Salivary glands

 The salivary glands  are exocrine glands that

produce saliva through a system of ducts.
 Humans have three paired major salivary
glands (parotid, submandibular, and
sublingual).
 as well as hundreds of minor salivary glands. 
 Salivary glands can be classified as serous,
mucous, or seromucous (mixed).

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Overall, diseases of the salivary glands are relatively
uncommon; however, as an organ system they have one
of the greatest diversities of pathology.
 The vast majority of lesions are of an inflammatory
origin; however, some arise from :  
 posttraumatic
  systemic
 uncertain pathogenesis. 
There also is a wide spectrum of benign and malignant
neoplasms.74 As a group, the salivary neoplasms
account for less than 3% of all head and neck tumors
and they account for less than 0.1% of all cancer deaths.
 The relative incidence of salivary gland tumors is
estimated to be that for every :
 100 parotid tumors
  10 submandibular tumors
  10 minor salivary tumors
 and 1 sublingual tumor.
.  parotid, submandibular, and sublingual
  The
glands are often referred to as the major salivary
glands, whereas the minor salivary glands line the
oral cavity and upper aerodigestive tracts. 3
 EMBRYOLOGY
o parotid anlagen are the first to develop, followed by --> anlagen of the
submandibular gland and then the sublingual gland.
o  The minor salivary glands do not start to develop until later. The epithelial
buds of each gland enlarge, elongate, and branch, initially forming solid
structures.  creating lumina ,This ductal canalization process is completed
before the terminal buds, or eventual acini, develop.
o  The lining epithelial cells of the ducts, tubules, and acini then differentiate
both morphologically and functionally and the contractile myoepithelial cells
become placed about the acini It has also been shown that an interaction of
the salivary gland parenchymal and stromal elements with the autonomic
system is necessary for normal salivary development and function to occur
o sympathetic nerve stimulation leads to acinar differentiation, whereas
parasympathetic nerve stimulation is necessary for overall glandular growth. 4
Although the parotid anlagen are the first to develop, they become
encapsulated after the submandibular and sublingual glands. 
This delayed encapsulation is critical why?
  because during the period after the submandibular and sublingual
glands encapsulate, but prior to the parotid gland encapsulation,
the emergence of the lymphatic system occurs in the mesoderm.
  Because of this, in the adult there are intraglandular lymph nodes
and lymphatic channels only within the parotid glands.
  In addition, during the encapsulation of the intraparotid and
periparotid lymph nodes,salivary epithelial cells can be included
within these .

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Parotid gland 
••These are largest of the salivary glands
•The glands are located posterior to the mandibular
ramus and anterior to the mastoid process of the
temporal bone.
• secretes serous saliva through the duct into the
mouth, to facilitate swallowing and chewing.
•A number of different structures pass through the
gland:
• From lateral to medial--> these are Facial nerve,
Retromandibular vein, External carotid artery,
Superficial temporal artery, branches of the great
auricular nerve, and maxillary artery. 
 Submandibular Gland
• The submandibular gland is the second largest salivary gland,
being about one half the weight of the parotid gland.
• It occupies most of the submandibular triangle of the neck, and
the gland is folded around the dorsal free edge of the mylohyoid
muscle.
• divided into superficial and deep lobes, with the larger superficial
lobe lying in the submandibular triangle, superficial and caudal to
the mylohyoid muscle, and the deep portion lying above the
mylohyoid muscle ---> It is from the deep portion of the gland
that Wharton’s duct extends to the anterior floor of mouth on
the sublingual papilla.
• The submandibular glands receive their primary blood supply
from the submental and sublingual arteries, which are branches
of the facial artery and lingual artery. .

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 SublingualGlands 

••The sublingual gland is the smallest of the major

salivary glands, weighing only about 2 g.
•located inferior to the tongue, anterior to the
submandibular glands.
•The gland rests on the mylohyoid muscle and its
medial contour is separated from the genioglossus
muscle by the lingual nerve and Wharton’s duct
•here are about 20 individual small ducts.

