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Questions and Answers
Which type of salivary gland tumor is the most common?
Which type of salivary gland tumor is the most common?
What is a characteristic feature of Adenoid cystic carcinoma?
What is a characteristic feature of Adenoid cystic carcinoma?
Which type of salivary gland tumor affects children?
Which type of salivary gland tumor affects children?
What is the characteristic histological pattern of Adenoid cystic carcinoma?
What is the characteristic histological pattern of Adenoid cystic carcinoma?
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What is the clinical presentation of a benign salivary neoplasm?
What is the clinical presentation of a benign salivary neoplasm?
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What is the consistency of a benign salivary neoplasm on palpation?
What is the consistency of a benign salivary neoplasm on palpation?
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Which nerve is NOT affected by a benign salivary neoplasm?
Which nerve is NOT affected by a benign salivary neoplasm?
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What is the characteristic feature of an Adenolymphoma?
What is the characteristic feature of an Adenolymphoma?
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What is the incidence of salivary neoplasms among all neoplasms?
What is the incidence of salivary neoplasms among all neoplasms?
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What percentage of salivary neoplasms arise in the parotid gland?
What percentage of salivary neoplasms arise in the parotid gland?
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What percentage of parotid neoplasms are malignant?
What percentage of parotid neoplasms are malignant?
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What percentage of benign tumors are pleomorphic adenomas?
What percentage of benign tumors are pleomorphic adenomas?
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What is the treatment for parotid gland fistula that is resistant to healing?
What is the treatment for parotid gland fistula that is resistant to healing?
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What is the most common location of fistula related to the gland?
What is the most common location of fistula related to the gland?
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What increases salivary discharge in parotid salivary fistula?
What increases salivary discharge in parotid salivary fistula?
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What is the treatment for parotid duct fistula?
What is the treatment for parotid duct fistula?
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What is the most common type of salivary gland tumor?
What is the most common type of salivary gland tumor?
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What is the characteristic of a pleomorphic adenoma?
What is the characteristic of a pleomorphic adenoma?
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Where is an adenolymphoma (Warthin's tumor) usually found?
Where is an adenolymphoma (Warthin's tumor) usually found?
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What is the characteristic of an adenolymphoma (Warthin's tumor)?
What is the characteristic of an adenolymphoma (Warthin's tumor)?
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What is the age group most affected by pleomorphic adenoma?
What is the age group most affected by pleomorphic adenoma?
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What is the characteristic of a carcinoma of salivary glands?
What is the characteristic of a carcinoma of salivary glands?
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What is the risk factor for adenolymphoma (Warthin's tumor)?
What is the risk factor for adenolymphoma (Warthin's tumor)?
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What is the rare complication of long-standing pleomorphic adenoma?
What is the rare complication of long-standing pleomorphic adenoma?
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Study Notes
Classification of Salivary Neoplasms
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Benign salivary neoplasms:
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Pleomorphic adenoma (mixed salivary tumor)
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Monomorphic adenoma
- Warthin's tumor (adenolymphoma)
- Oncocytoma (oxyphil adenoma)
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Malignant salivary neoplasms:
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Mucoepidermoid carcinoma
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Adenoid cystic carcinoma (cylindroma)
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Acinic cell carcinoma
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Adenocarcinoma
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Carcinoma ex pleomorphic adenoma
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Epidermoid carcinoma (squamous cell carcinoma)
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Lymphoma
Pathology of Benign Salivary Neoplasms
Pleomorphic Adenoma (Mixed Parotid Tumor)
- Most common tumor of salivary glands (75% of parotid and 50% of submandibular gland neoplasms)
- Equally distributed between males and females
- Occurs in the fourth decade of life
- Pathology: epithelial, myoepithelial, and stromal components with wide variations in cellular and architectural morphology
- Incomplete capsule that allows extension of neoplastic epithelium into surrounding tissues
- Rarely turns into carcinoma after 10 years
Warthin's Tumor (Adenolymphoma)
- Found in the lower part of the parotid gland
- Represents 15% of all parotid tumors and is bilateral in 10-15% of cases
- Thought to arise from heterotopic salivary tissue in parotid lymph nodes
- Macroscopy: multiple cysts of variable sizes
- Microscopy: epithelial-lined spaces filled with creamy material, surrounded by lymphoid tissue
- Affects elderly people and is related to smoking
Pathology of Carcinoma of Salivary Glands
Mucoepidermoid Carcinoma
- Arises from duct epithelium
- Most common malignant tumor of salivary glands
- Affects the parotid gland
- Three grades: low, intermediate, and high
- Low-grade type is the most frequent and affects children
Adenoid Cystic Carcinoma (Cylindroma)
- Commonest malignancy affecting minor salivary glands
- Histology: alternating layers of cylinders of cells and hyaline material
- Slow rate of growth and perineural spread
- High recurrence rate due to incomplete removal
Acinic Cell Carcinoma
- Uncommon tumor
- Cells resemble acinic cells of the parotid gland
- May metastasize to local lymph nodes or distant sites
Miscellaneous Adenocarcinomas
- Vary according to histologic pattern (trabecular, anaplastic, mucous carcinomas)
- Highly malignant
Clinical Picture of Benign Salivary Neoplasm
- Symptoms: painless, slowly growing swelling in the parotid region
- Signs:
- Swelling over the angle of the mandible
- Elevated lobule of the ear
- Swelling is superficial to the masseter muscle
- Facial nerve is not affected by the tumor
Clinical Picture of Benign Salivary Neoplasm (continued)
- Palpation:
- Swelling is not hot, not tender, not attached to the skin, masseter, or mandible
- Well-defined borders
- Consistency: varies from firm to cystic (but never hard)
- Parotid Salivary Fistula:
- May be connected to duct or gland
- Fistula related to gland is usually related to the lower pole of the parotid
- Salivary discharge is increased by meals and sucking of a lemon
Treatment of Parotid Salivary Fistula
- Heal spontaneously by granulation tissue
- Use atropine derivatives to decrease salivation
- Irradiation needle inside the fistula to cause fibrosis
- Avulsion of auriculo-temporal nerve to cause atrophy
- Excision of the fistula with the lower part of the gland and close the fascia
- Conservative superficial parotidectomy may be done
Treatment of Parotid Duct Fistula
- Excision and end-to-end anastomosis
- Slitting the opening of the duct proximal to the site of the fistula
- Reimplantation of the fistulous opening to the inner side of the cheek
- Rectangular pedicle flap of mucosa from the inner aspect of the cheek
- Superficial parotidectomy if all else fails
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Description
This quiz covers the classification of salivary neoplasms, including benign and malignant tumors, and their characteristics.
