Salivary Gland Tumors

T2 > _____ cm (with/without) extraparenchymal extension.

2-4cm Without extraparenchymal extension

What age group does acinic cell carcinoma occur in? Good or bad prognosis?

20-70 years (mid 40s is mean age) Good prognosis

Mumps is unilateral in ____% of cases. ______ in 25% of postpubertal males (usually unilateral).

25% Orchitis

T1 </= _____ cm and (with/without) extraparenchymal extension.

2cm Without extraparenchymal extension

____% of mumps infections are subclinical.

30%

What is the average age of mucoepidermoid carcinoma? Males or females?

45 years Males (3:2)

T3 > _____ cm and/or extraparenchymal extension

4cm

What percentage of minor salivary gland tumors are benign?

50%

What percentage of SGT in minor glands are benign? What percentage are malignant?

50% Benign 50% Malignant

_____% of adenoid cystic carcinoma occurs in parotid. _____% occurs in minor glands of palate.

50%, 50%

What is the peak age for salivary gland tumors?

50-70 years

What is the mean age for Adenoid Cystic Carcinoma? Male or Female? Rapid or slow growing? Ulcerated or Non-ulcerated? Painful or painless?

53 years Males (3:2) Slow-growing Non-ulcerated Chronic pain

What is the mean age of PMLGA? Male or female?

56 years Male (3:1)

What is the mean age for monomorphic adenoma? Symptomatic or Asymptomatic? Fixed or movable?

60 years Asymptomatic Movable mass

What age is Warthin's tumor typically seen? Male or female? Slow or rapid growth? Painful or painless?

6th decade. Male (7:1) Smokers Slow growing, soft Painless

Salivary gland tumors account for _____% of head and neck neoplasms.

7%

What percentage of parotid gland tumors are benign?

75-85%

What percentages of SGT in major glands are benign? What percentage are malignant?

80% Benign 20% Malignant

What percentage of tumors occur in major glands (parotid)?

85-90%

Prognosis of mucoepidermoid carcinoma: Low-grade lesions have _____ % 5-year survival. High-grade leesions have less than _____ % 5-year survival.

90-95% 40%

Where is the most common site PMLGA occurs?

Junction of hard and soft palate.

Does pleomorphic adenoma have a (high/low) recurrence rate? (Low/high) risk of malignant transformation to carcinoma?

Low recurrence Low risk

Where is a salivary gland tumor (SGT) more likely to occur? (Major or Minor glands)

Major Glands (80%) Minor Glands (20%)

What age group is most affected by Pleomorphic Adenoma? Females or Males?

Mean age 45 years. Females > Males (3:2)

Rank the following MINOR glands from most common to least common in which a SGT would occur.

Palate (55%) > Retromolar pad, others (30%) > Upper lip (15%)

Which gland(s) does mucoepidermoid carcinoma (malignant) occur in?

Parotid

Rank the following MAJOR glands from most common to least common in which a SGT would occur.

Parotid (80%) > SMG (5-10%) > SLG (rare)

Where does acinic cell carcinoma mostly occur?

Parotid gland

What is the most common type of salivary gland tumor?

Parotid tumors. Parotid tumors 10x more common than SMG and 100x more common than SLG tumors.

Name the major glands

Parotid, Submandibular (SMG), Sublingual (SLG)

Warthin's tumor almost exclusively affects _______ gland, specifically the ______.

Parotid, tail

An incisional salivary gland biopsy has a similar approach to _______. 90% of lesions in superficial lobe so superficial parotidectomy is ________ for (benign/malignant) lesion?

Parotidectomy Curative Benign

Diagnosis of SGTs include:

Patient history, clinical exam, imaging (CT, MRI, PET scans), biopsy (parotid: FNA, not incisional biopsy, palate: incisional biopsy)

What tumor is the most common benign salivary gland tumor?

Peopmorphic adenoma (parotid)

What is the most common salivary gland tumor?

Pleomorphic Adenoma

Histopath of PMLGA: _______ cells in a variety of patterns (_____, _____, _____). Infiltrative proliferation of ______ ______ cells shows predilection for ______ invasion.

Polygonal solid, trabecular, cribiform ductal epithelial neural

What are the risk factors for salivary gland tumors?

Radioactive iodine EBC CMV HPV 16, 18 Smoking Radiation Asbestos Mining Rubber manufacturing Plumbing Woodworking Nickel exposure Chromium Cement dust

How is mumps spread?

Respiratory droplets, saliva, and urine.

Which gland(s) does adenoid cystic carcinoma (malignant) occur in?

SMG, SLG, others.

Tx. of Monomorphic Adenoma

Simple surgical excision

T4b invades ______ and/or ______ plates and/or encases _______ artery.

Skull base, pterygoid, carotid artery.

Is pleomorphic adenoma rapid or slow growing? Painless or Painful?

Slow growing Painless

Is PMLGA.... Rapid or Slow growing? Symptomatic or Asymptomatic?

Slow growing Asymptomatic mass which may become ulcerated.

Is acinic cell carcinoma... Rapid or slow growing? Low or high grade malignancy? Pain or painless?

Slow-growing Low-grade malignancy Can have pain or paresthesia and metastasize.

Adenoid Cystic Carcinoma is the ______ common SG malignancy. a. most common b. 2nd most common c. 3rd most common d. least common

c. 3rd most

Histologically, Warthin's tumor is seen as entrapped ___ ___ ____ in developing ________. _________ _________ pattern, lymphoid ________ centers.

salivary epithelial rests lymph nodes Epithelial papillary germinal

Name the minor glands

1,000 glands Labial, Buccal, Palatine, Tonsillar, Retromolar

Intraoral salivary gland tumors can originate throughout the oral mucosa EXCEPT for the following locations:

1. Anterior hard palate 2. Gingiva and attached alveolar mucosa *** No salivary glands in these areas!!

Name the 5 malignant SGTs.

