Chapter 7 Salivary Gland and Odontogenic Tumors

Salivary Gland Tumors

• Pleomorphic adenoma

• Monomorphic adenoma

• Adenoid cystic carcinoma (Cylindroma)

• Mucoepidermoid carcinoma

• May arise in either major or minor salivary glands

• Minor salivary gland tumors are most often located at the junction of the hard and soft palate

• Adenomas: benign tumors of salivary glands

• Tumors of minor salivary gland origin are much more common in the uper lip than in the lower lip

Pleomoprhic adenoma (Benign mixed tumor)

• A benign salivary gland tumor

• Ninety percent of all salivary gland tumors

• The most common extraoral location is the parotid gland; the most common intraoral location is the palate

• Most pleomorphic adenomas occur in individuals over 40 years of age, and a female predilection has been noted.

• Clinically: appears as a slowly enlarging, non ulcerated, painless, dome-shaped mass

• Treatment: surgical excision; recurrence rates vary; they are related to the success of the initial surgical removal

• Lesions have been known to undergo malignant transformation

• A small percentage (2% to 4%) of long-standing pleomorphic adenomas have been reported to undergo malignant transformation.

Monomorphic Adenoma

• A benign encapsulated salivary gland tumor

• A uniform pattern of epithelial cells

• Occurs most commonly in adult females

• Occurs most often in the upper lip and buccal mucosa

• Treatment: Surgical excision

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Monomorphic Adenoma: Warthin Tumor

• An encapsulated tumor with epithelial and lymphoid tissue

• A painless, soft, compressible or fluctuant mass

• Usually occurs on the parotid gland, rarely intraorally

• Occurs predominantly in adult men (bilaterally)

• A higher incidence is noted in individuals who smoke.

Adenoid Cystic Carcinoma (Cylindroma)

•A slow-growing malignant tumor of either major or minor salivary gland tissue

•May be ulcerated and painful

•Most common site: Parotid gland

•Microscopic

•Unencapsulated, infiltrates surrounding tissue

•Small, deeply staining, uniform epithelial cells that resemble “Swiss cheese”

•Treatment: Surgical excision

Mucoepidermoid Carcinoma

•A malignant salivary gland tumor

•Unencapsulated, infiltrating tumor

•Major gland tumors are most often found in the parotid gland, minor gland tumors on the palate

•Appear clinically as slowly enlarging masses

•A combination of mucus cells interspersed with squamous-like epithelial cells called epidermoid cells

•May appear in bone as either a unilocular or multilocular radiolucency

•May occur over a wide age range

•Usually occurs in adults, but is the most common malignant salivary gland tumor in children

•Occurs most often in females

•Treatment: Surgical excision

Other Malignant Salivary Gland Tumors

• Polymorphous low-grade adenocarcinoma

• Acinic cell adenocarcinoma

• Other adenocarcinoma

Epithelial Odontogeninc Tumors

•Ameloblastoma

•Calcifying epithelial odontogenic tumor (CEOT)

•Adenomatoid odontogenic tumor

•Calcifying odontogenic cyst

Ameloblastoma

• A benign, slow-growing but locally aggressive epithelial odontogenic tumor

• May occur in either mandible or maxilla, most often in the mandible in the molar or ramus area

• Unencapsulated; infiltrates into surrounding tissue

• Composed of ameloblast-like epithelial cells surrounding areas resembling stellate reticulum

Ameloblastoma 2/2

•Radiographic

•A multilocular soap bubble–like or honeycombed radiolucency

•May occur anywhere within the jaws; can occur in association with a dentigerous cyst

•May cause bone expansion

•Treatment

•Surgical removal

•Recurrence is common

Calcifying epithelail odontogeninc tumor

•A benign epithelial odontogenic tumor

•Composed of islands and sheets of polyhedral epithelial cells

•Amyloid-like material is seen with calcifications within the deposits

•Most often affects adults, with no sex predilection

•Radiographic

•A unilocular or multilocular radiolucency

•Occurs more often in mandible than maxilla, and most often in the bicuspid and molar area

•Treatment: Surgical excision

Adenomatoid Odontogenic Tumor (AOT)

•An encapsulated, benign epithelial odontogenic tumor

•Seventy percent occur in females less than age 20

•Seventy percent involve the anterior portion of the jaws

•More common in maxilla than in mandible

Many are associated with impacted teeth

•The tumor is surrounded by a dense, fibrous connective tissue capsule

•Consists of ductlike structures, whorls, and large masses of cuboidal and spindle-shaped epithelial cells

•Radiographic

•A well-circumscribed radiolucency; may have radiopaque areas

•Treatment

•Enucleation

Mesenchymal Odonogenic Tumors

•Odontogenic myxoma

•Central cementifying and ossifying fibromas

•Benign cementoblastoma

Odonogenic Myxoma

•A benign nonencapsulated infiltrating tumor

•Most often occurs in young people age 10 and 29

•No sex predilection

•Radiographic

•A multilocular, honeycombed radiolucency with poorly defined margins

•May become large and displace teeth

Most often occurs in the mandible

•Composed of pale-staining mucopolysaccharide ground substance containing dispersed cells with long cytoplasmic processes

•Treatment

•Surgical excision

•May recur

Central Cementifying and Central Ossifying Fibromas

•A benign well-circumscribed tumor

•Usually occurs in adults in the third and fourth decades

•Occurs in females more often than in males

•Most cases occur in the mandible

•Radiographic

•Varies from radiolucent to radiopaque depending on the amount of calcified tissue

•Contains fibrous connective tissue and calcifications

•Treatment

•Surgical excision

Recurrence is rare

Beningn Cementoblastoma

•A cementum-producing lesion

•Radiographic

•A well-defined radiopaque mass with a surrounding radiolucent halo

•Treatment

•Enucleation of the tumor and removal of the involved tooth

•Does not recur

Mixed Odontogenic Tumors

• Ameloblastic Fibroma

• Ameloblastic fibro-odontoma

• Odontoma

Ameloblastic Fibroma

•A benign, nonencapsulated odontogenic tumor

•Occurs in young children and young adults

•Occurs more often in males

•Most commonly in the mandibular bicuspid and molar region

•Composed of both strands and small islands of odontogenic epithelium and tissue that resembles the dental papilla

•Radiographic

•Well-defined or poorly defined unilocular or multilocular radiolucency

•Treatment

•Surgical excision

•Low recurrence rate

Ameloblastic Fibrodontoma

•A benign odontogenic tumor

•Has features of an ameloblastic fibroma and an odontoma

•Most cases in young adults, with an average age of 10 years

•No sex predilection

•Typically arises in posterior jaws

•Radiographic

•A well-delineated radiolucent lesion

•May be unilocular or multilocular

•Calcifications are noted within the radiolucency

•Treatment

•Conservative surgical excision

•Recurrence is unusual

Odontogenic Tumor: Odontoma

•Compound

•A mass that resembles teeth

•Usually located in anterior maxilla

•Complex

•A mass that does not resemble teeth

•Usually located in posterior mandible

•Most are found in adolescents and young adults

•Clinical manifestation: Failure of tooth to erupt

•Treatment

•Surgical excision