Salivary gland tumors
I – Introduction
Salivary gland tumors are relatively rare, however their ignorance can
imply inappropriate and serious diagnostic and therapeutic behaviors.
These tumors are characterized by histological polymorphism while their
common clinical expression remains a non-specific tumor syndrome.
Salivary gland tumors
II – Clinical Study
*TUMORS
A- Epithelial tumors:
I – benign tumors or adenomas:
1) pleomorphic adenoma (or mixed tumor):
constitutes the most frequent variety of salivary tumors (74%).
1°/Generalities:
Location: superficial lobe of the parotid (¾ of cases), the remaining 25% are located under
the maxilla and accessory glands.
Appears at all ages but especially between the 4th and 5th decade.
2°/Histology:
macroscopy:
Nodular formation of a few mm to several cm in diameter, firm and not hard,
whitish and translucent in appearance with the appearance of a false encapsulation which exposes to the risk of
recurrence after limited excision.
Microscopy: characteristic structure.
Proliferation of epithelial and myoepithelial cells embedded in an abundant
myxoid and/or chondroid stroma, hyaline or elastic, sometimes containing islands of adipose or
bone tissue.
4°/ Clinic:
Young people are most affected.
Presents as a lump in front of or below the lobe (ear).
No sensory or motor disorders.
Painless, well-defined, more or less mobile, never fixed.
It is rounded, firm, of regular consistency.
5°/ Differential diagnosis:
It is made with all benign subcutaneous tumors,
With inflammatory lesions of the parotid gland,
With tumoral or inflammatory lesions of non-salivary tissues
With parotid adenopathies,
With vascular tumors, nerve tumors, lipoma.
6°/ Sialography:
It shows a rounded gap in a normal parenchyma: this is the classic image of a bullet
in the hand.
7°/Scintigraphy:
does not fix technetium.
8°/Puncture:
formally prohibited.
9°/Evolution:
APs are very recurrent locally, especially in forms with abundant myxoid stroma and when there are breaches in the peripheral capsule.
Cancerization is rare (5%) (10-15 years without treatment)
2) Warthin tumor or cystadenolymphoma (CAL)
1°/ Clinical study:
This is a tumor of adults or elderly males.
It is located in the superficial lobe of the parotid gland.
It is a tumor with imprecise contours and a liquid consistency.
It may undergo inflammatory flare-ups.
2°/ Sialography:
Image of a lacuna that is + or – hemicircular and limited by efferent ducts that are + or – packed on
top of each other.
3°/ Scintigraphy:
the CAL captures technetium.
Salivary gland tumors
4°/Histology:
Macroscopy: well-defined tumor with thick, stringy, brownish content.
Microscopy: vegetation with double epithelial layer comprising cylindrical superficial cells, very irregularly arranged and smaller basal cells.
Lymphoid tissue (+++) and clear centers are found. The superficial elements have enzymatic activity.
5°/Treatment: enucleation
3) Oncocytoma = adenoma with oncocytic cells.
1°/ Clinic:
Rare, it mainly affects elderly male subjects, located in the parotid gland.
2°/Histology:
Proliferation of large cells with small nuclei and acidophilic cytoplasm, with many mitochondria.
3°/Differential diagnosis:
Especially with pleomorphic adenoma.
4) other adenomas:
Basal cell adenoma:
Mainly affects the elderly, its histological structure is reminiscent of the epidermal basement membrane. Predominates in the parotid gland.
Sebaceous cell adenoma
II- Malignant epithelial tumors:
1- adenoid cystic carcinoma = cylindroma.
Often revealed by a painful nodule, more readily located at the level of the
submaxillary glands, or the palatine or jugal GSA.
It is characterized by a potential for recurrence and often gives rise to metastases (pulmonary, bone, lymph node, etc.)
*histology:
made up of cells poor in cytoplasm without nuclear abnormalities.
2) acinar cell carcinoma:
Very often located in the parotid gland.
The more precise tumor boundaries mean that the prognosis is better after surgery .
Metastases are rarer.
3) Mucoepidermoid carcinoma (MEC)
Mainly affects children and adolescents
4) Squamous cell carcinomas:
Are highly malignant and spread locally rapidly.
They have a poor prognosis because they are highly metastatic and recurrent.
B – Non-lymphoid connective tissue tumors
I – Benign tumors:
by far the most frequent:
- lipomas: parotid++
*angiomas: observed mainly in children, these are mainly lymphangiomas and hemangiomas. - *neurinoma, neuroma, plexiform neuroma are sometimes observed in the context of Von Recklinghausen’s disease.
- II- Malignant tumors:
- described exceptionally. These are rhabdomyosarcomas, malignant schwannomas or melanomas.
- C – Lymphomas:
- The lymphoid tissue of the salivary glands belongs to two different systems, each of which can give rise to LMNH.
- the MALT (mucosa-associated-lymphoid-tissue) system
- the usual lymph node and periganglionic intraglandular lymphatic system
- Lymphomas can be isolated or develop as part of systemic involvement.
- *histology:
- lymph nodes +/- destroyed with presence of lymphocyte cell layers.
- D – Secondary tumors:
- This is most often a direct invasion of the gland by regional cancers.
- *PSEUDOTUMORS = salivary cysts
- Mucoid cyst = mucocele.
- It is a true retentional cyst due to inflammatory or traumatic stenosis of an excretory duct or a false cyst due to degeneration of the parenchyma.
- Affects mainly the lower lip and produces the appearance of a rounded or ovoid nodule, indolent, bluish-gray, renitent or fluctuating
- At floor level it is called a “frog” occupying the entire floor and can become bilobed.
- The rupture of a salivary cyst allows the evacuation of stringy liquid that looks like egg white.
- Differential diagnosis:
- Discussed with:
- varicosity,
- angioma,
- dermoid cyst,
- Thyroglossal duct cyst,
- Mucoepidermoid carcinoma in its more cystic than firm form.
Salivary gland tumors
Baby teeth need to be taken care of to prevent future problems.
Periodontal disease can cause teeth to loosen.
Removable dentures restore chewing function.
In-office fluoride strengthens tooth enamel.
Yellowed teeth can be treated with professional whitening.
Dental abscesses often require antibiotic treatment.
An electric toothbrush cleans more effectively than a manual toothbrush.