54. MALIGNANT TUMOURS OF SALIVARY GLANDS

what is a mucoepidermoid carcinoma?

the most common malignant salivary gland tumour

has mucous and epidermal cell origin

low/high grade

mucoepidermoid carcinoma typically affects who and where

60-90% parotid next palate

affects men and women equally

highest incidence 30-50

low grade vs high grade

low grade = less aggressive and behaves more like a benign tumour

 High grade = more malignant with a poorer prognosis

what are the clinical features for mucoepidermoid carcinomas?

low grade- long term development, slow growing, painless, feels firm

high grade- rapid development, painful, reduced mouth opening, higher chance of metastasis, ulcer of skin overlaying

what will be seen on biopsy for mucoepidermoid carcinomas?

low grade- small or partial capsule

high grade- no capsule, this is why it metastasises quicker

what are other methods for diagnosing ME carcinoma?

sialography

CT

MRI

what is the treatment for low grade ME carcinoma?

partial resection- superficial parotidectomy

what is the treatment for high grade ME carcinoma?

total parotidectomy- can leave the facial nerve if possible. if not, excise the nerve and do reconstruction

what is the clinical presentation for an adenoid cystic carcinoma?

slow growing - may dealy diagnosis

firm unilobular mass in the gland

painful - parotid tumors may cause facial nerve paralysis

can invade around nerves

what are the pathlogical findings of an adenoid cystic carcinoma?

tumor is unilobar and either partially encapsulated or non-encapsulated

invasion into adjacent tissues

how is diagnosis made for adenoid cystic carcinoma- what will be seen?

biopsy

- chromatin, invasion of nerves

diff diagnosis adenoid cystic carcinoma

pleomorphic adenoma

polymorphus low grade adenocarcinoma

what is the treatment for adenoid cystic carcinoma?

radical surgical excision needed

neutron beam radiation

pt need to monitored indefinetly

what is a carcinoma ex pleomorphic ademona?

a pleomorphic adenoma which has been left untreated and become malignant

what is the clinical presentation of a carcinoma ex pleomorphic adenoma?

15 + years slow growth then become apparent

thick nodule with surrounding structure involvement

tumor invade adjacent nerves

what is seen on diagnosis of carcinoma ex pleomorphic adenoma?

pseudo capsule

projections coming from capsule

within capsule have epithelial and mesenchymal cells

what is the treatment for a carcinoma ex pleomorphic adenoma?

extended total parotidectomy ,immediate plastic of facial nerve

need for cervical lymph node dissection after palpation 3-5 wks after

Clinical presenation of Adenoid cystic carcinoma ??

firm unilobular mass in the gland

occasionally painful with parotid tumors leading to nerve paralysis

Radiographic presentation Adenoid cystic carcinoma

tumor reveals extension into adjacent bone

metastatses into lung common

Pathology presentation Adenoid cystic carcinoma

tumor unilobular and either partially encapsulated or non

evidence of invasion onto adjacent tissues

differential diagnosis adenoid cystic carcinoma

pleomorphc adenoma

polymorphus low grade adenocarcinoma

Treatment Adenoid cystic carcinoma

radical surgical excision due to ability to spread across nerve sheath

neutron beam radiation

pt have to be monitored indefinetly due to ability to reoccur