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Minor salivary glands
•Minor salivary glands are located throughout the
oral cavity within the submucosa of the oral mucosa
in the tissue of the buccal, labial, and lingual mucosa,
the soft palate, the lateral parts of the hard palate,
and the floor of the mouth or between muscle fibers
of the tongue.

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 PHYSIOLOGY
•The physiologic control of the salivary glands is almost entirely by the autonomic nervous system
and parasympathetic effects predominate. If the parasympathetic innervation is interrupted,
glandular atrophy occurs.
•Normal saliva is 99.5% water and the total daily production of saliva is between 1000 and 1500 mL.
Of this total, the parotid glands contribute about 45%, the submandibular glands about 45%, the
sublingual glands 5%, and the minor salivary glands 5%.
•The antibacterial activity of saliva is accomplished by secretory
  IgA; enzymes, such as lysozyme, peroxidase, a-amylase, and lactoferrin; and ions, such as
thiocyanate and hydrogen. 
 The normal range of salivary pH is 5.6 to 7.

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DEVELOPMENTALANOMALIES 
•Developmental anomalies of the salivary glands are rare, are usually associated with other facial
abnormalities, such as :
Xerostomia
 Sialadenitis
 dental caries
Parotid gland agenesis has been reported with hemifacial microstomia
 mandibulofacial dysostosis
 cleft palate
 anophthalmia. 
Hypoplasia of the parotid gland has been reported in the Melkersson-Rosenthal syndrome
and congenital fistula formation of the ductal system has been associated with branchial cleft
abnormalities, accessory parotid ducts, and diverticula

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 IMAGINGAPPROACH 

•The old approach relied on plain films and

sialograms.
•today the emphasis is on CT, MR imaging, and
ultrasound
•the general rule utilized by many radiologists is that:
• inflammatory diseases are probably best imaged by
CT . tumors are best imaged by MR imaging. 
•if the patient's history suggests an Inflammatory
disease, CT not only demonstrates the actual salivary
gland disease, but also potential sialoliths that may be
responsible 
• If clinically  find mass MR.
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CALCIFICATIONS
•Solitary or multiple calcifications within the parotid or submandibular glands usually indicate the
presence of chronic sialadenitis. 
•The finding is nonspecific and specific etiologies for the sialadenitis cannot be distinguished based
on the pattern of calcifications if the calcification is within a salivary gland mass, however, the most
likely lesion is a pleomorphic adenoma.
•calcification within a salivary gland mass can be seen in a schwannoma ,mucoepidermoid
carcinoma, parotid lymph nodes in such conditions as posttreatment lymphoma and long-standing
amyloidosis, and rarely within a chronic intraglandular hematoma.
•Ossification within a  parotid mass is also rare; the most common lesion  is a pleomorphic adenoma

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DIFFERENTIATINGBENIGNAND MALIGNANT MASSES

•The distinction between benign and malignant lesions frequently cannot be made based solely on
the morphology as demonstrated by CT and MR imaging. By utilizing the imaging and clinical
findings, however, such a distinction may be able to be made in almost 90% of the cases.
•most benign salivary lesions  cysts, tumors, and nodes have a capsule and thus are smoothly
contoured and sharply delineated from the adjacent salivary tissue 
•the most common low-grade salivary gland malignancies (i.e., lowgrade mucoepidermoid
carcinomas, some acinic cell carcinomas, and some adenoid cystic carcinomas) .
•Conversely, high-grade malignancies (i.e., highgrade mucoepidermoid carcinomas,
adenocarcinomas, undifferentiated carcinomas, and squamous cell carcinomas) have irregular,
infiltrating, indistinct margins with the adjacent salivary tissue and it is only rarely that a benign mass
is surrounded by inflammation or hemorrhage and presents an aggressive sectional imaging
appearance

