Tumors Tumors of of orofacial orofacial region region
08:16 2/125 Pseudotumors Pseudotumors of of orofacial orofacial region region True True tumors tumors of of orofacial orofacial region region Odontogenic Odontogenic tumors tumors Soft tissue and bone tumors Soft tissue and bone tumors Epitelial Epitelial tumors tumors Salivary Salivary gland gland tumors tumors 08:16 3/125 Pseudotumors Pseudotumors of of orofacial orofacial region region mostly mostly the the jaw jaw cysts cysts classified in several categories depending on histogenesis and etiology True cysts True cysts Odontogenic cysts ( Odontogenic cysts (arising arising from from the epithelium involved in the process of the epithelium involved in the process of teeth teeth development development) ) From the rest From the rests s of of Malassez Malassez (periapical, residual cyst) (periapical, residual cyst) From From t the he reduced reduced enamel epithelium ( enamel epithelium (dentigerous dentigerous, , eruption eruption, , paradent paradental al) ) From From dental dental lamina lamina ( (rests rests of of Serres Serres) ) (odontogenic keratocyst, lateral (odontogenic keratocyst, lateral periodontal cyst) periodontal cyst) Non Non- -odontogenic odontogenic cysts cysts Developmental Developmental cyst cyst P Pseudocysts seudocysts Post Post- -traumatic bone cyst traumatic bone cyst Aneuryzmatick bone cyst Aneuryzmatick bone cyst 08:16 4/125 Odontogenic Odontogenic cysts cysts ( (cysts cysts derivated derivated from from rests rests of of Malassez Malassez) ) Rests Rests of of Malassez Malassez rests rests of of Hertwig's Hertwig's Epithelial Root Sheath Epithelial Root Sheath Periapical Periapical cyst cyst ( (radicular radicular) ) Residual Residual cyst cyst 08:16 5/125 Periapical Periapical ( (radicular radicular) ) cyst cyst Located at the root tips of nonvital teeth Activation: necrosis of the pulp, advanced tooth caries, chronic pulpitis Remnants of Hertwigs epithelial root sheath proliferate due to the inflammatory stimulus subsequent liquefaction necrosis in the center of these enlarged epithelial nests lined by nonkeratinising squamous epithelium may be thin and atrophic but mucous cells may be present inflammatory changes in the underlying connective tissue cholesterol clefts with adjacent giant cells hyaline Rushton bodies residual cyst is radicular cyst that is retained in jaws after removal of the associated tooth 08:16 6/125 Odontogenic Odontogenic cysts cysts ( (cysts cysts derivated derivated from from reduced reduced enamel enamel epithelium epithelium) ) Follicular Follicular ( (dentigerous dentigerous cyst cyst) ) Eruption Eruption cyst cyst 2 08:16 7/125 Odontogenic Odontogenic cysts cysts ( (cysts cysts derivated derivated from from reduced reduced enamel enamel epithelium epithelium) ) Follicular Follicular ( (dentigerous dentigerous cyst cyst) ) Eruption Eruption cyst cyst 08:16 8/125 Dentigerous Dentigerous ( (follicular follicular) ) cyst cyst Developmental cyst surrounds the crown of an unerupted tooth and is attached to the neck of this tooth Usually associated with the maxillary canine or the mandibular third molar tooth accumulation of fluid between the reduced enamel epithelium and the crown surface or between the layers of the enamel epithelium itself no epithelial proliferation is needed to form this cyst thin epithelial lining - two to three cells thick resembles the reduced enamel epithelium mucus-producing cells as well as ciliated cells are more common 08:16 9/125 Eruption Eruption cyst cyst type of dentigerous cyst located in the gingival soft tissues overlying the crown of an erupting tooth appear as blue-stained blisters of the oral mucosa cyst rupturing with progressive eruption of the associated tooth 08:16 10/125 Odontogenic Odontogenic cysts cysts ( (from from dental dental lamina lamina remnants remnants rests rests of of Serres Serres) ) Odontogenic Odontogenic keratocyt keratocyt Lateral Lateral periodontal periodontal cyst cyst 08:16 11/125 Odontogenic Odontogenic keratocyst keratocyst Frequently Frequently affects