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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 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.