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1. Head and Neck
2. Head and Neck
3. Salivary glands
Major -parotid, Submandibular, sublingual
Minor- mainly oral cavity – multiple small glands
Sialadenitis = inflammation of salivary glands
Mucoceles are the MC type of inflammatory salivary gland lesion.
MC viral cause – Mumps
In Children, mumps is not dangerous but in adults ? Orchitis , Acute Pancreatitis
Bacterial (secondary to ductal obstruction) is associated with chronic dehydration
Sjogren’s syndrome= Autoimmune cause
dry mouth, dry eyes
? infiltration of lymphocytes – ? risk of lymphoma
Age, sex, clinical presentation ?????
4. Sialothiasis (stones)
Dehydration & drugs that suppress salivary secretion may cause stones
Submandibular salivary gland - MC affected
Tumors of Salivary Glands
Uncommon , in middle-aged adults (malignant if develop in older)
80% arise in the parotid gland & most are benign
10% in the Submandibular - 40% malignant,
10% in minor salivary glands - 50%are malignant
when the gland size is big= decreased risk of malignancy
5. SALIVARY GLANDS
6. Sialadenitis
7. SALIVARY GLANDS
8. Mucocele
9. Histologic Types:
1) Pleomorphic Adenoma- 45% (benign)
2) Warthin’s Tumor - 11% (benign)
3) Mucoepidermoid carcinoma- 15% (malignant)
4) Adenoid Cystic Carcinoma -10% (malignant)
5) Acinic Cell Carcinoma - 03% (malignant)
Other Tumors:
Lymphomas ((malignant)
NOTE:
Malignancy is inversely proportional to the size of gland, therefore:
? size of gland ? ? malignancy
? size of gland ? ? malignancy
10. 1. Pleomorphic Adenoma also called mixed tumors
MC in parotid (60% of tumors of the parotid)
MC neoplasm in salivary gland
MC benign neoplasm in salivary gland
Composed of Benign epithelial elements dispersed in myxoid having varying degrees of Myxoid, Hyaline, Chondroid (cartilaginous) background
all are derived from one germ layer (unlike Teratoma)
Grow around facial nerve – making it harder to remove (but not invades it)
Treatment:
Surgical enucleation ? 25% recurrence
Adequate parotidectomy ? 4% recurrence rate
facial nerve damage is possible
Adenocarcinoma arises in 2-3% of pre-existing pleomorphic adenomas (very bad prognosis)
11. Pleomorphic Adenoma
12. 2. Warthin’s Tumor (papillary cystadenoma lymphomatosum)
Benign cystic capsulated tumor,
2nd MC salivary gland neoplasm
Restricted to the parotid gland.
Incidence:
M:F ratio is 5:1
Smokers 8 times more common
Histology:
Cystic spaces lined by a double layer of epithelial cells resting on dense Lymphocytic stroma (form follicles with germinal centers)
13. Warthin’s Tumor
14. 3. Adenoid Cystic Carcinoma
MC in the minor salivary glands
Small, poorly encapsulated, infiltrative gray-pink lesions
Slowly growing, Locally invasive & Tending to spread in perineural spaces ( surrounding nerves) (this is also seen in Prostatic , breast ca., pancreatic,? pain
50% disseminate widely to bones, liver, brain, etc.
Prognosis
5-year survival rate is above 60%
15. Adenoid Cystic Carcinoma
16. 4. Mucoepidermoid Carcinoma
MC Primary malignant tumor of salivary glands ( in kids)
Radiation-induced neoplasm
Biphasic tumor (Glandular cells & Squamous cells)
Morphology:
Biphasic pattern
Grading
Low grade tumors: Squamous cells
Intermediate grade tumors ( with increasing glandular content)
High grade tumors - Glandular cells
5-year survival rate - 50%.
5. Acinic Cell Tumor
Tumor cells similar to the normal serous cells of the salivary glands
Mostly arise in parotids
90% 5-year survival rate
17. Mucoepidermoid Carcinoma
18. Tumors of Salivary Glands