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NONNEOPLASTIC  AND INFLAMMATORY CONDITIONS

•Viral and Bacterial Diseases :

the acute viral and bacterial inflammatory diseases are the most common salivary gland abnormalities
Most of the bacterial infections ascend from the oral cavity and are related to a decrease in the
salivary flow.
The production of saliva can be decreased by prior infections; dehydration; trauma; surgery; radiation;
some medications; and obstruction  masses, such as stones or tumors.
The most common salivary gland viral disease is mumps It primarily involves the parotid glands but can
occur in the submandibular and sublingual glands
Other viruses that can cause parotitis include Coxsackie viruses; parainfluenza viruses (types I and 111);
influenza virus type A; herpesvirus; echovirus; and choriomeningitis virus. , Epstein-Barr virus and
cytomegalovirus may be found in the saliva but not majority effect salaviry glands.
When imaging a patient with an acute sialadenitis, the primary clinical concern is to differentiate
between a sialadenitis without an abscess, which is routinely treated only with antibiotics, and
sialadenitis with an abscess, which requires immediate surgery.
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 .   Sialadenitis is the inflammation of the salivary gland,
acute infections like mumps and post-operative
parotitis, chronic conditions like swellings related to
nutritional deficiency, and iodine hypersensitivity,
wherein in all these conditions causes hypo salivation.
Calcified sialolithiasis can be clearly identified on CT and
may be located within the ductal system of the gland or
within Stensen's or Wharton's duct. 
Between 80% and 90% of salivary gland stones occur in
the submandibular gland , 10% to 20% occur in the
parotid glands, and only 1% to 7% occur in the sublingual .

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 Autoimmune Disease

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o Sjogren's syndrome :systemic autoimmune disorder of the exocrine glands that occurs either alone (primary Sjogren's syndrome) or
with any of several connective tissue diseases (secondary Sjogren's syndrome). The childhood form of the disease is one tenth as
common as the adult form., The adult form of the disease is most common between the ages of 40 and 60 years and nearly 90% to
95% of the patients are women.
o diagnosis is established when two or more of the following clinical hallmarks are present:
1. keratoconjunctivitis sicca
2.  xerostomia
3. connective tissue disease, which usually is rheumatoid arthritis
o It is diffuse exocrino pathy that primarily affects the lacrimal and salivary glands &Other exocrine gland.
o Symptoms:
1. Tracheobronchitis
2. dry skin
3. Dysphagia
4.  atrophic vaginitis.
o  Sjogren's syndrome difficult to establish because the symptoms can be nonspecific, and the specific autoimmune antibodies (SS-A
and SS-B) may be elevated only during active disease not all.
o In adults, the parotid disease tends to be progressive, occasionally requiring a parotidectomy to relieve the symptoms of recurrent
infection
o  On both CT and MR imaging in the earliest stages of Sjogren’s syndrome-->the involved glands appear normal.
o  As the disease progresses, glandular enlargement occurs and on CT the gland is denser than normal, a nonspecific finding. As the
parotid disease continues to progress, on CT a honeycomb glandular appeara nce develops.
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o Sialosis: 
o refers to a nonneoplastic, noninflammatory, nontender, chronic or recurrent enlargement of the parotid glands. 
o The parotid disease is usually bilateral and symmetric, but can be unilateral or asymmetric.
o The onset is usually insidious and the disease is associated with a variety of endocrine diseases, nutritional states,
and certain medications.
o Sialosis is especially prevalent in patients with diabetes.
o the parotid gland enlargement may be the first clinical evidence of the underlying disease.
o Sialosis may also lead --> xerostomia.
o both CT and MR imaging, the parotid glands are enlarged, but may appear either dense or fatty depending on the
dominant pathologic change.

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 Postirradiation Sialadenitis 
• Postirradiation sialadenitis can occur in either an acute or chronic form.
•  Today, the acute type is rare and is characterized by a tender, painful swelling of the gland within 24 hours after
it has been irradiated, usually by a single dose of 1000 cGy or more,  These manifestations usually subside within
3 to 4 days, and there may be an associated transient xerostomia. the acute phase of this disease does the gland
have a higher than normal T2-weighted signal intensity due to edema.
• .The chronic form occurs in glands irradiated as part of a curative treatment plan, usually for oral cavity or
pharyngeal tumors  After a full dose of irradiation, the gland atrophies and xerostomia occurs because of direct
effects both on the major and minor salivary glands, CT and MR imaging usually show the involved gland(s) to be
smaller than normal, cellular, and fibrotic.

