Salivary Gland Neoplasms
48
SALIVARY GLAND NEOPLASMS
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Transcript of Salivary Gland Neoplasms
- 1. SALIVARY GLAND NEOPLASMS
2. Epidemiology
- 90% of trs arise in parotid
- 75% of parotid trs are pleomorphic adenoma
- Muco epidermoid MC malignancy
3. Epidemiology
- 1.2% of all neoplasms
- Slow growing masses
- Pain not an indicator of malignancy
- Benign tumors also present with pain
4. Indications of malignancy
- Facial nerve involvement
- Indurations/ ulceration of skin , mucous membrane
- Lymph node metastasis
- Rapid tumor growth
5. Classification
- Epithelial tumors
- Non epithelial tumors
6. Epithelial tumors
- Adenoma
- Muco epidermoid tumors
- Acinic cell tumors
- Carcinoma
7. Adenoma
- Pleomorphic Adenoma
- Monomorphic Adenoma
8. Monomorphic Adenoma
- Adenolymphoma
- Oxyphilic adenoma
- Other types
9. Carcinoma
- Adenoid cystic
- Adenocarcinoma
- Epidermoid carcinoma
- Undifferentiated carcinoma
- Carcinoma in pleomorphic adenoma
10. Non epithelial tumors
- Hemangioma
- Lymphangioma
- Lipoma
- sarcoma
11. Investigations
- FNAC
- CT
- MRI
12. FNAC
- 95% accuracy
- Differentiate inflamatory from neoplastic in sub mandibular gland
- Controversial in parotid
13. CT Scan
- Limited to malignancy
- Tumor extension
- Deep lobe tr from parapharyngeal trs
14. MRI
- Superior to CT
- Better clarity of margins
- More sensitive
- Lack of artefact from dental filling
15. Open biopsy
- Contraindicated
- Justified only in minor gland trs
- Ulcerated lesions
16. Benign tumors
- Painless
- Slow growing
- No facial palsy
17. Pleomorphic Adenoma
- Commonest benign tr
- Pseudocapsule
- Pseudopodal extensions
- Not multicentric
18. Pleomorphic Adenoma
- Mixed tumor
- Consists of cartilage besides epithelial cells
- Cartilage not of mesodermal origin
- Derived from mucin secreted by epithelial cells
19. Microscopy
- Epithelial and myoepithelial components
- Abundant matrix mucoid,myxoid or chondroid supporting tissue
20. Diagnosis
- Lobulated , painless swelling
- Long duration
- Neither adherent to skin/ masseter muscle
- Generally firm / variable consistency
21. Malignant transformation
- 3 5 % of cases
- Pain
- Rapid growth
- Hard
22. Malignant transformation
- Fixed to masseter
- Fixity to skin
- Lymph nodes
- Restricted jaw movements
23. Treatment
- Superficial parotidectmy
- Total parotidectomy
24. Warthins tumor
- Papillary cystadenoma lymphamatosum
- 5 15 % of parotid trs
- Always at the lower pole of the parotid
- Overlies the angle of mandible
25. Warthins tumor
- More in white races
- Not seen in negroes
- Encapsulated lesions
- No malignant transformation
26. Warthins tumor
- Only salivary neoplasm more in males
- Elderly males
- Slow growing
- painless
27. Warthins tumor
- Surface is smooth
- Well defined
- Distinct margins
- Soft in consistency with fluctuation
- Not tansilluminant
28. Microscopy
- Cystic / glandular spaces
- Lined by columnar epithelium
- Within abundant lymphoid tissue with germinal centres
29. Investigations
- FNAC
- Tc99 scan hot spot
30. Treatment
- Superficial parotidectmy
- Enucleation
31. Oncocytoma
- 6
46. Treatment
- Total parotidectomy
- Radical neck dissection involved nodes
47. RT
- Residual tr
- Positive margin
- Advnced primary tr stage
- Lymphoma
- Secondaries in parotid
48. Thank you