SALIVARY GLANDTUMORS

Dr Yoseph Eyob DDM,MD

Lecture for DDM students
Oral pathlogy II
 GENERAL CONSIDERATIONS

• Tumors of the salivary gla nds constitute an important

area in the field of oral and maxillofacial pathology.
• Although such tumors are uncommon, they are by no
means rare.
The annual inciden ce of salivary gland tumors the world
ranges from about I to 6.5 cases per 100,000 people.
Although soft tissue neoplasms (e.g.. hemangioma),
lymphoma , and meta static tumors can occur within
the salivary gland
 PLEOMORPHIC ADENOMA (BENIGN
MIXED TUMOR
• The pleo morp hic adenoma , or benign mixed
tumor Is easily the most common salivary
neoplasm.
• It accounts for 53 % to 77 % of parot id tumo
rs, 44 % to 68 % of submand ibular tumors.
and 38 % to 43 % of minor gland tumors.
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• Pleomorphic adenomas are derived from a
mixture of ductal and myoepithelial elements.
• A remarka ble microscopic diversity can exist
from one tumor to the next.As well as in
different areas of the same tumor.
• The term s pleomorphic adenoma and mixed
tu mor both represent attempts to descri be
thi s tumor's unusual histopathologic features
Clinical and Radiographic Features
• Rega rdless of the site of origin, the pleomorphic adenoma
typically appears as a painless. slowl y growing, firm
mass
• The patient may be aware of the lesion for many months or years
before seeking a diagnosis.
• The tumor can occur at any age but is most common in young adults
between the ages of 30 and 50.
• There is a slight female predilection .
• Most pleomorphic adenomas of the parotid gland
occur in the superfi cial lobe and present as a swelling
overlying the mandibular ramu s in front of the ear.
• Facialnerve palsy and pain are rare
• Init ially the tumor is m but becomes less
mobile as it grows larger.
• If neglected the lesion can grow to grotesque
proportions.
• About 10% of parotid mixed tumors develop
within the deep lobe of the gland beneath the
facial nerve
•
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• Th e palate is the most common site for minor
gland mixed tumors, accounting for approximately
60% of intraoral examples.
• This is followed by the upper lip
(20% ) and buccal mucosa (10%).
• Palatai tumors almost always are found on the
posterior lateral aspect of the palate, presenting as
smooth-surfaced. dome-s haped
masses
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• If the tumor is traumatized secondary
ulceration may occur.
• Because of the tightly bound nature of the
hard palate mucosa .
• Tumors in this location are not movable,
although those in the lip or buccal mucosa
frequently are mobile
Pleomorphic adenoma
 Treatment and Prognosis
• Pleomorphic adenomas are best treated by surgical
excision.
• For lesions In the superficial lobe of t he
parotid gland. superf icial parotidectomy with Identification and
preservation of the facial nerve is recommended.
• Local enucleation should be avoided because
the entire tumor may not be removed or the capsule
may be violated. resulting in seeding of the tumor bed.
• For tumors of the deep lobe of the parotid total
parotidectomy is usually necessary also with preservation of the
facial nerve if possible.
• Submandibular tumors are best treated by total removal of the
gland
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• Tumors of th e hard palate usually are
excised down to periosteum including the overlying
mucosa.
• In other oral sites. the lesion often enucleates easily
through the incision site.
• With adequate surgery the prognosis is excellent.
wit h a cure rate of more than 95%.
• The risk of recurrence appears to be lower for tumors of
the minor glands.
• The risk of malignant transformation is probably small but
it may occur in as many as 5% of all cases.
 WARTHIN TUMOR (PAPILLARY
CYSTADENOMA LYMPHOMATOSUM)
• Warth!" tumor is a benign neoplasm that occurs
almost exclusively in the parotid gland.
• Although it is much less common than the
pleomorphic adenoma, it represents
the secon d most com mo n benign parotid tumor,
accounting for 5% to 14% of all parotid neoplasms.
• The pathogenesisof thesetumors is uncertain. The
traditional hypothesis suggests that they arise from
heterotopic salivary gland tissue found within
parotid lymph nodes
 Clinical Features
• The Warthin tumor usually appears as a slowly growing,
painless, nodular mass of the parotid gland It may be firm
or fluctuant to palpation.
• The tumor most frequently occurs in the tail of the parotid
near the angle of the mandible, and it may be noted for
many months before the patient seeks a diagnosis.
• One unique feature is the tendency of Warthin tumor to
occur bilaterally, which has been noted in 5% to 14% of
cases.
 Treatment and Prognosis
• Surgical removal is the treatment of choice for patients
with Warthin tumor.
• The procedure usually is easily accomplished because of
the superficial location of the tumor.
• Some surgeons prefer local resection with minimal
surrounding tissue; others opt for superficial
parotidectomy to avoid violating the tumor capsule and
because a tentative diagnosis may not be known
preoperatively.
• A 6% to 12% recurrence rate has been reported
 Reading assaignment
• BASAL CELL ADENOMA
• MUCOEPIDERMOID CARCINOMA
• ADENOID CYSTIC CARCINOMA
•