Salivary malignant tumors Flashcards

1
Q

What is the most common salivary gland malignancy in children?

A

Mucoepidermoid carcinoma

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2
Q

True or False. A history of radiation therapy to the head and neck is a risk factor for future development of salivary gland tumors.

A

True. A history of radiation therapy at any age and any dose increases the risk for development of salivary gland tumors.

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3
Q

List the risk factors associated with salivary gland

cancer.

A

Previous radiation exposure, history of head and neck skin
cancer, Epstein-Barr virus, HIV infection, Hodgkin disease,
industrial exposure to rubber manufacturing or nickel compound, or employment in a beauty salon are risk
factors.

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4
Q

What are clinical signs and symptoms of salivary gland malignancy?

A

Pain, fixed lesion, invasion of overlying skin, rapidly growing
mass, facial nerve palsy, and cervical lymphadenopathy

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5
Q

True or false. In general, the best radiologic study
to evaluate a malignant salivary gland mass is CT
with contrast.

A

False. Although CT provides useful information, MRI is the
preferred imaging modality for parotid gland lesions. MRI
provides superior detail regarding invasion of surrounding
structures and type of pathology.

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6
Q

True or False. FNA biopsy of salivary gland malignancies has high sensitivity but low specificity.

A

False. The sensitivity is fairly low, whereas the specificity is
quoted to be greater than 90% in most studies.

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7
Q

Define the T stages for the Tumor, Node, Metastasis (TNM) classification for major salivary gland malignancies.

A

T1 ≤ 2 cm
T2 > 2 cm and ≤ 4 cm
T3 ≥ 4 cm and/or extraparenchymal extension
T4a Invades skin, mandible, ear canal, or facial nerve
T4b Invades skull base, pterygoid plates, or encases carotid artery
Data from Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, eds. AJCC Cancer Staging Manual 7th Edition. New
York, NY: Springer; 2010.

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8
Q

Define the N stages for the TNM classification for major salivary gland malignancies.

A

● Nx: Regional lymph nodes cannot be assessed.
● N0: No regional lymph nodes
● N1: Single ipsilateral node, 3 cm or smaller
● N2a: Single ipsilateral node 3 to 6 cm in diameter
● N2b: Multiple ipsilateral nodes; none larger than 6 cm
● N2c: Bilateral or contralateral nodes, none larger than
6 cm
● N3: Any lymph node larger than 6 cm in diameter

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9
Q

Define the overall staging (I through IV) for major salivary gland malignancies.

A
● Stage I: T1N0M0
● Stage II: T2N0M0
● Stage III: T3N0M0 or T1–3N1M0
● Stage IVA: T1–3N2M0 or T4aN0–2M0
● Stage IVB: T4bN1–3M0 or T1–4N3M0
● Stage IVC: M1
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10
Q

What is the incidence of malignancy in tumors of

the major salivary glands?

A

About 15 to 32% of parotid tumors are malignant, 41 to
45% of submandibular tumors are malignant, and 70 to 90%
of sublingual gland tumors are malignant.

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11
Q

What is the incidence of cervical lymph node

metastasis in a primary submandibular neoplasm?

A

30%

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12
Q

What is the most common histologic subtype of

malignant salivary gland tumors?

A

Mucoepidermoid carcinoma is the most common malig-
nant salivary gland tumor, followed by adenoid cystic
carcinoma, and then adenocarcinoma.

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13
Q

Grading of mucoepidermoid carcinoma is critical

to prognosis and management. What is the histologic appearance of low-grade mucoepidermoid carcinoma?

A

Low-grade mucoepidermoid carcinoma is more cystic with little atypia and low mitotic activity. High grade is more solid.

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14
Q

What is the prognosis of mucoepidermoid carcinoma?

A

Patients with low-grade and intermediate-grade carcinoma with no regional or distant metastases have an excellent prognosis, with 5-year survival greater than 90%. High-grade tumors have a lower 5-year survival of around 50%.

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15
Q

What is the recommended treatment for low-

grade and high-grade mucoepidermoid carcinoma?

