Salivary Gland Tumor Assessment Quiz

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Questions and Answers

What percentage of minor salivary gland tumors is estimated to be malignant?

80-90% (correct)

70-90%

30-50%

60-80%

When is imaging strongly advised for a parotid tumor?

If the tumor is less than 2 cm

If the tumor is greater than 4 cm (correct)

If the tumor is asymptomatic

If there are no cervical lymph nodes involved

Which imaging technique is superior for evaluating parotid tumors?

X-ray

Computerized tomography (CT)

Ultrasound

Magnetic resonance imaging (MRI) (correct)

Where is the majority of parotid salivary tissue located in relation to the facial nerve?

Lateral to the facial nerve Signup and view all the answers

What is the role of fine-needle aspiration cytology (FNAC) in the pre-operative assessment of a parotid mass?

It is complementary to conventional MRI Signup and view all the answers

What does the TNM staging indicate regarding lymph node characteristics?

Considers both the size and the presence of extranodal extension. Signup and view all the answers

Which component of the TNM staging specifically refers to the presence or absence of distant metastasis?

M Signup and view all the answers

What does N2a represent in the TNM classification?

Single ipsilateral node larger than 3–6 cm without extranodal extension. Signup and view all the answers

Which type of carcinoma is most commonly associated with the parotid gland?

AcCC Signup and view all the answers

How does the size of the salivary gland relate to tumor occurrence according to the information provided?

Tumors are less frequent in smaller salivary glands but more likely to be malignant. Signup and view all the answers

Which of the following TNM stages corresponds to the classification of Tis, N0, and M0?

Stage 0 Signup and view all the answers

What is the significance of the fusion oncogene MECT1-MAML2 in relation to MEC?

It is implicated in both low-grade and high-grade MEC. Signup and view all the answers

Which of the following viruses is implicated in MEC disease besides CMV?

Human herpes virus 8 Signup and view all the answers

What is the recurrence event associated with AdCC as per the content?

t(6;9) translocation Signup and view all the answers

In studies of minor salivary gland carcinomas, which type is noted to be particularly prevalent?

AdCC Signup and view all the answers

What is the reported rate of carcinoma found in recurrent pleomorphic adenoma?

7% to 16% Signup and view all the answers

What is the relative risk of local recurrence for surgical patients compared to patients receiving combined surgery and radiotherapy?

9.7 times the risk Signup and view all the answers

What classification distinguishes 'carcinoma ex-pleomorphic adenoma' in the 2005 WHO classification?

Non-invasive carcinoma Signup and view all the answers

Why is optimal initial surgery emphasized despite the lack of randomized trials?

Evidence comes from retrospective reports Signup and view all the answers

What is a characteristic feature of carcinosarcoma?

It metastasizes while containing benign structures Signup and view all the answers

What indicates a likely diagnosis of malignancy in parotid tumors?

Rapid increase in size and presence of pain Signup and view all the answers

Which imaging technique is mandatory for evaluating invasion of the VIIth nerve in parotid tumors?

MRI scanning Signup and view all the answers

Which TNM classification signifies Stage IVb of parotid tumors?

T4B, any N, M0 Signup and view all the answers

What commonly presents at an advanced disease stage among salivary gland tumors?

MiSG tumors Signup and view all the answers

What is characterized as clinical extraparenchymal extension in salivary gland tumors?

Invasion to deep structures or soft tissues Signup and view all the answers

What does FNAC stand for in the context of diagnosing salivary neoplasms?

Fine-needle aspiration cytology Signup and view all the answers

In the TNM classification, what does the 'M' stand for?

Metastasis Signup and view all the answers

Which of the following is NOT a symptom associated with the diagnosis of malignancy in parotid tumors?

Slow-growing lump without pain Signup and view all the answers

What is a notable feature of perineural growth in adenocarcinoma cases?

It is associated with skip lesions. Signup and view all the answers

What percentage of positive margins was reported in skull base AdCC cases in a study from the University of Michigan?

80% Signup and view all the answers

Which adenocarcinoma type was previously known as polymorphous low-grade adenocarcinoma?

PAC Signup and view all the answers

What is the common site for the occurrence of PAC?

Palate Signup and view all the answers

What characterizes the biological behavior of PAC compared to other adenocarcinomas?

Less aggressive behavior Signup and view all the answers

What is true about the recurrences associated with AdCC?

Local recurrences can occur 15 years post-treatment. Signup and view all the answers

What is the categorization of every AdCC based on its clinical behavior?

Clinically high-grade malignant neoplasm Signup and view all the answers

What does the prognosis imply when perineural growth is observed in adenocarcinoma?

