Glands are those organs or tissues in which the cells are engaged in synthesis, storage and discharge of
secretory products.
Salivary glands are the compound, tubuloacinar, merocrine, exocrine glands whose ducts open
into the oral cavity.
All these are derived from atleast 2 primary germ layers.
2) Mesoderm Connective tissue part of the gland which carries the blood and nerve supply to the
gland.
Salivary gland tumours have a special status in human neoplasia. They are likely have the most
complex histopathology of any organ / tissue and they are histologically heterogenous group of tumours
and the have greatest diversity of morphologic features among their cells and tissue.
Is the presence of unique myoepithelial cell in organs such as salivary, sweat and mammary glands a factor
responsible for the diversity of squamous tumours?
Tumours may be derived from salivary epithelium (parenchyma) or supportive stroma (mesenchymal).
70% occur in major salivary gland and 30% occur minor salivary gland mainly palate, bone
marrow, upper lip, oropharynx, lower lip, tongue.
Benign parenchymal tumours Adenoma
Malignant Adenocarcinoma
Parotid Mainly benign salivary gland tumours
Submandibular and minor salivary gland malignant = benign.
Histologically these glands can be regarded as having two main types of cells.
Luminal and Non luminal, organized in a specific relationship.
Luminal : Refers to the secretary cells comprising acini and the lining or lumen fusing cells of ductal
system, ductal cells and
Non-Luminal : Similarly has two main components myoepithelial and basal.
In routinely stained histologic sections, luminal cells are readily recognized at all functional levels
of the gland and non luminal cells can be difficult to identify in the intercalated ducts and acini of salivary
gland lobules whereas apparent in the interlobar and main excretory ducts.
CLASSIFICATION :
World Health Organization Histological Classification of Salivary Gland Tumours (1991) :
1) Adenomas
- Pleomorphic adenoma
- Myoepthelioma
- Basal cell adenoma
- Warthins tumour
- Oncocytoma
- Canalicular adenoma
- Sebaceous adenoma
- Ductal papilloma
- Inverted ductal papilloma
- Intraductal papilloma
- Sialadenoma papilliferum
- Cystadenoma
- Papillary cystadenoma
- Mucinous cystadenoma
2) Carcinomas
- Acinic cell carcinoma
- Mucoepidermal carcinoma
- Adenoid cystic carcinoma
- Polymorphous low grade
- Epithelial myoepithelial carcinoma
- Basal cell adenocarcinoma
- Sebaceous carcinoma
- Papillary cystadenoma
- Mucinous adenoma
- Oncocytic carcinoma
- Salivary duct carcinoma
- Adenocarcinoma
- Malignant myoepithelioma
- Carcinoma of pleomorphic adenoma
- Squamous cell carcinoma
- Small cell carcinoma
- Undifferentiated carcinoma
- Other carcinoma
3) Non-epithelial tumours
4) Malignant lymphomas
5) Secondary tumours
6) Unclassified tumours
7) Tumour like lesions
- Sialadenosis
- Oncocytosis
- Necrotizing sialometaplasia
- Benign lymphoepithelial lesion
- Salivary gland cysts
- Chronic sclerosing sialadenitis of submandibular glands (Kuttner tumour)
- Cystic lymphoid hyperplasia in AIDS
ETIOLOGY:
1) Viruses : Epstein barr virus, polyoma virus, cytomegalovirus type C and type B particles, human
papilloma virus 16 and 18 types.
2) Radiation :
• 483 rads given 1 cm below the parotid skin.
• Excessive use of dental and medical diagnostic radiograph
3) Occupation : Asbestos, Rubber products, plumbing and wood working.
4) Life style :
• Severe malnutrition i.e. Kwashiokar causes salivary gland enlargement and has a risk for
carcinoma
• Smoking association with Warthins tumour
5) Hormones
DIFFERENCES :
Benign Malignant
Clinical Features :
1. Smooth, uniform surface 1. Nodular surface
2. Normal surface colouration 2. Surface telangiectasia
3. Round, dome shaped 3. Irregularly shaped
4. Intact overlying mucosal skin 4. Ulcerated
5. Movable 5. Fixed and indurated
6. Asymptomatic 6. Occlusal nerve deficits
Histological Features :
1. Distinct and intact capsule 1. Lacks encapsulation
2. Uniformity of cells 2. Cells irregular in size and shape
3. Tissue structure resembles normal 3. Altered tissue patterns
4. Neoplastic cells, displace nerves 4. Invades nerves
5. Normal stroma 5. Lacks sufficient stroma
6. No necrotic areas 6. Occlusal areas of necrosis
Note :
Myoepithelial cells : Ferritin, GFAP, Actin, Myosin, Fibronectin, Elastin, Laminin and Vimentin.