A

Low-grade carcinoma requires removal of the salivary gland
with a margin of healthy tissue, but elective neck dissection
is not necessarily required. High-grade carcinoma requires total excision and elective or therapeutic neck dissection and often adjuvant radiation.

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16
Q

Describe the natural history of adenoid cystic carcinoma.

A

Adenoid cystic carcinoma is difficult to cure. Its course is
slow and prolonged; it commonly has perineural invasion at
manifestation; and despite excision, it frequently recurs.

17
Q

Which salivary gland malignancy has the highest rate of distant metastasis?

A

Adenoid cystic carcinoma. About 30% to 50% of patients develop metastasis, most commonly to the lungs.

18
Q

What are the 5- and 10-year survival rates for patients with acinic cell carcinoma?

A

Acinic cell carcinoma is a relatively low-grade cancer with a
5-year survival rate ranging from 75 to > 90% and a 10-year
survival rate ranging from 60 to 75%.

19
Q

What are the two main subtypes of malignant

mixed tumor?

A

Carcinoma expleomorphic adenoma and carcinosarcoma

rare

20
Q

True or False. With complete surgical excision, patients with salivary gland carcinosarcoma have
good long-term survival.

A

False. Death from disease often occurs within 3 years of diagnosis even with complete surgical excision.

21
Q

What is the most common presentation of carcinoma ex-pleomorphic adenoma?

A

A male patient in his 60s to 70s with a long-standing parotid
mass that suddenly increases in size over several months

22
Q

What is the most common manifestation of a polymorphous low-grade adenocarcinoma?

A

The most common initial manifestation is an asymptomatic

mass of the hard palate present for months to years.

23
Q

Describe the clinicopathologic features of polymorphous low-grade adenocarcinoma.

A

Slow growth, indolent behavior, and almost exclusively involves minor salivary glands with an infiltrative growth
pattern and perineural invasion

24
Q

What other cancer does salivary duct carcinoma

histologically resemble?

A

High-grade ductal carcinoma of the breast

25
Q

What is the most important diagnosis to rule out when squamous cell carcinoma is found in the parotid gland?

A
Other primary (e.g., skin) carcinomas with metastasis to the
parotid must be ruled out. This situation is much more common than primary parotid squamous cell carcinoma.
26
Q

Which cancer most commonly metastasizes to the

parotid lymph nodes?

A

Skin cancer of the head and neck

27
Q

Although this topic is debated, what are the
general indications for total parotidectomy in a
patient with parotid malignancy?

A

● Benign tumors in the deep lobe
● Malignant tumors in the deep lobe
● High-grade parotid tumors, even if in superficial lobe
● Parotid malignancy with cervical lymph node metastasis
● Any tumor that metastasizes to parotid gland

28
Q

In general, what is the management of salivary gland malignancy with cervical lymph node
metastasis?

A

If a parotid gland malignancy has cervical metastases, an ipsilateral modified radical or select neck dissection is
recommended.

29
Q

True or False. Patients with node-negative (N0) necks and parotid malignancies < 4 cm should undergo prophylactic neck dissection.

A

False. Although the topic is debated, most of the literature
shows that tumors with larger than 4-cm extraparotid tumor extension and higher-risk histologic types (undifferentiated carcinoma, squamous cell carcinoma, high-grade mucoepidermoid, adenocarcinoma not otherwise specified,
carcinoma ex-pleomorphic adenoma, and salivary duct
carcinoma) are the only parotid tumors that warrant prophylactic neck dissection.

30
Q

What type of neck dissection should a patient with a node-negative (N0) neck and high-grade salivary gland malignancy have?

A

In general, selective neck dissection: levels I through IV for a
parotid primary and levels I through III for submandibular
primaries

31
Q

What are the indications for adjuvant radiation therapy for salivary gland malignancies?

A

Adjuvant radiation is indicated in cases of advanced stage, positive margins after resection, high-grade tumor, peri-
neural invasion, or bony invasion.

32
Q

What is the most common tumor type of the minor salivary glands?

A

When combining all tumor types, malignant tumors are more common than benign tumors in the minor salivary glands, with mucoepidermoid carcinoma the most common malignant tumor.