932169

research-article2020
VDIXXX10.1177/1040638720932169Salivary gland diseases of dogsLieske, Rissi

Brief Communication

Journal of Veterinary Diagnostic Investigation

A retrospective study of salivary gland 2020, Vol. 32(4) 604­–610

© 2020 The Author(s)
Article reuse guidelines:
diseases in 179 dogs (2010–2018) sagepub.com/journals-permissions
DOI: 10.1177/1040638720932169
https://doi.org/10.1177/1040638720932169
jvdi.sagepub.com

Danielle E. Lieske, Daniel R. Rissi1

Abstract. Salivary gland diseases are well characterized in human medicine but are uncommonly reported in dogs. Herein
we describe the clinical and pathologic features of 179 canine salivary gland biopsy submissions to the Athens Veterinary
Diagnostic Laboratory from 2010 to 2018. The mean age of affected dogs was 8.5 y; no sex or breed predisposition was
evident. The main reason for sample submission was regional swelling (107 cases; 59.7%). Extraoral (major) salivary glands
were affected in 125 cases (69.8%), and oral (minor) salivary glands were affected in 43 cases (24% of cases). The location
of the lesion (extraoral or oral) was not specified in 11 cases (6.1%). The diagnoses included nonspecific sialoadenitis (89
cases; 49.7%), normal salivary gland (42 cases; 23.4%), neoplasia (36 cases; 20.1%), salivary gland lipomatosis (7 cases;
3.9%), necrotizing sialometaplasia (4 cases; 2.2%), and traumatic hemorrhage (1 case; 0.5%). Most cases of sialoadenitis
(63 cases), neoplasia (23 cases), and lipomatosis (5 cases), as well as all cases of necrotizing sialometaplasia and the only
case of traumatic hemorrhage, affected extraoral glands. Most neoplasms (32 cases, 88.8% of the tumors) were epithelial and
malignant, followed by round cell tumors (2 cases; 5.5%), a carcinosarcoma (1 case; 2.7%), and a tumor of undetermined
histogenesis (1 case; 2.7%).

Key words: dogs; neoplasia; salivary gland; sialoadenitis; sialometaplasia.

In human medicine, salivary gland disorders are associated
with systemic disease (diabetes, stroke, AIDS, Alzheimer’s
disease, Parkinson’s disease, among others), certain medica-
tions (such as chemotherapy), head and neck radiotherapy,
local infections, sialolithiasis, sialocele and mucocele, and
neoplasia.23 Depending on the severity and clinical course,
salivary gland dysfunction can cause xerostomia and conse-
quent oral or systemic problems, including altered taste, dys-
phagia, halitosis, predisposition to aspiration pneumonia,
and nutritional imbalances.23 Human salivary gland neo-
plasms are classified into > 40 distinct subtypes based on
morphology, which typically correlates well with clinical
behavior, prognosis, and specific therapeutic protocols.27
In veterinary medicine, there is a scarcity of studies charac-
terizing the clinical and pathologic changes in salivary
glands.16,26 Salivary gland diseases are described uncommonly
and mainly in dogs and cats, with an overall prevalence of
0.3% of diagnostic case submissions.12,25,26 In dogs, the main
salivary gland disorders include primary or secondary neopla-
sia,3,5–7,9,11,13,16,24,26 followed by nonspecific sialoadenitis,
sialocele, and necrotizing sialometaplasia.4,10,12,14,15,18,21,26
However, most of these descriptions are single case reports,
and there have been only a few population studies assessing
the prevalence of different salivary gland diseases in
dogs.12,13,21,25,26 Herein we describe the clinical and pathologic
features of 179 salivary gland tissue samples from dogs sub-
mitted to the biopsy service at the Athens Veterinary Diagnos-
tic Laboratory (AVDL; Athens, GA) over a period of 8 y.
Our laboratory web-based archive system was searched
for salivary gland biopsy cases submitted between 2010 and
2018 using the keyword “salivary gland”. Submission forms
and biopsy reports from selected cases were assessed for
patient signalment, clinical signs, and anatomic location of
the sample (major extraoral salivary gland [i.e., mandibular,
sublingual, parotid, and zygomatic] or minor oral salivary
gland), as well as pathology diagnosis. Archived hematoxy-
lin and eosin–stained slides were reviewed concomitantly by
both authors and tissue changes were categorized as 1) non-
pathologic, 2) inflammatory, 3) infectious, 4) neoplastic, or
5) other. Neoplasms were reviewed and diagnosed after a
consensus was reached between the authors. All neoplasms
were classified according to the World Health Organization
Histological Classification of Tumors of the Alimentary Sys-
tem of Domestic Animals and the fifth edition of Tumors in
Domestic Animals.11,19
We selected and included 179 cases in our study (Suppl.
Table 1). Ninety-three samples (51.9%) were from male dogs
(69 castrated, 24 intact) and 86 (48%) were from female dogs
Department of Pathology (Lieske, Rissi) and Athens Veterinary
Diagnostic Laboratory (Rissi), College of Veterinary Medicine, University
of Georgia, Athens, GA.
1
Corresponding author: Daniel R. Rissi, Department of Pathology and
Athens Veterinary Diagnostic Laboratory, College of Veterinary Medicine,
University of Georgia, Athens, GA 30602. rissi@uga.edu
 Salivary gland diseases of dogs 605