Ductal epithelial cells : Keratin, S-100 (Intercalated cells and acinar cells), BMP (Luminal cells of
tubuloglandular structure), CEA and Lactoferrin (Ductal epithelial cells).
Histogenesis:
Histos Web (a combining form denoting relation to tissue).
Genesis Production.
The formation or development of tissues from the undifferentiated cells of germ layers of the
embryo.
In pathology, this term has become synonymous with the “cell of origin” for a neoplasm rather
than the development process underlying the tumour.
Morphogenetic Concepts:
In the simplest possible scenario based on the ducto-acinar unit.
Tumour cell differentiation results in three basic models of benign or malignant salivary gland
neoplasm.
1) In one form of differentiation, tumour cell population results in a dual population that combines
recognizable luminal and/or acinar cells with myoepithelial and/or basal cells.
2) A second different pattern results primarily in luminal / glandular cells that resemble to some extent
normal duct epithelial and /or acinar cells.
3) The third process produces tumour cells resembling normal myoepithelial and/or basal cells.
HISTOGENESIS:
• Intercalated duct reserve cells can differentiate in to ductal or myoepithelial cells.
• Either ductal or myoepithelial or both play a role in the histogenesis of the tumor.
• Myoepithelial cells are responsible for the morphologic diversity of the tumor in the production of
fibrous mucinous , chondroid or osseous areas.
• it shows cytogenetic abnormalities involving chromosome region 12q13-15.
• Putative pleomorphic adenoma gene ( PLAG1) has been mapped to chromosome 8q12.
CLINICAL FEATURES:
• Most common tumor of salivary glands.
• It Accounts 53 – 77% Parotid Tumors, 44 – 68% Sub mandibular tumors and 38 – 43 % minor
gland tumors.
Age:
• 4 -6th decade of life, rletively common in young adults also.
Sex:
• Female predominance.
Location:
• Most common - parotid gland – in the lower pole of the superficial lobe of the gland ..
• May occur in any major or accessory glands but rare in sublingual gland.
• Minor salivary salivary glands - palate is most common site
Clinical presentation:
• Presents as small , painless, quiescent nodule which slowly begins to increase in size, some times
show intermittent growth.
• It presents as swelling overlying the ramus in front of the ear.
• Lesion between ascending ramus and sylomandibular ligament results in dumblee- shaped tumor
on the lateral pharyngeal wall or soft palate.
• Irregular nodular lesion , firm in consistency although areas of cystic degeneration may be
palpated superficially.
• Lesion is not fixed to either deeper tissues or to the overlying skin.
• Intra oral lesions may cause difficulty in mastication, talking and breathing.
• Palatal pleomorphic adenoma is fixed to underlying bone but not invasive.
HISTOPATHOLOGIC FEATURES:
Macroscopic features :
• Irregular to ovoid mass with well defined borders.
• Cut surface is rubbery , fleshy, mucoid or gelatinous with a homogeneous tan or white in colour.
Microscopic features:
• Capsule may be incomplete or show infiltration by tumor cells.
• Characteristically show morphologic diversity.
• Show combination of epithelium and mesenchymal like tissues
ETIOPATHOGENESIS:
CLINICAL FEATURES
Age:
• Adults
Sex
• Equal gender predilection.
Clinical presentation:
• Similar to pleomorphic adenoma
HISTOPATHOLOGY:
ETIOPATHOGENESIS:
• Intercalated or reserve cells is the histogenic source.
CLINICAL FEATURES
• Show uniform population of basaloid epitheloid cells arranged in solid, trabecular, tubular or
membranous pattern.
Age:
• Peak sixth decade of life
Sex:
• Female predominance.
Location:
• Predominantly in major salivary glands – parotid gland.
• Second most common site – minorsalivary glands – lip and buccal mucosa.
Clinical presentation:
• Painless slow growth, firm, may be cyatic and compressible.
