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Benign tumors of Salivary Gland Tumors
INDIAN DENTAL ACADEMYLeader in continuing Dental Education
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LEARNING OBJECTIVES
• At the end of the lecture student should • Describe histological classification of salivary gland
tumors.• Describe etiology, clinical features, histopathological
features of Pleomorphic adenoma.
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Histological Classification of Salivary Gland Tumors
1) Adenomas
a. Pleomorphic Adenoma
b. Myoepithelioma
c. Basal cell Adenoma
d. Warthin’s Tumor (Adenolymphoma)
e. Oncocytoma (Oncocytic Adenoma)
f. Canalicular Adenoma
g. Sebaceous Adenoma
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h. Ductal Papilloma :a. Inverted Ductal Papilloma
b. Intraductal Papilloma
c. Sialadenoma Papilleferum
i. Cystadenoma
a. Papillary cystadenoma
b. Mucinous Cystadenoma
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2) Carcinomas
a. Acinic cell carcinoma
b. Mucoepidermoid carcinoma
c. Adenoid cystic carcinoma
d. Polymorphous low grade adenocarcinoma (Terminal duct Adenocarcinoma)
e. Epithelial myoepithelial carcinoma
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f. Basal cell adenocarcinoma
g. Sebaceous carcinoma
h. Papillary Cystadenocarcinoma
i. Mucinous Cystadenocarcinoma
j. Oncocytic Carcinoma
k. Salivary duct Carcinoma
l. Adenocarcinoma
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m. Malignant myoepithelioma (Myoepithelial carcinoma)
n. Carcinoma in pleomorphic adenoma ( Malignant mixed tumor)
o. Squamous cell carcinoma
p. Small cell carcinoma
q. Undifferentiated carcinoma
r. Other carcinomas
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3) Non Epithelial Tumors
4) Malignant Lymphomas
5) Secondary Tumors
6) Unclassified Tumors
7) Tumor Like Lesions:
a. Sialadenosis
b. Oncocytosis
c. Necrotizing Sialometaplasia
d. Benign Lymphoepithelial tumors
e. Salivary Gland cyst
f.Chronic sclerosing sialadenitis of submandibular gland (Kuttner tumor)
g. Cystic Lymphoid hyperplasia in AIDS
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Pleomorphic Adenoma (Benign Mixed Tumor)
Most common
53-77% - Parotid gland
44- 68% - Submandibular gland
38- 43% - Minor glands
Derived from a mixture of ductal and myoepithelial elements
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That is reserve cells in intercalated duct
Intercalated duct reserve cell differentiate into ductal and myoepithelial cell
Myoepithelial cell can undergo mesenchymal metaplasia and gives rise to morphologic diversity of this tumor
Not truly a mixed neoplasm
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• Clinical Features
Parotid gland is most common site 4th to 6th decade female predilection i.e. 6:4 Also common in young adults, children. Small, painless quiescent nodule Slowly grow and increase in size Sometimes show intermittent growth
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Do not show fixation to deeper tissue or the overlying skin It is an irregular nodular lesion that is firm in consistency. Areas of cystic degeneration may be palpated if superficial. Skin seldom ulcerates. Pain is not a common symptom. Local discomfort is frequently present
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Most pleomorphic adenomas of parotid gland occur in the superficial lobe
It present as a swelling overlying the mandibular ramus in front of ear
Facial palsy in rare Tumor initially is mobile, but becomes less mobile as it grows
larger
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• Intraoral Tumors < 1- 2 cm in diameter Palate is the most common site for minor gland followed by
upper lip and buccal mucosa Causes difficulty in mastication, talking a breathing Palatal Tumors – on posterior lateral aspect Present as smooth surfaced, dome shaped mass If traumatized – ulcerates Appear fixed to underlying bone but is noninvasive
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• Histopathology
Well circumscribed encapsulated tumor
Capsule may be incomplete/ show infiltration
Commonly seen in minor gland tumors tumor is composed of
mixture of glandular epithelium and myoepithelial cells in
mesenchyme like background
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The epithelium after forms ducts and cystic structures or may
from islands or sheets of cell.
Keratinizing sq. cells i.e. mucous producing cells can also be
seen.
Myoepithelial Cells – Present in large number
Have variable morphology – angular/ Spindle
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Some are rounded ; eccentric nucleus and hyalinized
eosinophilic cytoplasm; resembling plasma cell.
Characteristically; plasmacytoid appearance of myoepithelial
cell is seen in minor gland tumors.
Stromal change is produced by the myoepithelial cells.
Collection of mucoid material in tumor cells result in
myxomatous background
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Vacuolar degeneration of cells produce chondroid appearance.
At places eosinophilic hyalinized change
At times, fibrous, fat or osteoid is seen
Presence of entirely myoepithelial cell as myoepitheliomas
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Benign Salivary Gland Tumors
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Neoplastic cells arrange in ductal pattern
Loose collagenous stroma
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• Treatment
Surgical Excision
In Parotid – The tumor and involved lobe of the gland is removed.
Submax gland tumors are treated by removal of gland and tumor
in continuity
Intraoral – by extracapsular excision
Palatal tumor- excised overlying mucosa
Lining mucosa enucleation/ extracapsular excision
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SUMMARY
Histopathological classification of salivary gland tumors.
Etiology, clinical features, histopathological features of:• Pleomorphic adenoma
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BIBLIOGRAPHY
• Text book of oral pathology Shafer's, 5 & 6th edition• Surgical Pathology of Salivary Glands Ellis 1st Edition • Color Atlas of Oral Diseases Cawson, R. 2nd edition• Oral and Maxillofacial Pathology Neville, Brad W. 2nd • Lucas’s Pathology Of Tumor’s of the Oral Tissues• Cawson, R. A., Bennie, W. H 5th edition
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THANK YOU!