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Non inflammatory

Helwa Mageed Asakly

Sialadenosis/ sialosis
Disease mechanism:
nonneoplastic, noninflammatory enlargement of the
.parotid salivary gland
Usually related to Metabolic and secretory
hormonal sialadenosis
alcoholics(dystrophic metabolic sialadenosis),
vitamin deficiencies
neurologic disorders(neurogenic sialadenosis)

: Imaging feature
Enlargement(splayed) / normal appearance
MDCT& MRI: more straightforward depiction,
but are nonspecific.
Treatment: identifying the cause of the
metabolic or secretory disorder.
conservative Tx : local massage, increase fluid
intake , sialagogues.

Cystic lesions
Rare <5%
Unilateral in parotid gland
Congenital/ lymphoepithelial/dermoid/acquired
Mucous extravasation pseudocysts.
Benign lymphoepithelial cysts: are squeal of cystic
degeneration of salivary inclusions within lymph nodes.
Multicentric parotid cysts: associated with HIV benign
lymphoepithelial lesions of immunodeficiency syndrome
These lesion are accompanied by cervical
.occur bilateral, in the superficial portion of parotid gland

Imaging feature:
Indirectly visualized on sialography only by the
.displacement of the ducts arching around them
Well-circumscribed, non enhancing
Ultrasonography: sharply marginated and
echo-free(dark area)
Tx: surgical(local/total excision of the gland)

Benign tumors

Uncommon < 0.003% of population.

About 3% of all tumors.
80% of salivary tumors arise in the parotid
gland, most of them occur in the superficial
lobe, most are benign or low-grade
high-grade malignancies are uncommon .
The chance of neoplasms of major salivary
glands being benign varies directly with the
size of the gland.

imaging features: benign tumors and low grade

malignances may have similar appearance , well
defined margins which are most apparent in
MRI is preferential modality for salivary gland
neoplasia (espically for S.M).
Benign tumors may present low/high intensity
tissue signals on MRI.
Sialography : may suggest a space occupying mass
when the ducts are compressed or displaced
around the lesion ( ball- in-hand appearance)

benign tumors of parotid gland : partially incised or
totally excised.
Submandibular & sublingual glands: totally excised.

ball-in-hand appearance, which

is suggestive of a space
occupying mass

Benign Mixed
tumor\pleomorphic adenoma

A neoplasm arising from the ductal epithelium

&mesenchymal components.
75%of all salivary gland tumors, 80% found in
parotid gland.
Slow growing, unilateral, encapsulated,
asymptomatic mass.
occurs in the fifth decade of life.
female predilection.
recurrence occurs in 50% of cases after excision
and 15%malignant transformation of untreated

imaging feature:
MDCT: sharpely circumscribed, infrequently
lobulated and round homogeneous lesion that has
a higher density than the adjacent glandular tissue.

Rare malignant form, called malignant mixed tumor/

Foci of low signal intensity usually represent area of
fibrosis or dystrophic calcification, if present the
diagnosis favors a benign mixed tumor, otherwise it is
difficult to differentiate from other parotid masses.

Black arrow:Well- defined

periphery and internal
density that less than
surroding muscles
White arrow : the
remaining parotid displaced
MRI: the tissue
signals of tumor
is isointense
with muscle

image: increased
signal of the
tumorhyperintense to

warthin's tumor

Synonym : papillary cystadenoma lymphomatosum

/adenolymphoma, and lymphomatous adenoma.
benign tumor arise from proliferating salivary ducts
trapped in lymph nodes during embryogenesis of S.G.
the second most common benign neoplasm of the salivary
gland tumors.
2%-6% of parotid tumors, usually found in the inferior
lobe of the gland.
slow growing, painless, round to ovoid mass .
multiple in 20% of cases.
Men > 40 years.
Unilateral /bilateral.

