1. Hari Dev
2008 MBBS

2. Salivary Gland tumors
Parotid
Submandibular
Minor salivary glands

3. Pleomorphic Adenoma
 Benign Tumor
 Represent 60% of tumors in parotid –
Most common tumor of major salivary glands.
 Mixed Tumor – Derived from a mixture of Ductal
[ epithelial] and myoepithelial cells, showing
epithelial and mesenchymal differentiation.
 Radiation – A risk factor!!

4. Pleomorphic Adenoma –
Gross
 Rounded , well demarcated
 Rarely exceed 6cm
 Pseudo – Encapsulated !!
 Cut surface shows
 grey white – Myxoid
 bluish translucent - Chondroid

6. Pleomorphic Adenoma -
Histology
 HETEROGENEITY
 Epithelial cells resembling ductal cells or
myoepithelial cells arranged as ducts,
acini , tubules, strands, sheets…
 Dispersed within mesenchyme – loose
myxoid tissue of chondroid, foci of bone.
 There is no epithelial dysplasia/ mitotic
activity.

8. Carcinoma Ex Pleomorphic
Adenoma
 Malignant mixed tumor
 Incidence of malignant transformation increases with
duration of tumor.
 Adenocarcinoma / Undifferentiated carcinoma
 Overgrows preexisting pleomorphic adenoma.
 Diagnosis- traces of pleomorphic adenoma must be
there.
 Most aggressive of all salivary gland neoplasms!!!!!

9. Carcinoma ex pleomorphic adenoma

10. Warthin’s Tumour
 Second most common salivary gland
neoplasm.
 Benign tumour
 Only tumour virtually restricted to parotid.
 More common in males
 Smoking - A risk factor!!
 10% multifocal , 10% Bilateral.

11. Warthin’s Tumour - Gross
 Round to Oval
 Encapsulated
 Mostly arises in superficial parotid
 Cut section – Pale grey surface
punctuated by cystic spaces filled with
mucinous/ serous secretions.

13. Warthin’s Tumour -
Histology
 Cystic spaces lined by double layer of
neoplastic epithelial cells –
 surface palisade by oncocytic columnar
cells resting on a layer of cuboidal cells
 these layers rest on a dense lymphoid
stroma
 Papillary projections of lymphoepithelial
elements into the cystic spaces
 Papillary Cystadenoma Lymphamatosum

16. Mucoepidermoid Carcinoma
 Malignant tumor
 Most common form of primary malignant
tumour of salivary glands.
 Variable mixtures of squamous cells,
mucus secreting cells, intermediate
cells.
 Divided into Low , intermediate and high
grade tumors.
 Radiation – A Risk factor !!

17. Mucoepidermoid Carcinoma - Gross
• Grow up to 8cms
• Though apparently
circumscribed, lack well
defined margins
• On cut section.
- Pale and grey white
- Small mucin
containing cysts.

18. Mucoepidermoid Carcinoma - Histology
 Squamous , mucous, intermediate cells
 Arranged in cords, sheets, cystic
spaces.
 Mucous filled vacoules.
 Regular benign looking to highly
anaplastic cells
 Hence low, intermediate , high grade.

20. Adenoid cystic carcinoma
•Relatively Uncommon tumor
•Most common tumor of
minor salivary glands
•Gross – poorly encapsulated
, grayish pink on cut section.
•Histology – small cells with
dark compact nuclei arranged
in tubular, solid , cribriform
pattern.

21. Adenoid cystic carcinoma
 Tendency to invade perineural spaces!!
 Stubbornly recurrent!!
 >50% disseminate to bone, liver ,brain

22. Acinic cell Carcinoma
 Relatively uncommon
 Mostly arise in parotids
 Sometimes bilateral and multicentric.
 Gross – small discrete lesions, appears
encapsulated.
 Histology – cells resemble normal serous
acinar cells of salivary gland, clear
cytoplasm arranged in solid , microcystic ,
papillary cystic patterns etc..

23. Acinic cell Carcinoma

24. Non Hodgkin’s Lymphoma
 uncommon tumor
 most often occurs in the parotid gland (70%) and
belongs to MALT type
Lymphoid proliferation of salivary gland
REACTIVE MALIGNANT
Lymphoepithelial sialadenitis of NHL-MALT type cases derived from
Sjogren Syndrome lymphoepithelial sialadenitis

26. Squamous cell carcinoma
• True salivary gland primaries of squamous cell
carcinoma are very rare
• Most tumors of parotid gland are metastases to
intraparotid lymph nodes from primaries in oral
cavity, upper aerodigestive tract or skin
• May represent malignant component of malignant
mixed tumor or high grade mucoepidermoid
carcinoma
• Rapid growth with infiltration of surrounding
structures, regardless of origin

28. To conclude…..
 Most common tumour
1. Of major salivary glands?? Pleomorphic Adenoma
2. Of minor salivary glands?? Adenoid Cystic Ca
3. Malignant tumour of salivary glands.?? Mucoepidermoid
 Salivary gland tumour
1. with strong predilection to invade nerves??
Adenoid Cystic Ca
2. associated with smoking?? Warthin’s tumor
3. with double layer of epithelial cells and
lymphoid stroma?? Warthin’s tumor