Poorer prognosis Signup and view all the answers

Study Notes

Malignant Tumors of the Salivary Glands

Malignant tumors of the salivary glands are predominantly (>80%) epithelial tumors.
Mesenchymal tumors make up a lesser portion (<20%)
Hematolymphoid tumors (lymphoma and plasmacytoma) are a smaller component
Epithelial tumors are complex with low incidence and heterogeneous behavior, differing microscopically and clinically.
Major vs Minor Salivary Glands:
- Major glands (parotid, submandibular, sublingual) are paired.
- Minor glands are located throughout the upper aerodigestive tract, primarily in the oral cavity and oropharynx.
Incidence:
- Epithelial tumors account for the majority (95%) of malignant salivary gland tumors.
- Incidence ranges from 4 to 135 new patients per million per year.
- Inuit communities of Greenland and the Canadian Arctic have the highest incidence.
- The incidence in the USA is 10 new patients per million per year.
- Europe's incidence is lower with Belgium, the Netherlands, the UK and Finland at 6-7 new cases per million per year.
Risk Factors:
- Environmental and nutritional factors influence incidence.
- Increased incidence in atomic bomb survivors and Chernobyl survivors of benign and malignant salivary gland tumors.
- Warthin's tumors are doubled and multicentric in smokers.
- Epstein-Barr virus (EBV) is implicated in bilateral Warthin tumors and undifferentiated parotid cancer.
- Cytomegalovirus (CMV) may be linked to mucoepidermoid carcinoma.
- Inverse relationship between diets rich in polyunsaturated fatty acids and salivary cancer.
- Danish study linked livestock feed processing (possibly related to Aspergillus toxins) with increased risk of salivary cancer.

Histogenetic Theories

Salivary gland histology varies by location (major and minor glands).
Major glands have a true excretory ductal system.
Minor glands are unencapsulated acini.
The duct system includes intercalated, striated, and excretory ducts.
Myoepithelial cells and pluripotent basal cells surround luminal cells within the ducts and acini.
Two theories explain salivary gland tissue:
- Multi-cellular theory: Transformation throughout the entire gland tissue.
- Reserve cell theory: Differentiation from precursor cells explains diverse components.

Clinical Presentation & Imaging

Parotid gland tumors are often asymptomatic, presenting as pre-auricular lumps (80-90% are lateral to VIIN)
In some cases, swelling of the soft palate or lateral oropharynx, or accessory parotid glands (along Stensen's duct).
Malignant tumors increase in size rapidly or are accompanied by pain, neck lymph nodes, or facial nerve (VIIN) dysfunction.
Minor salivary gland tumors often present in the 5th to 6th decades, varying according to site (e.g., palate, buccal mucosa, retromolar trigone).
MiSGCs have various presentations depending on the site.
Imaging (MRI) is essential to assess extent, location, and malignancy likelihood. Diffusion-weighted MRI is useful.

Staging of Salivary Gland Cancers

TNM classification is used for staging.
T= Tumor size and extraparenchymal extension.
N= Lymph node involvement (number, size, extranodal extension).
M= Distant metastasis.
Stage grouping is based on these factors.

Pre-treatment Histopathology Typing

Accurate histology is crucial to identify salivary origin.
Fine-needle aspiration cytology (FNAC) is a valuable diagnostic tool.
FNAC is safe, quick, and less invasive but may not detect cancerous subtypes as accurately.
Incisional biopsy is warranted for certain cases, like MiSGCs with ready access, but not recommended for major glands.

Surgical Treatment

Primary surgical excision is the standard treatment for parotid cancer.
The extent of surgery depends on the tumor size, relation to VIIN, and extraparotid involvement.
Total or radical parotidectomy may be necessary in cases involving deeper lobes, the facial nerve, or large tumors.
Elective neck dissection may be considered in cN+ (clinically positive neck) cases.
Submandibular resection, often involving neck dissection, is standard.
Minor salivary gland surgery prioritizes wide local resection with clear margins.

Post-Operative Radiotherapy

Postoperative radiotherapy is a standard adjunct for patients with high risk of recurrence or metastasis.
3D conformal or IMRT techniques are employed.
Radiotherapy is crucial for advanced stage disease or unfavorable prognostic factors.
Radiotherapy helps control recurrence.

Treatment Results & Prognosis

Treatment outcomes are influenced by tumor type, grading, surgical margins, and patient-specific factors.
5- and 10-year survival rates vary across studies.
Prognostic factors include age, tumor stage, and histology.

Complications

Temporary or permanent facial nerve palsy is the most common complication in parotid surgery.
Hemorrhage, infection, and Frey syndrome (temporary facial nerve paralysis) are also possible.
Radiotherapy can cause mucositis, skin ulceration, osteoradionecrosis, fibrosis, and xerostomia.

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Description

Test your knowledge on the characteristics and assessment of salivary gland tumors, focusing on parotid tumors and their diagnosis. This quiz covers imaging techniques, TNM staging, and cytology roles in pre-operative assessments. Enhance your understanding of the malignancy rates and classification of these tumors.