SALIVARY GLAND TUMORS

1)PLEOMORPHIC ADENOMA
2)MONOMORPHIC ADENOMA
3)MUCOEPIDERMAL CARCINOMA
SALIVARY GLAND
ORGAN THAT PRODUCE SALIVA IN THE ORAL CAVITY.
FUNCTIONS OF SALIVA :-
1. PROTECTION
2. BUFFERING
3. DIGESTION
4. TASTE
5. ANTIMICROBIAL ACTION
6. MAINTAINANCE OF TOOTH INTEGRITY
THE SALIVARY GLAND CAN BE CLASSIFIED AS :-
• MAJOR SG
• MINOR SG
MAJOR SG:- THREE LARGE PAIRED AND FOUND
BILATERALLY.
1. PAROTID GLAND
2. SUBMANDIBULAR GLAND
3. SUBLINGUAL GLAND
MINOR SG :- SMALL GLANDS.THESE GLANDS ARE
NAMED ACCORDING TO THEIR LOCATIONS AS:-
1. LABIAL
2. BUCCAL
3. PALATINE
4. LINGUAL
1) PAROTID GLAND :- SEROUS.
LOCATION:- ANTERIOR TO THE EXTERNAL EAR.
OPENING IN THE ORAL CAVITY:-ON THE BUCCAL
MUCOSA OPPOSITE THE MAXILLARY SECOND MOLAR
DUCT:- STENSENS DUCT
2) SUBMANDIBULAR GLAND:-MIXED HAVING BOTH
SEROUS AND MUCOUS SECRETORY TERMINAL UNITS.
LOCATIONS:- IN THE SUBMANDIBULAR TRIANGLE
OPENING IN THE ORAL CAVITY:-OPENS IN THE
FLOOR OF THE MOUTH AT THE SITE OF LINGUAL
FRENUM.
DUCT:-WHARTONS DUCT
3) SUBLINGUAL GLANDS:-MIXED
LOCATION:- BETWEEN THE FLOOR OF THE MOUTH
AND THE MYLOHYOID MUSCLE .
DUCT:- OPENS INTO THE ORLA CAVITY THROUGH A
MAIN DUCT CALLED BARTHOLINS DUCT AND
SEVERAL SMALL DUCTS FOLLOWING THE
SUBLINGUAL FOLDS.
BARTHOLINS DUCT OPEN WITH OR NEAR THE
SUBMANDIBULAR DUCT.

TUMOR:- DEFINED AS AN ABNORMAL MASS OF

TISSUE THE GROWTH OF WHICH EXEEDS AND IS
UNCOORDINATED WITH THAT OF NORMAL TISSUE
AND PERSISTS IN THE SAME EXCESSIVE MANNER
AFTER CESSATION OF STIMULI WHICH EVOKE THE
CHANGE.
TUMOR MAY BE BENIGN OR MALIGNANT.
ALL TUMORS BENIGN AS WELL AS MALIGNANT HAVE
TWO BASIC COMPONENT
• PARENCHYMA : COMPRISED BY
PROLIFERATING TUMOR CELLS
• SUPPORTIVE STROMA: COMPOSED OF
FIBROUS CONNECTIVE TISSUE AND BLOOD
VESSELS
FEATURES BENIGN MALIGNANT
BOUNDARIES WELL POORLY
CIRCUMSCRIBE CIRCUMSCRIBE
D D
SURROUNDING OFTEN INVADED
TISSUE COMPRESSED
SIZE SMALL LARGE
MICROSCOPIC
FEATURES
PATTERN RESEMBLES THE POOR
TISSUE OF RESEMBLANCE
ORIGIN TO TISSUE OF
CLOSELY ORIGIN
BASAL POLARITY RETAINED LOST
PLEOMORPHISM NOT PRESENT OFTEN PRESENT
ANISONUCLEOSIS USUALLY NOT PRESENT
PRESENT
HYPERCHROMATI ABSENT PRESENT
SM
GROTH RATE SLOW RAPID
METASTASIS ABSENT PRESENT
PROGNOSIS LOCAL DEATH BY
COMPLICATION LOCAL AND
METASTAIC
COMPLICATION