Table 1. Diagnoses and anatomic location of salivary gland conditions in 179 dogs between 2010 and 2018.

Diagnosis No. of cases Anatomic location (n)

Nonspecific inflammation 89 (49.7%) Extraoral (63) Oral (20) NS (6)
Mandibular (18) Tongue (5)
Sublingual (13) Gum (4)
Parotid (3) Oropharynx (4)
NS (29) Soft palate (3)
Cheek (1)
Hard palate (1)
NS (2)
No pathologic changes 42 (23.4%) Extraoral (29) Oral (10) NS (3)
Mandibular (16) Gum (5)
Parotid (1) Oropharynx (3)
Sublingual (1) Soft palate (1)
NS (11) Tongue (1)
Neoplasia 36 (20.1%)
Epithelial 32 (88.8% of the neoplasms) Extraoral (20) Oral (11) NS (1)
Mandibular (13) Gum (3)
Parotid (4) Hard palate (2)
Zygomatic (1) Tongue (2)
NS (2) Oropharynx (2)
NS (2)
Carcinosarcoma 1 (2.7% of the neoplasms) Extraoral (1) Oral (0) NS (0)
Parotid (1)
Undetermined 1 (2.7% of the neoplasms) Extraoral (0) Oral (1) (NS (0)
Gum (1)
Round cell 2 (5.5% of the neoplasms) Extraoral (2) Oral (0) (NS (0)
Mandibular (2)
Lipomatosis 7 (3.9%) Extraoral (5) Oral (1) NS (1)
Mandibular (1) Lip (1)
Parotid (1)
NS (3)
Necrotizing sialometaplasia 4 (2.2%) Extraoral (4) Oral (0) NS (0)
Mandibular (2)
NS (2)
Hemorrhage 1 (0.5%) Extraoral (1) Oral (0) NS (0)
Parotid (1)
NS = specific gland not specified.

(73 spayed, 13 intact). The mean age of affected dogs was
8.5 y, with a range of 6 mo to 20 y. The most common affected
breeds were mixed breed (17), Dachshund (16), Labrador
Retriever (12), Shih Tzu (10), German Shepherd (8), Golden
Retriever (8), and Chihuahua (7). The most common reason
for sample submission was regional swelling (107 cases),
which often raised suspicion of sialocele or neoplasia. Other
less frequently reported clinical signs included halitosis (2
cases), gagging, and fight wound (1 case each). The clinical
signs were not specified in the other cases. Extraoral (major)
salivary glands were examined in 125 cases (69.8%); the
most commonly affected glands were mandibular (52 cases),
sublingual (14), parotid (11), and zygomatic salivary gland
(1); the affected extraoral site was not specified in 47 cases.
Oral (minor) salivary glands were evaluated in 43 occasions
(24%); the main sites included the gum (13 cases), orophar-
ynx (9), tongue (8), palate (7), cheek (1), and lip (1); the
affected oral site was not specified in 4 cases. The location of
the lesion (extraoral or oral) was not available in 11 cases
(6.1%).
The most common diagnosis in the examined data set was
nonspecific sialoadenitis (89 cases; 49.7%), which consisted
of lymphoplasmacytic or neutrophilic inflammatory infil-
trates that expanded the periglandular, interlobar, and inter-
lobular spaces (Table 1). Inflammatory cells occasionally
effaced the salivary gland acini and were admixed with
necrotic cell debris or fibrosis. Cavitated areas with accumu-
lation of mucoid secretory material were detected in 24
(26.9%) of these cases, which was consistent with a diagno-
sis of sialocele; no cause for inflammation was evident. No
pathologic changes were detected in 42 (23.4%) of the cases.
Neoplasia was diagnosed in 36 cases (20.1%); 32 of 36
(88.8%) of the neoplasms were of epithelial origin, consist-
ing of 14 adenocarcinomas, 10 mucoepidermoid carcinomas,
606 Lieske, Rissi

