Several factors have hindered attempts to evaluate the procedures sensitivity and specificity. Establish an immunohistochemical staining pattern to aid in distinguishing between certain tumors. Salivary gland tumors sgts are rare neoplasms accounting for 0. The anatomy and physiology of salivary glands benefits of saliva is that it is easily available for noninvasive collection and analysis. Pdf ultrasound characterization of salivary lesions. Types of salivary gland cancer memorial sloan kettering. The severity grade depends on the extent of area of salivary gland affected and the density of the cellular infiltrate. Salivary gland anatomy n parotid gland n submandibular gland n sublingual gland n minor glands it is not our intent to cover anatomy during this course. Malignant sgts represent 6% of head and neck cancers and 0. A clinical approach to diagnosis and management of atypical and suspicious lesions w. Evolution in ultrasound technology leads to birth of high frequency, high resolution linear transducers which in turn revolutionized the imaging of superficial structures. Cystic salivary gland tumors including cystic neoplasms.
Mucoepidermoid carcinoma is the most common type of salivary gland cancer. Salivary gland cancer starts in one of the salivary glands. Figure 2 salivary gland, sublingual, duct hyperplasia in a male f344n rat from a subchronic study. Salivary gland tumors symptoms and causes mayo clinic. Rajesh c kamble et al ultrasound characterization of. The salivary glands are classified as major or minor. The classification of salivary gland tumors is rapidly evolving with description of new entities, such as mammary analogue secretory carcinoma masc. The salivary glands make saliva and release it into the mouth. Salivary gland tumors are variable in location, origin and malignant potential pathology. Salivary gland cancers are named according to which of these cell types they most look like when seen under a microscope. Fineneedle aspiration biopsy of salivary gland lesions. Request pdf lesions of the salivary gland salivary glands play critical roles in oral health and the initiation of digestion.
One duct is dilated and has an increased number of epithelial cells arrow. Salivary glands adenoid cystic carcinoma benign mixed tumor. Diagnostic difficulties in lesions of the minor salivary. Multidisciplinary management of salivary gland cancers. They are uncommon lesions morphologically and clinically diverse, distinct from other cancers of. A sialogram is helpful if the cyst communicates with the ductal system. Judiciously applied, fnab can assist the clinician in developing a suitable treatment plan. Salivary gland cancer is a rare disease in which malignant cancer cells form in the tissues of the salivary glands. Salivary gland histopathology and rank were evaluated by researchers who were blinded to diagnosis, and at least one tissue section from each salivary gland was examined. You have three pairs of major salivary glands under and behind your jaw parotid, sublingual and submandibular. In addition to the true oncocytic lesion, there exists another group of salivary gland lesions, which demonstrate cells with abundant and occasionally granular cytoplasm. The tumors can arise in about 80% in parotid gland, 15% in submandibular gland and 5% in the sublingual and minor salivary gland. Less than 30% of focal lesions in the parotid gland are malignant, whereas almost 50% of focal lesions in the submandibular gland are malignant, 3, 66. A total of fine needle aspirations of salivary gland lesions were done in the cytology department of our institute during the period of january 2007 to december 2008.
Salivary gland hyperplasia nonneoplastic lesion atlas. Ultrasound characterization of salivary lesions aijoc and has its orifice in the parotid papilla at the level of the upper second molar. Salivary gland lesions are uncommon in children and may be related to the parotid, submandibular or sublingual glands. The length of the stensens duct usually varies between 3 and 5 cm. Within medical history he does not refer to anything of importance. Figure 1 normal submandibular salivary gland in a male f344n rat from a subchronic study. Fine needle aspiration biopsy of salivary gland lesions a. Understand the potential risks associated with a fine needle aspiration biopsy of a.
