Salivary gland Tumors

Benign Malignant

Salivary gland Tumors

Tumors that arise from the salivary gland may arise from the salivary epithelium (the parenchyma) or the supportive stroma (mesenchymal) Benign parenchymal tumors are known as Adenomas Malignant tumors are known as adenocarcinomas . Salivary gland tumors may arise form any cellular component including the basal cells ductal, striated interclated ducts, acini and the myoepithelial cells.

Benign salivary gland tumors

PLEOMORPHIC ADENOMA MONOMORPHIC ADENOMA PAPILLARY CYSTADENOMA ONCOCYTOMA

Pleomorphic Adenoma
It is the most common benign salivary gland tumor composed predominantly by the proliferation of the myoepithelial cells and a wide spectrum of the epithelial and the mesenchymal tissue component surrounded by a distinctive capsule.

Pleomorphic Adenoma

Pleomorphic Adenoma
CLINICAL FEATURES: PA accounts for 60% of all parotid gland tumors,50% of submandibular tumors and 25% of sublingual tumors PA is encountered in patients of all ages. PA is a slow growing tumor. It is soft or slightly firm on palpation and on larger gland it is freely movable. In parotid glands the tumor id spherical and arises in the superficial lobe as an obvious mass. In minor gland there is soft to slightly firm swelling without any ulceration.

Pleomorphic Adenoma

Pleomorphic Adenoma

Pleomorphic Adenoma
DIAGNOSIS: MRI is the most reliable source of diagnosis and to determine the extent of the disease particularly in the major salivary glands. Biopsy has always been a best tool for the definitive diagnosis.

Pleomorphic Adenoma
HISTOPATHOLOGY: In PA there is presence of a pronounced fibrous capsule. This is the most important histological feature when distinguishing between the benign and the malignant tumors Some lesions of the long standing lesions are multinodular and each nodule is surrounded by the fibrous capsule. The tumor cells shoe wide variation of the cells involved that is why the name pleomorphic has been given. The most prominent pattern contains the ductal and the myoepithelial cells contd

Pleomorphic Adenoma
Sheets of the myoepithelial cells loose there typical spindle shape becoming polygonal with eccentric nuclei with hyalinized cytoplasm. Although PA,s are well capsulated it uncommon for the tumor cells to perforate the capsule and creating new tumor foci. There is less than 1% chances of malignant transformation for those which have undergone recurrences. The tumors are termed as Carcinoma ex. Pleomorphic adenoma.

Pleomorphic Adenoma

Pleomorphic Adenoma

Pleomorphic Adenoma
TREATMENT: Lobulectomy is done in the larger salivary glands. Enucleation is not done because of the chances of recurrence (deposition) of exracapsular foci of tumor cells) PA,s of the lip are enucleated as there chances of recurrence are minimal as some normal tissue is also excised with the tumor.

Pleomorphic Adenoma

Monomorphic adenoma
Monomorphic adenomas lack wide cellular diversity as seen in pleomorphic adenomas. They are composed of single cell type that is why term monomorphic has been used There are to distinct entities in this group: 1. The Basal cell Adenoma 2. Canalicular adenoma

Basal cell adenoma

Interclated ducts or the reserve cells are the source of this tumor. CLINICAL FEATURES: Occur in the major salivary glands 96% in the parotid gland and Rest of 4% in the other salivary glands They are painless and are slow growing. Major patients are over the age of 60 years. Basal cell adenomas of the minor salivary gland are usually present on the upper lips, in elderly patients.

Basal cell adenoma

HISTOPATHOLOGY: They have well defined capsule composed of connective tissue. The cells isomorphic and basaloid in appearance. The nuclei is round to oval with a scanty and ill defined cytoplasm. The tumor cells are arranged in solid nests with the peripheral cells often showing palisaded arrangment.

Basal cell adenoma

TREATMENT: Enucleation or surgical excision can be done. Recurrence is rare.

Canalicular Adenoma
CLINICAL FEATURES: The lesion originates from the intraoral accessory salivary glands. It occurs in the upper lip and there are instances when it occurs on the palate or the buccal mucosa. The tumor is a well circumscribed firm nodule which is not fixed and moves through the tissues.

Canalicular Adenoma
HISTOPATHOLOGY: There long strands or cords of epithelial cells, arranged in a double row There cystic spaces of varying sizes enclosed by these cords. The cystic spaces are filled with eosinophilic coagulum. The supporting stroma is loose and fibrillar with delicate vascularity.

Canalicular Adenoma

Canalicular Adenoma
TREATMENT: Enucleation or surgical excision can be done. Recurrence is rare.