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Granulomatous-type Diseases :
• These diseases may affect the intraparotid or juxtaglandular lymph nodes.
and this may occur either as an ascending infection from the oral cavity or
as part of a systemic process.
• granulomatous diseases that may involve the major salivary glands
include sarcoidosis, tuberculosis, atypical mycobacterial infection, syphilis,
cat-scratch fever, toxoplasmosis, and actinomycosis

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Sarcoidosis : is a systemic disease of presumed infectious etiology characterized by noncaseating
granulomas involving multiple organ systems. The parotid glands are affected in 10% to 30% of patients, and
in some cases the parotid disease may be the initial and only manifestation of the disease. 
In 83% of these patients bilateral parotid gland enlargement is present and in some patients involvement of
the minor salivary glands can cause xerostomia. 
In most patients a nontender, nonpainful, chronic enlargement of the gland occurs. 
The gland is often multinodular and clinically may mimic a malignancy ,in some patient have uveitis and
facial nerve paralysis -->This  findings is called Heerfordt's syndrome. 
Most cases of such salivary gland sarcoidosis usually resolve as the underlying disease is treated .
 ---> On CT and MR multiple, benign-appearing noncavitating masses, these nodes are
frequently radiographically described as being "foamy" in appearance .

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 Primary tuberculous : involvement of the salivary glands is rare, affect the salivary
glands, 70% involve the parotid glands, 27% involve the submandibular glands, and only
3% involve the sublingual glands, arises from a focus in the tonsils or teeth and spreads
to the gland via the regional lymph nodes. The clinical presentation may either be
that of an acute tuberculous sialadenitis that can mimic other acute infections or a
more indolent disease that may mimic a tumor.

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 Toxoplasmosis is caused by the protozoa Toxoplasma gondii, and this disease is one of the most common
infections occurring in humans, infecting from 5% to 95% of the population, depending on geographic
location. Most commonly the disease causes asymptomatic lymphadenopathy, and in the parotid
region the disease may be indistinguishable from cat-scratch fever, sarcoidosis, and tuberculosis.
 Actinomycosis is caused by the bacterium Actinomyces israelii, and the disease in humans usually
arises in the oral cavity of patients with poor dentition.
  The disease is an indolent, chronic infection that invades the salivary glands from a focus usually in
the mandible.
  Sinus tracts are commonly infected, and nodal disease can occur in and around the parotid.
 at-scratch (animal-scratch) fever is a granulomatous disease that may involve the parotid lymph
nodes and mimic primary salivary gland disease.
•  Its radiographic findings can resemble either those of sarcoidosis or tuberculosis.

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 Cystic Lesions 

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Cystic Lesions
• cystic salivary gland lesion has a limited differential diagnosis. 
• The imaging character of the cyst wall : thickness, nodularity.
• which includes:
1.  primarily Warthin’s tumor (either solitary or multiple)
2. lymphoepithelial  as a result of any chronic infection or multiple as seen in HIV infection, Most commonly with HIV
infection there are multiple, bilateral parotid lymphoepithelial cysts with a diffuse cervical adenopathy.
• Many acquired cysts of the major salivary glands develop as a result of an obstruction to part of the ductal system
that may be caused by a post-inflammatory stricture, a calculus, trauma, postsurgical complication, or a mass. 
• . A sialocele arises when saliva accumulates within a cyst area that develops secondary to a complete or incomplete
traumatic interruption of the excretory ducts draining the region. These sialoceles develop rapidly after trauma, and
needle aspiration of saliva from the cyst confirms the diagnosis.
• The term runulu specifically refers to a mucous retention cyst in the sublingual gland, and the ranula occurs in two
forms:
1.  A simple ranula, which is the most common form, is a retention cyst that remains in the floor of the mouth above
the level of the mylohyoid muscle . The simple ranula is a true cyst because it has an epithelial lining around its entire
periphery.
2. The deep or plunging ranula develops from the rupture of the wall of a simple ranula. As such, it usually extends
below the level of the mylohyoid muscle, and in reality is a pseudocyst. Pathologically, inflammatory tissue forms
part of the cyst wall where the irritating saliva penetrated into the muscles and soft tissues. 
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 TUMORS AND TUMORLIKE
CONDITIONS 

