Salivary Gland Tumors Oral Patho

Full text

(1)

SALIVARY GLAND TUMORS 1)PLEOMORPHIC ADENOMA

2)MONOMORPHIC ADENOMA 3)MUCOEPIDERMAL CARCINOMA SALIVARY GLAND

ORGAN THAT PRODUCE SALIVA IN THE ORAL CAVITY. FUNCTIONS OF SALIVA :-1. PROTECTION 2. BUFFERING 3. DIGESTION 4. TASTE 5. ANTIMICROBIAL ACTION

6. MAINTAINANCE OF TOOTH INTEGRITY

THE SALIVARY GLAND CAN BE CLASSIFIED AS

:-• MAJOR SG

MINOR SG

MAJOR SG:- THREE LARGE PAIRED AND FOUND BILATERALLY.

1. PAROTID GLAND

2. SUBMANDIBULAR GLAND 3. SUBLINGUAL GLAND

MINOR SG :- SMALL GLANDS.THESE GLANDS ARE NAMED ACCORDING TO THEIR LOCATIONS AS:-1. LABIAL

2. BUCCAL 3. PALATINE 4. LINGUAL

1) PAROTID GLAND :- SEROUS.

LOCATION:- ANTERIOR TO THE EXTERNAL EAR. OPENING IN THE ORAL CAVITY:-ON THE BUCCAL MUCOSA OPPOSITE THE MAXILLARY SECOND MOLAR DUCT:- STENSENS DUCT

2) SUBMANDIBULAR GLAND:-MIXED HAVING BOTH SEROUS AND MUCOUS SECRETORY TERMINAL UNITS.

(2)

LOCATIONS:- IN THE SUBMANDIBULAR TRIANGLE OPENING IN THE ORAL CAVITY:-OPENS IN THE FLOOR OF THE MOUTH AT THE SITE OF LINGUAL FRENUM.

DUCT:-WHARTONS DUCT

3) SUBLINGUAL GLANDS:-MIXED

LOCATION:- BETWEEN THE FLOOR OF THE MOUTH AND THE MYLOHYOID MUSCLE .

DUCT:- OPENS INTO THE ORLA CAVITY THROUGH A MAIN DUCT CALLED BARTHOLINS DUCT AND

SEVERAL SMALL DUCTS FOLLOWING THE SUBLINGUAL FOLDS.

BARTHOLINS DUCT OPEN WITH OR NEAR THE SUBMANDIBULAR DUCT.

TUMOR:- DEFINED AS AN ABNORMAL MASS OF TISSUE THE GROWTH OF WHICH EXEEDS AND IS UNCOORDINATED WITH THAT OF NORMAL TISSUE

AND PERSISTS IN THE SAME EXCESSIVE MANNER AFTER CESSATION OF STIMULI WHICH EVOKE THE

CHANGE.

TUMOR MAY BE BENIGN OR MALIGNANT.

ALL TUMORS BENIGN AS WELL AS MALIGNANT HAVE TWO BASIC COMPONENT

PARENCHYMA : COMPRISED BY PROLIFERATING TUMOR CELLS

SUPPORTIVE STROMA: COMPOSED OF FIBROUS CONNECTIVE TISSUE AND BLOOD VESSELS

FEATURES BENIGN MALIGNANT

BOUNDARIES WELL CIRCUMSCRIBE D POORLY CIRCUMSCRIBE D

(3)

TISSUE COMPRESSED

SIZE SMALL LARGE

MICROSCOPIC FEATURES

PATTERN RESEMBLES THE TISSUE OF ORIGIN CLOSELY POOR RESEMBLANCE TO TISSUE OF ORIGIN

BASAL POLARITY RETAINED LOST

PLEOMORPHISM NOT PRESENT OFTEN PRESENT ANISONUCLEOSIS USUALLY NOT

PRESENT PRESENT HYPERCHROMATI

SM ABSENT PRESENT

GROTH RATE SLOW RAPID

METASTASIS ABSENT PRESENT PROGNOSIS LOCAL

COMPLICATION DEATH BY LOCAL AND METASTAIC COMPLICATION PLEOMORPHIC

ADENOMA:-• TERM SUGGESTED BY WILLIS

ADENOMA MEANS BENIGN NEOPLASM OF THE GLAND.

IT IS BENIGN MIXED TUMOR WHICH IS

HISTOLOGICALLY CHARACTERIZED BY COMPLEX INTERMIXING OF EPITHELIAL AND

MESENCHYMAL COMPONENT.