HISTOPATHOLOGY:
Macroscopic features:
• Single well defined nodule
• Membranous type – multifocal
• Tumor in major salivary glands – well defined capsulated
• In minor glands - less well defined.
• Cut surface – gray to brown, may have cystic areas.
Microscopic features:
• Two morphologic forms of basal cells are present
• Small cell with scanty cytoplasm and round basophilic nucleus.
• Large cell with eosinophillic cytoplasm and an ovoid pale staining nucleus.
• Depending on the morphologic appearance it is of four types
o Solid
o Tubular
o Trabecular
o Membranous
Solid :
Most common type
Basaloid cells , form islands ( occasionally show keratin pearls) and cords that have broad,
rounded, lobular pattern.
Peripheral cells of the islands are palisaded and cuboidal to columnar in shape., hyper chromatin
Central cells have palar staining nuclei.
These are sharply demarcated from the connective tissue stroma by basement membrane
Tubular pattern:
Multiple small, round duct like cells structures lined by two distinct distinct layer of cells, inner
cublidal ductal cells surrounded by an outer layer of basoloid cells.
Least common
Membranous type:
Characterized by the presents of abundant, thick, eosonophillic hyaline layer that surrounds and
separates the epithelial islands. ( hyaline material is the reduplicated basement membrane).
Multiple large lobular Epithelial islands are arranged in jigsaw puzzle pattern.
Menbranous basal cell adenoma / dermal analogue tumors - appear to be hereditary, offen associated with
skin appendage tumors lke dermal cylindromas and trichoepitheliomasa.
• Rare benign tumor composed of oncocytes with granular eosinophillic cytoplasm and large no of
atypical mitochondria.
CLINICAL FEATURES
Age:
• Peak bet 51 – 80 YRS
Sex:
• Slight female predominance.
Location:
• Major salivary glands ( most common) -Parotid gland
• Minor salivary glands ( rare) - lip and buccal mucosa.
Clinical presentation:
• Discrete encapsulated mass
• Pain is generally absent
HISTOPATHOLOGY:
• Characterized by large polyhedral cells with abundant granular eosiniphillic cytoplasm and
distinct cell membrane arranged in narrow rows or cords.
• Oncocytes arranged in sheets or nests and cords form alveolar or organoid pattern.
• Cellular atypia, nuclear hyperchromatism and plemorphis are seen.
• Lymphoid cells are frequently present but not the integral part of the lesion.
• Oncocytic cystic adenoma – chiefly composed of numerous duct like structures lined with
oncocytes
• Clear cell oncocytoma – show marked clear cell changes.
• Granularity in oncocytoma is due to abundant mitochondria can be stained by PTAH
• Presents of glycogen give rise to PAS positive stain.
CANALICULAR ADENOMA:
Uncommon neoplasm composed of columnar epithelial cells arranged in a single or double layer forming
branching cords in a loose stroma.
CLINICAL FEATURES
Age:
• 34 – 65yrs
Sex:
• Female predominance.
Location:
• Most common in intraoral accessory salivary glands – upper lip ( majority) followed by buccal
mucosa.
Clinical presentation:
• Slowly growing, well circumscribed , firm nodule, not fixed to the tissue moves through the tissue
for some distance.
• Overlying mucosa may be of normal colour or slightly bluish in colour.
HISTOPATHOLOGY:
• Surrounded by thin fibrous capsule.
• Composed of long columns or cords of cuboidal or columnar cells in a single layer
• The single layer of cells are parallel, forming long canals .
• Party wall may be formed by the double wall of cells.
• Cystic spaces are filled with eosinophillic coagulum
• Stroma is loose and fibrillar with delicate vascularity.
SEBACEOUS ADENOMA:
CLINICAL FEATURES
Age:
• Mean -58YRS
Sex:
• Male predominance.
Location:
• Both major and minor salivary glands.
Clinical presentation:
HISTOPATHOLOGY:
• Sebaceous cell nests show minimal atypia and pleomorphism and has no tendency to invade local
structures.
• Many tumor are microcystic and may be composed of ectactic salivary duct with focal sebaceous
differentiation.
• Tumor may exhibit - oncocytic metaplasia and histiocytes and /or forign body giant cells
DUCTAL PAPILLOMA:
It includes three rare group of benign papillary salivary gland tumors they are
• Inverted ductal papilloma
• Intra ductal papilloma
• Sialadenoma papilliferum
CLINICAL FEATURES
Age:
• Adults
Sex:
• No gender prediliction
Location:
• Only in minor salivary gland tumors. – lower lip followed by buccal vestibular mucosa.
