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Salivary glands

Epithelial/myoepithelial tumors

General

Reviewers: Fatima Aly, M.D. (see Reviewers page)
Revised: 9 October 2011, last major update August 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

General
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● Risk factors: Radiation exposure (atomic bomb survivors, radiation therapy, chemoradiation therapy) with mean latency after low dose radiation exposure of 11 years for malignant tumors and 21 years for benign tumors
● Alcohol and tobacco are NOT risk factors except for Warthin’s tumor (associated with smoking)

● Benign: Pleomorphic adenoma (50%), Warthin’s tumor (5%), oncocytoma, basal cell adenoma, ductal papilloma

● Malignant: Mucoepidermoid carcinoma (15%), polymorphous low grade adenocarcinoma (10%), acinic cell carcinoma, adenoid cystic carcinoma, malignant mixed tumor, squamous cell carcinoma (1%)

● Bilateral tumors: Warthin’s tumor is most common, also pleomorphic adenoma and acinic cell carcinoma

● 15% of parotid tumors are malignant, 40% elsewhere

● Children: Pleomorphic adenoma most common, but more often malignant; most common malignant tumors are mucoepidermoid carcinoma, adenoid cystic carcinoma, acinic cell carcinoma

● Regional lymph nodes: Nodal metastases usually evident on initial clinical evaluation
● Low grade tumors rarely metastasize to regional nodes, high grade tumors often do; nodal involvement tends to be orderly from intraglandular to adjacent nodes to upper and midjugular nodes, and occasionally to retropharyngeal nodes
● Bilateral nodal involvement is rare

● Metastases: usually to lungs

Sites
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● >90% arise in parotid gland, 5% in submandibular gland
● Deep parotid tumors may present as intraoral masses
● Sublingual tumors are rare and may be difficult to distinguish from minor salivary gland primary tumors of anterior floor of mouth
● Minor salivary gland tumors usually in hard palate (site with most glandular tissue); may arise in lymph nodes around salivary glands

Treatment
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● Parotid gland tumors - superficial lobe tumors are treated with superficial / partial parotidectomy with preservation of facial nerve
● Total parotidectomy with sacrifice of facial nerve may be necessary if high grade or advanced tumor
● Neck dissection necessary if nodal involvement
● Submandibular tumors - total excision; often recur because of difficulty of getting good margins due to closeness of mandible
● Radiation therapy - for inoperable tumors

Poor prognostic factors
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● Postoperative recurrence, submandibular gland site, facial nerve paralysis, high grade tumor

End of Salivary Glands > Epithelial/myoepithelial tumors > General

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