MORPHOLOGY COMPLEXITY OF THIS TUMOR ACCOUNT FOR THE TERM PLEOMORPHIC.

MYOEPITHELIAL CELLS ARE RESPONSIBLE FOR MORPHOLOGIC COMPLEXITY OF THIS TUMOR

(4)

INCLUDING PRODUCTION OF

FIBROUS,MUCINOUS AND OSSEOUS STRUCTURE. CLINICAL

FEATURES:-1) AGE: OCCURS AT ANY AGE BUT MOST

FREQUENT BETWEEN 30 AND 50

2) SEX:OCCURS FREQUENTLY IN FEMALES

3) SITE: IT MAY OCCUR ANY OF THE MAJOR OR

MINOR GLANDS.IT MOSTLY INVOLVES THE PAROTID GLAND

60-80% OF THE PAROTID GLAND TUMOR IS PLEOMRPHIC ADENOMA.

IT IS THE 2/3RD PART OF THE TOTAL NEOPLASM OF ORAL CAVITY.

IN THE PAROTID GLAND THIS TUMOR

MOSTLY PRESENT IN THE LOWER POLE OF THE SUPERFICIAL LOBE OF THE GLAND.

IT INVOLVES THE MINOR SALIVARY GLAND AND PALATE IS THE MOST COMMON SITE OF THE MINOR SG INVOLVEMENT.

4) SYMPTOMS: SMALL,PAINLESS NODULES WHICH

SLOWLY BEGINS TO INCREASE IN SIZE.

5) SHAPE: IRREGULAR TO OVOID

6) SIZE: IT MAY INCREASE TO CRICKET BALL SIZE 7) SURFACE:SMOOTH

8) FIXATION:NO FIXATION EITHER TO THE DEEPER

TISSUE OR OVERLYING SKIN

9) CONSISTENCY:FIRM AND RUBBERY

HISTOPATHOLOGICAL FEATURES: 1)TUMOR IS ENCAPSULATED

2)MICROSCOPIC APPEARANCE IS VARIABLE

3) TUMOR IS COMPOSED OF MIXTURE OF

GLANDULAR EPITHELIUM AND MYOEPITHELIAL CELLS.

(5)

4)EPITHELIUM MAY FORM SHEETS OR STRANDS OR DUCT LIKE STRUCTURE

5)MYOEPITHELIAL CELLS HAVE A VARIABLE MORPHOLOGY

6)THE STROMA COSISTS OF MUCOID OR

MYXOCHONDROID TISSUE AND MAY FORM THE BULK OF THE LESION

7) OCASSIONALLY SOME SG TUMORS CONTAINS

ONLY MYOEPITHELIAL CELLS IN STROMA CALLED AS MYOEPITHELIOMA.

TREATMENT AND PROGNOSIS:SURGICAL EXCISION

1) PAROTID GLAND:LESION IN SUPERFICIAL

LOBE- SUPRFICIAL PAROTIDECTOMY WITH PRESERVATION OF FACIAL NERVE.

LESION IN THE DEEP LOBE-TOTAL

PAROTIDECTOMY WITH PRESERVATION OF FACIAL NERVE

2) SUBMANDIBULAR GLAND: BY TOTAL

REMOVAL OF GLAND

3) HARD PALATE:EXCISED WITH OVERLYING

MUCOSA

4) LIP,SOFT PALATE:EXTRACAPSULAR EXCISION

THE USUAL CLINICAL COURSES IS GOOD.

RARELY A MALIGNANT TUMOR MAY ARISE WITHIN THIS TUMOR CALLED AS CARCINOMA EX

PLEOMRPHIC ADENOMA.

MONOMORPHIC ADENOMA :-DEMONSTRATE THE MORE UNIFORM

HISTOPATHOLOGIC PATTERN

MONOMORPHIC ADENOMA IS DIVIDED INTO THREE GROUPS BY WHO:

1)ADENOLYMPHOMA OR WARTHINS TUMOR 2)OXYPHILIC ADENOMA OR ONCOCYTOMA

(6)

3)OTHER HISTOLOGIC PATTERNS LIKE BASAL CELL ADENOMA AND CANALICULAR ADENOMA

BUT WARTHINS TUMOR AND ONCOCYTOMA ARE

RECOGNISED SEPARATE ENTITY NOWADAY. SO ONLY INCLUDING MONOMORPHIC ADENOMA ARE BASAL CELL ADENOMA AND CANALICULAR ADENOMA

1) BASAL CELL ADENOMA

:-CLINICAL FEATURES:

