carcinomas

1. TUMORS OF SALIVARY
GLANDS

2. INTRODUCTION
• The majority of these neoplasms are benign 80%
and only20% are malignant.
• These best distinguished by their histologic
patterns.

3. EPIDEMIOLOGY
• Uncommon neoplasms
• Up to 6.5% of all head and neck neoplasms.
• Most salivary gland tumors originate in the parotid glands
(64%-80%), malignancy (15%- 32%).
• 7-11% occur in the submandibular glands, malignancy (37%- 45%).
• less than 1% in the sublingual glands, malignancy (70% - 90%)

4. RULE OF 80
80% of parotid tumors are benign.
80% of parotid tumors are Pleomorphic adenomas
80% of salivary gland Pleomorphic adenomas occur in
the parotid
80% of parotid Pleomorphic adenomas occur in the
superficial lobe
80% of untreated Pleomorphic adenomas remain benign

5. ETIOLOGY
• viruses- EBV, CMV, Polyoma virus,
• Ionizing radiation.
• occupational risks- asbestos, nickel
compounds or silica dust.
• Employment . woodworking, rubber industries
beauty saloons.
• Lifestyle- Warthin’s tumors - cigarette
smoking.

6. BENIGN EPITHELIAL TUMORS
• Pleomorphic adenoma
• Myoepithelioma
• Basal cell adenoma
• Warthin tumour
• Oncocytoma
• Canalicular adenoma
• Sebaceous adenoma
• Lymphadenoma
• Sebaceous
• Nonsebaceous

7. PLEOMORPHIC ADENOMA
• Most common neoplasm of salivary gland tumor.
• Its cells differentiate to epithelial (ductal and
nonductal) cells and mesenchymal (chondroid,
myxoid, osseous) cells.
• origin: epithelial

8. CLINICAL FEATURES
• Most common tumor.
• Rate of occurrence
– 60-70%- parotid glands
– 40-60%- submandibular glands
– 40-70%- minor salivary glands
– seldomly- sublingual glands
• Age: 30-50 years
• Sex: female> male – 3:1 – 4:1
• In parotid- presents in the lower lobe of the superior
lobe

9. CLINICAL PRESENTATION
• painless, slow growing, firm mass, initially small in
size and begins to increase in size.
• Initially movable but with continued growth become
more nodular and less movable.
• Recurrent tumor- multinodular, fixed on palpation.
• Palate – intraorally common site.
• Seldom ulcerated- unless secondarily traumatized.

12. INVESTIGATION
• MRI
• CT SCAN
• FNAC showing well encapsulated mass tan coloured and
glossy in appearance

13. • DIFFERENTIAL DIAGNOSIS
• Polymorphous low grade adenocarcinoma.
• Adenoid cystic carcinoma.
• Epithelial myoepithelial carcinoma.
• Squamous cell carcinoma.
• Mucoepidermoid carcinoma.

14. • TREATMENT AND PROGNOSIS
• Superficial parotidectomy with preservation of the
facial nerve
• total parotidectomy for deep lobe with preservation
of the facial nerve.
• Local enucleation should be avoided .

15. MALIGNANT
TUMORS
• Mucoepidermoid carcinoma
• Adenoid cystic carcinoma
• Polymorphous low grade adenocarcinoma

16. MUCOEPIDERMOID CARCINOMA
• 5% of all salivary gland tumors
• Commonest malignant tumor in adult and childhood.
• 1st to 9th decade peaking in 4-5th decade
• Females
• Parotid gland (45%)And palate (21%)
• Malignant glandular epithelial neoplasm characterized by
mucous cells, intermediate cells, and epidermoid cells.

17. Etiology
Therapeutic Radiation
Lipoidal installation
Presence of other foreign material
Origin: Cells of the salivary gland excretory and
intercalated duct

18. CLINICAL FEATURES:
Age: 3rd – 5th decade
Sex: females> male
Site: parotid is most commonly affected.
Intraorally: palate
Most common salivary gland neoplasm in
children

19. CLINICAL FEATURES
• Low grade: slowly enlarging, painless mass, seldom
exceeds 5cm in diameter in low grade.
• may be mistaken as mucocele.
• High grade: grows rapidly, facial nerve paralysis
• ulceration, trismus, draining from the ear, dysphagia.
• metastasis to regional lymph node, lung, bone, brain,
suncutaneous tissue.

20. Blue-pigmented mass of the posterior
lateral hard palate.
Mucoepidermoid carcinoma.
Mass of the tongue

21. • Intraosseous MEC

22. • Low grade
• Mucous cell predominate
• squamous cell lining the cystic spaces seen.
• Size, shape & staining characteristics of cells are
• uniform
• Intermediategrade
intermediate cells predominate

23. • High grade: nearly solid cellular proliferation of
epidermoid & intermediate cells
– Noticiable degree of cellular atypia
– N:C ratio altered
– nucleoli prominent, mitosis- numerous
• 2 differentiation pattern:
• a)Resemble a MDSCC
• b) variety of cell types that are most often dominated by
• intermediate cells.

24. • DIFFERENTIAL DIAGNOSIS:
• Necrotizing sialomataplasia
• Pleomorphic adenoma
• Inverted ductal papilloma
• Cystadenoma
• Matastatic SCC
• Sebaceous carcinoma
• Clear cell tumors
• Adenosquamous carcinoma

25. • TREATMENT AND PROGNOSIS
• Conservative excision with preservation of facial nerve
• Submandibular gland- removal of the gland
• Minor salivary gland- surgical
• Matastatis- 12% of cases
• Prognosis- fairly good.

26. Adenoid cystic carcinoma. Painful mass of the hard palate and
maxillary alveolar ridge.

27. Polymorphous low-grade adenocarcinoma. Ulcerated mass of
the posterior lateral hard palate