Oral Medicine & Pathology

Salivary Neoplasms: Clinical features, Incidence, Etiology, Diagnosis, Management

 

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.Salivary gland neoplasms Salivary gland neoplasms Salivary gland neoplasms Salivary gland neoplasms Salivary gland neoplasms Salivary gland neoplasms

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