1) SITE: PRIMARILY IN MAJOR GLANDS PARTICULAR

IN PAROTID

2) AGE: USUALLY OLDER AGE GROUP OVER 60

YEARS

3) SEX: COMMON IN MALES

4) SYMPTOMS: SLOW GROWING 5) DIAMETER: LESS THAN 3 CM

HISTOPATHOLOGIC FEATURES:

THIS LESION ARE FAIRLY UNIFORM AND REGULAR TWO MORPHOLOGIC FORMS CAN BE SEEN

A)SMALL CELLS WITH ROUND NUCLEUS B)LARGE CELLS WITH OVAL NUCLEUS

TUMOR SHOW 4 SUB TYPE OF HISTOPATHOLOGIC

PATTERN:-A) SOLID: MOST COMMON SUBTYPE.COSISTS OF

EPITHELIAL ISLANDS WHICH ARE SHARPLY DEMARCATED FROM CONNECTIVE TISSUE BY BASEMENT MEMBRANE.

B) TRABECULAR: SAME AS SOLID TYPE BUT

EPITHELIAL ISLANDS ARE NARROWER AND

INTERCONNECTED WITH ANOTHER PRODUCING A RETICULAR PATTERN.

C) TUBULAR: LEAST COMMON SUBTYPE

(7)

D) MEMBRANOUS:EXHIBITS MULTIPLE LARGE

ISLANDS OF TUMOR THAT ARE MOLDED TOGETHER IN THE JIGSAW PUZZLE

FASHION.THEES ISLANDS SURROUNDED BY A THICK LAYER OF HYALINE MATERIAL WHICH REPRESENT REDUPLICATED BASEMENT

MEMBRANE.

TREATMENT: SURGICAL EXCISION.RECURRENCE SELDOM SEEN.

CANALICULAR ADENOMA CLINICAL

FEATURES:-1) SITE:PRIMARILY IN THE INTRAORAL ACESSORY

GLANDS

2) AGE:OVER 60 YEARS

3) SEX:NO SEX PREDILECTION

4) SYMPTOMS :SLOW GROWING DIAMETER

RANGE LESS THAN 2CM

HISTOPATHOLOGIC FEATURES:

SINGLE LAYER CORDS OF COLUMNAR OR CUBOIDAL EPITHELIAL CELLS

THIS SINGLE LAYER OF CELLS PARALLEL FORMING LONG CANALS

THESE CELLS ARE SUPPORTED BY A LOOSE CONNECTIVE TISSUE STROMA

CYSTIC SPACES ARE ALSO SEEN..

CYSTIC SPACES ARE USUALLY FILLED WITH AN EOSINOPHILIC COAGULUM.

TREATMENT :SIMPLE ENUCLEATION.RECURRENCE SELDOM SEEN.

MUCOEPIDERMOID CARCINOMA: 1) PERIPHERAL MUCOEPIDERMOID TUMOR:

(8)

TERM WAS INTRODUCED IN 1945 BY STEWART FOTE AND BECKER

THE TERM RECOGNISED ONE SUBSET THAT ACTED IN A MALIGNANT FASHION AND A SECOND GROUP THAT BEHAVE IN A BENIGN FASHION.

IT WAS LATER RECOGNISED THAT EVEN LOW GRADE TUMOR OCASSIONALLY COULD

EXHIBIT MALIGNANT BEHAVIOUR.

THEREFORE THE TERM MUCOEPIDERMOID CARCINOMA IS THE PREFFERED DESIGNATION.IT ACCOUNTS FOR 6-9% OF THE SG TUMOR

AND FOR ABOUT 1/3RD OF THE ALL

MALIGNANT SG TUMOR CLINICAL FEATURES:

1) SITE: ABOUT 60% OCCUR IN PAROTID

GLAND AND 30% IN THE MINOR SG

2) AGE: OCCURS INBETWEEN 30 AND 50 3) SEX: SLIGHT FEMALE PREDILECTION

THE TUMOR OF LOW GRADE

MALIGNANCY USUALLY APPEAR AS A SLOWLY ENLARGING PAINLESS MASS WHILE TUMOR OF HIGH GRADE

MALIGNANCY GROWS RAPIDLY AND THUS PRODUCE PAIN AS AN EARLY SYMPTOM.

FACIAL NERVE PARALYSIS IS FREQUENT IN PAROTID TUMOR.