: imaging features
.MRI& MDTC are the preferred techniques
non specific appearance and is typical of benign
.mixed tumor
.on MDTC: soft tissue or cystic density
MRI: heterogeneous and may demonstrate
.hemorrhagic foci
warthins tumors is characteristically intensely
.hot (high spot) on Tc-pertechnetate scan

Bilateral warthins tumor, a

large tumor involving the left
parotid and a much smaller
tumor in the right side.

Synonym :vascular nevus.
the most common benign neoplasm of proliferating endothelial
cells(congenital hemangioma) and vascular malformations
.resulting from abnormal vessel morphogenesis
85% arise in the parotid gland.
the most common salivary tumor during infancy and childhood.
AVG age at diagnosis in 10 years, 65% occurring in the first 2
unilateral, asymptomatic
2:1 F:M ratio.
Tx: local excision for pt who do not undergo spontaneous

phleboliths are common in this tumor, they

appear as discrete soft tissue calcifications
with a radiolucent center and are best
identified on plan images & MDCT.
when this tumor occurs in association with a
salivary gland, the ducts of the gland may be
displaced curving about the mass(apparent in

malignant tumors
20% of tumors in the parotid are malignant,
50-60% of submandibular tumors, 90% of
sublingual , 60-75% of minor salivary gland
imaging features: variable, and related to
grade, aggressiveness, location, and type of
ill defined margins, invasion, and destruction of
adjacent osseous structures malignancy,
Tx of low grade malignancy of the parotid gland : *
.partially incised/ totally excised
Tx of high grade tumors: radical neck dissection, *
combination of surgery& therapeutic radiation&


of the left
parotid gland

Adenoid cystic carcinoma

The internal
density of this
tumor equal to
the remaining

Tissue signal in
MRI is slightly
less than

High tissue signal

in T2-weighted
MRI is contrasts
with the remaining
image, the
tumor has a
higher signal
than the


A malignant tumor composed of variable admixture of

epidermoid & mucous cells arising from the ductal epithelium
of the salivary gland.
the most common malignant salivary gland tumor(35%), more
than half occur in the major salivary gland (commonly parotid
gland) . the rest occur in minor
.salivary gland with the palate
Highest prevalence in the fifth decade of life
slight predilection for females.
clinically the tumor movable, slow growing, painless nodule
similar to benign mixed tumor.
only1-4 cm , prognosis is good , the 5 years survival rate >

High grade tumors cause facial pain, paralysis,

.ill-defined margins and relatively immobile
metastasis by blood and lymph node.
recurrence in half of pts after excision.
poor prognosis and varies with histologic grade.
5 years survival rate may be 25% in some

Low grade mucoepidermoid carcinoma:

May have lobulated or irregularly sharply
circumscribed appearance, cystic areas may present
.and calcifications rarely may be seen
High- grade mucoepidermoid carcinoma appearance
of Irregular margins and has homogeneous low
signal intensity on T1- weighted images .
T2- weighted images are more heterogeneous , has
higher signal intensity than T1-weighted images ,
but still slightly darker relatively to the
surrounding tissues.

A mass in the right

parotid gland, poorly
defined margins suggest a
low grade malignancy : low
grade mucoepidermoid

other malignances and

metastasis tumors
The incidence of other malignant tumors of major salivary
gland is low.
23% of them are adenoid cystic carcinoma(most of them minor
adenocarcinoma accounts for only 6.4% with acinic cell
carcinoma, primary lymphoma, and SCC.
pain, parasthesia and paralysis especially in high grade tumors.
Tumor spread: direct invasion/ metastasis
Adenoid cystic carcinoma spreads along nerve sheaths.
metastasis in the parotid gland are more common because of the
.extensive lymphatic and circulatory components
Most metastasis lesions of parotid gland occur through the
lymphatic system (SCC/lymphoma/melanoma)

Mass in the submandibular

gland, that has a
heterogeneous hypoechic
pattern compared with
adjacent tissue(echo-free):
adenoid cystic carcinoma