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TUMORS AND TUMORLIKE CONDITIONS 
• Salivary gland neoplasms cause about 750 deaths .
• Reported in Eskimos, survivors of atomic bomb blasts, and those exposed to previous radiation.
• Between 70% and 80% of parotid gland tumors, 40% and 58% of submandibular gland tumors, 15% and 30% of
sublingual gland tumors, and 20% and 51% of minor salivary gland tumors are benign.----> these figures indicate that
the smaller the salivary gland involved, the greater the likelihood that a tumor is malignant.
• The TNM ( Tumour, Node and Metastasis)  staging of salivary gland tumors according to the American Joint
Committee on Cancer is weighted heavily on the size of the primary lesion. By using this staging system, it becomes
evident that the higher the stage, the greater the recurrence rate, the greater the incidence of metastasis and
the lower the survival rate.
• Although salivary gland tumors are uncommon in children, there is a higher frequency of malignancies in children
compared with adults. Of all epithelial and nonepithelial salivary gland tumors children, 35% are malig1ant. The most
common tumors in the pediatric age group are hemangiomas, followed in descending frequency by pleomorphic
adenomas, mucoepidermoid carcinomas, lymphangiomatous-type tumors, acinic cell carcinomas, and
undifferentiated carcin0mas.
• For all salivary gland malignancies, the presence of metastatic regional lymph node disease is a poor prognostic
finding.
• The presence of pain is not necessarily a criterion of malignancy because 5.1% of benign tumors and 6.5% of
malignant tumors present with parotid pain.
•  the treatment philosophy for parotid gland malignancies has changed as the limitations of surgery for the more
aggressive neoplasms have become known. Postoperative irradiation is now used frequently to improve local
control, and chemotherapy is being utilized more often to control distant metastasis!
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 Epithelial Tumors 

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Epithelial Tumors 
  The pleomorphic adenoma, also referred to as the benign mixed tumor, is the most common salivary gland tumor
and represents 70% to 80% of all benign tumors of the major salivary glands.
•  For all pleomorphic adenomas, 84% occur in the parotid gland, 8% in the submandibular gland, 6.5% in the minor
salivary glands, and 0.5% in the sublingual glands.
•  Of the parotid tumors, 90% arise lateral to the plane of the facial nerve .
•  Although about 50% of all minor salivary gland tumors are malignant, the pleomorphic adenoma is still the single
most common tumor of these glands.
• The imaging of pleomorphic adenoma shows the typical picture of a benign-appearing mass. The smaller lesions are
usually homogeneous in appearance and ovoid. 
•The larger masses most often have a nonhomogeneous appearance,sites of lower attenuation representing areas of
necrosis, and cystic change.
 Warthin’s tumor, adenolymphoma or papillary cystadenoma lymphomatosum, is the second most common benign
lesion of the parotid gland, representing 2% to 10% of all parotid tumors. The lesion is exclusively limited to the
parotid gland and the peri-parotid lymph nodes. As many as 10% of cases have bilateral involvement. It is also the
most common lesion to occur as multifocal unilateral and bilateral disease. The tumor is benign and most patients
are in their fourth to seventh decades of life; this tumor is  ppear as small, ovoid, homogeneous, smoothly
marginated masses in the posterior and inferior aspect of the superficial lobe (tail) of the parotid gland.
 When multiple lesions are seen either in one parotid gland or bilaterally, the most likely diagnosis is Warthin’s
tumors. 

