Salivary gland tumors
Treatment for Mucoepidermoid carcinoma :
-Depends on location, histologic grade, clinical stage of tumor -In general, Surgical excision is needed. -Radical neck dissection if metastatic disease is present
Prognosis of Mucoepidermoid carcinoma:
-Depends on location, histologic grade, clinical stage of tumor -Low-grade tumors : GOOD (90~98% cured) -High-grade tumors: guarded (30~54% cured)
Name 2 salivary gland tumors that are composed of mixture of Myoepithelial cells and ductal cells:
-Pleomorphic adenoma -Adenoid cystic carcinoma
Prognosis of Adenoid cystic carcinoma:
-Prone to late recurrence and metastasis → LUNGS, BONES -Tumors with SOLID pattern have WORSE prognosis
Which 3 sites of minor salivary gland tumor are RAREST but almost always MALIGNANT?
-Retromolar pad -Floor of mouth -Tongue
Histopathologic features of Acinic cell Carcinoma:
-SEROUS acinar cells with GRANULAR basophilic (blue) cytoplasm -Granular due to zymogen granules = granules in serous cells -Lymphoid infiltrate with germinal center formation -Several growth patterns: solid, microcystic, papillary-cystic, and follicular
Histopathologic features of Intraosseous mucoepidermoid carcinoma:
-Similar to soft tissue counterpart ("Mucoepidermoid carcinoma") -most tumors are LOW-GRADE
Minor salivary gland tumors in PALATE is usually (benign/ malignant) Minor salivary gland tumors in Buccal mucosa is usually (benign/ malignant)
50% benign, 50% malignant 50% benign, 50% malignant
List all Monomorphic adenoma:
<benign> -Canalicular adenoma -Basal cell adenoma <malignant> -Mucoepidermoid carcinoma -Intraosseous mucoepidermoid carcinoma -Acinic cell carcinoma -Adenoid cystic carcinoma
For which salivary gland tumor is "radical neck dissection" NOT indicated? Why?
Adenoid cystic carcinoma because local metastasis is RARE
Cylindroma is another name for:
Adenoid cystic carcinoma ("swiss-cheese appearance")
Which salivary gland tumor commonly involves PAIN?
Adenoid cystic carcinoma (notorious for wrapping around nerves)
Most common INTRABONY salivary gland tumor:
Intraosseous mucoepidermoid carcinoma
Which salivary gland tumor is associated with well-defined unilocular/ multilocular radiolucency ?
Intraosseous mucoepidermoid carcinoma
What treatment is indicated if Acinic cell carcinoma metastasizes?
Lymph node dissection
General rule for Salivary gland tumors is that they affect which age group?
MIDDLE-age (VERY uncommon in children, except mucoepidermoid carcinoma)
Most Sublingual gland tumors are (benign / malignant)
Malignant
If CHILDREN (2nd decade) gets salivary gland tumor, it's most likely (malignant/ benign) and it's going to be ___________________ (name the tumor).
Malignant ; Mucoepidermoid carcinoma
Intraosseous mucoepidermoid carcinoma occurs more commonly in (mandible/ maxilla)
Mandible (molar-ramus area, where dentigerous cyst occurs)
Which salivary gland tumor may be associated with skin appendage tumors?
Membranous basal cell adenoma
Where is the most common SITE of minor salivary glands tumor (benign or malignant)? 2nd most common site?
Palate Lips
Order the following sites of Minor salivary gland tumor from most common to least common: -Upper lip -Lower lip -Buccal mucosa -Palate
Palate > Upper lip > Lower lip > Buccal mucosa
Warthin tumor is also called:
Papillary cystadenoma lymphomatosum
Where does Oncocytoma most commonly occur?
Parotid gland
The most common site for salivary gland tumors: 2nd most common site for salivary gland tumors :
Parotid gland Minor salivary gland
Most common site of Mucoepidermoid carcinoma: 2nd most common site:
Parotid gland Palate
Most common MAJOR gland site of Pleomorphic adenoma: Most common MINOR gland site of Pleomorphic adenoma:
Parotid gland Palate > Upper lip > Buccal mucosa
MOST common benign parotid tumor: 2nd most common benign parotid tumor:
Pleomorphic adenoma Warthin tumor
Name the most common salivary gland neoplasm:
Pleomorphic adenoma (PA)
What is the most common benign salivary gland tumor, regardless of site?
