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Spectrum Of
Salivary Gland
Dr.Ch.Sushma
Lesions 2 year P.G
nd
SVS Medical
college.
Introduction:
Observation
Total number of salivary glands
aspirated are 50.
Out of 50 cases ,3 cases were proved
uncertain.
Sex Distribution
In sex distribution females slightly outnumbered
the males in ratio of 1.2:1.
Female ; 56%
Male ; 44%
Age distribution
Age distribution, shows peak incidence in fourth
decade of the lesions.
25
20
15
10
5
0
No.of Cases
Site distribution
In our study , parotid swellings predominated
with 84% followed by submandibular(12%) and
minor salivary glands(2%)
minor salivary glands 2
Submandubular
parotid
42
0 5 10 15 20 25 30 35 40 45
Sialadenitis
Neoplasms
Uncertain
benign
malignant
Discussion
In our study of 50 cases,5 cases are non
neoplastic which were found to be sialadenitis.
42 cases are neoplastic,out of which 29 cases
are benign and 13 cases are reported as
malignant.
3 cases were reported as uncertain in which
diagnosis couldnt be made.For these cases
histopathological evaluation is adviced.
Discussion
In our study, most of the lesions are
in the age group of 41-60 years and
predominantly females.
Similarly Ritu et al*, showed M: F
1.1:1 and mean age of 35 years.
Ritu Jain, D., Madhur Kudesia, M., Ruchika Gupta, M., & Sompal Singh, M. (2013). Fine
needle aspiration cytology in diagnosis of salivary gland lesions: A study with
histologic comparison.Cytojournal,2013(10), 5-5
Discussion
In our study, parotid swellings were
observed in 84% similar to study by
Perkins Mukunyadzi et al
Discussion
Out of 29 benign neoplastic
cases,93% cases are of pleomorphic
adenoma and 6.8% cases are
oncocytoma.
Out of 13 malignant cases, 77% of
cases are of mucoepidermoid
carcinoma and 15% of acinic cell
carcinoma and low grade salivary
gland carcinoma of 0.1 %.
Tumours of
the
Parotid gland
Mostly seen .
Overall, PLEOMORPHIC ADENOMA is the
most frequent SGT, comprising about
50-60% of cases.
The second most frequent benign SGT is
WARTHIN TUMOR.
MUCOEPIDERMOID CARCINOMA is the
most common malignant SGT.
Location
Swellings below the ear or
in front of the ear
Upper aspect of the neck.
Less commonly, tumours
may arise from the
accessory lobe and
present as persistent
swellings within the cheek.
Rarely, tumours may arise
from the deep lobe of the
gland and present as
parapharyngeal masses
Incidence
SGTs predominantly arise in female patients
The average age of patients with SGT is about 45 years old.
The peak incidence of most specific types is in the 6thand
7thdecades.
The highest incidence of Pleomorphic adenoma (PA),
mucoepidermoid carcinoma (MEC), and acinic cell
carcinoma is in the third and fourth decades.
In the pediatric population, the most common malignant
SGT is mucoepidermoid carcinoma.
Parotid
Epithelial
Non
tumours
Malignant
Benign
MOST
epithelial
OFTEN OF SQUAMOUS CELL ORIGIN
Classificatio
n WHO
Malignant
salivary gland
tumours
Low-grade malignant tumours, e.g. acinic cell
carcinoma, are indistinguishable on clinical
examination from benign neoplasms.
High-grade malignant tumors usually present
as rapidly growing, often painless swellings in
and around the parotid gland. Presentation with
advanced disease is common, and cervical lymph
node metastases may be present.
Invasion
The facial nerve, may be directly
involved by tumors in 10 to 15% of
patients.
Trismus is associated with
involvement of the pterygoid
musculature by deep parotid lobe
malignancies.
Pleomorphic
adenoma
PA
Most common form of all salivary gland neoplasms and the majority
of the PAs occur in the parotid gland.
Incidence - 40% to 70%
usually occur in the tail of the parotid.
PA is typically a slowly growing, asymptomatic, discrete nodule most
often located in the superficial lobe of the parotid gland.
These slow growing tumors are surrounded by an imperfect pseudo
capsule traversed by fingers of tumors.
Although PAs are benign tumors, subsets of these tumors have a
tendency to recur and/or undergo malignant transformation.
Microscopically.
PA is characterized by its morphological
diversity.
It comprises epithelial and myoepithelial cells
variably arranged in a mucoid, myxoid or
chondroid background.
PA usually presents with a variably thick capsule
that on serial sectioning may be focally absent.
The lesion typically harbors few mitoses and
cytological atypia.
Pleomorphic adenoma
Pleomorphic adenoma:
Epithelial
The epithelial
component may
predominate
and in this
instance the
lesion is called
cellular PA.
Epithelial
Cell
types
Other component
The myoepithelial component may form a
fine reticular pattern or sheets of spindle
cells.
The mesenchymal tissue is mucoid, myxoid
or chondroid, and predominates in some
instances.
Osseous metaplasia or lipomatous
differentiation may be seen.
Genetics of PA
inv(8)(q12.1;q12.1)
Warthins tumor, or
papillary
cystadenoma
lymphomatosum
Warthins
Second most common benign parotid
tumor and occurs most often in older
white men.
Because of the high mitochondrial
content within oncocytes, the oncocyte
rich Warthin tumor and oncocytomas will
incorporate technetium-99m and appear
as hot spots on radionuclide scans.
Pathology
These tumors are well encapsulated
lesions with cystic and solid areas.
These tumors consist of an oncocytic
epithelial cell component arranged in
double layers, which develops cysts
and papillary projections, and a
variable amount of lymphoid tissue
often with germinal centers.
A few Warthin's tumors (about 8%)
show areas of squamous cell
metaplasia and regressive changes.
Oncocytoma
Oncocytomas are benign
neoplasms composed
ofoncocytes; the large
eosinophilic cuboidal to
columnar cells with
more than 60% of their
cytoplasmoccupied by
mitochondria.
Oncocytomas represent
less than 1% of the
salivary gland
neoplasmsand 82% to
90% of them occur in
the parotid gland
Oncocytoma
Oncocytes are one to two times the size of normal
acinar cells, display abundant granular eosinophilic
cytoplasm and a central pyknotic nucleus.
The cytoplasmic granularity is due to the
accumulation of mitochondria that may occupy
upto 60% of the cytoplasm. In contrast,
mitochondria occupy only 5.2% of the cytoplasm of
normalacinar cells.
The increased concentration of mitochondria is
accompanied by a gradual disappearance from the
cytoplasm of other cytoplasmic membrane systems
and loss of plasmalemmar specializations.
Malignant
tumors of
parotid
Mucoepidermoid carcinoma
Mucoepidermoid carcinoma is the most
common malignant tumor of the parotid
gland and can be divided into low-grade
and high-grade tumors.
High grade lesions have a propensity for
both regional and distant metastases and
corresponding shorter survival rates than
low grade mucoepidermoid carcinomas.
Mucoepidermoid carcinoma
An indolent growth
pattern and a relentless
propensity for perineural
invasion characterize
adenoid cystic
carcinoma.
Regional lymphatic
spread is uncommon
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