Clinical presentation:
• Presents as submucosal nodule which may have a pit or indentation in the overlying mucosa.
HISTOPATHOLOGY:
• Basaloid and squamous cells arranged in thick, bulbous papillary proliferation that projects in to
ductal lumen.
• Lumen of the tumor is narrow and may communicates to the exterior of the mucosal surface
through the constricted opening.
CLINICAL FEATURES
Age:
• Adults, mean – 54 yrs
Sex:
• No gender predilection
Location:
• Minor salivary glands – lower lip followed by upper lip, palate and buccal mucosa
Clinical presentation:
• Submucasal swelling.
HISTOPATHOLOGY:
• Show unicystic dialated structure.
• Cyst wall lined by a single or double row of cuboidal columnar cells which extend in to the cyst
lumen as papillary projections having fibro vascular stroma.
SIALADENOMA PAPILLIFERUM:
CLINICAL FEATURES:
Age:
• Adults – 56 yrs
Sex:
Male predilection
Location:
• Most commonly involve minor salivary glands.
Clinical presentation:
• Characteristically presents as exophytic , papillary surface lesion.
HISTOPATHOLOGY:
• Exhibits both exophytic and endophytic proliferation of ductal epithelium.
• Papillary projections of the surface epithelium is supported by the fibrovascular core having
inflammatory cell infiltrate of lymphocytes , plasma cells and neutrophills.
• , covered by parakeratotic stratified squamous epithelium.
• Ductal lumen are lined by tall columnar cells resting on the cuboidal basal layer of cells.
CYSTADENOMA:
• Characterized by formation of multiple cystic structures
CLINICAL FEATURES
Age:
• Older age group – 8th decade
Sex
• Female prediliction
Location:
• Both major and minor salivary glands.
Clinical presentation:
• Painless slightly compressible swelling
HISTOPATHOLOGY:
• Lining of the cystic structure varies from flattened to tall columnar cells and cuboidal, mucous
and oncocytic cells
• Limited papillary growth with central connective tissue
• Dense scattered fibrous connective tissue stroma are present with scattered inflammatory cells.
ETIOPATHOGENESIS:
Here the malignant cells show acinar differentiation.
Def:
Acinic cell carcinoma is defined by cytologic differentiation towards serous acinar cells, whose
characteristic feature is cytoplasmic PAS – positive zymogen – type sceretory granules.
CLINICAL FEATURES
Age
• Middle age group. mean – 44yrs
Sex
• Female predominance – 3;2 ratio.
Location:
• more than 80% occur in the parotid gland.
• Common intraoral sites – lip and buccal mucosa.
Clinical presentation:
• Slow growing , mobile or fixed mass of various duration
• Rare features – facial muscle weakness, bilateral synchronous tumors.
HISTOPATHOLOGY
• Well differentiated cells bear remarkable resemblance to normal acinar cell
• Less differentiated cell resemble embryonic ducts and immature acinar cells.
• Show four growth patterns:
Solid – numerous well differentiated acinar cells arranged in a pattern that resemble
normal parotid gland tissue.
Papillar cystic – large cystic areas that are lined by epithelium having papillary
projections in to cystic spaceses.
Follicular – appear similar to that of thyroid tissue.
Microcystic – show multiple small cystic spaces having some mucinous or eosinophillic
material.
• Characteristically cells resemble acinar cells with abundant granular basophilic cytoplasm and
round darkly stained eccentric nucleus.
• Presents of intercalated duct like cells, which are smaller and vacuolated cells are unique to the
acinic cell carcinomas
• Delicately fibrovascular collagenous tissue.
• Parotid acinic cell carcinoma show lymphoid elements.
MUCOEPIDERMOID CARCINOMA:
Most common malignant salivary gland tumor in both major and minor salivary glands. ( 29 – 34%)
Tumor consists of both mucous secreting cells and epidermoid type cellsin varying proportions.
CLINICAL FEATURES
Ionizing radiation increase the risk of developing mucoepidermoid carcinoma.
Age:
• 3rd or 5th decade of life.
• Most common salivary gland tumor of children.
Sex:
• Slight female prediliction
Location:
• Major salivary glands - parotid is the most common site
• Minor salivary glands – palate is the most common site.