affects mandible mandible last last third third of of mandible mandible and ramus and ramus Typically Typically located located in in bone with possible bone destruction bone with possible bone destruction Recurrence rate 25 Recurrence rate 25- -60% (like ameloblastoma) 60% (like ameloblastoma) Gorlin Gorlin- -Goltz syndrome Goltz syndrome - - multiple OKC, AD, n multiple OKC, AD, ne evoid basal cell void basal cell carcinomas, mil carcinomas, milias ias, , thin epithelial layer thin epithelial layer (6 (6- -10 10 cells cells) ) with parakeratosis with parakeratosis basal cell layer basal cell layer no inflammatory reaction no inflammatory reaction 08:16 12/125 Nonodontogenic Nonodontogenic cysts cysts ( (developmental developmental cysts cysts) ) Fissural cysts: Median mandibular cyst (median alveolar), Median palatal cyst Globulomaxillary cyst Nasolabial cyst (nasoalveolar) Lateral cysts, Branchiogenic cysts Remnants of epithelial ducts Nasopalatine duct cyst (incisive canal cyst, nasopalatine canal cyst) Ductus thyreo-glossus cyst Dermoid cyst 3 08:16 13/125 Nasopalatine duct cyst Midline cyst near the incisive foramen intraosseous lesion from nasopalatine duct remnants epithelial lining (squamous, respiratory, with or without mucous cells, cuboidal, ...) chronic inflammatory infiltrate 08:16 14/125 Nasolabial cyst in the soft tissue, beneath the ala of the nose from parts of nasolacrimal duct pseudostratified collumnar epithelium mucous cells 08:16 15/125 Dermoid cyst medial cyst in the neck region, base of the oral cavity teratoma epithelium: squamous epithelium fibrous capsule may contain sweat and sebaceous glands, hair follicles, ... 08:16 16/125 Pseudotumors Pseudotumors of of orofacial orofacial region region True True tumors tumors of of orofacial orofacial region region Odontogenic Odontogenic tumors tumors Epitelial Epitelial tumors tumors Salivary Salivary gland gland tumors tumors Soft Soft tissue tissue and bone and bone tumors tumors 08:16 17/125 Odontogenic Odontogenic tumors tumors group of lesions that arises from the odontogenic tissue. They develop from the epithelial part of the tooth germ, the ectomesenchymal part, or from both. Epithelial Epithelial odontogenic odontogenic tumors tumors Ameloblastoma Ameloblastoma Odontogenic Odontogenic tumors tumors from from connective connective tissue tissue Odontogenic Odontogenic fibroma fibroma Odontogenic Odontogenic myxoma myxoma Cementoblastoma Cementoblastoma Mixed Mixed odontogenic odontogenic tumors tumors Odontoma Odontoma Ameloblastic Ameloblastic fibroma fibroma Malignant Malignant Malignant Malignant ameloblastoma ameloblastoma 08:16 18/125 Ameloblastoma Ameloblastoma Tumor grows slowly; typical is locally aggressive behaviour, but do not metastasise most common odontogenic tumour mandible (molars) 75%, 20-40y Deformating the face, loosening of teeth X-ray - as multilocular cyst Rare metastatic malignant ameloblastoma polycystic amelobalstoma - unicystic ameloblastoma (younger patients) Histologically anastomosing epithelial strands and fields or discrete epithelial islands peripheral cells at the border with the adjacent fibrous stroma are columnar, with nuclei usually in the apical half of the cell body away from the basement membrane tumour infiltrates into the adjacent cancellous bone spread into soft tissues is highly unusual follicular follicular type type tumor tumor islands islands in in fibrous fibrous stroma stroma plexiform plexiform type type forming forming net net ( (the the farmer farmer pattern pattern) ) 4 08:16 19/125 Odontogenic Odontogenic tumors tumors group group of of lesions lesions that that arises arises from from the the odontogenic odontogenic tissue tissue. . They They develop develop from from the the epithelial epithelial part part of of the the tooth tooth germ germ, , the the ectomesenchymal ectomesenchymal part, or part, or from from both both. . Epithelial Epithelial odontogenic odontogenic tumors tumors Ameloblastoma Ameloblastoma Odontogenic Odontogenic tumors tumors from from connective connective tissue tissue