Pleomorphic adenoma (PA)
Treatment for Intraosseous mucoepidermoid carcinoma:
RADICAL SURGICAL RESECTION (you can NOT just curette it out !!)
If Mucoepidermoid carcinoma metastasizes, what treatment is indicated?
Radical neck dissection
Which pattern of Adenoid cystic carcinoma has the WORST prognosis? -Cribriform -Tubular -Solid
Solid form
Mucoepidermoid carcinoma is derived from:
Squamous epithelium ("epidermoid") + Mucous cells ("muco")
Which one is mostly low-grade? a. Mucoepidermoid carcinoma b. Intraosseous Mucoepidermoid carcinoma
b. Intraosseous mucoepidermoid carcinoma
Where does Basal cell adenoma commonly occur?
#1 - Parotid gland #2 - upper lip and buccal mucosa
Prognosis of Acinic cell carcinoma:
-10~20% have local recurrence -10% develop metastasis -10% of patients die of disease
Warthin tumor
-BENIGN neoplasm that occurs almost exclusively in PAROTID gland -2nd most common BENIGN parotid tumor -Develops from proliferation of salivary gland ductal epithelium associated with 2ndary formation of lymphoid tissue -Strong association with Cigarette smoking (8x greater risk than nonsmokers) -Usually occurs in TAIL of parotid gland (near angle of mandible)
Oncocytoma:
-BENIGN salivary gland tumor composed of oncocytes -85~90% of cases occur in Parotid gland -Minor gland tumors RARE
Basal cell adenoma:
-BENIGN salivary gland tumor that occurs primarily in PAROTID gland (75%) -2nd most common location: upper lip and buccal mucosa -membranous basal cell adenoma: may be associated with skin appendage tumors (e.g. hair follicles, sebaceous glands, etc)
List characteristics of LOW-GRADE tumors:
-CYSTIC -No neural invasion -no necrosis -no mitoses -no anaplasia
Histopathologic features of Pleomorphic adenoma:
-ENCAPSULATED (surrounded by fibrous capsule) -Mixture of glandular epithelium + Myoepithelial cells within mesenchyme-like background -"Stromal" changes produced by Myoepithelial cells : Myxomatous change with chondroid appearance -May see FAT and OSTEOID
Histopathologic features of Basal cell adenoma:
-ENCAPSULATED or well-circumscribed -Cells have basaloid appearance (resemble basal cells) -Several subtypes recognized
Prognosis of Oncocytoma:
-GOOD prognosis -LOW rate of recurrence
Prognosis of Intraosseous mucoepidermoid carcinoma:
-GOOD prognosis -10% of patients die -higher recurrence rate with conservative treatment (vs. radical treatment)
List all parameters that determine Grading (low, intermediate, high) of Mucoepidermoid carcinoma:
-Intracystic component<20% -Neural invasion present -Necrosis present -Lot of mitotic figures -Anaplasia present
Acinic cell carcinoma
-MALIGNANT salivary gland tumor showing serous acinar differentiation→ recapitulates serous acini in parotid gland -85~90% of cases arise in parotid gland -Minor gland tumor involve buccal mucosa, lips, palate
Who gets Acinic cell carcinoma?
-Middle 40's -FEMALES> males
Who gets Intraosseous mucoepidermoid carcinoma?
-Middle-aged adults -FEMALES > males
Who gets Adenoid cystic carcinoma ?
-Middle-aged adults -FEMALES> males
Who gets Basal cell adenoma ?
-Middle-aged and older adults -FEMALES > males
Where does Adenoid cystic carcinoma commonly occur in?
-Minor salivary glands in PALATE -submandibular gland (RARE in parotid gland)
Histopathologic features of Warthin tumor:
-Mixture of ductal epithelium + lymphoid stroma -PAPILLARY projection lined by double row of ONCOCYTES (mitochondria) -Germinal center formation may be seen (center hollow white space)
Histopathologic features of Mucoepidermoid carcinoma:
-Mixture of mucous-producing cells + squamous ("epidermoid") cells -Lymphoid infiltrate may be present (w/ no germinal center) -Prognosis depends heavily on Grading (low, intermediate, high)
Histopathologic findings of Adenoid cystic carcinoma
-Mixture of myoepithelial cells and ductal cells -3 major patterns: cribriform, tubular, solid -often shows perineural invasion -Swirling arrangement around nerve bundles -"swiss-cheese" appearance
Mucoepidermoid carcinoma:
-Most common malignant salivary gland neoplasm -Most common malignant salivary gland tumor in CHILDREN -WIDE age range -most common site: 1) parotid 2) Palate (50% rule)
Who gets Warthin tumor?