THE PATIENT ALSO COMPLAINTS OF TRISMUS,DRAINAGE FROM THE EAR , DYSPHAGIA AND NUMBNESS OF THE ADJACENT AREA. AND ULCERATION IS NOTED PARTICULARLY IN TUMORS OF THE MINOR SG.

(9)

HISTOPATHOLOGIC FEATURE

TUMOR COMPOSED OF 5 TYPES OF CELLS A)MUCOUS CELLS

B)EPIDERMOID CELLS C)INTERMEDIATE CELLS D) LYMPHOCYTES E)CLEAR CELLS

EPIDERMOID CELLS AND INTERMEDIATE CELLS LINE CYSTIC SPACE AND FORM THE SOLID MASS

MUCOEPIDERMOID CARCINOMA HAVE BEEN CATEGORIZED INTO THREE

HISTOPATHOLOGIC GRADES BASED ON THE FOLLOWING:

1)AMOUNT OF CYST FORMATION 2)DEGREE OF CYTOLOGIC ATYPIA 3)RELATIVE NUMBER OF CELLS

A) LOW GRADE

:-• PROMINENT CYST FORMATION

MINIMAL CELLULAR ATYPIA

HIGH PROPORTION OF MUCOUS CELLS

B) HIGH GRADE

:-• CYSTIC COMPONENT USUALLY VERY LESS

PROMINENT CYTOLOGIC ATYPIA

INTERMEDIATE AND EPIDERMOID CELLS PRESENT

C) INTERMEDIATE GRADE

:-• CYST FORMATION IS SEEN BUT LESS PROMINENT THAN LOW GRADE.

CYTOLOGIC ATYPIA MAY OR MAY NOT BE PRESENT.

ALL TYPES OF CELLS ARE PRESENT BUT INTERMEDIATE CELLS ARE PROMINENT.

(10)

TREATMENT AND

PROGNOSIS:-• SURGICAL EXCISION WITH PRESERVATION OF FACIAL NERVE IF POSSIBLE IS RECOMMENDED FOR LOW AND INTERMEDIATE GRADE

MALIGNANCY OF THE PAROTID GLAND

THE AFEECTED SUBMANDIBULAR GLAND SHOULD BE REMOVED ENTIRELY.

TREATMENT FOR THE MINOR GLAND IS ALSO PRIMARILY SURGICAL.

SURGICALEXCISION FOLLOWED BY

RADIOTHERAPY IS RECOMMENDE FOR HIGH GRADE TUMOR

2) CENTRAL MUCOEPIDERMOID CARCINOMA

[INTRAOSSEOUS MUCOEPIDERMOID CARCINOMA]

IN THIS TUMOR SG TUMOR ARISE CENTRALLY WITHIN THE JAW.

THE MOST COMMON AND BEST

RECOGNISED INTRABONY SALIVARY TUMOR IS THE CENTRAL MUCOEPIDERMOID

CARCINOMA.

OTHERS ARE ADENOID CYSTIC CARCINOMA OR ADENOCARCINOMA

IT MAY ORIGINATE FROM ENTRAPMENT OF SALIVARY GLAND TISSUE WITHIN THE JAW WHICH SUBSEQUENTLY UNDERGO

NEOPLASTIC TRANSFORMATION. CLINICAL FEATURES:

AGE: COMMON IN MIDDLE AGEDSEX: SLIGHT FEMALE PREDILECTION

SITE: THREE TIMES MORE COMMON IN THE MANDIBLE THAN MAXILLA AND MOST OFTEN SEEN IN THE MOLAR RAMUS AREA.

(11)

SYMPTOMS:PRIMARY SWELLING AND PAIN TRISMUS REPRTED LESS FREQUENTLY

TREATMENT AND PROGNOSIS: SURGERY FOLLOWED BY RADIATION THERAPY. THE OVERALL PROGNOSIS IS FAIRLY GOOD.

THE OVERALL PROGNOSIS IS FAIRLY GOOD. REFRENCES:-

ORAL PATHOLOGY – SHAFFERS,HINE,LEVE PAGE NO.-311-318 AND 326-329

ORAL PATHOLOGY -

NEVILLE,DAMM,ALLEN,BOUQUOT PAGE NO-410-414 AND 416,417,420-422

ORAL MEDICINE –ANIL GOVINDRAO GHOMGENERAL PATHOLOGY -HARSH MOHAN

(12)

Figure

Updating...

References

Updating...

Related subjects :