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# Salivary Gland Disease 2 ## Tumors **Benign Tumors (Adenomas)** * **Pleomorphic Adenoma (Mixed Tumor):** * **Most Common:** 40-60% * **Origin:** From epithelial tissue, not mixed origin. * **Clinical features:** 1. Slowly growing swelling 2. Well-defined, encapsulate...

# Salivary Gland Disease 2 ## Tumors **Benign Tumors (Adenomas)** * **Pleomorphic Adenoma (Mixed Tumor):** * **Most Common:** 40-60% * **Origin:** From epithelial tissue, not mixed origin. * **Clinical features:** 1. Slowly growing swelling 2. Well-defined, encapsulated (benign) 3. Painless 4. Rubbery swelling on palpation 5. Located at the angle of the mandible, anterior to the tragus, external to the ramus * **Histology:** Extensive variations; epithelial and stromal (CT) components are mixed together; epithelial duct cells (line duct-like structures); myoepithelial cells; some myoepithelial cells may undergo squamous metaplasia. * **Canalicular Adenoma:** * **Common:** In upper lip and Parotid * **Warthin Tumor:** * **Second Most Common.** * **Origin:** From Epithelial tissue with Lymph node. * **Not Lymphoma**: Lymphatic tissue * **Usually Bilateral** * **Clinical Features:** Slowly growing, soft or rubbery; no ulcer, no neural signs; sometimes numbness, paresthesia, or paralysis; * **Risk Factor:** Smoking **Malignant Tumors (Carcinomas)** * **Mucoepidermoid Carcinoma:** * **Most Common:** In major salivary glands; 50% Parotid * **Age:** 40-50 years old * **Clinical:** Clinically can present similar to pleomorphic adenoma, but can present with signs of malignancy; ulceration, necrosis, invasion, destruction; developing in parotid can cause facial paralysis; developing in palatal can cause anesthesia/paresthesia. * **Histology:** Composed of 3 cell types: mucous, squamous and intermediate which can differentiate between mucous or squamous cells. * **Adenoid Cystic Carcinoma:** * **Second Most Common** * **Minor SG (more common)**, **most dangerous** * **Histology:** It causes three main patterns * **Clinical:** May resemble pleomorphic adenoma, but actually adenoid cystic can clinically causes pain, ulceration, facial paralysis and paresthesia, anesthesia in region. So, clinically can give signs of malignancy * **Poor Prognosis:** ↑LRR * **Acinic Cell Carcinoma:** * **Rare** - mainly Parotid; any age; PA * **Histology:** Large cells and granular basophilic cytoplasm often in acinar pattern; arranged in solid, microcystic, papillary, cystic, follicular pattern. * **Clinical:** Slowly growing swelling, well-defined, capsulated, painless * **Poor Prognosis**: ↑ LRR * **Carcinoma ex-pleomorphic adenoma:** * **Features**: Malignant tumor that develops in a long-standing pleomorphic adenoma; particularly in those with a long-standing [10-15 years] pleomorphic adenoma or with history of local recurrence; PSA (clinical observation) with signs of malignancy (pain, palsy, ulceration), mostly in the parotid gland. * **Basal Cell Adenoma:** * **1–2.7%** * **Parotid:** superior lip * **Clinical features:** 1. Slowly growing swelling 2. Well-defined, capsulated (benign) 3. Painless 4. Rubbery swelling on palpation * **Histology:** Well-encapsulated; composed of basaloid cells of different forms (solid, trabecular, tubular, membranous). * **Oncocytoma:** * **Oncocyte** - eosinophilic * **Parotid:** bilateral * **Clinical features:** Slowly growing, swelling, well-defined, encapsulated (benign), painless, rubbery swelling on palpation * **Ductal Papillomas:** * **Rare** * **Types:** Different types (not mentioned in this lecture, only in slides) - sialadenoma papilliferum, inverted ductal papilloma, intraductal papilloma * **Polymorphous Low-Grade Adenocarcinoma:** * **Location:** often in palate, rare metastasis * **Histology:** Composed of cytologically benign-looking pale-staining cells; Arranged in different forms; tubular, lobular, papillary, cystic; cribriform