Clinical presentation:
• Low – grade malignancy appear as slowly enlarging painless mass .
• High –grade malignancy grows rapidly and does produce pain as an early symptom, facial nerve
paralysis in parotid gland tumors.
• Rare features - trismus, drainage from the ear, dysphagia, nubness of the adjacent areas and
ulceration ( particularly in minor salivary glands)
• Intraosseous tumors also may develop.
• Distant metastasis to lung, bone, brain and subcutaneous tissue are also common.
HISTOPATHOLOGY
• It characteristically contain
• Mucous sercreting cells
• Epidermoid cells( squamous cells)
• Intermediate cells.
• Mucous cells are of various shape and have abundant, pale, foamy cytoplasm that stain positive
for mucin stain.
• Epidermoid cells have squamoid feature demonstrate polygonal shape, intercellular bridges and
rarely keratinization
• Intermediate cells are larger than basal cells and smaller than the squamous cells
• Progenitors of epidermoid and mucous cells.
• Occasionally show clear cells ar seen which are mucin and glycogen free.
• Lymyphoid infiltrate can be seen in few cases.
Denpending up on
Amount of cyst formation
Degree of cytologic atypia
Relative no of mucous, epidermoid and intermediate cells
It is devided in to three grades.
Low-grade
Intermediated-grade
High -grade
Low grade:
• Show well formed glandular structure and prominent mucin filled cystic spaceses, minimal
cellular atypia and a high proportion of mucous cells
Intermediate grade:
• Show solid areas of epidermoid cells or squamous cells with intermediate basaloid cells. Cyst
formation is less prominent than in low grade mucoepidermoid carcinoma
• Intermediate cells are prominent.
High-grade:
• Show solid nests and cords of intermediate basaloid cells and epidermoid cells.
• Prominent nuclear pleomorphism and mitotic activity is noted
• Cystic component is less than 20%
• Glandular component predominates rarely
• Necrosis and perineural invasion is present
Grading parameters and point values
Histologic variants
Sclerosing mucoepidermoid carcinoma
Intraosseous mucoepidermoid carcinoma
ETIOPATHOGENESIS:
Tumor arises in the salivary gland tissue entrapped with in paraparotid or intrparotid lymphnode during
embryogenesis. / lymphoid component is the exaggerated secretory immune response.
Strongly associated with smoking.
EBV may be associated with the disease.
CLINICAL FEATURES:
Age:
• 6 and 7th decade of life.
Sex:
• Male predominance.
Location:
• Almost exclusive in parotid gland. – tail region – at the angle of the mandible.
Clinical presentation:
• Slow growing nodular masss.
• Painless, firm in palpation.
HISTOPATHILOGIC FEATURES:
• Macroscopic examination:
• Soft parotid mass, well encapsulated , contain variable no of cysts that contain clear fluid.
Chocolate coloured fluid can be seen.
Microscopic features:
• Show two histologic components epithelial and lymphoid.it shows papillary projections in to the
cystic space and lymphoid matrix showing germinal centers.
• Cyst lined by bilayered papillary proliferation of oncocytes
• Inner layer is tall columnar with finely granular and eosinophilic cytoplasm due to presence of
mitochondria and centrally placed pallisaded, slightly hyperchromatic nuclei.
• Outer layer of cells are triangular and occasionally fusiform basaloid cells.
CLINICALFEATURES
Age:
• 5TH AND 6TH decade of life.
Sex:
• Female predominance
Location:
• Major glands- parotid,sub maxillary glands
• Acessary glands – palate,tongue.
Clinical presentation
• Local pain,facial nerve paralysis in the case of parotid.
• Fixation to the deeper structures and local invasion.
• Intra oral lesions may exhibit ulcerations.
• Show marked tendency to spread through perineural space.
• Tumor in palate or maxillary sinus may radiographic evidence of bone distruction.
HISTOPATHOLOGY:
Myoepithelial and ductal cells show varying arrangement.
Characteristically show perineural invasion
Morphologically show 3 growth patterns:
Cribriform pattern
Tubular pattern
Solid pattern
Cribriform pattern:
• Basalpid epithelial nests form multiple cyst like patterns resembling a swiss cheese or honey comb
pattern.
• Classic and best recognized pattern
• Lumen contain PAS positive mucopolysaccharide secretion.
