid tumors)
- 10% submandibular (makes up 60% of all submandibular tumors)
- 10% intraoral (40% of all intraoral salivary gland tumors)
(palate 54%, upper lip 22%, buccal mucosa 15%)
What age group is most common for pleomorphic adenoma? Male or female?
- adult patient, in 4th to 6th decade (mean age is 45 years)
- slight female predilection
What is the clinical appearance of pleomorphic adenoma?
- in major glands
- slow-growing, painless, freely moveable mass
- rubbery firm on palpation
- palatal lesions usually to one side of the midline, no mobility, usually non-ulcerated
- when the lesion is small, it is usually round, but it typically becomes bosselated as it grows larger
Describe the histology of pleomorphic adenoma.
- encapsulated proliferation of ductal epithelial cells and myoepithelial cells in proportions that may vary tremendously from lesion to lesion
- myoepithelial cells may appear spindled or plasmacytoid and they have the ability to produce a myxoid stroma, hyaline material, cartilaginous material, or even osteoid
What is the recommended treatment for pleomorphic adenoma?
- PAROTID: remove the lesion with the involved lobe (subtotal parotidectomy)
- SUBMANDIBULAR: remove the lesion and the involved gland
- HARD PALATE: remove the lesion, includingthe overlying oral mucosa, down to the periosteum
- SOFT PALATE, LABIAL MUCOSA, AND BUCCAL MUCOSA: enucleation (pull the hard process out of the soft tissue)
What is the prognosis of pleomorphic adenoma?
- if inadequately treated, this lesion will recur
- more of a problem with parotid lesions rather than oral lesions
- if not removed, may undergo malignant transformation in 5% of cases
What is the technical name for “Warthin tumor”?
papillary cystadenoma lymphomatosum
What is the histogenesis of papillary cystadenoma lymphomatosum?
salivary duct epithelium entraped in parotid lymph nodes during development
Papillary cystadenoma lymphomatosum makes up __% of all salivary gland neoplasms and __% of parotid gland neoplasms.
5%
5-22%
What gland is papillary cystadenoma lymphomatosum almost exclusively found in? More often in males or females? Average age? Associated with what risk factor?
- parotid gland
- males
- 55-60 years old
- cigarette smoking
What are the clinical signs and symptoms of papillary cystadenoma lymphomatosum?
- non-tender, slowly-growing, freely-movable mass of the parotid region
- mostly metachronous lesions, may be bilateral or unilateral
- grossly, encapsulated with cystic spaces containing serous, milky, or chocolate syrup-like fluid
Describe the histology of papillary cystadenoma lymphomatosum.
- encapsulated collection of lymphoid tissue that usually exhibits typical germinal center formation
- contained within this tissue are dilated cystic spaces into which project papillary infoldings that are lined by double-row of columnar to cuboidal oncocytes (altered ductal epithelial cells)
What is the treatment for papillary cystadenoma lymphomatosum?
surgical excision
What is the prognosis of papillary cystadenoma lymphomatosum?
very low recurrence rate (5% range); recurrences may actually represent development of metachronous lesions
Which is more common: pleomorphic adenoma or monomorphic adenoma?
pleomorphic adenoma
What is the following salivary neoplasm?
“characterized by a proliferation of ONE cell type”
monomorphic adenoma
What are the 2 major subtypes of monomorphic adenoma?
- canalicular adenoma
- basal cell adenoma
Where is canalicular adenoma usually seen? Most often?
- seen in both major salivary glands and intraorally
- more common intraorally, especially in upper labial mucosa
What age group does canalicular adenoma usually affect? Gender?
- 65 years old
- female
What are the signs and symptoms of canalicular adenoma?
well-encapsulated, non-tender mass; may be blue/purple
Describe the histology of canalicular adenoma.
encapsulated proliferation of cuboidal to columnar cells that form tubules and narrow trabecular cords, with the appearance of channels or “canals”
What is the treatment for canalicular adenoma? Prognosis?
- simple enucleation
- excellent prognosis (virtually no tendency to recur)
What is the most common intraoral salivary gland malignancy?
mucoepidermoid carcinoma
What is age group is most affected by mucoepidermoid carcinoma?
- wide age range
- most common salivary gland malignancy in children (15% occur in patient
Where is mucoepidermoid carcinoma more often found?
- intraorally, palate is the most common site (28%), followed by the retromolar area (23%)
- may also be found centrally within mandible or maxilla
- a mucocele-appearing lesion of the retromolar area should be considered to be mucoepidermoid carcinoma until proven otherwise
What is the clinical appearance of mucoepidermoid carcinoma?
- well-demarcated or infiltrative mass
- non-tender and non-ulcerated initially
- may have blue tinge due to entrapped mucin
- ulceration and pain may develop as the lesion progresses
Describe the histology of mucoepidermoid carcinoma.
- must have 2 cellular elements: MUCOUS CELLS and EPIDERMOID CELLS (both must be seen to make the diagnosis)
- low-grade lesions are more common intraorally and have more mucous cells
- high-grade lesions are more squamous (epidermoid) cells
- lesional cells usually do not show significant pleomorphism or increased mitotic activity, but a spectrum of differentiation is recognized
What is the recommended treatment for mucoepidermoid carcinoma?
- low-grade: wide surgical excision
- high-grade: wide surgical excision, plus radiation and/or chemotherapy
What is the prognosis of mucoepidermoid carcinoma? 10-year survival?