Odontogenic Odontogenic fibroma fibroma Odontogenic Odontogenic myxoma myxoma Cementoblastoma Cementoblastoma Mixed Mixed odontogenic odontogenic tumors tumors Odontoma Odontoma Ameloblastic Ameloblastic fibroma fibroma Malignant Malignant Malignant Malignant ameloblastoma ameloblastoma 08:16 20/125 Odontogenic Odontogenic fibroma fibroma peripheral peripheral or or central central tumor tumor with with the the dominant dominant fibrous fibrous component component odontogenic odontogenic fibroma fibroma ( (with with odontogenic odontogenic epithelium epithelium) ) 08:16 21/125 Odontogenic Odontogenic fibroma fibroma The lesion is seen within the jaw as well as in the gingiva Odontogenic fibroma consists of fibroblasts lying in a background of myxoid material with collagen fibres that may vary from delicate to coarse Odontogenic epithelium, may occur. Only rarely is the epithelial component so conspicuous that differentiation between odontogenic fibroma and ameloblastoma may be difficult. 08:16 22/125 Odontogenic Odontogenic myxoma myxoma rare rare tumor, tumor, growing growing in in the the bone bone with with the the locally locally agressive agressive behaviour behaviour maxilla maxilla a a mandibula mandibula erosion into the surrounding erosion into the surrounding area (sinus) area (sinus) swelling, pain swelling, painless less growth growth X X- -ray: resembling ray: resembling honeycomb honeycomb curettage curettage or or block resection block resection 08:16 23/125 Cementoblastoma Cementoblastoma benign, well circimscribed tumor, heavily mineralised cementum masses connected to the apical root rare rare tumor tumor 20 20- -30 y 30 y patients patients molars molars a a premolars premolars pain pain tooth tooth is is vital vital vascular, loose-textured fibrous tissue surrounds coarse trabeculae of basophilic mineralised material bordered by plump cells with large but not atypical nuclei. Mitotic figures are rare Also, osteoclastic giant cells may be present Th Th: : tooth tooth extraction extraction 08:16 24/125 Odontogenic Odontogenic tumors tumors group of lesions that arises from the odontogenic tissue. They develop from the epithelial part of the tooth germ, the ectomesenchymal part, or from both. Epithelial Epithelial odontogenic odontogenic tumors tumors Ameloblastoma Ameloblastoma Odontogenic Odontogenic tumors tumors from from connective connective tissue tissue Odontogenic Odontogenic fibroma fibroma Odontogenic Odontogenic myxoma myxoma Cementoblastoma Cementoblastoma Mixed Mixed odontogenic odontogenic tumors tumors Odontoma Odontoma Ameloblastic Ameloblastic fibroma fibroma Malignant Malignant Malignant Malignant ameloblastoma ameloblastoma 5 08:16 25/125 Odontoma Odontoma 70% 70% odontogenic odontogenic tumors tumors, , hamartoma hamartoma the the differenciation differenciation into into dontoblast dontoblast and and ameloblast ameloblast ( (dentin dentin and and enamel enamel production production) ) is is present present benign benign process process 10 10- -20 y 20 y life life, , maxilla maxilla Histologically Histologically: : Complex form well delineated mass of dental hard tissues in a irregular arrangement (dentin, enamel, cementum) stroma consists of mature fibrous connective tissue Compound Compound form form malformation consisting of tiny teeth may vary in number from only a few to numerous do not resemble normal teeth normal arrangement of centrally placed fibrovascular pulp tissue surrounded by dentin with enamel in the crown area and cementum in the root part. 08:16 26/125 Odontogenic Odontogenic tumors tumors group of lesions that arises from the odontogenic tissue. They develop from the epithelial part of the tooth germ, the ectomesenchymal part, or from both. Epithelial Epithelial odontogenic odontogenic tumors tumors Ameloblastoma Ameloblastoma Odontogenic Odontogenic tumors tumors from from connective connective tissue tissue Odontogenic Odontogenic fibroma fibroma Odontogenic Odontogenic myxoma myxoma Cementoblastoma Cementoblastoma Mixed Mixed odontogenic odontogenic tumors tumors