“SALIVARY GLANDS TUMORS”

Oleh : Dian N Agus Imam7 November 2015 1

SALIVARY GLAND DISEASES

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A. SPESIFIC DISEASES AND DISORDERS OF THE SALIVARY GLANDS

B. SALIVARY GLAND TUMORS

C. XEROSTOMIA VS SIALORRHEA

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B. SALIVARY GLAND TUMORS

Benign tumors

Pleomorfic adenoma; monomorfic adenoma : papillary cystadenoma

lymphomatosum, oncocytoma, basal cell adenomas, canalicular adenoma,

myoepithelioma, sebaceous adenoma

Malignant tumors

Mucoepidermoid carcinoma, adenoid cyst carcinoma, aciniccell carcinoma, carcinoma ex

pleomorphic adenoma, adenocarcinoma, myoepithelial

carcinoma

Penjelasan Umum Tumor Gl. Saliva:

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Sebaran Tumor 80% tumor yg tjd pada gland parotis tumor jinak

60% tumor yg tjd pada gland sublingual tumor ganas

Tumor jinak yg paling seringPLEOMORPHIC ADENOMA

Tumor ganas yg paling sering MUCOEPIDERMOID CARCINOMA & ACINIC CELL CARCINOMA

1.Pleomorphic adenoma (mixed tumor)

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Description: The most common tumor 60% The majority found in parotid glands-sub mandibular-

sublingual-minor salivary glands 40th – 60th

The most common salivary neoplasm in children

Clinical features: painless, firm, mobile, jarang menimbulkan ulserasi pd

jaringan yg melapisinya Slow growing Pada gl. Parotis: post-inferior dari lobus superfisialis Pada gl. Saliva minor: palatum, bibir atas, mukosa bukal

1.Pleomorphic adenoma (mixed tumor)

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Clinical features:

1.Pleomorphic adenoma (mixed tumor)

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Clinical features:

1.Pleomorphic adenoma (mixed tumor)

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Pathology: The gross appearance a firm smooth mass within a

pseudocapsule Secara histologis, jaringan tumor terdiri dari epitel &

mesenkimal The epithelial cells make up a trabecular patern that is

contained within a stroma. The stroma may be chondroid, myxoid, osteoid or fibroid Myiepithelial cells are also present in this tumor

1.Pleomorphic adenoma (mixed tumor)

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Pathology:

1.Pleomorphic adenoma (mixed tumor)

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Treatment: Surgical removal with adequate margins (wide resection)

to avoid reccurence Parotid PAROTIDECTOMY Submandibular removal of the entire gland

The gross appearance

MONOMORPHIC ADENOMA

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Description:• A monomorphic adenoma is a tumor that is composed

predominantly of one cell type, as opposed to a mixed tumor.

• According to Batsakis and Brannon histological classification of monomorphic adenoma is as follows:

1. Tumors of striated duct origin: papillary cystadenoma lymphomatosum (tumor whartin), oncocytoma.

2. Tumors of terminal duct origin: Basal cell adenoma, canalicular adenoma.

3. Tumors of terminal or striated duct origin: Sebaceous adenoma

4. Tumors of excretory duct origin: Sialadenoma papillefrumor inverted ductal papilloma.

2.Warthin’s Tumor

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Description: Sinonim: PAPILLARY CYSTADENOMA LYMPHOMATOSUM,

adenolimfoma 2nd most common benign tumor of the parotid gland Most commonly located in the inferior pole of the gland, posterior

to the angle of the mandible 50th -80th

6-12% bilateral

Clinical features: Well-defined, slow growing mass in

the tail of parotid gland Painless unless it becomes

superinfected

2.Warthin’s Tumor

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Pathology: The gross appearance of this tumor is smooth, with a well-defined

capsule Histologically the tumor consist of papillary projection lined

with eosinophilic cell that project into cystic spaces. The projection are characterized by a lymphocytic infiltrate

Treatment: Surgical removal This lesion is easily removed with a margin of normal tissue Superficial parotidectomy if involve the significant amount of the

superficial lobe Recurrencs and malignant degeneration rare.

2.Warthin’s Tumor

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3.Oncocytoma

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Description: Synonim : oxyphilic adenoma Less common benign tumor that make up less than 1% of all salivary

gland neoplasms. Oncocytes large granular acidophilic cells. This lesion occurs almost exclusively in the parotid glands (from striated

ductal) Grow very slowly 60th

Clinical presentation: Solid round tumors Bilateral

3.Oncocytoma

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Pathology: This tumor appear noncystic and firm Consist of brown granular eosinophilic cells Can be visualized by Tc 99m scintigraphy Malignant oncocytoma can occur and these aggressive lesion rare

Treatment : Superficial parotidectomy Removal gland submandibular & minor salivary gland

4.Basal Cell Adenomas

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Description: Characterized by a proliferation of basaloid-appearing cell Basal cell adenomas are slow-growing and painless masses Male predilection 40th – 90th

70% parotis; upper lip Clinical presentation : mobile, asymptomatic; lip or palatal tumor

ulceration Etiology : unknown

Pathology: There are 3 varieties of basal cell adenomas exist: solid, trabecular-

tubular & membranous. The solid form basaloid cells The trabecular-tubular form trabecular cords epithelium The membranous form multilocular

5.Basal Cell Adenomas

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4.Basal Cell Adenomas

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Treatment: Lesions are removed with conservative surgical excition extending to

normal tissue. Except : the membranous form.