- depends on tumor size and histologic grade
- lesions
What is the second most common intraoral salivary gland malignancy?
polymorphous low-grade adenocarcinoma (PLGA)
What gender is polymorphous low-grade adenocarcinoma (PLGA) more common in? What age group?
- female (2:1 ratio)
- adult population, mean age of 56 years with range of 23-94 years
What is the clinical appearance of polymorphous low-grade adenocarcinoma (PLGA)?
- firm, painless swelling that may or may not be ulcerated
- typically well-demarcated initially, but later becomes more infiltrative and diffuse
- usually a very slow-growing lesion
Where is polymorphous low-grade adenocarcinoma (PLGA) most often found intraorally?
most common in posterior hard/soft palate (65%), followed by upper lip and buccal mucosa
What two conditions can polymorphous low-grade adenocarcinoma (PLGA) be confused with, histologically?
- adenoid cystic carcinoma
- pleomorphic adenoma
Describe polymorphous low-grade adenocarcinoma (PLGA) histologically.
- low-power shows lobular growth pattern that infiltrates the surrounding normal tissue, although a pseudocapsule may be present in some areas
- called “polymorphous” because one often sees a variety of growth patterns from lesion to lesion or within the same lesion (solid, trabecular, cribriform-like, ductal, and spindle cell areas)
- lesional cells are usually cytologically bland
What is the treatment for polymorphous low-grade adenocarcinoma (PLGA)?
wide surgical excision
What is the prognosis for polymorphous low-grade adenocarcinoma (PLGA)? Recurrence? Lymph node metastasis? Death due to disease?
- excellent
- recurrence in 9-29%
- lymph node metastasis in 9-17%
- death due to disease is rare (
Adenoid cystic carcinoma comprises __% of all salivary gland neoplasms.
5%
What sites are most commonly affected by adenoid cystic carcinoma?
- parotid and submandibular gland are affected about equally
- intraorally, the palate is the most common (approx 50% of intraoral lesions involve that area)
Is adenoid carcinoma more common in male or female? What age group?
- female
- age range is reported 15-88 with mean 55 years
- most tumor present in 5th decade
What is the clinical appearance of adenoid cystic carcinoma?
- initially a slow-growing, non-ulcerated infiltrative mass
- frequently associated with pain/tenderness
- ulceration may develop later in its course
*Note: on x-rays, no lamina dura or PDL, resorption of teeth, can be considered malignant
Describe the histology of adenoid cystic carcinoma.
- hyperchromatic basaloid cells with minimal cytoplasm
- little pleomorphism or mitotic activity
- perineural and intraneural invasion!
- unencapsulated lesion with one of 3 growth patterns (tubular, cribriform, solid)
Differentiate between the 3 growth patterns of adenoid cystic carcinoma.
- tubular: well-differentiated
- cribriform: classic “swiss-cheese” pattern; intermediate
- solid: poorly differentiated; mitotic figures are seen
What is the recommended treatment for adenoid cystic carcinoma?
wide surgical excision, with radiation therapy afterwards
What is the prognosis of adenoid cystic carcinoma? 10-year survival? 20-year survival?
- depends on the location of lesion, grade, anatomic structures involved, presence of tumor at surgical margins
- generally poor (slow-growing and relentless)
- death from disease up to 20-25 years after diagnosis
- 10-year survival is 50%
- 20-year survival is 25%
*it is the Freddy Kreuger who keeps coming back
What types of metastasis are usually seen with adenoid cystic carcinoma?
- usually go to the lung, followed by brain, bone, and liver
- lymph node involvement typically accounts for only 5% of metastatic deposits
Acinic cell adenocarcinoma comprises __% of all salivary gland tumors.
2%
What site is most often associated with acinic cell adenocarcinoma?
90% in parotid
10% intraorally (buccal mucosa or palate)
What age is most often affected by acinic cell adenocarcinoma?
range of 5-84 years, with a mean age of about 45 years
What is the clinical appearance of acinic cell adenocarcinoma?
- fairly circumscribed, slow-growing mass in parotid region, buccal mucosa, or palate
- pain/tenderness in 50% of cases
Describe the histology of acinic cell adenocarcinoma.
- appear to be pseudo-encapsulated
- basophilic bland cells that are very similar to acinar cells (looks like acinar cells from salivary tissues, but no ductal cells)
- cells are mostly very bland low-grade
What is the recommended treatment of acinic cell adenocarcinoma?
surgical excision
What is the prognosis of acinic cell adenocarcinoma?
- guarded prognosis
- 35% recurred, 16% metastasized (usually lymph node), 16% died
What age group is most often affected by carcinoma ex-pleomorphic adenoma?
6th to 8th decades of life
What is the clinical appearance of carcinoma ex-pleomorphic adenoma?
- long-standing asymptomatic mass that suddenly becomes tender or is associated with paresthesia
- majority show areas of typical pleomorphic adenoma from which carcinomatous elements appear to arise
Describe the histology of carcinoma ex-pleomorphic adenoma.
- malignancy is usually a form of adenocarcinoma (NOS), sometimes PLGA, adenoid cystic carcinoma, or others
What is the treatment of carcinoma ex-pleomorphic adenoma?
wide surgical excision
What is the prognosis of carcinoma ex-pleomorphic adenoma?
varies with degree of invasion and type of adenocarcinoma
- invasion 8 mm = bad; all patients died
