salivary neoplasm 1 Flashcards
Salivary gland neoplasms comprise approximately __% of all head and neck neoplasms
3%
how many cases of salivary gland neoplasms are diagnosed each year? who is at the greatest risk?
A) Uncommon, but not rare, with 4,000 new cases diagnosed each year in U.S.
B) May be a slight female sex predilection
C) Vast majority of these lesions arise during adulthood
which salivary glands are most likely to be effected with neoplasms?
Parotid- 61-80%
Submandibular- 8-11%
Sublingual- less than 1%
Minor glands- 9-28%
what is the most common INTRAORAL site of involvement for salivary neoplasms?
Palate (50%)
- 20% are found on lips, 15% on buccal mucosa
Minor salivary gland neoplasms typically effect what intraoral site?
palate
what salivary gland has the highest risk for malignant transformation of salivary neoplasms?
Sublingual gland
what is the prevalence of MALIGNANCY in salivary gland neoplasms in the parotid/sublingual/submandibular/minor glands?
A) parotid = 15-32%
B) submandibular = 26-45%
C) sublingual = 70-95%
D) minor = 45-50%
which intraoral sites are most likely to present with malignancies?
A) Retromolar- 90% B) Tongue - 80% C) Lower lip - 60% D) Palate & Buccal mucosa - 45% E) Upper lip - 15%
______________ are also known as “benign mixed tumor”
Pleomorphic Adenomas
T/F: Pleomorphic Adenomas are a relatively rare form of salivary neoplasms
FALSE
- PA’s are the most common salivary gland neoplasm
what does the naming of “pleomorphic adenomas” refer to?
the combination of neoplastic ductal epithelial and myoepithelial cells that often show a variety of histologic patterns
___% of all Pleomorphic Adenomas are found in the parotid gland
PA’s account for ___% of all parotid tumors
80% of all PA’s are in the parotid
PA’s make up 63% of all parotid tumors
___% of Pleomorphic Adenomas are found in the submandibular gland
PA’s account for ___% of all submandibular tumors
10% - submandibular (60% of all submandibular tumors)
___% of Pleomorphic Adenomas are found intraorally
PA’s account for ___% of all intraoral salivary gland tumors
10% - intraoral (40% of all intraoral salivary gland tumors)
what is the clinical presentation of a salivary gland Pleomorphic adenoma?
In the major glands, a slow-growing, painless, freely moveable mass will be detected
Rubbery firm on palpation
in what location of the mouth would you NOT expect a pleomorphic adenoma to be mobile?
Posterior Hard Palate
T/F: PA’s are typically non-ulcerated, and are NOT bilateral in presentation
True
A) Palatal lesions are usually to one side of the midline
B) Usually non-ulcerated, but ulceration may be present secondary to trauma
When a Pleomorphic Adenoma lesion is small, it’s usually round, but it typically becomes ___________ as it grows larger
bosselated
intraorally, where are pleomorphic adenomas most likely to be found?
palate is most frequent (54%), followed by upper lip (22%) and buccal mucosa (15%)
T/F: For Pleomorphic Adenomas, the encapsulated proliferation of ductal epithelial cells and myoepithelial cells vary in proportions from lesion to lesion
true
what are the histological features of Pleomorphic Adenomas?
1) The myoepithelial cells may appear spindled or plasmacytoid
2) myoepithelial cells have the ability to produce a myxoid stroma, hyaline material, cartilaginous material or even osteoid
what is the treatment protocol for Pleomorphic Adenomas?
Tx: Depends on location:
1) Parotid - remove the lesion with the involved lobe
2) Submandibular - remove the lesion and the involved gland
3) Hard palate - remove the lesion, including overlying oral mucosa, down to periosteum
4) Soft palate, labial and buccal mucosa - enucleation
a pleomorphic adenoma in what location has the highest rate of reoccurance?
what is the risk for malignancy in PA’s?
A) reoccurance = parotid gland
B) 5% of PA’s will undergo malignant transformation
Papillary Cystadenoma Lymphomatosums are also known as “_____________”
Warthins tumors
what is the histogenesis of Warthins tumors (PCL)?
Probably arises from salivary duct epithelium entrapped in parotid lymph nodes during development
Prevalence of Warthins tumors (PCL):
Comprises 5% of all salivary gland neoplasms and 5-22% of parotid gland neoplasms
Papillary Cystadenoma Lymphomatosums are almost always found in what location?
