Salivary Gland Tumors
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1 Sasan Dabiri, M.D. - Assistant Professor Department of Otorhinolaryngology Head & Neck surgery Amir A lam hospital Tehran University of Medical Sciences
2 Overall prevalence: Epidemiology 3% of Head & Neck neoplasms 100 parotid neoplasms 10 submandibular neoplasms 10 minor salivary gland neoplasms 1 sublingual neoplasm
3 Epidemiology The most common neoplasms: Benign in anywhere: Pleomorphic Adenoma Malignant in parotid: Mucoepidermoid Carcinoma Malignant in others: Adenoid Cystic Carcinoma Post radiation, benign: Warthin s tumor Post radiation, malignant: Mucoepidermoid Carcinoma
4 Fine Needle Aspiration / Biopsy Goals are: Differentiation of neoplastic and non-neoplastic mass Differentiation of benign and malignant neoplasm High specificity (96-98%) Good sensitivity (79-96%)
5 Fine Needle Aspiration / Biopsy Is it Accurate? Highest inaccuracy rates in Parotid Diversity in pathology ( 11 benign & 24 malignant ) Other than mixed tumor, are uncommon Morphologically complex Some carcinomas have not malignant cellular appearance Lower accuracy for diagnosing malignant tumor
6 Frozen Section Indications : Determination of tumor extension Evaluation of surgical margin Non-diagnostic FNA Incompatible FNA according to clinical judgement
7 Imaging
8 Imaging
9 Imaging
10 Imaging
11 Imaging
12 Imaging
13 Imaging Differentiation of benign and malignant tumors is not the primary goal of CT and MRI; but: Anatomical localization Local, Regional (lymph node), and Distant invasion Overall Low intensity in T1 & T2 malignant (high probable)
14 Imaging Why MRI is better than CT? Well visualized on T1 (especially parotid fatty gland ) Excellent assessment of margins Deep extension & Infiltration Best mapping on T1+ Gd + Fat suppression Bone marrow & cortex: hyposignal invasion, well visualized Fatty & bony foramina at skull base: hyposignal perineural spread: well visualized Meningeal invasion
15 Imaging Perineural invasion for parotid tumor Facial nerve entire nerve should be assessed all the way ( even if there is no clinical facial paralysis ) Auriculotemporal nerve through a small fat pad along the medial aspect of the lateral pterygoid muscle and just inferior to the foramen ovale
16 Imaging Perineural invasion for submandibular tumor Hypoglossal nerve Tongue movement impairment Lingual nerve Tongue tingling MRI visualizes : enlarged nerve obliterated fat enlarged ganglion atrophy of the masticator muscles
17 Imaging Radionuclide Scanning (Tc 99m) Warthin s tumor Oncocytoma Helpful for elderly patients with parotid mass Aldred Scott Warthin
18 Ultrasonography Pros Imaging Differentiation of glandular from extraglandular mass Guiding the biopsy (FNA) Cons Operator dependent Just in superficial masses
19 Pleomorphic Adenoma Epithelial and Mesenchymal components 10% risk of malignancy after 15 years
20 Warthin s tumor Papillary Cystadenoma Lymphomatosum Only in parotid Male & cigarette smoking No risk of malignancy bilateral
21 Mucoepidermoid Carcinoma Contains mucoid and epidermoid cells Low, intermediate and high grade classification
22 Adenoid Cystic Carcinoma Perineural invasion Grading according dominant cells: Cribriform Tubular Solid
23 Surgery Management primary management in all new and recurrent cases Unless : Surgery cannot be done (patient s condition) Invasion to skull base Invasion to pterygoid plates Encase carotid artery T4b
24 Management Radiation therapy ± Chemotherapy Unable to surgery Adenoid cystic carcinoma Intermediate or high grade carcinoma Close or positive margin Perineural or perivascular invasion Lymph node metastasis In cases with complete resection
25 Thanks for Your Attention
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