Neoplasm of salivary glands
-Karthik Rati
Tumours of salivary glands
Benign
Malignant
Epithelial
Epithelial
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Pleomorphic adenoma
Adenolymphoma
Oncocytoma
Mesenchymal
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Haemangioma
Lymphangioma
Lipoma
Neurofibroma
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Mucoepidermoid carcinoma
Low grade
High grade
Adenoid cystic carcinoma
Acinic cell carcinoma
Adenocarcinoma
Malignant mixed tumour
Squamous cell carcinoma
Undifferentiated carcinoma
Mesenchymal
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Lymphoma
Sarcoma
Benign tumours
Pleomorphic Adenoma
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They are slow growing tumours and may be quite large at initial
presentation,usually seen in third or fourth decade of life with propensity for
females.
They are called mixed tumors because both epithelial and Mesenchymal
elements are seen in histology .
The stroma of the tumour may be mucoid,fibroid,vascular,myxochondroid or
Chondroid and it’s proportion to the epithelial element may vary .
Surgical management in case of parotid is superficial parotidectomy.
Adenolymphoma(warthin tumour)
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Commonly seen between fifth and seventh decades with preponderance in
males (5:1).
Bilateral in 10% patients and usually involves tail of parotid .
Adenolymphoma is a rounded ,encapsulated tumour,at times cystic with
mucoid or brownish fluid .
Histologically ,epithelial and lymphoid elements are seen
Treatment is superficial parotidectomy .
Oncocytoma(oxyphil adenoma )
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They arise from acidophilic cells called oncocytes and comprise less than 1%
of all salivary gland tumors.
Seen in elderly,they usually do not grow larger than 5cm and involve the
superficial lobe of parotid .
Benign Oncocytoma are usually cystic.
They show increased uptake of technetium -99
Treatment for parotid Oncocytoma is also superficial parotidectomy.
Haemangiomas
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These are most common benign tumours of parotid in the
children,predominantly affecting females.
Discovered at birth ,grow rapidly in the neonatal period and then involute
spontaneously.
Cutaneous haemangioma may coexist in 50% of the patients.They are soft
and painless and increase in size with crying or straining.
Overlaying skin may show bluish discolouration.
Surgical excision is indicated if do not regress spontaneously.
Malignant tumours
Mucoepidermoid carcinoma
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It is slow growing but can invade the facial nerve .
Histologically there are areas of mucin producing cells and the squamous
cells
Greater the epidermoid element ,more malignant is the behaviour of the
tumour .
They are further divided into low grade and high grade
Low grade tumours have good prognosis (90% 5year survival rate),high grade
tumours are more aggressive and have poor prognosis (30% 5 year survival
rate )
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Behaviour of Mucoepidermoid tumours of minor salivary glands is more
aggressive and akin to adenoid cystic carcinoma ,but in major salivary glands
they behave like Pleomorphic adenoma.
Low grade tumours of the parotid are treated by superficial or total
parotidectomy depending on the location of the tumour.Facial nerve is
preserved.
High grade tumours being more aggressive are treated by total
parotidectomy.Facial nerve may be sacrificed if invaded by the tumour.It may
be combined with radical neck dissection because of high incidence of
microscopic spread of the tumour.
Adenoid cystic carcinoma
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It is a slow growing tumour but infiltrates widely into the tissue planes and muscles.
It also invades perineural spaces and lymphatics and thus causes pain and 7th
nerve paralysis.
It can metastasize to lymph nodes .
Local recurrences after surgical excision are common and can occur as late as 10
-20 years after surgery .
Distant metastases to lung brain and bone .
Treatment is radical parotidectomy with largest cuff of grossly normal tissue around
the boundaries of the tumour.
Radical neck dissection is not done unless nodal ,metastases are present.
Postoperative radiation is given if margins of the resected specimen are not free of
tumour.
Acinic cell carcinoma
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It’s a low grade tumour which appears similar to benign mixed tumour
It presents as small ,firm ,movable and encapsulated tumour ,sometimes
bilateral.
A conservative approach of superficial or total parotidectomy is adopted.
Squamous cell carcinoma
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It is rapidly growing tumour that infiltrates ,causes pain and ulcerates through
the skin.
It can ,metastasize to neck nodes .
Treatment is radical parotidectomy which may include cuff of muscle or even
portion of mandible ,temporal bone and the involved skin.
Surgery is followed by post operative radiation to primary site and the neck .
Parotid surgery
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Lazy Z incision /modified blair incision is used .
Incision should be at least 2 finger breath below mandible .To prevent injury to the
marginal mandibular nerve .
Types of parotid surgery
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Minimum surgery is superficial parotidectomy.
If both superficial and deep lobe are involved
Total Conservative parotidectomy-superficial and deep lobe is removed but
facial nerve is conserved
Total radical parotidectomy-superficial and deep lobe along with facial nerve
is removed .
Complications of parotid gland
1)
2)
3)
Hemorrhage
Infections
Injuries to the nerves - marginal mandibular nerve -drooping of the angle of
the mouth
Greater Auricular nerve - loss of sensation over the angle of the mouth
Facial nerve injury
4)Frey's syndrome (gustatory sweating)
Frey's syndrome
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It is characterized by sweating and flushing of preauricular skin during mastication .
It is the result of aberrant innervation of sweat gland by parasympathetic
secretomotor fibres which were destined for the parotid .
Now instead of salivary gland secretion from parotid they cause secretions from
sweat glands .
Treatment
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Tympanic neuroctomy
Subcutaneous infiltration of botulinum toxin .
By placings sheet of fascia lata between skin and underlying fat to prevent
secretomotor fibres from reaching the sweat glands .
References
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Diseases of ear nose and throat - P L Dhingra