Tubular pattern:
• Structures are lined by stratified cuboidal epithelium.
Solid pattern:
• Show little tendency of cyst formation
• Least common type
• High grade lesion
Variants:
Dedifferentiated adenoid cystic carcinoma:
• Rare variant
Histologically characterizedby two components
CLINICALFEATURES
Age:
• 50 – 79 years
Sex
• Female predominance (2;1)
Location
• Most common in minor salivary gland tumors – 60% - hard and soft palate, 16% buccal mucosa,
12% upper lip.
Clinical presentation:
• Firm, non-tender swelling.
• Occasionally – discomfort, bleeding, telangiectasia or ulceration over the mucosa can be seen.
HISTOPATHOLOGY:
• Characterized by infiltrative growth with diverse morphology and uniform cytologic features.
• Polymorphic nature of the lesion refers to variety of growth patterns like – solid, ductal, cystic and
tubular.
• Or cribriform pattern resembling adenoid cystic carcinoma.
• Composed of cuboidal to columnar isomorphic cells that have uniform ovoid to spindle – shaped
nuclei,with scant to moderate amounts of eosinophilic cytoplasm.stroma – fibrovascular or mucoid
to hyaline
• Show perineural invasion.
CLINICALFEATURES
Age
• Mean – 60yrs
Sex
• Female predominance
Location
• Most common in parotid gland.
Clinical presentation:
• Slow growing localized swelling.
• Occasionally patient experience facial weakness or pain
HISTOPATHOLOGY:
• Histopathology varies from Solid lobules separated by bands of hyalinized fibrous tissue to
irregular,papillary cystic arrangements with tumor cells which partially or completely fill the
cystic spaces
• Islands of tumor cells composed of small ducts lined by cuboidal epithelium that is surrounded by
clear cells which interfere with a thickened , hyaline like basement membrane.
Un common low grade malignant neoplasm that is cytologically similar to basal cell adenoma but is
infiltrative and has a small potential for metastasis.
CLINICALFEATURES
Age:
• Mean age 60yrs
Sex
• No gender prediliction
Location
Most common in major salivary gland tumors
- parotid gland (90%)
- rare – buccal mucosa, palate and respiratory tract.
Clinical presentation
• Swelling of the affected site.
• Rarely sudden increasein size.
HISTOPATHOLOGY:
Histologically show four subtypes.
Solid
Ductal
Trabecular and
Membranous
SEBACEOUS CARCINOMA:
CLINICALFEATURES
Characterized by malignant sebaceous cells arranged in sheete and/or nests
Age
• Bimodaldistribution- 3rd decade, 7-8th decade.
Sex
• Equal gender predilection.
Location
• Most common- parotid gland.
Clinical presentation
• Paiful mass with varying degree of facdialnerve paralysis
• Occasionally fixed to the underlying skin
HISTOPATHOLOGY:
• Well or partially encapsulated with pushing or infiltrating masses.
• Cellular pleomorphism and cellular atypia are uniformly present.
• Multiple large foci or sheets of tumor cells have hyperchromatic nuclei surrounded by abundant
clear to eosinophilic cytoplasm
Rare malignant tumor characterized by prominent cystic and frequently ,papillary growth.
CLINICALFEATURES
Age:
• Average 59 years
Sex
• Equal gender predilection
Location
• Major salivary glands- primarily parotid gland
Clinical presentation
• Slow growing asymptomatic mass.
HISTOPATHOLOGY:
• predominately show cystic growth pattern.
• Lumen often filled with mucus and hemorrhage
• Rarely focal dystrophic calsifications are present
• Lining cells of the tumor are cuboidal to columnar
• Tumor cells may contain basaloid, oncocytic, clear and mucus cells to form adenomatous or
nodular ,solid areas
• Tumor may infiltrate either as cyst like structure or as solid islands
• Majority of them are low grade lesions.
MUCINOUS ADENOCARCINOMA:
CLINICALFEATURES
Rare malignant neoplasm charatarized by large amountof extracellular epithelial mucin that contain
cords,nests,and solitary epithelial cells
Age
Sex
Location:
• Major salivary glands primarily –subandibular gland.
Clinical presentation
• May be associated with pain and tenderness.
• Presents as soft, spongy masses
HISTOPATHOLOGY:
• Grossly specimens aremucoid with slimy texture and may ooze mucoid material.
