1. SALIVARY GLAND NEOPLASMS

2. Epidemiology

90% of trs arise in parotid

75% of parotid trs are pleomorphic adenoma

Muco epidermoid MC malignancy

3. Epidemiology

1.2% of all neoplasms

Slow growing masses

Pain not an indicator of malignancy

Benign tumors also present with pain

4. Indications of malignancy

Facial nerve involvement

Indurations/ ulceration of skin , mucous membrane

Lymph node metastasis

Rapid tumor growth

5. Classification

Epithelial tumors

Non epithelial tumors

6. Epithelial tumors

Adenoma

Muco epidermoid tumors

Acinic cell tumors

Carcinoma

7. Adenoma

Pleomorphic Adenoma

Monomorphic Adenoma

8. Monomorphic Adenoma

Adenolymphoma

Oxyphilic adenoma

Other types

9. Carcinoma

Adenoid cystic

Adenocarcinoma

Epidermoid carcinoma

Undifferentiated carcinoma

Carcinoma in pleomorphic adenoma

10. Non epithelial tumors

Hemangioma

Lymphangioma

Lipoma

sarcoma

11. Investigations

FNAC

CT

MRI

12. FNAC

95% accuracy

Differentiate inflamatory from neoplastic in sub mandibular gland

Controversial in parotid

13. CT Scan

Limited to malignancy

Tumor extension

Deep lobe tr from parapharyngeal trs

14. MRI

Superior to CT

Better clarity of margins

More sensitive

Lack of artefact from dental filling

15. Open biopsy

Contraindicated

Justified only in minor gland trs

Ulcerated lesions

16. Benign tumors

Painless

Slow growing

No facial palsy

17. Pleomorphic Adenoma

Commonest benign tr

Pseudocapsule

Pseudopodal extensions

Not multicentric

18. Pleomorphic Adenoma

Mixed tumor

Consists of cartilage besides epithelial cells

Cartilage not of mesodermal origin

Derived from mucin secreted by epithelial cells

19. Microscopy

Epithelial and myoepithelial components

Abundant matrix mucoid,myxoid or chondroid supporting tissue

20. Diagnosis

Lobulated , painless swelling

Long duration

Neither adherent to skin/ masseter muscle

Generally firm / variable consistency

21. Malignant transformation

3 5 % of cases

Pain

Rapid growth

Hard

22. Malignant transformation

Fixed to masseter

Fixity to skin

Lymph nodes

Restricted jaw movements

23. Treatment

Superficial parotidectmy

Total parotidectomy

24. Warthins tumor

Papillary cystadenoma lymphamatosum

5 15 % of parotid trs

Always at the lower pole of the parotid

Overlies the angle of mandible

25. Warthins tumor

More in white races

Not seen in negroes

Encapsulated lesions

No malignant transformation

26. Warthins tumor

Only salivary neoplasm more in males

Elderly males

Slow growing

painless

27. Warthins tumor

Surface is smooth

Well defined

Distinct margins

Soft in consistency with fluctuation

Not tansilluminant

28. Microscopy

Cystic / glandular spaces

Lined by columnar epithelium

Within abundant lymphoid tissue with germinal centres

29. Investigations

FNAC

Tc99 scan hot spot

30. Treatment

Superficial parotidectmy

Enucleation

31. Oncocytoma

6

46. Treatment

Total parotidectomy

Radical neck dissection involved nodes

47. RT

Residual tr

Positive margin

Advnced primary tr stage

Lymphoma

Secondaries in parotid

48. Thank you