Salivary Gland Tumors - Tehran University of Medical Sciences Gland Tumors.pdf · •Diversity in pathology ( 11 benign & 24 malignant) •Other than mixed tumor, are uncommon •Morphologically

Salivary Gland Tumors

Sasan Dabiri, M.D. - Assistant Professor

Department of Otorhinolaryngology – Head & Neck surgery

Amir A’lam hospital

Tehran University of Medical Sciences

Epidemiology

• Overall prevalence:

– 3% of Head & Neck neoplasms

– 100 parotid neoplasms

– 10 submandibular neoplasms

– 10 minor salivary gland neoplasms

– 1 sublingual neoplasm


Epidemiology

• The most common neoplasms:

– Benign in anywhere:Pleomorphic Adenoma

– Malignant in parotid:Mucoepidermoid Carcinoma

– Malignant in others:Adenoid Cystic Carcinoma

– Post radiation, benign: Warthin’s tumor

– Post radiation, malignant: Mucoepidermoid Carcinoma


Fine Needle Aspiration / Biopsy

• Goals are:

– Differentiation of neoplastic and non-neoplastic mass

– Differentiation of benign and malignant neoplasm

• High specificity (96-98%)

• Good sensitivity (79-96%)


Fine Needle Aspiration / Biopsy

• Is it Accurate?

– Highest inaccuracy rates in Parotid

• Diversity in pathology ( 11 benign & 24 malignant )

• Other than mixed tumor, are uncommon

• Morphologically complex

• Some carcinomas have not malignant cellular appearance

Lower accuracy for diagnosing malignant tumor


Frozen Section

• Indications :

– Determination of tumor extension

– Evaluation of surgical margin

– Non-diagnostic FNA

– Incompatible FNA according to clinical judgement


Imaging


Imaging


Imaging


Imaging


Imaging


Imaging


Imaging

• Differentiation of benign and malignant tumors is not the primary goal of CT and MRI; but:

– Anatomical localization

– Local, Regional (lymph node), and Distant invasion

• Overall

– Low intensity in T1 & T2 malignant (high probable)


Imaging

• Why MRI is better than CT?

– Well visualized on T1 (especially parotid “fatty gland”)

• Excellent assessment of margins

• Deep extension & Infiltration

– Best mapping on T1+ Gd + Fat suppression• Bone marrow & cortex: hyposignal

invasion, well visualized

• Fatty & bony foramina at skull base: hyposignal

perineural spread: well visualized

• Meningeal invasion


Imaging

• Perineural invasion for parotid tumor

– Facial nerve

• entire nerve should be assessed all the way

( even if there is no clinical facial paralysis )

– Auriculotemporal nerve

• through a small fat pad along the

medial aspect of the lateral pterygoid muscle and just inferior to the foramen ovale


Imaging

• Perineural invasion for submandibular tumor

– Hypoglossal nerve

• Tongue movement impairment

– Lingual nerve

• Tongue tingling


MRI visualizes :• enlarged nerve• obliterated fat• enlarged ganglion• atrophy of the masticator muscles

Imaging

• Radionuclide Scanning (Tc 99m)

–Warthin’s tumor

– Oncocytoma


Helpful for elderly patients with parotid mass

Aldred Scott Warthin1866 - 1931

Imaging

• Ultrasonography

Pros

– Differentiation of glandular from extraglandular mass

– Guiding the biopsy (FNA)

Cons

– Operator dependent

– Just in superficial masses


Pleomorphic Adenoma


• Epithelial and

Mesenchymal

components

• 10% risk of

malignancy after

15 years

Warthin’s tumor


• Papillary Cystadenoma Lymphomatosum

• Only in parotid

• Male & cigarette smoking

• No risk of malignancy

• bilateral

Mucoepidermoid Carcinoma


• Contains mucoid

and epidermoid cells

• Low, intermediate

and high grade

classification

Adenoid Cystic Carcinoma


• Perineural invasion

• Grading according

dominant cells:

• Cribriform

• Tubular

• Solid

Management

• Surgery

– primary management in all new and recurrent cases

Unless :

• Surgery cannot be done (patient’s condition)

• Invasion to skull base

• Invasion to pterygoid plates

• Encase carotid artery


T4b

Management

• Radiation therapy ± Chemotherapy

– Unable to surgery

– Adenoid cystic carcinoma

– Intermediate or high grade carcinoma

– Close or positive margin

– Perineural or perivascular invasion

– Lymph node metastasis


In cases with complete resection

Thanks for Your Attention

Documents

Salivary Gland Tumors - Tehran University of Medical Sciences Gland Tumors.pdf · •Diversity in pathology ( 11 benign & 24 malignant) •Other than mixed tumor, are uncommon •Morphologically