Salivary-020626-slides

Salivary-020626-slides - Salivary Gland Neoplasms Elizabeth...

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Salivary Gland Neoplasms Elizabeth J. Rosen, MD Shawn D. Newlands, MD, PhD 6/26/02
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Salivary Gland Neoplasms Benign Neoplasms Malignant Neoplasms Controversial Issues
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Salivary Gland Neoplasms Diverse histopathology Relatively uncommon 2% of head and neck neoplasms Distribution Parotid: 80% overall; 80% benign Submandibular: 15% overall; 50% benign Sublingual/Minor: 5% overall; 40% benign
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Pleomorphic Adenoma Most common of all salivary gland neoplasms 70% of parotid tumors 50% of submandibular tumors 45% of minor salivary gland tumors 6% of sublingual tumors 4 th -6 th decades F:M = 3-4:1
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Pleomorphic Adenoma Slow-growing, painless mass Parotid: 90% in superficial lobe, most in tail of gland Minor salivary gland: lateral palate, submucosal mass Solitary vs. synchronous/metachronous neoplasms
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Pleomorphic Adenoma Gross pathology Smooth Well-demarcated Solid Cystic changes Myxoid stroma
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Pleomorphic Adenoma Histology Mixture of epithelial, myopeithelial and stromal components Epithelial cells: nests, sheets, ducts, trabeculae Stroma: myxoid, chrondroid, fibroid, osteoid No true capsule Tumor pseudopods
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Pleomorphic Adenoma
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Pleomorphic Adenoma Treatment: complete surgical excision Parotidectomy with facial nerve preservation Submandibular gland excision Wide local excision of minor salivary gland Avoid enucleation and tumor spill
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Warthin’s Tumor AKA: papillary cystadenoma lymphomatosum 6-10% of parotid neoplasms Older, Caucasian, males 10% bilateral or multicentric 3% with associated neoplasms Presentation: slow-growing, painless mass
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Warthin’s Tumor Gross pathology Encapsulated Smooth/lobulated surface Cystic spaces of variable size, with viscous fluid, shaggy epithelium Solid areas with white nodules representing lymphoid follicles
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Warthin’s Tumor Histology Papillary projections into cystic spaces surrounded by lymphoid stroma Epithelium: double cell layer Luminal cells Basal cells Stroma: mature lymphoid follicles with germinal centers
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Warthin’s Tumor
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Oncocytoma Rare: 2.3% of benign salivary tumors 6 th decade M:F = 1:1 Parotid: 78% Submandibular gland: 9% Minor salivary glands: palate, buccal mucosa, tongue
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Oncocytoma Presentation Enlarging, painless mass Technetium-99m pertechnetate scintigraphy Mitochondrial hyperplasia
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Oncocytoma Gross Encapsulated Homogeneous, smooth Orange/rust color Histology Cords of uniform cells and thin fibrous stroma Large polyhedral cells Distinct cell membrane Granular, eosinophilic cytoplasm Central, round, vesicular nucleus
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Oncocytoma Electron microscopy: Mitochondrial hyperplasia 60% of cell volume
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Monomorphic Adenomas Basal cell, canalicular, sebaceous, glycogen- rich, clear cell Basal cell is most common: 1.8% of benign epithelial salivary gland neoplasms 6 th decade M:F = approximately 1:1 Caucasian > African American Most common in parotid
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