5.Canalicular Adenoma

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Description:

> 50th ; mostly in women 80% upper lip The lesions are slow growing, movable and asyptomatic

Pathology:

This lesion is composed of long strands of basaloid tissue, usually arranged in a double row

Supporting stroma is loose, fibrillary and highly vascular

Treatment:

Surgical excision with a margin of normal tissue Patient should be monitored periodically

5.Canalicular Adenoma

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6.Myoepithelioma

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Description : Occur mostly in the parotid gland & the minor salivary glands of the

palate No gender predilection exists 60th

Clinical features: Well-circumscribed Asymptomatic Slow-growing mass

6.Myoepithelioma

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Pathology: Consist of spindle-shaped cells, plasmacytoid or combination. Growth patterns vary from a solid to a loose stroma formation with

myoepithelial cells.

Treatment: Standart surgical excisions

6.Myoepithelioma

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7.Sebaceous Adenoma

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Description: This lesion is rare 0,1% Derived from sebaceous glands located within salivary gland tissue

(interlobularis ductal) Most commonly parotid

Pathology: Cell derived from sebaceous glands are present Benign well-differentiated sebaceous cells Malignant more poorly differentiated cells

8.Mucoepidermoid carcinoma

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Description: The most common malignant tumor of salivary glands. Parotid (60-90%), submandibular glands, palate No gender predilection exists 30th – 40th; rarely in children Consist of both epidermal & mucous cells grading !

Clinical features: Low-grade less aggressive lesion; slow growing; painless enlargement. High-grade more malignant; poor prognosis; rapid growth; local tissue

invasion; higher likelihood for metastasis; pain; ulceration; facial palsy.

8.Mucoepidermoid carcinoma

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Pathology: Low-grade small & partially encapsulated; mucinous fluid High-grades less capsule because rapid growth and local tissue

invasion; solid

High grade

8.Mucoepidermoid carcinoma

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Treatment: Low-grade superficial parotidectomy High-grade total parotidectomy; neck dissection; postoperative

radiation therapy

9.Adenoid cystic carcinoma

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Description: Occurs 6-10% of all salivary gland tumors The most common malignant tumors of the submandibular & minor

salivary glands. No gender predilection exist 50th

Characteristic : frequent late distant metastases & local recurrences

Clinical features : Firm unilobular mass Painful If infected the parotid gland it may cause facial nerve paralysis

(perineural invasion) Tumor tissue often can extend far beyond the obvious tumor margin

bone, LN the slow growth may delay diagnosis I.O. exhibit mucosal ulceration

9.Adenoid cystic carcinoma

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Pathology: Gross examination :unilobular & either partially encapsulated or

noncapsulated Invasion into normal tissue Perineural & intraneural invasion Cells small, cuboidal, chromatin aggregation Acellular material fill the pseudocystic space

Treatment: Radical surgical excision

10.Acinic cell carcinoma

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Description: Acinic cell carcinoma (ACC) is a low-grade malignant salivary neoplasm Represent about 1% of all salivary gland tumors Parotid & submandibular gland Higher frequency in women 50th

Clinical features: Slow growing masses Pain Common sites superficial & inferior

10.Acinic cell carcinoma

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Pathology: Well-defined mass Two types cells : acinar cells with clear cytoplasma & lymphocytic

infiltration

Treatment: Superficial parotidectomy Total gland removal submandibular gland Postoperative radiotherapy may be useful for recurrent

10.Acinic cell carcinoma

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Acinic cell carcinoma, which is

encapsulated (arrow)

Consists of clusters of malignant

cells forming acini (left). The

malignant cells themselves are

pleomorphic and have atypical

nuclei

Acinic cell carcinoma cells growing

in a solid pattern. Most of the

tumor cells demonstrate fine

serous cytoplasmic granules,

resembling the normal serous

acinar salivary gland cells. Some

tumor cells with a clear cytoplasm

are also noted

11.Carcinoma ex pleomorphic adenoma

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Description:

Synonims : malignant mixed tumor; metastasizing

mixed tumor; carsinosarcoma

Malignant tumor that arises within a preexisting

pleomorphic adenoma

The most common the parotid gland (74%), minor salivary glands (17%) and submandibular glands

(10%).

The most common site of metastasis bone, head & neck area, lung & abdominal viscera

symptomatic

11.Carcinoma ex pleomorphic adenoma

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Predominant epithelial tubular

component surrounded by

myxoid components in salivary

gland lesion

The epithelial component of

tubular morphology with regular

nuclei without atypia

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