Malignant salivary gland tumors
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MALIGNANT SALIVARY GLAND TUMORS . M ucoepidermoid carcinoma A denoid cystic carcinoma A cinic cell carcinoma. Mucoepidermoid Carcinoma.

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Malignant salivary gland tumors
MALIGNANT SALIVARY GLAND TUMORS

Mucoepidermoid carcinoma

Adenoid cystic carcinoma

Acinic cell carcinoma


Mucoepidermoid carcinoma
Mucoepidermoid Carcinoma

  • Malignant salivary gland tumor is of varying degree of aggressiveness composed of mucous secreting and stratified squamous epithelial cells and lacking a capsule.


Mucoepidermoid carcinoma1
Mucoepidermoid Carcinoma

CLINICAL FEATURES:

  • Adulthood tumor

  • Significant female predilection

    SITE:

  • 50% MEC occur in the parotid gland (arising in superficial lobe)

  • 20% occur on the palate

  • Rest of the lesions arising from the minor salivary glands with the buccal mucosa, lips, tongue and retro molar areas to be the favored sites.

    C/F.. Cont..d


Mucoepidermoid carcinoma2
Mucoepidermoid Carcinoma

  • The tumor may be movable, which is an uncommon feature for a malignant tumor. High grade lesions are often fixed to the adjacent tissues.

  • Their size is 1-4 cm when diagnosed.

  • There may be facial weakness due to VII nerve involvement.



Mucoepidermoid carcinoma4
Mucoepidermoid Carcinoma

  • HISTOPATHOLOGY:

  • They have three dominant cell types

  • Mucinous, epidermoid and intermediate

  • Their cells are arranged in the nests and diffuse sheets that may surround cystic spaces

  • There is no capsule, but the edge of the tumor is well-demarcated


Mucoepidermoid carcinoma5
Mucoepidermoid Carcinoma

  • There may be focal areas of malignant cells infiltrated into the normal salivary tissue

  • Tumors predominant mucous cells and more cystic spaces are classified as low grade (with limited metastatic potential)

  • Those with solid sheets and fewer mucous secreting cells and high proportion of stratified squamous epithelium are classified as high grade tumors



Mucoepidermoid carcinoma low grade high grade
Mucoepidermoid CarcinomaLOW GRADE / HIGH GRADE


Mucoepidermoid carcinoma7
Mucoepidermoid Carcinoma

TREATMENT/PROGNOSIS:

  • Low grade tumors follow a benign course whereas high grade show distant metastasis to the regional lymph nodes as well ( cervical lymph nodes)

  • Treatment of primary malignancy is managed with surgery followed by radiotherapy to the primary site.

  • Prognosis depends on the histological grade of the malignancy.



Adenoid cystic carcinoma1
ADENOID CYSTIC CARCINOMA

  • It is a malignant salivary gland tumor composed of cuboidal cells in a solid cribriform tubular pattern

  • ACC is one of the most deceptive and frustrating tumor of the head and neck region

    ORIGION:

  • ACC arises from intercalated duct reserve cells or the terminal tube complex


Adenoid cystic carcinoma2
ADENOID CYSTIC CARCINOMA

CLINICAL FEATURES:

  • Peak incidence is in sixth decade of life with slight female predilection

  • 50-70% cases reported are in the minor salivary glands, the major glands that are affected are the parotid glands

  • In major salivary glands, the clinical appearance is that of a unilocular mass, which is firm on palpation

  • There might be some pain and tenderness


Adenoid cystic carcinoma3
ADENOID CYSTIC CARCINOMA

  • The lesion has a slow growth rate.

  • Facial nerve paralysis or weakness maybe the initial symptom

  • Bone invasion occurs frequently. There are no radiographic changes initially as there is infiltration through the marrow spaces

  • Metastasis is often seen in lungs

  • The tumor has tendency to invade the perinural spaces


Adenoid cystic carcinoma4
ADENOID CYSTIC CARCINOMA

HISTOPATHOLOGY:

  • Slight microscopy will reveal cribriform or cylindro-matous pattern (Swiss cheese pattern)

  • Areas of necrosis with solid clusters of cells indicate more aggressive form of the disease

  • The individual tumor cells are cuboidal small with a disproportionate large nuclei


Adenoid cystic carcinoma5
ADENOID CYSTIC CARCINOMA

  • There are no mitotic figures

  • There is formation of pseudocystic spaces that contain variety of acellular substances

  • Myoepithelial cells may represent a minor part of the cellular component






Adenoid cystic carcinoma10
ADENOID CYSTIC CARCINOMA

TREATMENT/PROGNOSIS:

  • Primary lesion always requires surgical innervation in the parotid gland with resection in the form of superficial parotidectomy or deep lobulectomy

  • Post surgical radiotherapy has shown promising results

  • Multiple agent chemotherapy has shown some promise in the management of the patients with metastatic disease

  • 5 years survival rate is approximately 70%

  • After 15 years, the rate drops to 10% only.


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