Odontoma Odontoma Ameloblastic Ameloblastic fibroma fibroma Malignant Malignant Malignant Malignant ameloblastoma ameloblastoma 08:16 27/125 Malignant Malignant Malignant Malignant ameloblastoma ameloblastoma ( (mts mts) ) Ameloblastic Ameloblastic carcinoma carcinoma resembling resembling the the ameloblastoma ameloblastoma, , but but with with cellular cellular atypias atypias 08:16 28/125 Pseudotumors Pseudotumors of of orofacial orofacial region region True True tumors tumors of of orofacial orofacial region region Odontogenic Odontogenic tumors tumors Soft Soft tissue tissue and bone and bone tumors tumors Epitelial Epitelial tumors tumors Salivary Salivary gland gland tumors tumors 08:16 29/125 Soft Soft tissue tissue tumors tumors mesenchymal mesenchymal tumors tumors connective connective tissue tissue fibroma fibroma fibrosarcoma fibrosarcoma cartilage cartilage chondroma chondroma chondrosarcoma chondrosarcoma fat fat tissue tissue lipoma lipoma liposarcoma liposarcoma blood blood vessels vessels hemangioma hemangioma hemangiosarcoma hemangiosarcoma lymphatic lymphatic vessels vessels lymphangioma lymphangioma lymphangiosarcoma lymphangiosarcoma cross cross- -striated striated m. m. rhabdomyoma rhabdomyoma rhabdomyosarcoma rhabdomyosarcoma smooth smooth m. m. leiomyoma leiomyoma leiomyosarcoma leiomyosarcoma ... ... 08:16 30/125 Bone Bone tumors tumors by by the the dignity dignity: : benign benign and and malignant malignant Benign Benign Osteoma Osteoma Osteoblastoma Osteoblastoma Giant Giant cell cell lesions lesions Aneurysmal Aneurysmal bone bone cyst cyst Malignant Malignant Osteosarcoma Osteosarcoma ( (osteogenic osteogenic sarcoma sarcoma) ) Chondrosarcoma Chondrosarcoma Ewing's Ewing's sarcoma sarcoma 6 08:16 31/125 Benign Benign Benign Benign fibro fibro- -osseous osseous lesions lesions Osteoma Osteoma Osteoblastoma Osteoblastoma Giant Giant cell cell lesions lesions 08:16 32/125 Benign Benign fibro fibro- -osseous osseous lesions lesions nonneoplastic nonneoplastic intraosseous intraosseous lesions lesions that that replace replace normal normal bone and bone and consist consist of of cellular cellular fibrous fibrous connective connective tissue tissue periapical periapical cemental cemental dysplasia dysplasia anterior anterior mandible mandible, , asymptomatic asymptomatic, , radiolucent radiolucent areas areas florid florid cemento cemento- -osseous osseous dysplasia dysplasia nonsymptomatic nonsymptomatic fibrous fibrous dysplasia dysplasia one one or or many many bones bones, , mild mild malocclusion malocclusion cherrubism cherrubism distant distant facies facies, , symetric symetric, severe , severe malocclusion malocclusion 08:16 33/125 Cherrubism Cherrubism loss loss of of bone in bone in the the mandible mandible replaced replaced by by fibrous fibrous tissue tissue usually usually the the condition condition fades fades as as the the child child grows grows deform deform the the affected affected person person's face 's face causes causes premature premature loss loss of of the the primary primary teeth teeth and and uneruption uneruption of of the the permanent permanent teeth teeth. . rare rare autosomal autosomal dominant dominant disease disease of of the the maxilla maxilla and and mandible mandible Mutations Mutations in in the the SH3BP2 SH3BP2 gene gene have have been been identified identified in in about about 80 80 percent percent of of people people with with cherubism cherubism Orthodontic Orthodontic treatment treatment 08:16 34/125 Osteoma Osteoma / / exostosis exostosis / / torus torus palatinus palatinus torus torus palatinus palatinus, , mandibularis mandibularis 08:16 35/125 Osteoma Osteoma / / exostosis exostosis / / torus torus palatinus palatinus torus torus palatinus palatinus 20% 20% older older patients patients osseous osseous structure structure lined lined by by epithelium epithelium ulcerations ulcerations osteomyelitis osteomyelitis torus torus mandibularis mandibularis bilateral bilateral dentures dentures irritation irritation osteoma osteoma solitary solitary multilocular multilocular (AD, (AD, Gardner Gardner syndroma syndroma ~ ~ + + intestinal intestinal polyps polyps, , cysts cysts a skin a skin fibromas fibromas) )
