Adenolymphoma and mucoepidermoid tumor of parotid.pptx

Lecture notes for medical students

1. Tips on using my ppt. You can freely download, edit, modify and put your name etc. Don’t be concerned about number of slides. Half the slides are blanks except for the title. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. At the end rerun the show – show blank> ask questions > show next slide. This will be an ACTIVE LEARNING SESSION x three revisions. Good for self study also. See notes for bibliography.

2. Classification

3. Classification Epithelial (90%) 1) Adenomas Pleomorphic adenoma Monomorphic adenoma( Adenolymphoma ) 2) Carcinomas Mucoepidermoid carcinoma ( most common) Acinic cell Ca. Adenoid cystic Ca. Adenocarcinoma Sq. cell Ca. Ca. in ex pleomorphic adenoma

4. Benign tumors

5. Benign tumors - Painless - Slow growing - No facial nerve involvement

6. Aetiology

7. Aetiology Radiation Smoking ( Warthin’s tumor) Genetics – loss of alleles of chromosomes in 12q, 8q, 17q Environment & diet – Def. of vit A, industrial agents like nickel, cadmium, hair dyes, silica, preservatives Infective – Mumps, EBV, chronic sailadenitis Recurrent inflammation dysplasia carcinoma

8. Adenolymphoma -

9. Adenolymphoma - Warthin’s Tumor/ Papillary Cystadenolymphomatosum - Misnomer – Neither malignant nor Lymphoma - 5-15% of Parotid tumor (2 nd most common tumor) - Smoking – 8 times more risk - Mostly in the lower pole & overlies the angle of mandible

10. - Usually involve only the superficial lobe - More common in male, elderly and in whites - No malignant transformation Microscopy –: - Cystic/Glandular spaces - Lined by columnar epithelium - Abundant lymphoid tissue in the stoma

11. Investigations:

12. Investigations: - FNAC - Tc99 scan – Hot spot (due to high mitochondrial content) Treatment: - Superficial parotidectomy

13. Mucoepidermoid Ca.

14. Mucoepidermoid Ca. - Most common malignant tumor of the parotid - Occurs both in minor & major glands - Slow growing attaining large size - High grade – Epidermoid cells mainly –regional & distant spread - Low grade – Mucous cells mainly – regional nodes spread.

15. TNM staging of malignant salivary tumors (AJCC 7 th edition)

16. TNM staging of malignant salivary tumors (AJCC 7 th edition) Primary tumor (T) TX Primary tumor cannot be assessed T0 No evidence of primary tumor T1 Tumor 2 cm or smaller in greatest dimension, with or without extraglandular extension into the orbital soft tissue T2 Tumor larger than 2 cm but not larger than 4 cm in greatest dimension T3 Tumor larger than 4 cm in greatest dimension T4 Tumor invades periosteum or orbital bone or adjacent structures T4a Tumor invades periosteum T4b Tumor invades orbital bone T4c Tumor invades adjacent structures (brain, sinus, pterygoid fossa , temporal fossa )

17. Regional lymph nodes (N)

18. Regional lymph nodes (N) NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 Regional lymph node metastasis Distant metastasis (M) MX Distant metastasis cannot be assessed M0 No distant metastasis M1 Distant metastasis

19. Investigations

20. Investigations FNAC – Confirms possibility of lymphoma/inflammatory mass CT scan – To see the deep lobe Bone involvement Extension into the base of the skull Parapharyngeal space extension Neck nodes assessment MRI - Perineural spread Bone marrrow involvement

21. Treatment a)

22. Treatment a) Surgery - Total conservative parotidectomy T1,T2,T3 - Radical Parotidectomy (T4) - Both lobes - Facial nerve - Soft tissues with skin - Mandibular ramus - Masseter muscle Facial N reconstruction – Greater auricular nerve/ sural nerve

23. b) Radiotherapy 3-6 weeks after surgery Delayed for 6 weeks if nerve grafting is done Dose – 50-70 Gy (1.5 - 2Gy in 5-8 weeks. c) Chemotherapy 5FU Cisplatin Doxurubicin Epirubicin

24. Parotidectomy Superficial parotidectomy : Most common procedure of parotid pathology With/without hypotensive anesthesia Reduce blood loss Improve visual surgical field

25. Parotidectomy

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