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DMD3 > Salivary gland tumours > Flashcards

Salivary gland tumours Flashcards

1
Q

What is the incidence of salivary gland neoplasms as a total and for malignant neoplasms?

A

All: 0.4 - 13.5 cases per 100000

Malignant: 0.4 - 2.6 cases per 100000

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2
Q

What age is the peak incidence of salivary gland tumours?

A

6th and 7th decade of life.

Average age for benign is 46 and malignant is 47.

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3
Q

What is the sex distribution of salivary gland neoplasms?

A

Slight female predilection

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4
Q

What sites are most commonly affected by salivary gland tumours?

A

64 - 80% are in the parotid gland

7 - 11% are in the submandibular gland

1% are in the sublingual gland

9 - 23% in the minor salivary glands (Palate&raquo_space; upper lip)

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5
Q

What causes salivary gland tumours?

A

Aetiology is mostly unknown, however guesses and unsubstantial evidence ties them to:

Viral
Radiation
Occupation
Lifestyle
Hormones
Genetix
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6
Q

Which tumours are more common in salivary glands; Benign or malignant?

A

80% of salivary gland tumours are benign

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7
Q

Where are malignant tumours more likely to be found in salivary glands?

A

80 - 90% of salivary gland tumours that occur in the tongue, FoM and retromolar areas are malignant

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8
Q

What factors are looked at when trying to diagnose salivary gland tumours?

A

Initial history: Duration, rate of growth (how rapid), Pain/numbness/asymmetry of facial expression.

Clinical examination: Size of mass, mobility/fixation, trismus, pain on palpation, skin or scalp lesions, detailed facial nerve exam, assess cervical lymph nodes

Imaging: CT, US, CT sialography, MRI, FDG-PET

Biopsy techniques: FNA, Incisional biopsy.

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9
Q

What is looked at with initial history of a salivary gland tumour?

A

Duration

Rate of growth

Pain, numbness, facial nerve palsy, asymmetry of expression, Prior cancer history.

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10
Q

What factors are considered with clinical examination of a salivary gland tumour?

A

Size of the mass

Firm/mobility

Trismus

Skin or scalp lesions

Detailed facial nerve examination

Assess cervical lymphadenopathy

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11
Q

What kind of imaging should be considered for salivary gland tumours?

A

CT

Ultrasound

CT sialography

MRI

FDG-PET

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12
Q

Which salivary gland tumours are benign? Which is the most common?

A

Pleomorphic adenoma

Warthin’s tumour

Oncocytoma

Pleomorphic adenoma is the most common benign tumour of the salivary gland. (80% of benign tumours)

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13
Q

Which people get pleomorphic adenoma most commonly?

A

F > M

4th - 6th decades of life

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14
Q

What are the clinical features of pleomorphic adenomas?

A

Painless, slow growing (years), firm mass

Firm, rubbery on palpation

Parotid (deep or superficial)

Palate (postero-lateral)

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15
Q

What changes on pleomorphic adenoma histology?

A

It arises mainly from the intercalated duct reserve cells and differentiates into ductal cells and myoepithlial cells.

Pleomorphic structure (myxochondroid stroma with cartilage/bone/adipose tissue)

Encapsulated tumour with many ducts and prominent myxochondroid areas

Ducts surrounded by myoepithelial cells that merge into hyalinized stroma (containing spindled myoepithelial cells)

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16
Q

Why is pleomorphic adenoma known as pleomorphic?

A

Pleomorphic in its name because it has a variety of architecture. Myxochondroid stroma (cartilage + mucous) can be bone, cartilage, or adipose tissue.

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17
Q

How is a pleomorphic adenoma treated?

A

Complete excision to try and preserve the facial nerve

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18
Q

What is the prognosis and recurrence rate of pleomorphic adenoma?

A

Excellent prognosis if completely removed with low recurrence rate.

Rarely though, malignant transformation DOES occur

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19
Q

How common is warthin’s tumour?

A

2nd most common benign tumour

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20
Q

Who most commonly gets warthin’s tumour?

A

M>F

5th - 7th decades of life

Associated with smokers

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21
Q

What are the clinical features of warthin’s tumour?

A

It is often an asymptomatic, slow growing, fluctuant mass

Affects the parotid mostly and is sometimes bilateral

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22
Q

What is another name for warthin’s tumour?

A

Papillary cystadenoma lymphomatosum

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23
Q

What are the histological features of warthin’s tumour?

A

It is well circumscribed

It is a mixture of ductal epithelium and lymphoid stroma

Uniform cells in 2 layers surrounding cystic spaces (tall columnar cells lining lumen, cuboidal cells underneath.

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24
Q

How is warthin’s tumour treated?

A

Complete excision with margin (to preserve the facial nerve)

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25
Q

What is the prognosis of warthin’s tumour?

A

It has low recurrence

Malignant transformation is reported as rare (less than 0.1%).

26
Q

What malignant tranformations have been reported with Warthin’s tumour?

A

Epithelial: SCC

Lymphoid: Malignant lymphoma, non-hodgkin’s type.

27
Q

Who most commonly gets oncocytoma?

A

6th to 8th decade of life and seen in Males and Females equally

28
Q

What are the clinical features of oncocytoma?

A

Firm, painless, and slow growing

Affects the parotid and the minor salivary glands on the palate

29
Q

What are the histological features of oncocytoma?

A

Well-circumscribed tumour

Sheets of large epithelial cells known as oncocytes

Very little stroma

30
Q

How is oncocytoma treated?

A

Complete surgical excision with no radiotherapy

31
Q

What is the prognosis of oncocytoma like?