PLEOMORPHIC ADENOMA:-
• TERM SUGGESTED BY WILLIS
• ADENOMA MEANS BENIGN NEOPLASM OF THE
GLAND.
• IT IS BENIGN MIXED TUMOR WHICH IS
HISTOLOGICALLY CHARACTERIZED BY COMPLEX
INTERMIXING OF EPITHELIAL AND
MESENCHYMAL COMPONENT.
• MORPHOLOGY COMPLEXITY OF THIS TUMOR
ACCOUNT FOR THE TERM PLEOMORPHIC.
• MYOEPITHELIAL CELLS ARE RESPONSIBLE FOR
MORPHOLOGIC COMPLEXITY OF THIS TUMOR
 INCLUDING PRODUCTION OF
FIBROUS,MUCINOUS AND OSSEOUS STRUCTURE.
CLINICAL FEATURES:-
1) AGE: OCCURS AT ANY AGE BUT MOST
FREQUENT BETWEEN 30 AND 50
2) SEX:OCCURS FREQUENTLY IN FEMALES
3) SITE: IT MAY OCCUR ANY OF THE MAJOR OR
MINOR GLANDS.IT MOSTLY INVOLVES THE
PAROTID GLAND
60-80% OF THE PAROTID GLAND TUMOR IS
PLEOMRPHIC ADENOMA.
RD
• IT IS THE 2/3 PART OF THE TOTAL
NEOPLASM OF ORAL CAVITY.
• IN THE PAROTID GLAND THIS TUMOR
MOSTLY PRESENT IN THE LOWER POLE OF
THE SUPERFICIAL LOBE OF THE GLAND.
• IT INVOLVES THE MINOR SALIVARY GLAND
AND PALATE IS THE MOST COMMON SITE OF
THE MINOR SG INVOLVEMENT.
4) SYMPTOMS: SMALL,PAINLESS NODULES WHICH
SLOWLY BEGINS TO INCREASE IN SIZE.
5) SHAPE: IRREGULAR TO OVOID
6) SIZE: IT MAY INCREASE TO CRICKET BALL SIZE
7) SURFACE:SMOOTH
8) FIXATION:NO FIXATION EITHER TO THE DEEPER
TISSUE OR OVERLYING SKIN
9) CONSISTENCY:FIRM AND RUBBERY
HISTOPATHOLOGICAL FEATURES:
1)TUMOR IS ENCAPSULATED
2)MICROSCOPIC APPEARANCE IS VARIABLE
3) TUMOR IS COMPOSED OF MIXTURE OF
GLANDULAR EPITHELIUM AND MYOEPITHELIAL
CELLS.
4)EPITHELIUM MAY FORM SHEETS OR STRANDS OR
DUCT LIKE STRUCTURE
5)MYOEPITHELIAL CELLS HAVE A VARIABLE
MORPHOLOGY
6)THE STROMA COSISTS OF MUCOID OR
MYXOCHONDROID TISSUE AND MAY FORM THE
BULK OF THE LESION
7) OCASSIONALLY SOME SG TUMORS CONTAINS
ONLY MYOEPITHELIAL CELLS IN STROMA CALLED
AS MYOEPITHELIOMA.
TREATMENT AND PROGNOSIS:SURGICAL
EXCISION
1) PAROTID GLAND:LESION IN SUPERFICIAL
LOBE- SUPRFICIAL PAROTIDECTOMY WITH
PRESERVATION OF FACIAL NERVE.
LESION IN THE DEEP LOBE-TOTAL
PAROTIDECTOMY WITH PRESERVATION OF FACIAL
NERVE
2) SUBMANDIBULAR GLAND: BY TOTAL
REMOVAL OF GLAND
3) HARD PALATE:EXCISED WITH OVERLYING
MUCOSA
4) LIP,SOFT PALATE:EXTRACAPSULAR EXCISION
THE USUAL CLINICAL COURSES IS GOOD.
RARELY A MALIGNANT TUMOR MAY ARISE WITHIN
THIS TUMOR CALLED AS CARCINOMA EX
PLEOMRPHIC ADENOMA.
MONOMORPHIC ADENOMA :-
DEMONSTRATE THE MORE UNIFORM
HISTOPATHOLOGIC PATTERN
MONOMORPHIC ADENOMA IS DIVIDED INTO THREE
GROUPS BY WHO:
1)ADENOLYMPHOMA OR WARTHINS TUMOR
2)OXYPHILIC ADENOMA OR ONCOCYTOMA
 3)OTHER HISTOLOGIC PATTERNS LIKE BASAL CELL
ADENOMA AND CANALICULAR ADENOMA
BUT WARTHINS TUMOR AND ONCOCYTOMA ARE
RECOGNISED SEPARATE ENTITY NOWADAY. SO ONLY
INCLUDING MONOMORPHIC ADENOMA ARE BASAL
CELL ADENOMA AND CANALICULAR ADENOMA