08:16 36/125 Osteoblastoma Osteoblastoma cellulary cellulary osteoma osteoma, , osteoblastoma osteoblastoma (2cm and more) (2cm and more) osteoid osteoid osteoma osteoma (0,5 (0,5- -2cm) 2cm) young young patients patients, , swelling swelling a a pain pain osteoblasts osteoblasts a a osteoclasts osteoclasts activation activation + + cellulary cellulary bone + bone + osteoid osteoid areas areas 7 08:16 37/125 Giant Giant cell cell lesions lesions many many lesions lesions of of the the mandible mandible and and maxilla maxilla contain contain giant giant cell cell tissue tissue peripheral peripheral giant giant cell cell granuloma granuloma extraossueous extraossueous nodule nodule in in jaws jaws from from periosteum periosteum and and periodontal periodontal membrane membrane 30 30- -40 y 40 y women women focal focal prple prple nodule nodule on on the the gigiva gigiva aneurysmal aneurysmal bone bone cyst cyst vessels vessels resembling resembling hemangioma hemangioma 10 10- -20 y pacienti 20 y pacienti madibla madibla ramus ramus face face deformation deformation / bone / bone fracture fracture dif.dg.traumatic dif.dg.traumatic bone bone cyst cyst 08:16 38/125 Malignant Malignant Ewing's Ewing's sarcoma sarcoma Osteosarcoma Osteosarcoma ( (osteogenic osteogenic sarcoma sarcoma) ) 1:100.000 1:100.000 people people cca. 7% in cca. 7% in the the neck neck and face and face area area retinoblastoma retinoblastoma association association (Rb1 (Rb1 gene gene) ) pain pain?/face ?/face deformation deformation/ /teeth teeth lost lost normal normal a a abnormal abnormal osteoid osteoid pleomorfic pleomorfic a a hyperchromic hyperchromic sarkomatous sarkomatous cells cells 08:16 39/125 Ewing's Ewing's sarcoma sarcoma highly malignant bone tumor (10% of malignant bone tumors) highly malignant bone tumor (10% of malignant bone tumors) neuroektoderm neuroektodermal al cells cells ESFT ESFT - - t (11.22) t (11.22) - - EWS/FLI1 EWS/FLI1 human adenovirus type 5 human adenovirus type 5 children and adolescents (not older than 30 years) children and adolescents (not older than 30 years) fever, leukocytosis, FW fever, leukocytosis, FW pain and swelling, focal ulceration pain and swelling, focal ulceration sensitive and chemo sensitive and chemo- -and radiotherapy and radiotherapy recurrence rate (30% per 5 years) recurrence rate (30% per 5 years) 08:16 40/125 Epithelial tumors Epithelial tumors From squamous epithelium From squamous epithelium Benign Benign Papilloma Papilloma Keratoacanthoma Keratoacanthoma Benign pigmented lesions Benign pigmented lesions Peutz Peutz- -Jeghersov Jeghersov syndrm syndrm Leukoplakia Leukoplakia Epithelial dysplasia Epithelial dysplasia Erythroplakia Erythroplakia Malignant Malignant Squamous cell carcinoma Squamous cell carcinoma Basal cell carcinoma Basal cell carcinoma From glandular epithelium From glandular epithelium Salivary gland tumors Salivary gland tumors 08:16 41/125 Papilloma Papilloma HPV ( HPV (not allways) not allways) keratinisating keratinisating / / nonkeratinizating nonkeratinizating basal layer basal layer / / spinosa spinosa / / keratinocytes keratinocytes 08:16 42/125 Keratoacanthoma Keratoacanthoma predilection for the face, hands predilection for the face, hands solitary solitary nodule nodule, fast growth, possible spontaneous regression , fast growth, possible spontaneous regression solid papule with a central hollow, filled with keratin solid papule with a central hollow, filled with keratin central keratinization, hyperkeratosis seems embedded in the central keratinization, hyperkeratosis seems embedded in the epidermis, but bounded epidermis, but bounded by by normal epidermis normal epidermis; ; at the base of at the base of the the i infiltrative growing nfiltrative growing may be present may be present, possibly mitotic activity but , possibly mitotic activity but no atypical mitoses, small abscesses in the