• Characteristically in low power view show islands and cordsof tumorcells appearto befloating
with in the poolsof palestaining mucinpools of mucin may be devided in to irregular lobules by
fibrous connective septa.
• Tumor cells are moderately large,cuboidal and polygonal with eosinophilic to amphophillic
cytoplasm
• The tumor islands aresurrounded by pale-staining mucoid substance.
• Mucoid substance stain with mucicarmine, periodic-acid –schiff and alcian blue at PH 2
.
ONCOCYTIC CARCINOMA/ ONCOCYTIC ADENOCARCINOMA:
Rare high grade tumor
CLINICALFEATURES
Age
• Average age 63 years.
Sex
Location
• Major glands- parotid, submandibular glands
• Minor glands-palate.nasalcavity,ethmoidalandmaxillary sinuses.
Clinical presentation:
• Skin overlying the gland occasionally discoloured or wrinkled
HISTOPATHOLOGY:
• Show significant component of oncocytes
• Characterized by oncocytes with marked cellular atypia, frequent mitosis, distruction of the
adjacent structures, perineural invasion and distant or regional lymph node metastasis.
CLINICALFEATURES
Rare high grade tumor
Age
• Seventh and eight decade of life.
Sex
• Male predominance.
Location
• Most common is parotid gland.
Clinical presentation
• Parotid swelling is the common feature.
• Facial nerve disfunction or paralysis occur in fewcases
• High grade variant is most aggressive type, typified by localinvasion,lymphatic and
hematogenous spread with poor prognosis.
HISTOPATHOLOGY:
• Tumor cells may have small lumina or cribriform arrangement or frequently have solid, irregular
shaped cell aggregates.
• Neoplastic epithelial cells are cuboidal and polygonal with a moderate amount of eosinophilic
cytoplasn and are accompanied by dense fibrous connective tissue stroma that may be hyalinized
in some areas.invasion of nerves,blood vessels and salivary glands and extrasalivary gland tissue
occurs
ADENOCARCINOMA:
• Rare but aggressive tumor.
CLINICALFEATURES
Age:
• Average age – 40 years
Sex
• Equal sex prediliction
Location:
• Major salivary gands – parotid
• Minor salivary glands –palate, lip, tongue
Clinical presentation
• Enlarging mass
• App 25% of patients complaints of pain or facial paralysis.
HISTOPATHOLOGY:
• Solid tumor with out cystic spaces
• Commonly show formation of glandular structures
Based on degree of cellular differentiation it is graded in to
Grade I
Grade II
Grade III
Grade I have well formed ductal structures
Grade III have more solid growth pattern.and few glandular structures.
CLINICALFEATURES
Age
• Mean age 55 yrs
Sex
Location
• Most common parotid gland
Clinical presentation
• Painless mass
• Clinically Presents as intermediate to high –grade tumor and does not correlate with histological
grades.
HISTOPATHOLOGY:
• Individual cells are resemble tumor cells in myoepithelioma amd myoepithelial cells of mixed
tumor.
• Tumor cells are spindle shaped or plasmacytoid.
• Tumor is quite cellular resembling sarcoma than carcinoma
• Show infiltrative , destructive growth, increased mitotic activity and cellular pleomorphism.
• IHC – S100, smooth muscle actin, occasionally glial fibrillary acidic protein.
CLINICAL FEATURES:
Age:
• 6th to 8th decade of life
Sex:
• Slight female predominance
Location
• Major salivary glands – parotid followed by submandibular gland
• Minor salivary glands - palate
Clinical presentation:
• Painless mass / rapid enlargement of long – standing nodule
• May be associate with facial paralysis.
HISTOPATHOLOGY:
• Malignant appearing cells occur afjacent to a typically appearing pleomorphic adenoma.
• Malignant portion may transform in to any epithelial malignancy ( like undifferentiated carcinoma
or adenocarcinoma) except acinic cell
Origin
• Denovo
• In association with benign mixed tumor
CLINICAL FEATURES
Age:
• Average 60 years
Sex:
• Equal gender predilection
Localtion
• Major salivary glands
Clinical presentation:
• Swelling, pain, nerve palsy and ulceration.
•
HISTOPATHOLOGY:
• Tumor shows both sarcomatus and carcinomatus component.
• Sarcoma – chondrosarcoma is most common
• Carcinoma – undifferentiated or high grade ductal carcinoma.