Salivary gland tumors final p pt.pptx

''''''''''''''''''''''''''''''''''''''''''''''

1. SALIVARY GLAND NEOPLASMS DR. VISHWAS PAI D

2. ANATOMY ANATOMY

3. FACIAL NERVE

4. ANATOMICAL LANDMARKS FOR FACIAL NERVE IDENTIFICATION TRAGAL POINTER [CONLEY’S POINTER] POSTERIOR BELLY OF DIGASTRIC TYMPANOMASTOID SUTURE LINE PERIPHERAL BRANCHES

5. WHO CLASSIFICATION Adenoma Pleomorphic adenoma Warthin’s tumor Basal cell adenoma Sebaceous adenoma Canalicular adenoma Oncocytoma Duct papilloma Cystadenoma Carcinoma Low grade Low grade mucoepidermoid ca Acinic cell carcinoma High grade High grade mucoepidermoid ca Adenoid cystic cancer Carcinoma ex pleomorphic adenoma Adenocarcinoma Salivary duct cancer Squamous cell cancer

6. Nonepithelial tumors Hemangioma Lymphangioma Lymphoma Primary - NHL Secondary - Sjogren’s syndrome Secondary tumors Unclassified tumors Tumor like lesions Sialadenosis Oncocytosis Necrotizing sialometaplasia Benign lymphoepithelial lesion Salivary gland cysts Kuttner’s tumor Cystic lymphoid hyperplasia

7. EPIDEMIOLOGY Incidence : 2.5 – 3 /100000 Population / year. 5 % of head and neck tumors. 70 %

8. MOST COMMON BENIGN MALIGNANT ADULTS PLEOMORPHIC ADENOMA MUCOEPIDERMOID CARCINOMA CHILDREN HEMANGIOMA MUCOEPIDERMOID CARCINOMA

9. Memorial Sloan-Kettering: 35-Year Period THE DISTRIBUTION OF 2807 SALIVARY NEOPLASMS Histology Number of Patients Percent Pleomorphic adenoma 1274 45.4 Warthin's tumor 183 6.5 Benign cyst 29 1.0 Lymphoepithelial lesion 17 0.6 Oncocytoma 20 0.7 Monomorphic adenoma 6 0.2 Mucoepidermoid carcinoma 439 15.7 Adenoid cystic carcinoma 281 10.0 Adnocarcinoma 225 8.0 Malignant mixed tumor 161 5.7 Acinic cell carcinoma 84 3.0 Epidermoid carcinoma 53 1.9 Other (anaplastic) 35 1.3 Total 2807 100 Spiro RH:  Salivary neoplasms : overview of a 35-year experience with 2,807 patients.   Head Neck Surg   1986; 8:177-184.

10. ETIOLOGY Exposure to radiation EBV Occupational exposure - Silica dust Tobacco exposure - Warthin’s tumor Genetic factors

11. Bicellular theory: Intercalated Ducts Pleomorphic adenoma Warthin’s tumor Oncocytoma Acinic cell carcinoma Adenoid cystic carcinoma Excretory Ducts Squamous cell carcinoma Mucoepidermoid cancer Multicellular theory: Acinar cells - Acinic cell carcinoma Striated duct - Oncocytoma Excretory duct- Mucoepidermoid carcinoma Intercalated duct and myoepithelial cells— Pleomorphic adenoma THEORIES OF ORIGIN Unicellular theory Unicellular theory

12. PLEOMORPHIC ADENOMA Most common salivary gland neoplasm. Age - 4 – 5 th decade. Male : Female = 1:1 Most commonly in parotid. Typically in tail of parotid.

13. Gross: Well circumscribed Encapsulated HISTOLOGY: Cellular component Stromal component

14. Seifert’s subclassification : Myxoid type Cellular type Classical type Prone for recurrence After enucleation - 20 - 40% at 30 yrs After parotidectomy - 2 % Malignant transformation - 5% cases

15. Laryngoscope 2002 Dec;112(12):2141-54. The significance of the margin in parotid surgery for pleomorphic adenoma. Witt RL Source Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, Christiana Care Health Systems, Newark, Delaware, USA. Cancer 1977 Feb;39(2):388-96. Malignant mixed tumor of salivary origin: a clinicopathologic study of 146 cases. Spiro RH et al

16. WARTHIN’S TUMOR 2 nd M.C benign tumor. Age - 7 th decade. Female : Male = 7 : 1 Unique features: Bilateral - 5 - 10% Multifocality - 20% Association with tobacco Exclusively in parotid. Never turns malignant.

17. Acta otolaryngol . 2006 Dec;126(11):1213-7. High risk for bilateral Warthin tumor in heavy smokers--review of 185 cases. Peter Klussmann J et al Source Department of Oto -Rhino- Laryngology , Head and Neck Surgery, University of Cologne, Cologne, Germany. 185 patients Bilaterality - 17 % Smoking history – 89 % patients

18. Oncocytoma Basal cell adenoma Canalicular adenoma

19. MUCOEPIDERMOID CARCINOMA M.C malignant tumor. 3 types of cells Mucous cells Epidermoid cells Intermediate cells Grade - prognostic factor

20. Goode et al reported in 1998 on 234 patients with major salivary mucoepidermoid carcinomas who were followed up for >10 years. Low grade High grade Free of disease 143 (80%) 13 (42%) Local recurrence 2 (6.4%) 18 (10%) Regional metastasis 7 (4%) 3 (9.6%) Dead of disease 10 (5.6%) 13 (44%)

21. ADENOID CYSTIC CARCINOMA Unique features: Perineural invasion. Invasion along haversian canal Prone for recurrence. Prone for distant mets . Indolent natural history. Subtypes: Cribriform Tubular Solid

22. Malignant mixed tumor 3 types: Carcinoma ex pleomorphic adenoma Carcinosarcoma Metastasizing pleomorphic adenoma

23. Acinic cell carcinoma Polymorphous low grade adenocarcinoma Squamous cell carcinoma Adenocarcinoma

24. CLINICAL FEATURES Painless swelling infront of ear. Essential examinations Intra oral examination Deep lobe Duct opening Facial nerve examination Neck nodes

25. Benign Malignant 1. Growth Slow Rapid 2. Pain Absent Present 3. Consistency Soft to firm Hard 4. Fixity to skin Absent May be present 5. Fixity to masseter Absent May be present 6. Neck nodes Absent May be present 7. Facial nerve involvement Absent Present

26. TNM STAGING T x Primary cannot be assessed T0 No e/o primary T1 Tumor < 2 cm ; No extraparenchymal extension T2 Tumor 2 - 4 cm ; No extraparenchymal extension T3 Tumor > 4 cm or having extraparenchymal extension T4a Tumor invades skin / mandible / ear canal / facial nerve T4b Tumor invades skull base / pterygoid plates / carotid artery Nx Nodes cannot be assessed N0 No regional nodes N1 Ipsilateral , Solitary, < 3 cm N2 N2a Ipsilateral , Solitary, 3 – 6 cm N2b Ipsilateral , Multiple, None > 6 cm N2c Bilateral / contralateral , None > 6 cm N3 Any node > 6 cm Mx Mets cannot be assessed M0 No distant metastasis M1 Distant metastasis present

27. Staging: 1 T1 N0 M0 2 T2 NO M0 3 T3 T1 T2 T3 N0 N1 N1 N1 M0 M0 M0 M0 4A T4a T1,2,3,4a N0,1 N2 M0 M0 4B T4b Any T Any N N3 M0 M0 4C Any T Any N M1

28. THANK YOU