Figures 1–6. Various salivary gland neoplasms in dogs. H&E. Figures 1, 2. Salivary gland adenocarcinoma in dog 133. Figure 1. Multiple acini and
ducts are filled with eosinophilic secretory material and supported by a fine fibrovascular stroma. Figure 2. Neoplastic cells have polygonal-to-columnar,
eosinophilic cytoplasm and form acini filled with eosinophilic secretory material. Figure 3. Salivary gland adenocarcinoma in dog 142. Neoplastic cells
have indistinct, vacuolated, mucin-rich cytoplasm and form rare small acini (arrow). Figure 4. Salivary mucoepidermoid carcinoma in dog 152. Neoplastic
cells with abundant, round, finely vacuolated, mucin-rich cytoplasm (arrows) admixed with small clusters of epithelioid neoplastic cells with cytoplasmic
keratohyalin granules (arrowhead) and shrunken, hypereosinophilic cytoplasm (dyskeratosis; circle). Figure 5. Salivary mucoepidermoid carcinoma in
dog 151. Epidermoid neoplastic cells forming small clusters containing cytoplasmic keratohyalin granules (arrow) and dyskeratosis (arrowhead). Figure
6. Salivary mucoepidermoid carcinoma in dog 147. Epidermoid neoplastic cells displaying areas of squamous differentiation with keratinization.
 Salivary gland diseases of dogs 607

Figures 7–10. Various salivary gland neoplasms in dogs. H&E. Figure 7. Salivary acinic cell carcinoma in dog 159. Vacuolated
neoplastic cells arranged in distinct lobules separated by a fine fibrovascular stroma. Figure 8. Salivary acinic cell carcinoma in dog 160.
Neoplastic cells have finely vacuolated cytoplasm. Figure 9. Salivary squamous cell carcinoma in dog 163. Solid groups of neoplastic cells
displaying keratinization and clusters of neutrophils (center). Figure 10. Salivary carcinosarcoma in dog 164. The neoplasm contains areas
of chondroid and osteoid matrix (asterisks) admixed with areas of epithelial cell proliferation forming indistinct acini (inset).

7 acinic cell carcinomas, and 1 squamous cell carcinoma.
These malignant epithelial neoplasms consisted of solid lob-
ules of neoplastic cells that partially or completely effaced
the salivary gland architecture.
Adenocarcinomas were poorly demarcated and confined
to one or more salivary gland lobules. Tumors were com-
posed of multiple groups of neoplastic cells forming solid
lobules or small acini and ducts supported by a fine fibrovas-
cular stroma. Neoplastic acini often contained faintly baso-
philic or eosinophilic secretory material (Fig. 1). Neoplastic
cells had low-to-moderate pleomorphism with a moderate
amount of polygonal-to-columnar, eosinophilic or less often
vacuolated, mucin-rich cytoplasm (Figs. 2, 3). Nuclei were
round with finely stippled chromatin and 1 or 2 nucleoli.
There was low-to-moderate anisocytosis and anisokaryosis.
Mucoepidermoid carcinomas were poorly demarcated
tumors and consisted of solid lobules of neoplastic cells sup-
ported by a moderate amount of fibrovascular and collagen
stroma. Neoplastic cells had moderate pleomorphism and
abundant, round-to-polygonal, finely vacuolated, mucin-rich
cytoplasm with indistinct cell borders (Fig. 4). Scattered
throughout were neoplastic cells with epidermoid morphol-
ogy (present of cytoplasmic keratohyalin granules and occa-
sional dyskeratosis) arranged in clusters of small nests (Fig.
5). Overt keratinization was rare but also occurred within
these tumors (Fig. 6). Nuclei were round and had finely stip-
pled chromatin with 1 or 2 nucleoli.
Acinic cell carcinomas were poorly demarcated and were
invasive tumors that consisted of multiple distinct solid lob-
ules of neoplastic cells supported by a moderate amount of
608 Lieske, Rissi

Figures 11–14. Salivary lipomatosis and necrotizing sialometaplasia in dogs. H&E. Figure 11. Salivary lipomatosis in dog 174. There
is widespread adipose tissue infiltration of the salivary gland with consequent lobular atrophy. Figure 12. Necrotizing sialometaplasia in dog
176. Sub-gross view of necrotizing sialometaplasia with an extensive area of necrosis and hemorrhage (arrow) adjacent to the normal salivary
gland (asterisk). Figures 13, 14. Necrotizing sialometaplasia in dog 176. Figure 13. Extensive coagulative necrosis (arrowhead) surrounded
by areas of fibrosis (asterisks) and duct hyperplasia (arrows). Figure 14. Hyperplastic ducts exhibit marked squamous metaplasia.