1) BASAL CELL ADENOMA:-

CLINICAL FEATURES:
1) SITE: PRIMARILY IN MAJOR GLANDS PARTICULAR
IN PAROTID
2) AGE: USUALLY OLDER AGE GROUP OVER 60
YEARS
3) SEX: COMMON IN MALES
4) SYMPTOMS: SLOW GROWING
5) DIAMETER: LESS THAN 3 CM
HISTOPATHOLOGIC FEATURES:
THIS LESION ARE FAIRLY UNIFORM AND REGULAR
TWO MORPHOLOGIC FORMS CAN BE SEEN
A)SMALL CELLS WITH ROUND NUCLEUS
B)LARGE CELLS WITH OVAL NUCLEUS
TUMOR SHOW 4 SUB TYPE OF HISTOPATHOLOGIC
PATTERN:-
A) SOLID: MOST COMMON SUBTYPE.COSISTS OF
EPITHELIAL ISLANDS WHICH ARE SHARPLY
DEMARCATED FROM CONNECTIVE TISSUE BY
BASEMENT MEMBRANE.
B) TRABECULAR: SAME AS SOLID TYPE BUT
EPITHELIAL ISLANDS ARE NARROWER AND
INTERCONNECTED WITH ANOTHER PRODUCING
A RETICULAR PATTERN.
C) TUBULAR: LEAST COMMON SUBTYPE
.SMALL,ROUND DUCT LIKE STRUCTURE
D) MEMBRANOUS:EXHIBITS MULTIPLE LARGE
ISLANDS OF TUMOR THAT ARE MOLDED
TOGETHER IN THE JIGSAW PUZZLE
FASHION.THEES ISLANDS SURROUNDED BY A
THICK LAYER OF HYALINE MATERIAL WHICH
REPRESENT REDUPLICATED BASEMENT
MEMBRANE.
TREATMENT: SURGICAL EXCISION.RECURRENCE
SELDOM SEEN.
CANALICULAR ADENOMA
CLINICAL FEATURES:-
1) SITE:PRIMARILY IN THE INTRAORAL ACESSORY
GLANDS
2) AGE:OVER 60 YEARS
3) SEX:NO SEX PREDILECTION
4) SYMPTOMS :SLOW GROWING DIAMETER
RANGE LESS THAN 2CM
HISTOPATHOLOGIC FEATURES:
• SINGLE LAYER CORDS OF COLUMNAR OR
CUBOIDAL EPITHELIAL CELLS
• THIS SINGLE LAYER OF CELLS PARALLEL
FORMING LONG CANALS
• THESE CELLS ARE SUPPORTED BY A LOOSE
CONNECTIVE TISSUE STROMA
• CYSTIC SPACES ARE ALSO SEEN..
• CYSTIC SPACES ARE USUALLY FILLED WITH
AN EOSINOPHILIC COAGULUM.
TREATMENT :SIMPLE ENUCLEATION.RECURRENCE
SELDOM SEEN.

