Salivary Neoplasms
Clinical features
– Usually pleomorphic adenomas presenting as rubbery and lobulated asymptomatic swelling in one gland (usually parotid).
– Malignant tumours in late stages are often painful and ulcerate and metastasise to
upper cervical lymph nodes.
– Malignant neoplasms classically grow rapidly, and may involve nerves (e.g. facial palsy).
– Classification of salivary neoplasms:
• Adenomas
– pleomorphic
– monomorphic: adenolymphoma/oncocytic adenoma
– others
• Mucoepidermoid carcinoma
• Acinic cell carcinoma
• Adenoid cystic and other carcinomas.
– Most common are pleomorphic salivary adenomas, muco-epidermoid tumours and adenoid cystic carcinomas.
– 75% involve parotid; 60% are pleomorphic salivary adenomas and benign.
– Pleomorphic adenoma is the most common intraoral salivary neoplasm, but adenoid cystic carcinoma and mucoepidermoid carcinoma are relatively more common in the mouth than in the major glands.
– The palate is the site of predilection.
– Tumours in the tongue are usually malignant – especially adenoid cystic carcinoma.
– Those in the lips are typically benign (pleomorphic or other adenoma).
– Most sublingual gland tumours are malignant.
Incidence
– Rare: mainly in middle and old age.
Aetiology
– Unknown: polyoma viruses have been implicated in animal models, other viruses, such as EBV, and irradiation in some human neoplasms.
Diagnosis
– Microscopy after gland excision (biopsy allows seeding and recurrence).
– Differentiate from non-neoplastic salivary gland swellings.
Management
– Surgical excision; radiotherapy also for some.
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