epithelium, the no atypical mitoses, small abscesses in the epithelium, the inflammatory infiltrate inflammatory infiltrate elderly elderly 8 08:16 43/125 Epithelial tumors Epithelial tumors From squamous epithelium From squamous epithelium Benign Benign Papilloma Papilloma Keratoacanthoma Keratoacanthoma Benign pigmented lesions Benign pigmented lesions Peutz Peutz- -Jeghersov Jeghersov syndrm syndrm Leukoplakia Leukoplakia Epithelial dysplasia Epithelial dysplasia Erythroplakia Erythroplakia Malignant Malignant Squamous cell carcinoma Squamous cell carcinoma Basal cell carcinoma Basal cell carcinoma From glandular epithelium From glandular epithelium Salivary gland tumors Salivary gland tumors 08:16 44/125 Peutz Peutz- -Jeghers syndrome Jeghers syndrome AD AD formation of benign polyps in the gastrointestinal formation of benign polyps in the gastrointestinal - - hamart hamarthomas homas ( (risk risk intususcepcia!!) intususcepcia!!) hyperpigmented maculae of the lips and mucosa hyperpigmented maculae of the lips and mucosa dif.dg. hyperpigmentation: Addison's disease (adrenal insuf.) dif.dg. hyperpigmentation: Addison's disease (adrenal insuf.) 08:16 45/125 Epithelial tumors Epithelial tumors From squamous epithelium From squamous epithelium Benign Benign Papilloma Papilloma Keratoacanthoma Keratoacanthoma Benign pigmented lesions Benign pigmented lesions Peutz Peutz- -Jeghersov Jeghersov syndrm syndrm Leukoplakia Leukoplakia Epithelial dysplasia Epithelial dysplasia Erythroplakia Erythroplakia Malignant Malignant Squamous cell carcinoma Squamous cell carcinoma Basal cell carcinoma Basal cell carcinoma From glandular epithelium From glandular epithelium Salivary gland tumors Salivary gland tumors 08:16 46/125 Leukoplakia Leukoplakia "white "white coatings at the mocous of oral cavity coatings at the mocous of oral cavity, which can not be , which can not be wiped off and wiped off and classified classified as as other disease" other disease" precancer precancerosis osis! ! smoking!, alcohol, chron. smoking!, alcohol, chron. candidosis candidosis, HPV, EBV ... , HPV, EBV ... homogeneous homogeneous - - flat, uniform, white flat, uniform, white areas areas non non- -homogeneous homogeneous - - irregular, nodular irregular, nodular areas areas + erythroplakia + erythroplakia clinical diagnosis, has a characteristic histologic correlate clinical diagnosis, has a characteristic histologic correlate acanthosis acanthosis = thickening of the spinous layer of squamous = thickening of the spinous layer of squamous epithelium epithelium h hyperkeratosis yperkeratosis = thickening of the = thickening of the keratin keratin layer layer atrophy atrophy erythroplakia erythroplakia may lead to may lead to dysplasia and CIS dysplasia and CIS 08:16 47/125 Squamous cell carcinoma Squamous cell carcinoma malignant epithelial tumors malignant epithelial tumors smoking, sunlight, alcohol, chron. smoking, sunlight, alcohol, chron.irritation irritation, viruses , viruses older age, 90% men older age, 90% men mostly lower mostly lower lip lip and tongue and tongue f first irstly ly, the exophytic growth, slow , the exophytic growth, slow growth growth and and late late metastases metastases (in (in tongue tongue the the early early in ingrowth growth into the into the blood vessels and blood vessels and metastasis to the lung metastasis to the lung can be found can be found) ) may exulcer may exulcerate ate The The endofytic form endofytic form does exist does exist! ! 