- Found almost exclusively in parotid gland
Risk factors for Papillary Cystadenoma Lymphomatosum (Warthins tumor):
- More common in MALES
- May be caused by cigarette smoking
- Average age is 55-60 years
Clinical presentation of Warthins tumors (PCL):
Papillary Cystadenoma Lymphomatosum
A) Presents as a non-tender, slowly growing freely moveable mass of the parotid region
B) In 10% of cases, synchronous or (mostly) metachronous lesions are observed, may be bilateral or unilateral
C) Grossly, encapsulated with cystic spaces containing serous, milky or chocolate-syrup-like fluid
Histology of PCL’s (warthins tumors)
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 a double row of columnar to cuboidal oncocytes (altered ductal epithelial cells)
what is the treatment/prognosis/reoccurance for Papillary Cystadenoma Lymphomatosum?
Tx: Surgical excision
Prognosis: Very low recurrence rate - 5% range
Recurrences actually may represent development of metachronous lesion
T/F: Monomorphic adenomas are far more common than Pleomorphic adenomas
False
Pleomorphic adenomas are more common
what are the 2 major sub-types of Monomorphic adenomas?
canalicular adenoma and basal cell adenoma
where would Canalicular (tubular) adenomas usually be found?
- Seen in both the major salivary glands and intraorally
- Relatively more common intraorally, especially in the upper labial mucosa
what population is at greatest risk for Canalicular adenomas?
Presents as a well-encapsulated, non-tender mass in an older adult (mean age - 65 years)
Female predominance
histological characteristics of Canalicular Adenomas:
Encapsulated proliferation of cuboidal to columnar cells that form tubules and narrow trabecular cords, with the appearance of channels or “canals”
Treatment/reoccurance/prognosis for Canalicular Adenomas:
Tx: Simple enucleation
Prognosis: Excellent
Virtually no tendency to recur
_____________ are the most common intraoral salivary gland MALIGNANCIES
Mucoepidermoid Carcinoma
T/F: Mucoepidermoid carcinomas are typically found in older (45-60 years old) adults
FALSE
mucoepidermoid Ca is the most common salivary gland malignancy in children, with 15% occurring in patients less than 15 yrs old
In what intraoral locations are Mucoepidermoid carcinomas typically found?
A) Intraorally, palate is most common site (28%), followed by retromolar area (23%)
B) May also be found centrally within mandible or maxilla
Clinical presentation of Mucoepidermoid cysts:
1) Well-demarcated or infiltrative mass
2) Non-tender and non-ulcerated initially
3) May have bluish tinge due to entrapped mucin
4) Ulceration and pain may develop as lesion progresses
T/F: A Mucocele-appearing lesion of retromolar area should be considered to be mucoepidermoid Ca until proven otherwise
True
what are the 2 distinct cellular elements of Mucoepidermoid carcinoma?
- mucous cells
2. epidermoid cells
T/F: both cellular elements must be seen histologically to diagnose a lesion as Mucoepidermoid carcinoma
true
what is the treatment protocol for Mucoepidermoid carcinoma
Low-grade - wide surgical excision
High-grade - wide surgical excision, plus radiation
what is the prognosis for Mucoepidermoid carcinoma?
A) prognosis depends on tumor size and histologic grade
B) lesions less than 2.5 cm have excellent prognosis
C) 10 yr survival: low grade = 95%, high grade = 40%
____________ is the SECOND most common intraoral salivary gland MALIGNANCY
Polymorphous Low-Grade Adenocarcinoma (PLGA)
what population groups are at risk for developing PLGA?
Female predilection by a 2:1 ratio
Adult population, mean age of 56 years, with a range of 23-94 years
Clinical presentation of PLGA’s:
A) Usually presents as a firm, painless swelling that may or may not be ulcerated
B) Typically well-demarcated initially, later becomes more infiltrative and diffuse
C) Usually a very slow-growing lesion
where are most PLGA’s found?
Most commonly found in the posterior hard palate/soft palate (65%), followed by upper lip and buccal mucosa
histological features of PLGA’s
lobular growth pattern that infiltrates the surrounding normal tissue, although a pseudocapsule may be present in some areas
what are some possible growth patterns of PLGA?
solid, trabecular, cribriform-like, ductal and spindle-cell areas
Lesional cells are usually cytologically bland
PLGA can be confused with what other condition?
May be confused with adenoid cystic Ca or pleomorphic adenoma
what is the treatment/prognosis/reoccurrence of PLGA’s?
Tx: Wide surgical excision Prognosis: Excellent Recurrence - 9-29% Lymph node metastasis - 9-17% Dead of disease - rare