MUCOEPIDERMOID CARCINOMA:
1) PERIPHERAL MUCOEPIDERMOID TUMOR:
 • TERM WAS INTRODUCED IN 1945 BY STEWART
FOTE AND BECKER
• THE TERM RECOGNISED ONE SUBSET THAT
ACTED IN A MALIGNANT FASHION AND A
SECOND GROUP THAT BEHAVE IN A BENIGN
FASHION.
• IT WAS LATER RECOGNISED THAT EVEN LOW
GRADE TUMOR OCASSIONALLY COULD
EXHIBIT MALIGNANT BEHAVIOUR.
• THEREFORE THE TERM MUCOEPIDERMOID
CARCINOMA IS THE PREFFERED DESIGNATION.
• IT ACCOUNTS FOR 6-9% OF THE SG TUMOR
AND FOR ABOUT 1/3RD OF THE ALL
MALIGNANT SG TUMOR
CLINICAL FEATURES:
1) SITE: ABOUT 60% OCCUR IN PAROTID
GLAND AND 30% IN THE MINOR SG
2) AGE: OCCURS INBETWEEN 30 AND 50
3) SEX: SLIGHT FEMALE PREDILECTION
• THE TUMOR OF LOW GRADE
MALIGNANCY USUALLY APPEAR AS A
SLOWLY ENLARGING PAINLESS MASS
WHILE TUMOR OF HIGH GRADE
MALIGNANCY GROWS RAPIDLY AND
THUS PRODUCE PAIN AS AN EARLY
SYMPTOM.
• FACIAL NERVE PARALYSIS IS
FREQUENT IN PAROTID TUMOR.
• THE PATIENT ALSO COMPLAINTS OF
TRISMUS,DRAINAGE FROM THE EAR ,
DYSPHAGIA AND NUMBNESS OF THE
ADJACENT AREA. AND ULCERATION IS
NOTED PARTICULARLY IN TUMORS OF
THE MINOR SG.
 HISTOPATHOLOGIC FEATURE
TUMOR COMPOSED OF 5 TYPES OF CELLS
A)MUCOUS CELLS
B)EPIDERMOID CELLS
C)INTERMEDIATE CELLS
D) LYMPHOCYTES
E) CLEAR CELLS
• EPIDERMOID CELLS AND INTERMEDIATE
CELLS LINE CYSTIC SPACE AND FORM
THE SOLID MASS
• MUCOEPIDERMOID CARCINOMA HAVE
BEEN CATEGORIZED INTO THREE
HISTOPATHOLOGIC GRADES BASED ON
THE FOLLOWING:
1)AMOUNT OF CYST FORMATION
2)DEGREE OF CYTOLOGIC ATYPIA
3)RELATIVE NUMBER OF CELLS
A) LOW GRADE:-
• PROMINENT CYST FORMATION
• MINIMAL CELLULAR ATYPIA
• HIGH PROPORTION OF MUCOUS CELLS
B) HIGH GRADE:-
• CYSTIC COMPONENT USUALLY VERY LESS
• PROMINENT CYTOLOGIC ATYPIA
• INTERMEDIATE AND EPIDERMOID CELLS
PRESENT
C) INTERMEDIATE GRADE:-
• CYST FORMATION IS SEEN BUT LESS PROMINENT
THAN LOW GRADE.
• CYTOLOGIC ATYPIA MAY OR MAY NOT BE
PRESENT.
• ALL TYPES OF CELLS ARE PRESENT BUT
INTERMEDIATE CELLS ARE PROMINENT.
TREATMENT AND PROGNOSIS:-
• SURGICAL EXCISION WITH PRESERVATION OF
FACIAL NERVE IF POSSIBLE IS RECOMMENDED
FOR LOW AND INTERMEDIATE GRADE
MALIGNANCY OF THE PAROTID GLAND
• THE AFEECTED SUBMANDIBULAR GLAND
SHOULD BE REMOVED ENTIRELY.
• TREATMENT FOR THE MINOR GLAND IS ALSO
PRIMARILY SURGICAL.
• SURGICALEXCISION FOLLOWED BY
RADIOTHERAPY IS RECOMMENDE FOR HIGH
GRADE TUMOR
2) CENTRAL MUCOEPIDERMOID CARCINOMA
[INTRAOSSEOUS MUCOEPIDERMOID
CARCINOMA]
• IN THIS TUMOR SG TUMOR ARISE
CENTRALLY WITHIN THE JAW.
• THE MOST COMMON AND BEST
RECOGNISED INTRABONY SALIVARY TUMOR
IS THE CENTRAL MUCOEPIDERMOID
CARCINOMA.
• OTHERS ARE ADENOID CYSTIC CARCINOMA
OR ADENOCARCINOMA
• IT MAY ORIGINATE FROM ENTRAPMENT OF
SALIVARY GLAND TISSUE WITHIN THE JAW
WHICH SUBSEQUENTLY UNDERGO
NEOPLASTIC TRANSFORMATION.
CLINICAL FEATURES:
• AGE: COMMON IN MIDDLE AGED
• SEX: SLIGHT FEMALE PREDILECTION
• SITE: THREE TIMES MORE COMMON IN THE
MANDIBLE THAN MAXILLA AND MOST OFTEN
SEEN IN THE MOLAR RAMUS AREA.
• SYMPTOMS:PRIMARY SWELLING AND PAIN
TRISMUS REPRTED LESS FREQUENTLY
TREATMENT AND PROGNOSIS: SURGERY
FOLLOWED BY RADIATION THERAPY. THE
OVERALL PROGNOSIS IS FAIRLY GOOD.
THE OVERALL PROGNOSIS IS FAIRLY GOOD.
REFRENCES:-
• ORAL PATHOLOGY – SHAFFERS,HINE,LEVE
PAGE NO.-311-318 AND 326-329
• ORAL PATHOLOGY-
NEVILLE,DAMM,ALLEN,BOUQUOT PAGE NO-
410-414 AND 416,417,420-422
• ORAL MEDICINE –ANIL GOVINDRAO GHOM
• GENERAL PATHOLOGY-HARSH MOHAN