08:16 48/125 Basal cell carcinoma Basal cell carcinoma skin tumor (predominantly on the face) skin tumor (predominantly on the face) proliferation of the proliferation of the cells similar to the immature cells of the basal layer of the cells similar to the immature cells of the basal layer of the epidermis (but arises from hair follicule) epidermis (but arises from hair follicule) variable histological features variable histological features grows predominantly endophytic, with the dermis infiltration, an grows predominantly endophytic, with the dermis infiltration, and d surface exulceration (ulcus rodens) surface exulceration (ulcus rodens) without metastasis (semimalignant), locally destructive, with without metastasis (semimalignant), locally destructive, with relapses relapses the adequate surgical extirpation with the the adequate surgical extirpation with the histopathological examination of the borders is necessary histopathological examination of the borders is necessary 9 08:16 49/125 Tumors Tumors of of salivary salivary glands glands relatively rare tumors with an incidence 1 relatively rare tumors with an incidence 1- -3/100.000 3/100.000 A Affect ffect in in 70% 70% the the major glands (parotid gland 70% major glands (parotid gland 70% - - benign, benign, sublingual 70% sublingual 70% - - malignant) malignant) in in 30% 30% affect affect small glands small glands Histomorfologic Histomorfologically ally highly variable highly variable appearance appearance (glands, ducts (glands, ducts - - basal and reserve cells, basal and reserve cells, myoepithelial myoepithelial cells) cells) 08:16 50/125 Tumors Tumors of of salivary salivary glands glands Benign Benign tumors tumors Pleomorfic Pleomorfic adenoma adenoma Monomorfic Monomorfic adenoma adenoma Adenolymphoma Adenolymphoma Onkocytoma Onkocytoma Malignant Malignant tumors tumors Mukoepidermoid Mukoepidermoid carcinoma carcinoma Adenocystic Adenocystic carcinoma carcinoma ( (cylindroma cylindroma) ) Adenocarcinoma Adenocarcinoma Carcinoma Carcinoma from from acinous acinous cells cells 08:16 51/125 Pleomorphic Pleomorphic adenoma adenoma most most common common salivary salivary gland gland tumor, tumor, usually usually affects affects parotid parotid of of women women, 20 , 20- -60 r 60 r Slow Slow growth growth, , painless painless, face , face deformating deformating unfixed unfixed, , circumscribed circumscribed, , nodular nodular, soft , soft consistancy consistancy encapsulates encapsulates proliferation proliferation ( (fibrous fibrous capsule capsule) ) ductal ductal and and myoepithelial myoepithelial cells cells supported supported by by stroma stroma with with mucoid mucoid, , myxoid myxoid or or chondroid chondroid appearance appearance ( (myxochondroepithelioma myxochondroepithelioma) ) Myoepithelial Myoepithelial cells cells and and epithelial epithelial cells cells form form areas areas or or sheets sheets, , may may be be rarely rarely cribriform cribriform or or tubular tubular growing growing into into capsule capsule, , recurrency recurrency, , possible possible malignant malignant variant variant the the biological biological behaviour behaviour is is difficult difficult to to analyze analyze 08:16 52/125 Monomorphic Monomorphic adenoma adenoma The group of benign tumors formed by proliferation of epithelial The group of benign tumors formed by proliferation of epithelial cells of one type with a characteristic arrangement cells of one type with a characteristic arrangement Properties similar to PA, less recidivism Properties similar to PA, less recidivism ba bas socellul ocellular ar adenoma adenoma nests of tumor cells separated by fibrous nests of tumor cells separated by fibrous stroma stroma in in the the centre are centre are the the cuboidal cuboidal cells resembling cells resembling strat.basale strat.basale of of the the epidermus epidermus canalicular canalicular adenoma adenoma anastomo anastomosing sing sheets sheets forming the forming the canalicules canalicules formed formed by a layer of by a layer of cylindrical cylindrical to to cuboidal cuboidal cells cells myxomat myxomatous ous hypocellular stroma with dilated capillaries hypocellular stroma with dilated capillaries 08:16 53/125 Adenolymphoma Adenolymphoma ( (Warthin's Warthin's Tumor, Tumor, Papillary Papillary Cystadenoma Cystadenoma Lymphomatosum Lymphomatosum) ) benign benign, , slowly slowly growing growing tumor tumor lower lower pole pole of of the the parotid parotid, , accounting accounting 2 2- -10% 10% of of all all SGT SGT males males, over 50y , over 50y unfixed unfixed, , circumscribed circumscribed On palpation a solid, painless, smooth