A

Local recurrence is uncommon and transformation to oncocytic carcinoma is rare.

32
Q

What are the most common malignant salivary gland tumours?

A

Mucoepidermoid carcinoma

Acinic cell carcinoma

Adenoid cystic carcinoma

Polymorphous low-grade adenocarcinoma

33
Q

What is the most common salivary gland malignant tumour?

A

Mucoepidermoid carcinoma

34
Q

Who most commonly gets mucoepidermoid carcinoma?

A

F > M

4th - 5th decade of life

Most common paediatric salivary gland malignancy.

35
Q

What are the clinical features of mucoepidermoid carcinoma?

A

Presentation may vary

Most often present as a firm, fixed, painless mass

Ulceration

Affects the parotid and the palate

36
Q

What are the histological features of mucoepidermoid carcinoma?

A

It is an infiltrative tumour in continuity with surface epithelium containing cystic and solid components.

Epithelial component consists of mucous producing cells and epidermoid cells.

Stroma may contain prominent lymphoid cells

No capsule

In low grade cases it is well-circumscribed

37
Q

How is mucoepidermoid carcinoma treated?

A

Wide local surgical excision (including neck dissection)

Radiation therapy

38
Q

What is the prognosis of mucoepidermoid carcinoma?

A

Poor survival rate: 5 years = 35%, 10 years = 10 - 20%

39
Q

Who most commonly gets acinic cell carcinoma?

A

Slight F > M prevalence

2nd - 7th decade with median age of 52. 7th decade is most common.

40
Q

What percentage of SG neoplasms are acinic cell carcinoma?

A

18% of malignant SG neoplasms

6.5% of all SG neoplasms

41
Q

What are the clinical features of acinic cell carcinoma?

A

It is slow growing, solitary.

Fixation may occur

Facial paralysis occurs in 10% of cases

Occurs in the parotid in 80% of cases

42
Q

What are the histological features of acinic cell carcinoma?

A

It is a nonencapsulated tumour

Solid sheets of serous acinar cells (abundant hematoxylic granules, small dark eccentric nuclei, minimal cytological atypia)

43
Q

How is acinic cell carcinoma treated?

A

Complete excision with margins (neck dissection)

Adjuvant radiotherapy

44
Q

What is the prognosis and recurrence rate of acinic cell carcinoma?

A

Recurrence rate = 35%

Metastases develop in 16 - 25% of people (to the cervical lymph nodes, lung, liver, and brain)

Most patients do not die of the tumour. 5 year survival = 91% and 10 year survival - 67%

45
Q

Who commonly gets adenoid cell carcinoma?

A

slight F>M prevalence

5th - 7th decades of life and very uncommon prior to 3rd decade.

46
Q

What are the clinical features of adenoid cell carcinoma?

A

Slow growing mass (Often fixed)

Tenderness, pain, and facial nerve palsy can be present.

Ulceration is common

47
Q

Which salivary glands are most often affected by adenoid cell carcinoma?

A

~50% in minor salivary glands

48
Q

What are the histological features of adenoid cell carcinoma?

A

Classic swiss cheese (cribiform) pattern.

Lobules and islands of tumour cells with multiple small pseudoducts or true ducts.

49
Q

How is adenoid cell carcinoma treated?

A

Wide excision with clear margins. (Complicated by perneural invasion)

Adjuvant radiotherapy.

50
Q

What is the prognosis of adenoid cell carcinoma?

A

Long term prognosis is poor. Tumour is relentless and usually is fatal.

80 - 95% eventually die of the disease after multiple recurrences locally and metastases.

51
Q

Who commonly gets polymorphous low-grade adenocarcinoma?

A

F > M

Second most common intraoral malignant salivary gland tumour.

2nd - 10th decades of life

6th - 8th most common

52
Q

What are the clinical features of PLGA?

A

Painless mass/swelling

Bleeding, otalgia, odynophagia, tinnitus, airway obstruction uncommon.

Affects minor salivary glnads most often

60 - 70% occur at the junction of the hard and soft palate

53
Q

what are the histological features of PLGA?

A

It is an infiltrative tumour

Polymorphic in architecture: Solid sheets, duct cells, tubules, trabeculae, cribiform structures, and small islands/strands of cells.

54
Q

What is the treatment and prognosis for PLGA?

A

Treatment: Complete surgical excision + neck dissection.

Limited utility for radiotherapy an chemotherapy.

Prognosis is excellent: Local recurrence rate = 9 - 17% and regional metastases = 9 - 15%

55
Q

What is the DDx of mucoepidermoid carcinoma?

A

DDx benign mucocele but mucoceles are unlikely at that location because benign mucoceles appear posteriorly.

If visible take an OPG to observe for bone invasion. REFER THIS ONE. DO NOT TOUCH.

56
Q

How can mucous vs serous salivary glands be distinguished?

A

Mucous salivary glands are white

Serous salivary glands stain purple on H&E

57
Q

What do secretory ducts look like on histology?

A

Their lumen can often be seen and a single layer of cuboidal cells surrounds them typically.

58
Q

What kind of acini do parotid glands have?

A

Typically seromucous and serous.

Rarely mucous acini are found. The other 2 dominate the histology of these glands.

59
Q

What are submandibular glands composed of?

A

Largely composed of seromucous acini. Some mucous acini are present as well.

60
Q

What are sublingual glands composed of?

A

Largely mucous tubules and acini

61
Q

What acini are minor salivary glands typically composed of?

A

Large proportion of mucous acini and some seromucous acini.

DMD3 (53 decks)

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