1. Mucoepidermoid carcinoma 2. Adenoid cystic carcinoma 3. Malignant pleomorphic adenoma 4. Acinic cell carcinoma 5. Polymorphous low-grade adenocarcinoma *** Acronym MAMA-P

Name the 4 benign SGTs.

1. Pleomorphic adenoma 2. Adenoma (momomorphic) 3. Papillary cystadenoma lymphomatosum (Warthins tumor) 4. Oncocytoma *** Acronym PAPO

What are the 3 characteristics of benign tumors?

1. Well circumscribed 2. Encapsulated, freely movable (except on hard palate) 3. Slow growth rate

What 3 types of cells is mucoepidermoid carcinoma seen in? (histopath)

1. mucous cells 2. squamous (epidermoid) cells 3. intermediate (clear) cells Proportion of mucous cells vs. epidermoid cells determines grade of tumor.

Tx. of high grade mucoepidermoid carcinoma.

Aggressive surgical removal with possible radiation.

Adenoid cystic carcinoma has infiltrative pattern of _______ cells in _______. "_____-_____" pattern. Perineural invasion may occur to _______ nerves to base of skull.

Basaloid, cribriform "Swiss-cheese" cranial

Pleomorphic adenoma is considered a (benign/malignant) mixed tumor.

Benign

What is the treatment for pleomorphic adenoma? If parotid tumor?

Complete surgical excision with margin of normal tissue. Parotid tumor - remove superficial or deep lobe.

What are the characteristics of malignant tumors?

Painful Cause ulcerations Fixed to surrounding tissues Some may be encapsulated.

Where is the most common site for minor SGT?

Palate

The incidence of malignancy increases as the size of the gland (increases/decreases)

Decreases

Histopath: Monomorphic adenoma is seen as a (encapsulated/non-encapsulated) lesion with monomorphic _______ cells.

Encapsulated Ductal

Mumps complications include:

Encephalitis, meningitis, sterility (rare), death (rare).

What nerve divides the parotid gland?

Facial n.

What are the risks of an incisional salivary gland biopsy?

Facial n. injury Tumor seeding

Salivary gland tumors are more common in (males or females)?

Females - 5x greater incidence of breast cancer among patients who have had salivary gland neoplasms.

Where can SGT metastasize to?

Heart, bone, liver

What grade of lesion is more common? (High grade or Low grade)

High grade (49%)

Fine Needle Aspiration Biopsy has (high/low) sensitivity to distinguish _______ vs. _______ parotid masses. Diagnosis based upon histology of ________ cells.

High sensitivity (90%) and specificity (95%). benign vs. malignant only a few cells

Postoperative Radiation Therapy may (improve/worsen) survival in advanced Stage ______ disease over surgery alone.

Improve Stage III/IV

Which type of salivary gland biopsy is the least common?

Incisional biopsy

What is the most common salivary gland malignancy?

Mucoepidermoid Carcinoma

What types of tumors can SGT metastasize into in the heart?

Mucoepidermoid adenoid cystic and malignant pleomorphic adenoma.

What virus can cause major salivary gland enlargement?

Mumps

Tx. for Mumps

Non-aspirin analgesics and antipyretics. Bed rest for males until fever breaks to minimize orchitis. Avoidance of sour foods and drinks.

What does mucicarmine stain, stain? What color does it produce? Why is it used?

Stains mucin - producing cells red in MEC. Helps differentiate a high grade mucoepidermoid carcinoma from a SCC.

What are the clinical signs of mucoepidermoid carcinoma?

Submucosal mass, PAINFUL, ulcerated, may have bluish tinge (mucin).

What are the treatment options for SGT?

Surgery Modified radical neck dissection Postoperative radiation therapy

Tx. for Warthin's tumor Recurrence?

Surgical excision Recurrence is rare

Is it common or uncommon for mucoepidermoid carcinomas to occur as an intraosseous tumor?

Uncommon May still manifest as soft tissue tumors if they break through bone. (ex. retromolar pad)

Monomorphic adenoma is a(n) (common/uncommon) lesion. Affects predominantly _______, _______ (canalicular adenoma) and _______ (basal cell adenoma)

Uncommon upper lip, minor glands parotid

In a person with mumps, enlargement of glands usually begins (unilaterally/bilaterally).

Unilaterally. Followed by contralateral glandular changes within a few days (bilateral).

Papillary cystadenoma lymphomatosum is also known as...

Warthin's tumor

Tx. of low grade mucoepidermoid carcinoma.

Wide surgical excision.

Tx. for PMLGA. Recurrence?

Wide surgical excision. Recurrence is fairly high: 14%

Tx. for adenoid cystic carcinoma. Good or poor prognosis? 40% develop _______ metastases.

Wide surgical excision; may need radiation. Poor prognosis Pulmonary

When does mumps enlargement peak?

Within 2-3 days, pain is most intense during this period.

Polymorphous Low-Grade Adenocarcinoma (PMLGA) is the ____ SG malignancy. a. most common b. 2nd most common c. 3rd most common d. least common

b. 2nd most common

High grade of mucoepidermoid carcinoma has a predominance of ______ cells and ______ behavior.

epidermoid (squamous) Agressive

What are some symptoms of mumps?

low-grade fever, headache, malaise, anorexia, and myalgia. Followed within 1 day by significant salivary gland changes.

Low grade mucoepidermoid carcinoma has a predominance of _______ cells.

mucous

T4a invades _____, ______, _____, and/or ______ nerve.

skin, mandible, ear canal, facial nerve.