Salivary Gland Tumors Flashcards
ADENOMA
benign tumor
of glandular origin
Characteristics of a Benign Tumor:
Encapsulated ‐ distinguishable from surrounding tissues
Freely movable ‐ not fixed
Slow growing
Non tender ‐ patients do not complain of pain
BENIGN SALIVARY GLAND
TUMORS
(list 3)
Pleomorphic adenoma aka mixed tumor
Monomorphic adenomas
o Canalicular adenoma
o Basal cell adenoma
Warthin tumor (papillary cystadenoma lymphomatosum)
PLEOMORPHIC ADENOMA
(MIXED TUMOR)
- This tumor comes in many forms/shapes
- Most common salivary gland tumor
- Painless, slowly growing, firm mass
- Adults (30‐50 years old) ; slight female predilection
- Sites:
- 50% to 77% of parotid tumors (most commonly found in parotid-2/3rd to 3/4th of parotid tumors)
- Minor SG: palate>upper lip>buccal mucosa> other site (most common intraoral site is the palate)
- Malignant transformation possible in long standing lesions (about 5% cases) ‐> called Ca ex PA
What is this clinical finding?
PLEOMORPHIC ADENOMA
(MIXED TUMOR)
What is this clinical finding?
PLEOMORPHIC ADENOMA
Classic presentation: includes swelling in the parotid region
(MIXED TUMOR)
What is this clinical finding?
PLEOMORPHIC ADENOMA
Palatal presentation: since salivary glands are only in lateral sides of the palate, usually
swellings are in one side and not the midline. Lateral swelling is a clue that you are
looking at a salivary gland lesion (left pics)
On the right pic, it involved midline and crossed over to other side, so there are
exceptions. But more commonly found in lateral side of the palate.
(MIXED TUMOR)
What is this clinical finding?
PLEOMORPHIC ADENOMA
- Upper lip presentation: sometimes swelling can be seen extra orally and intraorally.
- Remember the swelling will be movable, not tender, not fixed to underlying structures.
(MIXED TUMOR)
What is this clinical finding?
Untreated pleomorphic adenoma
slow growing, but can grow to enormous sizes
Pleomorphic adenoma
histology
This is a mixed tumor with myxoid component (right) and
fibrous/epithelial component(left)
This type of tumor can produce a lot of different tissues, since the origin is from myoepithelial cells aka plasmacytoid cells, which are pluripotent cells which means they can differentiate into many different lineages of cells such as
Monomorphic Adenomas
What is it?
Types?
Treatment?
What is it?
Proliferation of 1 type of cell makes up the tumor.
Types? Includes:
o Canalicular Adenoma
o Basal Cell Adenoma
Treatment for all monomorphic adenomas is surgical excision & diagnosis is done with biopsy
Canalicular Adenoma
- Almost exclusively in minor SG
- Striking predilection for upper lip (>75%)
- Nearly always occurs in older adults
- Slowly growing, painless mass
- One clue for visualization of soft tissue swellings is increased vascularity with blue‐ish tint in the area.
What is this clinical finding?
Canalicular Adenoma
What is this clinical finding?
Canalicular Adenoma
- Mucocele might look this way, but what would make it lower on
- differential diagnosis is the location of the swelling. Mucocele is mostly seen on lower lip and this pic shows upper lip. Salivary gland tumors and mucoceles
- can have the same clinical presentation, so always do a biopsy for formal histopathology diagnosis.
Basal Cell Adenoma
- Basaloid appearance of the tumor cells
- Primarily parotid lesion
- predominantly in women over 50 years of age. It is uncommon in young adults.
(Basal cells are located in epithelium that is adjacent to interface with the connective tissue and they are separated from the CT by a basement membrane, stem cells of epithelium are located in basal cell layer)
Basal cells are typically Blue in appearance and cuboidal,
What is this clinical finding?
Basal Cell Adenoma
PAPILLARY
CYSTADENOMA
LYMPHOMATOSUM
(WARTHIN TUMOR)
- finger‐like projections, benign, cystic spaces, aggregates oflymphocytes)
- Vast majority occur within the parotid gland
- Very rare intraorally
- Predominantly in men
- Typically between 5th and 8th decades
- Strong correlation with cigarette smoking
- Most common SG tumor to occur bilaterally (bilateral parotid swelling), but can be unilateral
- Etiology: Thought to arise within lymph nodes as a result of entrapment of
- salivary gland elements early in development
-
Clinical Features:
- swelling that has more subtle presentation
- Doughy to cystic mass
- In the inferior pole of the gland, adjacent and posterior to the angle of the mandible
- Treatment: surgical excision, responds very well to it
What is this clinical finding?
PAPILLARY
CYSTADENOMA
LYMPHOMATOSUM
(WARTHIN TUMOR)
Summary for benign
tumors
Encapsulated, freely movable, not fixed to underlying structure, not tender, patients do not complain of pain, slow growing
There is one tumor of the ones discussed that does have a risk of malignant transformation (only 5% and will take many, many years) and that is Pleomorphic adenoma
MALIGNANT SALIVARY
GLAND TUMORS
List 5
Mucoepidermoid carcinoma
Acinic cell carcinoma
Adenoid cystic carcinoma
Carcinoma ex‐mixed tumor/malignant mixed tumor
Polymorphous adenocarcinoma
CLINICAL FEATURES OF
ADENOCARCINOMAS
(malignant gland tumors)
Infiltrative
Fixed to underlying structures, not moveable
Rapid or slow growth, depending on grade and type of malignant salivary
gland tumor
Larger, rapidly growing lesions may cause pain and/or paresthesia
Ulcerated overlying mucosa
MUCOEPIDERMOID
CARCINOMA
Charcterstics?
Location
Clinical appearance in minor gland
Can be mistaken for
Histopahtology
Most common malignancy of salivary glands
Most common malignant SG tumor in children
Locations
Palate, most common intraoral site
Rare primary intrabony (jaws) tumors
Most common in parotid
Minor SG: palate 2nd
Clinical appearance in minor gland: asymptomatic fluctuant swelling; blue or red colored
Can be mistaken for mucocele
Histopathology: note the cells growing into adjacent tissue, showing infiltration
MUCOEPIDERMOID
CARCINOMA
What are its compoenents?
Within jaw prognosis
Treatment
Prognosis
Therapy by gene?
What are its compoenents? Mixture of mucus‐producing cells and epidermoid or squamous cells
May arise within jaws from odontogenic epithelium of dentigerous cysts
• More common in the mandible than maxilla
• Molar‐ramus area
Treatment: Usually treated by surgical excision
Prognosis:
• Overall prognosis is fairly good
• 10% of patients die, due to local recurrence or metastasis
Low‐grade tumors have good prognosis (>90% are cured)
High‐grade tumors the prognosis is guarded (Only 30% survive)
Therapy by gene?
CRTC1–MAML2, CRTC3‐MAML2 gene fusions (targeted therapy)
What is this clinical finding?
MUCOEPIDERMOID
CARCINOMA
Request all for biopsies!
What is this clinical finding?
MUCOEPIDERMOID
CARCINOMA
What is this radiographical finding?
CENTRAL
MUCOEPIDERMOID
CARCINOMA
- Intrabony presentations, may have extraoral swelling depending on the stage
- Started as small swelling and progressed rapidly:, need to pick it up early!
- Patient recovered, but might need radiation, lost salivary glands, needed reconstruction of palate