-OLDER adults (6~7th decade) -MALES > females
Who gets Oncocytoma?
-OLDER adults (6~8th decade) -FEMALES > males
Who gets Canalicular adenoma:
-OLDER adults (7th decade) -FEMALES> males
Adenoid cystic carcinoma:
-Originally called Cylindroma -40~45% develop in minor salivary glands (most often in PALATE) -RARE in parotid gland -most common malignant salivary gland tumor of submandibular gland -PAIN is common & important finding
Histopathologic features of Canalicular adenoma:
-Single-layered cords of columnar or cuboidal epithelial cells forming canal-like structures -vascularized CT -No stromal alterations as seen with PA (meaning it does NOT make fat, cartilage, bone, etc) -All tumors look like each other, even ones between two people.
List all growth patterns of Acinic cell carcinoma:
-Solid -microcystic -papillary-cystic -Follicular
Canalicular adenoma:
-Striking predilection for Upper lip -1& 2nd most common tumor of Upper lip -2nd most common site : Buccal mucosa -May be Multifocal with separate tumors in upper lip (have multiple foci, but NOT bilateral) → can make "lumpy bumpy" appearance on upper lip
Treatment for Pleomorphic adenoma:
-Superficial lobe of parotid → partial parotidectomy -Deep lobe of parotid → TOTAL parotidectomy -Hard palate → excision including overlying mucosa
Prognosis of Pleomorphic adenoma:
-Very GOOD prognosis -95% cure rate -3~4% of cases undergo malignant transformation →"Carcinoma ex PA"
Who gets Mucoepidermoid carcinoma?
-WIDE age range (2nd~ 7th decade) -occur in CHILDREN -FEMALES > males
Name 2 salivary gland tumors with Lymphoid infiltrate with GERMINAL CENTER formation:
-Warthin tumor -Acinic cell carcinoma
Name 2 tumors associated with Mitochondria creating the granularity of tumors:
-Warthin tumor -Oncocytoma
Which salivary tumor used to be categorized under monomorphic adenoma but was pulled out into separate category due to its unique properties?
-Warthin tumor -Oncocytoma
Histopathologic features of Oncocytoma:
-Well-circumscribed tumor -Sheets of large Polyhedral cells with granular, eosinophilic cytoplasm -Granular cytoplasm (due to abundance of mitochondria)
Who gets Pleomorphic adenoma ?
-Young adults -FEMALES> males
Intraosseous mucoepidermoid carcinoma:
-most common INTRABONY salivary gland tumor -most likely source: odontogenic epithelium (esp. dentigerous cyst with mucous cells) -Mandible>maxilla; Molar-ramus area -Unilocular or multilocular radioLUCENCY with well-defined borders -same as Mucoepidermoid carcinoma except it occurs in BONE (mandible, maxilla)
Where does Acinic cell carcinoma commonly occur?
-mostly Parotid gland -Minor gland (buccal mucosa, lips, palate)
What would Pleomorphic adenomas feel like when touched?
-movable mass (able to squish it around movable skin if in parotid gland) -Fairly firm (but NOT hard) (b/c encapsulated)
Which salivary gland tumor is prone to late recurrence and metastasis to LUNGS and BONES?
Adenoid cystic carcinoma
Which salivary gland tumor shows swirling arrangement around nerve bundles?
Adenoid cystic carcinoma
Name the most common MALIGNANT tumor of Submandibular gland:
Adenoid cystic carcinoma
The most common malignant tumor of submandibular gland:
Adenoid cystic carcinoma
Which salivary gland requires surgical excision as well as adjunct radiation therapy?
Adenoid cystic carcinoma
Which salivary gland tumor is particularly difficult to treat, because of its propensity to travel along the NERVES ?