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  mucoepidermoid carcinomas account for less than 10% of all salivary gland tumors, they represent about 30% of
the salivary gland malignancies. Nearly 50% of these lesions occur in the parotid gland, and about 45% arise in the
minor salivary glands, primarily in the palate and buccal mucosa
  In adults, mucoepidermoid carcinomas are the most common parotid gland malignancy and the second most
common malignancy in the submandibular gland after adenoid cystic carcinoma.
 Mucoepidermoid carcinomas are also the most common salivary gland malignancies in children, These tumors can
be classified histologically as low, intermediate, or high grade, and the grade correlates well with prognosis. The
imaging findings of mucoepidermoid lesions vary with the grade of the tumor. 
 Low-grade lesions are benign in appearance. Cystic areas may be present and, rarely, focal calcification may be
seen. The appearance is similar to that of a benign mixed tumor.
 Adenoid cystic carcinoma accounts for 2% to 6% of parotid gland tumors, 12% of submandibular gland tumors, 15%
of sublingual gland tumors, 30% of minor salivary gland tumors, and 50% of lacrimal gland tumors. Overall, 4% to 8%
of all salivary gland tumors are adenoid cystic carcinomas, and they occur most commonly in the parotid gland,
the submandibular gland, and the palate. The tumor usually arises in patients between 20 and 80 years old.  it may
often have a slow rate of growth. Perineural invasion  refers to the invasion of cancer to the space surrounding a
nerve(seen in 50% to 60% of cases) is a pathologic hallmark of this tumor and accounts for the relatively frequent
clinical presentation with pain, on imaging tend to appear as benign well-delineated tumors, whereas the minor
salivary gland neoplasms usually have malignant infiltrative margins. Retrograde tumor extension to the skull base
often occurs via the facial nerve or the mandibular nerve. This neural invasion is best demonstrated by
postcontrast MR imaging, where nerve enhancement and enlargement signify tumor spread.

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 Acinic cell carcinoma represents only 2% to 4% of all major salivary gland tumors. They occur almost exclusively in the
parotid gland and represent 15% to 17% of all malignant parotid tumors. Bilateral parotid gland tumors occur in 3% of
cases, making these tumors second only to Warthin’s tumor as being the most common parotid lesion to occur
bilaterall. At least 80% of these tumors occur in the parotid gland; 4% in the submaxillary gland; and about 10%
intraorally, primarily in the buccal mucosa or lip. occur in patients in their fifth and sixth decades of life,acinic cell
carcinomas are the second most common parotid malignancy (after mucoepidermoid carcinoma),The imaging
characteristics of these tumors are nonspecific, with most lesions having a generally benign appearance.
 Salivary duct carcinoma is an uncommon, extremely aggressive malignancy that has a male predominance and a
predilection for the parotid gland. Histologically, this tumor resembles breast carcinoma, replete with intraductal in
situ carcinoma and comedonecrosis. This tumor may be confused histologically with mucoepidermoid carcinoma or
squamous carcinoma and distant metastasis may develop. tretment surgical resection, adjuvant radiotherapy is
recommended.

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 Nonepithelial Tumors

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Nonepithelial tumors
• nonepithelial tumors of the salivary glands represent of all salivary gland neoplasms. In children, however, they
may account for over 50% of the lesions. 
• The only tumors of statistical consequence are :
 hemangiomas, lymphangiomas, lymphomas, neurogenic lesions, lipomas, and sarcomas
 Hemangiomas of the parotid gland represent 1% to 5% of all salivary gland tumors, but they are the most common
salivary gland neoplasm in children. The congenital capillary hemangioma is the predominant tumor in the first year
of life, representing 90% of parotid gland tumors in this age group. This lesion is usually discovered shortly after
birth, is unilateral, compressible, and soft. Rapid enlargement can occur, and a bluish coloration can be seen in the
overlying skin, especially when the infant is crying ,also may be an associated hemangioma in the overlying skin.
 Cavernous hemangiomas occur in older children and adults, with most patients being older than 16 years of age.
These tumors tend to be well-circumscribed lesions and involve the extraparotid tissues. Surgery is the treatment
of choice.
 On CT these tumors enhance, are often lobular in contour, may be seen to extend to the overlying skin, or may
have phleboliths within the tumor tissues.

