Salivary Gland -Part3

8/9/2019 Salivary Gland -Part3

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Non infammatorydiseases

Helwa Mageed Asakly20102050290


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Disease mechanism:nonneoplastic, noninflammatory enlargement of theparotid salivary gland.Usually related to Metabolic and secretorydisorder. hormonal sialadenosis malnutrition

alcoholics(dystrophic metabolic sialadenosis, vitamin deficiencies neurologic disorders(neurogenic sialadenosis

Sialadenosis/ sialosis


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!maging feature: "ialography:#nlargement(splayed $ normal appearance

MD%&' M!: more straightforward depiction,but are nonspecific)

&reatment: identifying the cause of themetabolic or secretory disorder)

conservative &* : local massage, increase fluidintake , sialagogues)


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Rare +- Unilateral in parotid gland %ongenital$ lymphoepithelial$dermoid$ac.uired !ntraglandular$e*traglandular)

Mucous e*travasation pseudocysts) anulas) /enign lymphoepithelial cysts: are s.ueal of cystic

degeneration of salivary inclusions within lymph nodes) Multicentric parotid cysts: associated with H!0 1 benign

lymphoepithelial lesions of immunodeficiency syndrome&hese lesion are accompanied by cervical lymphadenopathy,occur bilateral, in the superficial portion of parotid gland.

Cystic lesions


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!maging feature:!ndirectly visuali2ed on sialography only by thedisplacement of the ducts arching around them.

3ell4circumscribed, non enhancing

Ultrasonography: sharply marginated andecho4free(dark area&*: surgical(local$total e*cision of the gland


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Uncommon + 5)556- of population) About 6- of all tumors) 75- of salivary tumors arise in the parotid

gland, most of them occur in the superficiallobe, most are benign or low4grademalignancies)

high4grade malignancies are uncommon )

&he chance of neoplasms of ma8or salivaryglands being benign varies directly with thesi2e of the gland)

Benign tumors


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imaging features: benign tumors and low grademalignances may have similar appearance , welldefined margins which are most apparent inMD&%$ M! )

M! is preferential modality for salivary glandneoplasia (espically for ")M)

/enign tumors may present low$high intensitytissue signals on M!)

"ialography : may suggest a space occupying masswhen the ducts are compressed or displacedaround the lesion ( 9ball4 in4hand appearance


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“ball4in4hand appearance, whichis suggestive of a spaceoccupying mass


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A neoplasm arising from the ductal epithelium'mesenchymal components)

;-of all salivary gland tumors, 75- found inparotid gland)

"low growing, unilateral, encapsulated,asymptomatic mass)

occurs in the fifth decade of life)

female predilection) recurrence occurs in 5- of cases after e*cision

and


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imaging feature:

MD%&: sharpely circumscribed, infre.uentlylobulated and round homogeneous lesion that has

a higher density than the ad8acent glandular tissue)

are malignant form, called malignant mi*ed tumor$carcinoma

=oci of low signal intensity usually represent area offibrosis or dystrophic calcification, if present thediagnosis favors a benign mi*ed tumor, otherwise it isdifficult to differentiate from other parotid masses)


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/lack arrow:3ell4 definedperiphery and internaldensity that less thansurroding muscles3hite arrow : the

remaining parotid displacedlaterally

&4weighted

image: increasedsignal of thetumor4hyperintense tomuscle


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"ynonym : papillary cystadenoma lymphomatosum$adenolymphoma, and lymphomatous adenoma)

benign tumor arise from proliferating salivary ductstrapped in lymph nodes during embryogenesis of ")?)

the second most common benign neoplasm of the salivarygland tumors) >-4@- of parotid tumors, usually found in the inferior

lobe of the gland) slow growing, painless, round to ovoid mass ) multiple in >5- of cases) Men B5 years) Unilateral $bilateral)

warthin's tumor


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imaging features:M!' MD&% are the preferred techni.ues.

non specific appearance and is typical of benign

mi*ed tumor.

on MD&%: soft tissue or cystic density.M!: heterogeneous and may demonstratehemorrhagic foci.

warthinCs tumors is characteristically intenselyhot (high spot on &c4pertechnetate scan.


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/ilateral warthinCs tumor, a

large tumor involving the leftparotid and a much smallertumor in the right side)


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"ynonym :vascular nevus)the most common benign neoplasm of proliferating endothelialcells(congenital hemangioma and vascular malformationsresulting from abnormal vessel morphogenesis. 7- arise in the parotid gland) the most common salivary tumor during infancy and childhood) A0? age at diagnosis in

decades) unilateral, asymptomatic

>:< =:M ratio) &*: local e*cision for pt who do not undergo spontaneous

remission)

hemangioma


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phleboliths are common in this tumor, theyappear as discrete soft tissue calcificationswith a radiolucent center and are bestidentified on plan images ' MD%&)

when this tumor occurs in association with asalivary gland, the ducts of the gland may bedisplaced curving about the mass(apparent in

sialography.


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>5- of tumors in the parotid are malignant,54@5- of submandibular tumors, 5- ofsublingual , @54;- of minor salivary glandtumors)

imaging features: variable, and related tograde, aggressiveness, location, and type oftumor)

ill defined margins, invasion, and destruction ofad8acent osseous structures》》 malignancy,

*&* of low grade malignancy of the parotid gland :partially incised$ totally e*cised.

*&* of high grade tumors: radical neck dissection,combination of surgery' therapeutic radiation'chemotherapy.

malignant tumors

Adenocarcinomaof the leftparotid gland


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Adenoid cystic carcinoma

&he internaldensity of thistumor e.ual tothe remaininggland)

&issue signal in&4weightedM! is contrastswith the remaining

gland)

=atsaturationimage, the

tumor has ahigher signalthan theremaininggland


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A malignant tumor composed of variable admi*ture ofepidermoid ' mucous cells arising from the ductal epitheliumof the salivary gland)

the most common malignant salivary gland tumor(6-, morethan half occur in the ma8or salivary gland (commonly parotid

gland ) the rest occur in minorsalivary gland with the palate. Highest prevalence in the fifth decade of life slight predilection for females)

clinically the tumor movable, slow growing, painless nodulesimilar to benign mi*ed tumor) only


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High grade tumors cause facial pain, paralysis, ill4defined margins and relatively immobile.

metastasis by blood and lymph node)

recurrence in half of pts after e*cision) poor prognosis and varies with histologic grade) years survival rate may be >- in some

cases)


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A mass in the rightparotid gland, poorlydefined margins suggest alow grade malignancy : lowgrade mucoepidermoidcarcinoma


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&he incidence of other malignant tumors of ma8or salivarygland is low)

>6- of them are adenoid cystic carcinoma(most of them minor")?

adenocarcinoma accounts for only @)B- with acinic cellcarcinoma, primary lymphoma, and "%%)

pain, parasthesia and paralysis especially in high grade tumors) &umor spread: direct invasion$ metastasis Adenoid cystic carcinoma spreads along nerve sheaths)

metastasis in the parotid gland are more common because of thee*tensive lymphatic and circulatory components.Most metastasis lesions of parotid gland occur through thelymphatic system ("%%$lymphoma$melanoma

other malignances andmetastasis tumors


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Mass in the submandibulargland, that has aheterogeneous hypoechicpattern compared withad8acent tissue(echo4free:adenoid cystic carcinoma

Salivary Gland -Part3

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