Adenoid cystic carcinoma
Upper lip tumors are usually (benign/ malignant) Lower lip tumors are usually (benign/ malignant)
Benign ; Malignant
1st most common tumor of upper lip:
Canalicular adenoma
Which salivary gland tumor has a striking predilection for UPPER LIP ?
Canalicular adenoma
Which salivary gland tumor may be MULTIFOCAL?
Canalicular adenoma (separate tumors in upper lip)
Pleomorphic adenoma in the (superficial/ deep) lobe of parotid gland requires TOTAL parotidectomy.
Deep
Can Warthin tumor recur?
YES, but rare.
Tumor in which salivary gland is this talking about? -"Smaller the gland, the greater the likelihood for malignancy"
Minor salivary gland tumor
The most common SWELLING laterally in the palate is _________________. The most common SWELLING in the midline of hard palate is _________________.
Minor salivary gland tumor Palatal tori
Tumor in which salivary gland is usually 50% malignant and 50% benign? Which 2 locations in mouth does this 50% rule usually apply to?
Minor salivary glands Palate + Buccal mucosa
Pleomorphic adenoma is derived from:
Mixture of ductal cells + myoepithelial cells (= several Ducts + myoepithelial cells "mimicking" fat, cartilage, bone in the background) (remember myoepithelial cells are contractile cells surrounding the duct of salivary gland)
Oncocytoma can be categorized as (monomorphic/ pleomorphic) adenoma.
Monomorphic (all cells look the same)
What is the most common swelling of the LOWER lip? What is the most common swelling of the UPPER lip?
Mucocele Canalicular adenoma
Most common malignant salivary gland tumor in CHILDREN:
Mucoepidermoid carcinoma
Name the most common MALIGNANT tumor of Minor salivary glands:
Mucoepidermoid carcinoma
Which salivary tumor is GRADING significant for patient's prognosis?
Mucoepidermoid carcinoma
Name the most common MALIGNANT tumor of Parotid gland:
Mucoepidermoid carcinoma (ME)
Is Intraosseous mucoepidermoid carcinoma usually unilocular or multilocular by the time of diagnosis?
Multilocular ; Because early phase is unilocular and later phase is multilocular. It usually never gets diagnosed when it's small & unilocular
What is the radiographic feature of Intraosseous mucoepidermoid carcinoma:
Multilocular radiolucency in posterior MANDIBLE
What's the most likely SOURCE of Intraosseous mucoepidermoid carcinoma?
Odontogenic epithelium (esp. "dentigerous cyst" - Cyst that forms around crown of impacted tooth)
What tumor should you think of with these key words? -older women -parotid gland -lots of mitochondria
Oncocytoma
Most tumors in (Parotid/ Submandibular/ Sublingual) gland is malignant.
Sublingual
Most tumors of _____________ gland are malignant.
Sublingual
(Parotid/ Submandibular/ Sublingual) gland is a RARE site for salivary gland tumors.
Sublingual gland
First thing you do if you radiographically see radiolucency adjacent to a tooth:
Test vitality of a tooth
Explain how "Pleomorphic adenoma" can take on multiple forms histologically :
The Myoepithelial cells in this tumor can make it look like cartilage, fat, bone, myxoid tissues, etc. But all of these tissues actually COME from myoepithelial cells - e.g. myoepithelial cells secrete chondroid matrix that makes it look like Cartilage (refer to pic)
most common site of Canalicular adenoma: 2nd most common site:
Upper lip Buccal mucosa
Explain the Pathogenesis of Intraosseous mucoepidermoid carcioma:
Usually starts from epithleial lining of Dentigerous cyst (e.g. 3rd molar area) → this epithelial lining undergoes "mucous change" → becomes neoplastic
What is the ONLY salivary gland tumor that's more common in MALES than females?
Warthin tumor
Which salivary gland tumor is STRONGLY associated with cigarette smoking?
Warthin tumor
Which salivary gland tumor can occur BILATERALLY in parotid gland and metachronously?
Warthin tumor (most other salivary gland tumors occur unilaterally)
Which salivary gland tumor almost exclusively occurs in parotid gland? Which part of parotid gland does it usually occur in?
Warthin tumor in the TAIL of parotid near angle of mandible
Can Basal cell adenoma recur?
YES, but rare