surface, elastic, On palpation a solid, painless, smooth surface, elastic, fluctuating fluctuating Papillary Papillary proliferation proliferation ( (epithelial epithelial part) part) with with inner inner and and outer outer layer layer of of epithelial epithelial cells cells lymphoid lymphoid stroma stroma organized organized in in follicules follicules 08:16 54/125 Oxyphilic Oxyphilic adenoma adenoma ( (Oncocytoma Oncocytoma) ) rare benign tumours predominantly tumours of those over middle age, women, usually in the seventh or eight decade parotid glands slow-growing and may rarely be bilatera. Well Well circumscribed circumscribed, , red red- -brown brown color color From From large large oxyphilic oxyphilic cells cells with with granular granular cytoplasm cytoplasm oncocytes oncocytes 10 08:16 55/125 Tumors Tumors of of salivary salivary glands glands Benign Benign tumors tumors Pleomorfic Pleomorfic adenoma adenoma Monomorfic Monomorfic adenoma adenoma Adenolymphoma Adenolymphoma Onkocytoma Onkocytoma Malignant Malignant tumors tumors Mukoepidermoid Mukoepidermoid carcinoma carcinoma Adenocystic Adenocystic carcinoma carcinoma ( (cylindroma cylindroma) ) Adenocarcinoma Adenocarcinoma Carcinoma Carcinoma from from acinous acinous cells cells 08:16 56/125 Mucoepidermoid Carcinoma most common, form 4.8% of all salivary gland tumours, most common types of post-irradiation salivary gland tumours parotid, peak age incidence is in the fifth decade. locally invasive locally invasive growth growth, destructive, metastases, often quickly, painfully , destructive, metastases, often quickly, painfully less malignant variants less malignant variants recurrency recurrency Well differentiated adenocarcinoma G1 Well differentiated adenocarcinoma G1 consists of squamous epithelial cells and mucus consists of squamous epithelial cells and mucus- -producing cells producing cells cystic formations lined by mucin cystic formations lined by mucin- -producing cells producing cells sheets sheets of squamous of squamous- -epithelial cells epithelial cells Poorly differentiated adenocarcinoma G3 Poorly differentiated adenocarcinoma G3 consists predominantly consists predominantly from from epithelial squamous cell epithelial squamous cell w without cystic formations, pleomorphic cells ithout cystic formations, pleomorphic cells 08:16 57/125 Adenoid Cystic Carcinoma ('Cylindroma') More More common common in in minor salivary salivary glands glands, , the palate is by far the most peak age incidence is in the sixth decade (range 12-72 years) and the female to male ratio is 1.3 Slow growth, but pain Slow growth, but painful ful and facial nerve palsy and facial nerve palsy late appearance of recurrences, but f frequent, metastases, worse requent, metastases, worse prognosis prognosis Perineur Perineura al dissemination l dissemination - - PAIN PAIN Poorly encapsulated, gray Poorly encapsulated, gray- -white color white color, , growing growing into into the surrounding the surrounding tissue tissue Typical cribriform adenoid cystic carcinomas Consists of cylindrical cavit Consists of cylindrical cavities ies filled with hyaline masses and filled with hyaline masses and connective connective tissue tissue with capillaries with capillaries Myoepit Myoepith hel elial ial cells cells 08:16 58/125 Acinic Acinic cell cell carcinoma carcinoma Arises Arises from from acinic acinic cell cells s Parotide Parotide, women , women Low Low- -grade malignanc grade malignancy y, but often recurs , but often recurs Well Well- -circumscribed, circumscribed, unfixed unfixed Cells Cells: : mucinous, serous, seromucin mucinous, serous, seromucinous ous in different structures (solid, mikrocystic, papillary in different structures (solid, mikrocystic, papillary- -cystic, cystic, follicular) follicular) Cells with abundant basophilic Cells with abundant basophilic granular cytoplasm granular cytoplasm Cells with Cells with vacuolated vacuolated cytoplasm cytoplasm Eosinophilic cells with Eosinophilic cells with centrally located centrally located nucleus nucleus