A wise man can learn more from a

foolish question than a fool can

learn from a wise answer.

– Bruce Lee
 Shashidhar Venkatesh Murthy
A/Prof. & Head of Pathology
CLINICAL PATHOLOGY College of Medicine & Dentistry

The foundation of clinical medicine.

Salivary Gland - Tumours

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Salivary gland Tumours: Incidence & types:
• <1% of all tumors, ~6% of head & neck tumors, Geographic variation.
• Benign: <60 years, Females > Males, Parotid > other.
• Malignant: >60 years, F=M, Minor salivary glands.

Tumour Parotid Submandibular

Pleomorphic adenoma 59% 36%
Warthins Tumour 7.3% --
Mucoepidermoid carcinoma 7.9% 12%
Adenoid cystic Ca. 3.1% 35% (minor gl.)
Acinic cell Ca. 3.5% 1%
Sq. Cell. Ca. 2% 7%
Adenocarcinoma. 7% 7%
Ca ex. Pleomorphic adenoma. 4.4% 10%
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Pleomorphic Adenoma:
 Commonest neoplasm – 80%
 Benign tumor of myoepithelium (CK14) 
 Mixed Epithelial & Connective Tissue.
 Adults, slow growth, asymptomatic.
 Single, bosselated, mobile, firm, Capsule not well developed,
often produce extensions into surrounding tissue – making
excision difficult.
 Recurrent, multiple, less mobile* rare.
 Gross Specimen: Solid, nodular, grey-white, ill defined
borders. Cut section shows grey white, myxoid and
translucent blue areas of cartilage.
 Microscopy:, epithelial and Connective tissues.
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Pleomorphic Adenoma:

Gross Features:

1. Parotid region*
2. Nodular, smooth
3. Well demarcated
4. Section: Capsulated
5. Bluish cartilage areas.
6. Mucoid, fibrous, etc.
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Microscopy:
 Epithelial
 Trabeculae anastomosing.
 Ducts, tubules, cysts.
 Connective tissue:
 Fibrous interlacing bundles.
 Myxoid, Chondroid, Myxochondroid &
Osseous areas.
 Fibrillar eosinophilic areas.

Carcinoma arises after many years*.

2% in <5 Years, 10% at 10 years. Carcinoma
completely replaces original benign tumor so called as,
“Carcinoma ex Pleomorphic adenoma” most
aggressive, mortality 50% at 5 years.
 Pleomorphic Adenoma

Cartilage

Epithelium
Normal Sal. Gland Pleomorphic Adenoma
Capsule

Glands

C.T.

Ca. ex Pleomorphic Adenoma  Cancer

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Warthin Tumor:
 7-8% of salivary tumors.
 Synonym: Papillary
Cystadenoma Lymphomatosum.
(tumor due to inclusion of
lymphoid tissue into gland)
 Males, Smokers common, Late age,
 Benign, painless, 85% unilateral,
 Found only in Parotid*
 Recurrence in 2% cases only.
Morphology:
 1-5cm, Round to oval, thin capsule.
 Double layer of neoplastic epithelium folded
around dense lymphoid tissue with & Lymphoid
follicles & cystic spaces.
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Mucoepidermoid Carcinoma:
 8%, but Commonest Carcinoma, Parotids 70%.
 Grey white, small mucous cysts, no capsule.
 Both squamous, mucous & intermediate cells.
 Low to high grade: Prognosis & survival depends on grade.

Int

Mu

Sq
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Adenoid Cystic Carcinoma:
 Uncommon, but more in minor salivary glands.
 Palate, cheek, nose & nasal sinuses.
 Slow growing, painful, recurrence common.
 Small, infiltrative, gray pink with ulcers.
 Microscopy: characteristic cribriform pattern (sieve)
 Perineural spread, recurrent, poor prognosis.

Other Carcinomas:
• Adenocarcinoma 7%
• Squamous carcinoma 2%
• Acinic Cell carcinoma 2%
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Salivary glands Pathology: Summary
 Inflammation: Sialadenitis.
 Acute / chronic, Autoimmune (Sjogren’s, SICCA Sy.)
 Xerostomia, Sialolithiasis.
 Infections:
 Viral, Bacterial, Fungal.
 Mumps
 Neoplasms:
Before you speak, think..
- Is it necessary ?
- Is it true?
- Is it kind?
- Will it hurt anyone?
– Baba.