Ultrasonography in the study of salivary gland lesions in. It can be used to monitor the presence and levels of hormones, drugs, antibodies, microorganisms and ions. Caused by laceration of minor salivary gland duct by trauma. Salivary gland tumors account for less than 3% of all head and neck tumors. Salivary gland fineneedle aspiration cytology fnac represents one of the most challenging areas of cytopathology due to wide range of lesions, both reactive and neoplastic that can be encountered in the salivary glands. This article will focus on some of the new advances in salivary gland tumor pathology that have a potential for clinical impact. Salivary gland tumours are a relatively rare and morphologically diverse group of lesions. Malignant lesions typically present after age 60, while benign lesions usually present after age 40. Cancers that develop here often form tiny mucousfilled cysts.
Salivary gland neoplasms make up 1% of all head and neck tumors 90. Histologic classification for salivary gland tumors in the who 4th edition has 22 carcinomas, 11 benign tumors, 4 nonneoplastic epithelial lesions, 3 benign softtissue entities, and malt lymphoma, making it one of the most extensive classifications for tumors7. An estimated 750 deaths related to salivary gland tumors occur annually. The neoplasms occurred more frequently in the parotid gland 65%, followed by submandibular gland 21. There is an increase in the number of ductal profiles within the gland. In general, lowrisk lesions can be managed with a single treatment modality, whereas advanced lesions require a more complex, multidisciplinary approach. Inflammatory lesions are the most common cause of salivary gland abnormalities in children and can be due to acute viral, acute. This continual pressure dilates the duct and forms a cyst like lesion. Fineneedle aspiration cytology of salivary gland lesions. Algorithm for determining the etiology of salivary gland swelling. Fineneedle aspiration biopsy fnab is a useful preoperative technique for the evaluation of patients with a salivary gland lesion1,2. Salivary gland cancers malignant salivary gland tumors there are many types of salivary gland cancers. Infarction of salivary glands, which occurs most often in.
Understand the clinical questions that can be answered by a fine needle aspiration biopsy of a salivary gland ii. Fineneedle aspiration fna is a wellestablished diagnos tic approach for salivary gland lesions. The impact of fnac in the management of salivary gland. Imaging evaluation of pediatric parotid gland abnormalities. Saliva has enzymes that help digest food and antibodies that help protect against infections of the mouth and throat. Acquired cysts may be a result of obstruction, trauma or surgical complication. Cytological spectrum of salivary gland lesions and their correlation. Due to obstruction of minor salivary gland duct, which causes a back up of saliva. In many series, the salivary gland is included in other head and neck lesions, and there is little agreement among authors over what constitutes an unsatisfactory, atypical, or. The age of the patient helps narrow the differential diagnosis, with vascular and congenital lesions being more frequent in the 1st year of life, while solid tumors are more frequent in older children. April 1983, 68 salivary gland tumors were treated by the author. To evaluate utility of fnac in salivary gland lesions. Zbaren et al3 have noted accuracy, sensitivity, and speci. The minor salivary glands consist of 800 small mucussecreting glands located throughout the lining of the oral cavity.
This could be particularly important for aggressive salivary gland tumors, such as salivary duct carcinoma sdc. Normal salivary glands are made up of many different kinds of cells, and tumors can start in any of these cell types. Due to the size discrepancy, in absolute numbers the. Tumors of salivary and lacrimal glands, nasal fossa and maxillary sinus. Salivary gland tumors represent a diverse group of neoplasms. Although most clinicians and pathologists will have encountered the more common benign neoplasms, few. Massachusetts general hospital harvard medical school, usa marc pusztaszeri, md, geneva, switzerland esther diana rossi, md, rome, italy. Along the course of the stensens duct in the soft tissues of the cheek, an accessory parotid gland may be found, unilaterally or. Salivary gland inflammation nonneoplastic lesion atlas. In general, fna of salivary gland lesions has good sensitivity 86100% and specificity 90100%. Imaging evaluation of pediatric parotid gland abnormalities parotid gland lesions in children can be divided into benign or malignant. In general, the ratio of benign to malignant tumors is proportional to the gland size. The majority of cases presenting to clinician in daytoday practice as facial lumps or neck lump could be evaluated using ultrasound and help in imaging of salivary gland lesions. However, you should know the locations and characteristics of the salivary glands.