fibrovascular and collagen stroma (Fig. 7). Neoplastic cells
had moderate pleomorphism and abundant, round-to-polyg-
onal, finely vacuolated cytoplasm with distinct cell borders
(Fig. 8). Nuclei were round with finely stippled to coarse
chromatin and one nucleolus. There was low anisocytosis
and anisokaryosis.
The squamous cell carcinoma was poorly demarcated
and effaced most of the affected salivary gland (Fig. 9).
Mitotic activity was common in all epithelial tumors, with
an average of 1–12 per high power (FN22/40×) field. Areas
of necrosis, hemorrhage, and fibrosis were also common
findings.
One tumor (2.7% of the neoplasms) was a carcinosar-
coma that effaced the salivary gland tissue and consisted of
clusters of chondroid and osteoid matrix surrounded by spin-
dle-shaped cells admixed with solid areas of epithelial cell
proliferation with scattered acini (Fig. 10). The mitotic count
was 59 per 2.4 mm2 (equivalent to 10 FN22/40× fields). One
tumor (2.7% of the neoplasms) had undetermined histogen-
esis, and 2 (5.5% of the neoplasms) had round cell origin (a
salivary lymphoma and a salivary plasma cell tumor). The
final consensus diagnosis for neoplasia after review differed
from the original diagnosis in 20 cases (Suppl. Table 1).
Other changes consisted of salivary gland lipomatosis (7
cases; 3.9%), necrotizing sialometaplasia (4 cases; 2.2%),
and disseminated hemorrhage (1 case; 0.5%). Lipomatosis
(Fig. 11) was characterized by widespread expansion of the
salivary gland by sheets of adipocytes and subsequent lobu-
lar atrophy. Necrotizing sialometaplasia was characterized
by extensive, well-demarcated areas of coagulative necrosis
(Fig. 12) bordered by mixed inflammation and fibrosis (Fig.
13), vascular thrombosis, and duct hyperplasia with squa-
mous metaplasia (Fig. 14). Salivary gland hemorrhage was
characterized by abundant extravasated erythrocytes within
 Salivary gland diseases of dogs
the salivary gland interstitium and glandular architecture; the
hemorrhage was attributed to physical trauma to the site. No
infectious agents were identified during routine histology
evaluation during the study period. However, additional
ancillary testing (e.g., special stains and bacterial or fungal
culture) was not attempted in any case.
The 179 salivary gland submissions in our study comprised
0.3% of 59 canine biopsy submissions to our laboratory within
the studied period, confirming the overall low frequency of
these routine submissions.2,10–12,26 Affected dogs were mainly
adults, and no sex or breed predisposition was evident.
Almost 70% of the changes in our case series affected a
major extraoral salivary gland, most commonly the mandib-
ular gland. When in the oral cavity, minor salivary glands
associated with the gum tissue were most frequently
involved. However, it is not possible to determine whether
the inflammatory changes affecting minor salivary glands
were primarily affecting these glands or reflected an exten-
sion of inflammatory processes occurring within the adjacent
oral tissues. There have been studies describing sialocele
(also referred to as mucocele) affecting mainly the cervical
and sublingual location,1,2,20 with rare cases occurring in the
minor salivary gland tissues present in the pharyngeal
mucosa.10,28 However, other population studies have not
assessed the anatomic distribution of non-neoplastic salivary
gland changes in dogs, and it remains undetermined whether
a predisposition may exist for specific disorders to affect
major versus minor salivary glands.26
Nonspecific sialoadenitis constituted the most frequent
pathologic change in our study and was characterized by non-
specific inflammatory infiltrates with no discernible cause.
Inflammation in most cases was attributed to a possible under-
lying sialocele, perhaps secondary to duct obstruction by sial-
oliths, which was confirmed by the presence of necrosis,
hemorrhage, and fibrosis associated with cavitated areas filled
with mucoid secretory material in 24 cases.2,10,28 Extraoral
salivary glands were affected in 63 of our cases, confirming a
predisposition for inflammatory changes, often associated
with sialocele, to affect the extraoral salivary glands.1,2,20
Most cases in our study had been submitted for histologic
evaluation because of local swelling near the salivary
glands. However, a surprising number of tissue samples had
no pathologic changes and consisted of normal salivary
gland. The reason for this discrepancy is elusive, but it has
been attributed to the compact nature of the cervical area,
which hosts multiple and closely associated structures,
prompting salivary gland samples to be incidentally submit-
ted in cases in which other tissues (such as lymph node)
were affected.26 This hypothesis was confirmed in 10 of our