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 lymphangiomas are benign tumors that are composed primarily of lymphatic vessels.
  These tumors are classified as lymphangioma simplex, cavernous lymphangioma, and cystic lymphangioma or cystic
hygroma. All three pathologic types may coexist within the same tumor. 
  Most of the lesions that are found in the head and neck are cystic hygromas. Lymphangiomas represent 5% to 6% of
all benign tumors of infancy and childhood, with 50% to 60% of the cases being present at birth. Between 80% and
90% of patients are diagnosed by the age of 2 years. This age range corresponds to the period of greatest lymphatic
growth. 
  Most tumors are painless, soft or semi firm masses, and some fluctuation in size is common. Sudden enlargement is
associated with infection or hemorrhage.  
 Facial nerve paralysis can occur either secondary to nerve compression by a parotid lesion with hemorrhage, or
secondary to an acute otitis media caused by a lesion obstructing the eustachian tube.
  On CT, these lesions are usually cystic masses filled with homogeneous low-attenuation material. The cysts usually
have thin walls and most commonly there are multiple intercommunicating cystic components

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lymphangiomas

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 Primary lymphoma of the salivary gland is very rare.
  This diagnosis can be made only if there is histologic proof of lymphoma in the salivary parenchyma without any
evidence of intraglandular or extraglandular nodal involvement. 
 These patients do not have bone marrow involvement and are therefore stage IV lymphomas, the prognosis of
stage I salivary lymphoma is good. 
 45 The mean age is over 50 years, with only 10% of patients being younger than 30 years of age. Womem represent
64% of the cases.
 Secondary lymphomatous involvement of the salivary glands is also rare, with about 80% of the cases involving the
parotid gland.
  Most commonly, large cell lymphoma is the pathologic tumor type. 
 All forms of non-Hodgkin’s and Hodgkin’s lymphomas, however, have been reported Because there is
disseminated lymphoma outside of the parotid gland, the prognosis in these patients is poor. 
 There is a well-documented relationship between Sjogren’s syndrome and non-Hodgkin’s lymphoma, as well as
with HIV infection and Waldenstrom’s macroglobulinemia. 
 The CT appearance of secondary lymphoma of the parotid gland varies as the pathologic distribution of the
disease. Most commonly, the parotid disease is confined to the intraparotid lymph nodes is homogeneous and
may enhance slightly on postcontrast CT scan

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lymphoma of the salivary 

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 Lipomas can arise either within the parotid gland or in the immediate periparotid region.
  it may be clinically and radiographically impossible to distinguish the true site of origin. 
 Lipomas represent about 1% of parotid gland tumors, and approximately 90% of the cases are ordinary lipomas.
The remaining lesions are either infiltrating lipomas, or they occurred as part of a lipomatosis syndrome.
 The ordinary lipomas are discrete lesions that usually have a homogeneously low attenuation.
 They have no definable capsule on imaging, yet they are easily delineated from the adjacent soft tissues.
 he infiltrating lipoma is similar in appearance to the ordinary lipoma except with poorly defined margins and
infiltration of adjacent muscles may be demonstrated on imaging.
 Hemorrhage and fibrotic changes can occur within lipomas; and on CT these changes may cause an increased
attenuation that approaches that of muscle. 
 Neurogenic tumors of the parotid gland are the second most common benign mesenchymal neoplasm after
vascular or lymphatic tumors.
 They may be either schwannomas or neurofibromas.
  Both lesions are usually ovoid, sharply delineated masses that arise primarily from the facial nerve trunk or its
branches
 . The schwannomas are solitary, whereas the neurofibromas often are multiple and associated with other
manifestations of neurofibromatosis type 1 (NF-1) or von Recklinghausen’s disease
 . On CT these tumors can enhance, be cystic, or be isodense with muscle. The cystic changes usually are small and
multiple. The neurofibromas may have a low, almost fatty attenuation that may simulate a lipoma.

Add  On MR imaging these tumors are indistinguishable from other benign masses
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 ipomas 

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Neurogenic tumors of
the parotid gland are
the s

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