This chapter will provide an overview of the functions of saliva, the anatomy and. Biopsy specimens were fixed, embedded, sectioned 4. Salivary gland cytopathology is one of the most challenging areas of diagnostic cytology. Palatal pleomorphic adenoma in a pediatric patient. Here you can find more information on the different types of salivary gland cancers.
Oncocytic lesions of the salivary gland include oncocytosis, oncocytoma, and oncocytic carcinoma. Salivary gland tumors an update american society for. Milan system has been proposed to classify the salivary gland cytological. Update in salivary gland pathology arup university of utah. The fine anatomical and histological details will be covered in other courses. Salivary gland tumours or neoplasms are tumours that form in the tissues of salivary glands. More than 30 percent of salivary gland cancers are thought to be this type. Salivary gland lesions exam 4 study guide by valronning includes 69 questions covering vocabulary, terms and more.
An analysis of all salivary gland lesions accessioned at the armed forces institute of pathology afip reveals that of the total of 9,993 cases affecting both the major and minor glands, 430 4. Pdf salivary gland tumours are a relatively rare and morphologically diverse group of lesions. The key radiologic and cytomorphologic features of. Fineneedle aspiration cytology fnac is widely accepted tool for preoperative diagnosis and management of suspected salivary gland tumors. Evaluation of patients with suspected salivary gland disorders figure 1. The major salivary glands consist of the parotid, submandibular, and sublingual glands. They are easily accessible for fnac fine needle aspiration cytology and risks of fistula formation or tumour implantation are low. Benign and malignant salivary gland tumors anticancer research. Salivary gland cytopathology will use a simplified algorithmic approach based upon differential diagnostic groups to cover practical aspects of diagnosing common as well as challenging salivary gland lesions. Pitfalls in the staging of cancer of the major salivary gland. Salivary gland cytopathology acgme competency checklist.
Salivary glands make saliva, which aids in digestion, keeps your mouth moist and supports healthy teeth. Analysis of salivary gland lesions by fnac and correlation with histopathology. Unlike benign salivary neoplasms, malignant tumors may grow rapidly, may be tender or painful at palpation, may be fixed to the background, and may cause facial nerve paresis or paralysis. Associated lesions, such as fibrosis, necrosis, edema, and hemorrhage, should not be diagnosed separately unless warranted by severity. Salivary gland, sublingual, duct hyperplasia in a male f344n rat from a chronic study higher magnification of figure 5. Differential diagnosis of salivary gland lesions 1.
Evaluation of cystic salivary gland lesions by fineneedle aspiration. There is an increase in the number of ductular epithelial cells within the gland arrows. Although the majority of salivary gland lesions, especially those that are common and benign, can be diagnosed with ease on fnac, limited cellularity and morphologic lesion heterogeneity can pose diagnostic challenges and lead to. There are numerous entities of salivary gland neoplasms and while. Cancer of the major salivary glands is a heterogeneous disease with a low overall incidence. Salivary gland tumors can begin in any of the salivary glands in your mouth, neck or throat. Fnac of salivary gland lesions with histopathological. Still in the us, carcinomas of the major salivary glands comprise 11% of.
So in the present study, salivary gland lesions were more common in males. Cystic lesions as a group comprise about 5% of all salivary gland tumors, but if neoplasms are excluded, this number is reduced considerably. Lesions consistent with an abscess are diagnosed as suppurative inflammation. Fine needle aspiration cytology of salivary gland lesions.
Salivary gland cysts cystic lesions of salivary gland may be congenital, which include first branchial cleft cysts fig. For diagnosis of minor salivary gland lesions therefore we always recommend an adequate salivary gland tumours most likely to be encountered in the minor salivary glands, in approximate descending order of frequency benign. In addition, sarscov rna can be detected in saliva before lung lesions appear wang et al. Salivary glands neoplasms represent a rare and diverse group of tumors with different characteristics. The age incidence varies widely, extending from children to adults over 80 years of age. Accuracy of fna to distinguish benign from malignant salivary gland lesions is also respectable 81100%, but to some extent less so 4894% when used to specifically subtype salivary gland neoplasms.
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