CLASSIFICATION OF PAROTID GLAND

TUMOURSPLEOMORPHIC ADENOMA

ANATOMYPara- around

otis-ear

Largest salivary gland

Parts – superficial (80%) , deep (20%)

Duct – Stensen’s

HISTOLOGY

FACIAL NERVE

FACIOVENOUS PLANE OF PATEY

BLOOD SUPPLY: External carotid artery

VENOUS DRAINAGE : External jugular vein

LYMPHATIC DRAINAGE : Deep cervical nodes

CLASSIFICATION OF PAROTID GLAND TUMOURS

EPITHELIAL( 90%)

NONEPITHELIAL HemangiomaLymphangiomaNeurofibroma

• MALIGNANT LYMPHOMA – NHL TYPE

EPITHELIAL (90%)BENIGN (ADENOMAS)

Pleomorphic adenomaMonomorphic adenoma

Warthin’s tumour (adenolymhoma)Oncocytoma ( oxyphil adenoma )Basal cell adenoma

EPITHELIAL ( 90% )MALIGNANT

LOW GRADE Acinic cell

carcinomaAdenoid cystic

carcinomaLow grade

mucoepidermoid carcinoma

• HIGH GRADE• Adenocarcinoma

•Squamous cell carcinoma

•High grade mucoepidermoid carcinoma

CASEA 45 yr old femaleC/0 – slow growing, painless

swelling below the left side of ear for the past 5 months

O/e – 5x3 cm,oval, lifting the ear lobule

No localised warmth, not tender Surface-smooth, Margins- well

defined. Retromand groove oblit. Variable consistency. Mobile Not adherent to skin, masseter

muscle No signs suggestive of facial N inv Examination of oral cavity is

normal

FNAC : shows ductal cells, chondromyxoid matrix and myoepithelial cells

DIAGNOSIS : PLEOMORPHIC ADENOMA

PLEOMORPHIC ADENOMAMIXED TUMOUR

SITE : MC: PAROTID GLAND ( 90%)- MC –Tail of gland

Submandibular gland (7%) Minor salivary glands-MC : Palate

Occurs more commonly in females (3:1) AGE : any age . MC : 40-50yrs Usually unilateral

PATHOLOGYBENIGN TUMORTumor capsule-well formed, but incompleteTiny excrescences (pseudopods) project

outside.Give rise to recurrences.

GROSS :CUT SECTION:

MICROSCOPIC APPEARANCE2 groups of cells :Well differentiated

epithelial cells-acini/cords/sheets

Spindle/stellate cells Abundant intercellular

mucoid material-resembles cartilage

Pleomorphic stromaNo necrosisRarity of mitotic figures

CLINICAL FEATURES Painless slow growing swellingIn the parotid both lobes involved. If only deep

lobe involved – DUMB BELL TUMOURDysphagia if deep lobe is involvedDeviation of uvula&pharyngeal wall towards

midline-deepDeep lobe swelling passes through PATEY’S STYLOMANDIBULAR TUNNELRaised ear lobuleCannot be moved abv zygomatic bone-CURTAIN

SIGNFACIAL NERVE NOT INVOLVED

INVESTIGATIONFNAC – IMPORTANT AND DIAGNOSTIC

OPEN BIOPSY – CONTRAINDICATEDDUE TO : chance of injury to facial nerve,seedling & high chance of recurrence,Parotid fistula formation

CT SCAN

MRI

MANAGEMENTTumor is RADIO RESISTANTSURGERY :ENUCLEATION –avoided. High recurrence.

TOC : SUPERFICIAL PAROTIDECTOMY – PATEY’S OPERATION( if supf lobe alone involved)

TOTAL CONSERVATIVE PAROTIDECTOMY (If both lobes involved)

FACIAL NERVE IS PRESERVED

COMPLICATIONS

RECURRENCE ( 1 – 5 %)

MALIGNANCY3-5 % IN EARLY TUMORS10% IN LONG DURATION( >15

YRS)

RECURRENCE AFTER SURGERYDUE TO : SpillageInadequate marginRetained pseudopodsMulticentricityImproper technique

Recurrent tumor is multinodular without capsule

Marker to predict recurrence : MUC1/DF3

CARCINOMA IN EX PLEOMORPHIC ADENOMALong standing Pl.adenoma-malignant

transformationRecent increase in sizePain , nodularityInvolvement of skin, ulcerationInvolvement of masseterInvolvement of facial nerveNeck lymph nodeRestriction of jaw movements

TAKE HOME MESSAGEMOST COMMON TUMOUR OF PAROTID

FACIAL NERVE IS NOT INVOLVED

TOC : SUPERFICIAL PAROTIDECTOMY

FACIAL NERVE IS PRESERVED.

CARCINOMA IN EX PLEOMORPHIC ADENOMA.

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-AISHWARYA. G