cases, which were submitted by the referring veterinarian as
lymph node but contained only salivary gland tissue.
Another possibility for such cases includes sialoadenosis, a
rare and poorly understood salivary gland disorder of labo-
ratory animals, dogs, and humans.25 Although sialoadenosis
is clinically characterized by an enlarged salivary gland, no
morphologic, histochemical, or immunohistochemical
609
changes are evident histologically, and the condition is
exceedingly difficult if not impossible to diagnose based on
histologic examination.25
A total of 36 neoplasms (20.1% of cases) were diagnosed
in our case series. A substantial number of salivary gland
neoplasms are associated with extraoral salivary glands, par-
ticularly the parotid and mandibular gland.9,11,16 In our data
set, extraoral salivary glands were affected in 23 cases in
which neoplasia was diagnosed, with 20 tumors occurring in
the mandibular or parotid gland. Approximately 88% of the
neoplasms in our study were malignant and of epithelial ori-
gin, similar to findings reported previously.9,11,13,16,26 Dogs
with salivary gland neoplasia were an average of 11 y old,
and no breed or sex predisposition was apparent. The neo-
plasms diagnosed most commonly were adenocarcinomas
(14), mucoepidermoid carcinomas (10), and acinic cell carci-
nomas (7). These findings are similar to previous repo
rts.8,9,11,16,26,29 One of the limitations of our study is the lack
of clinical follow-up after the diagnosis, which prevented us
from assessing the clinical behavior of these tumors. An
investigation of 24 dogs with malignant epithelial tumors of
the salivary gland indicated a median survival time of 550 d
after a diagnosis, with improved survival associated with
lower clinical stage.9 Further, histologic grading of malig-
nant salivary gland neoplasms in humans has been found to
correlate well with tumor prognosis,22 but the same has not
been found in canine cases based on limited data.9 Because
postdiagnosis clinical information was not available and,
more importantly, given that no standard grading system has
been proposed in veterinary medicine, we did not assess the
tumor grade in the current data set. It is also unknown
whether affected dogs in our study underwent any type of
treatment, but surgical excision alone or in combination with
radiation therapy has been shown to offer a longer survival
time in dogs with salivary adenocarcinomas.9
Salivary lipomatosis or lipomatous infiltration are rare
lesions that need to be differentiated from infiltrative lipomas.17
Although lipomatosis results in widespread infiltration and
swelling of the salivary gland without a discrete tumor mass,
infiltrative lipoma tends to form a tumor mass and infiltrate
adjacent tissues.17 However, lesions referred to as salivary lipo-
matosis forming a tumor mass have been described in dogs.3
These inconsistencies raise the suspicion that the morphologic
features of salivary lipoma and lipomatosis may overlap and
lead to confusion in terms of diagnosis.17 In our case series,
lipomatosis was originally diagnosed in 5 cases, with 2 other
similar cases originally diagnosed as salivary lipoma. After our
histologic reexamination, we reassigned the 2 lipomas to the
lipomatosis group based on the widespread salivary infiltration
by adipose tissue and absence of a tumor mass.
Necrotizing sialometaplasia was diagnosed in nearly 2%
of our cases. As seen in 2 of these cases, these lesions have
been shown to affect predominantly, but not exclusively, the
mandibular salivary gland.4,14,15,26 Numerous comorbidities
have been described in dogs suffering from necrotizing sialo-
metaplasia, but no causal link has been established.21
610 Lieske, Rissi
Although an underlying vascular injury leading to ischemia
and subsequent infarct has been proposed as the main mech-
anism for the development of the characteristic lesions in
such cases, the cause of necrotizing sialoadenitis remains
unknown.4,15,18 As seen in our cases, the distinct areas of duct
hyperplasia with prominent squamous metaplasia closely
resemble a salivary gland carcinoma or a squamous cell car-
cinoma, particularly if only small tissue sections are exam-
ined. Although we considered these possibilities, the
extensive, well-demarcated infarcts associated with normal
adjacent salivary gland tissue associated with the lack of
solid acinar proliferation are key findings in the differentia-
tion between necrotizing sialometaplasia and epithelial sali-
vary gland neoplasia.4,15
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, author-
ship, and/or publication of this article.
ORCID iD
Daniel R. Rissi https://orcid.org/0000-0003-4574-2836
Supplemental material
Supplemental material for this article is available online.
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