Salivary gland tumour

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Salivary gland tumour
Parotid Tumour.jpg
Parotid gland tumour
Specialty Oncology, oral and maxillofacial surgery, oral and maxillofacial pathology

Salivary gland tumours, also known as mucous gland adenomas [1] or neoplasms, are tumours that form in the tissues of salivary glands. The salivary glands are classified as major or minor. The major salivary glands consist of the parotid, submandibular, and sublingual glands. The minor salivary glands consist of 800 to 1000 small mucus-secreting glands located throughout the lining of the oral cavity. [2] Patients with these types of tumours may be asymptomatic. [1]

Contents

Presentation

Salivary gland tumours usually present as a lump or swelling in the affected gland which may or may not have been present for a long time. The lump may be accompanied by symptoms of duct blockage (e.g. xerostomia). Usually, in their early stages, it is not possible to distinguish a benign tumour from a malignant one. One of the key differentiating symptoms of malignant growth is nerve involvement; for example, signs of facial nerve damage (e.g. facial palsy) are associated with malignant parotid tumours. Facial pain and paraesthesia are also very often associated with malignant tumours. [3] Other red flag symptoms which may suggest malignancy and warrant further investigation are fixation of the lump to the overlying skin, ulceration and induration (hardening) of the mucosa. [4]

Diagnosis

Coronal MRI showing right parotid adenoid cystic carcinoma. Coronal MRI showing right parotid adenoid cystic carcinoma with perineural spread of tumor.jpg
Coronal MRI showing right parotid adenoid cystic carcinoma.

Many diagnostic methods can be used to determine the type of salivary gland tumour and if it is benign or malignant. Examples of diagnostic methods include:

Physical exam and history: An exam of the body to check general signs of health. The head, neck, mouth, and throat will be checked for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.

Endoscopy: A procedure to look at organs and tissues inside the body to check for abnormal areas. For salivary gland cancer, an endoscope is inserted into the mouth to look at the mouth, throat, and larynx. An endoscope is a thin, tube-like instrument with a light and a lens for viewing.

MRI or CT Scan: These tests can confirm the presence of a tumour. An MRI or CT Scan can also show whether metastasis has occurred. [5]

Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. [6]

Fine needle aspiration (FNA) biopsy: The removal of tissue or fluid using a thin needle. An FNA is the most common type of biopsy used for salivary gland cancer and has been shown to produce accurate results when differentiating between benign and malignant tumours. [7]

Radiographs: An OPG (orthopantomogram) can be taken to rule out mandibular involvement. A chest radiograph may also be taken to rule out any secondary tumours. [8]

Ultrasound: Ultrasound can be used to initially assess a tumour that is located superficially in either the submandibular or parotid gland. It can distinguish an intrinsic from an extrinsic neoplasm. Ultrasonic images of malignant tumours include ill-defined margins. [9] Furthermore, high resolution ultrasound can identify the exact tumour location within the parotid gland, its relationship to the retromandibular vein and assist surgical excision. [10]

Classification

Relative incidence of parotid tumors. Relative incidence of parotid tumors.png
Relative incidence of parotid tumors.
Relative incidence of submandibular tumors. Relative incidence of submandibular tumors.png
Relative incidence of submandibular tumors.

Due to the diverse nature of salivary gland tumours, many different terms and classification systems have been used. Perhaps the most widely used currently is that system proposed by the World Health Organization in 2005, which classifies salivary neoplasms as primary or secondary, benign or malignant, and also by tissue of origin. This system defines five broad categories of salivary gland neoplasms: [12] [13]

Benign tumour of the submandibular gland, also known as pleomorphic adenoma, presented as a painless neck mass in a 40-year-old man. At the left of the image is the white tumor with its characteristic cartilaginous cut surface. To the right is the normally lobated submandibular salivary gland. Mixed Tumor of the Salivary Gland.jpg
Benign tumour of the submandibular gland, also known as pleomorphic adenoma, presented as a painless neck mass in a 40-year-old man. At the left of the image is the white tumor with its characteristic cartilaginous cut surface. To the right is the normally lobated submandibular salivary gland.

Benign epithelial tumors

Others, not included in the WHO classification above, include: [12]

Treatment

Most patients with early-stage lesions that are resectable generally tend to undergo surgery as their initial therapeutic approach, whereas those with advanced or unresectable cancers tend to be treated with radiotherapy (RT) alone or chemoradiotherapy (CRT), which hampered the comparison of the efficacy of RT alone with that of surgery combined with adjuvant RT. But some effort had been made to reflect the role of surgery in salivary gland tumours.

Specimen from a parotid gland tumour. It was removed by John Hunter from a 37-year-old man called John Burley on 24 October 1785. The tumour weighed over 4 kilograms and took twenty-five minutes to remove. The specimen currently resides in the Hunterian Museum at the Royal College of Surgeons of England John Burley's parotid gland tumor - 2.jpg
Specimen from a parotid gland tumour. It was removed by John Hunter from a 37-year-old man called John Burley on 24 October 1785. The tumour weighed over 4 kilograms and took twenty-five minutes to remove. The specimen currently resides in the Hunterian Museum at the Royal College of Surgeons of England

Treatment may include the following:

Fast neutron therapy has been used successfully to treat salivary gland tumors, [14] and has shown to be significantly more effective than photons in studies treating unresectable salivary gland tumors. [15] [16]

Targeted Therapy - Due to the poor results with chemotherapy, it's urgent to explore novel therapeutic interventions for this disease. And great expectations have been put into individualized therapies: in particular, the EGF receptors family (EGFR and HER2), KIT and androgen receptors are the most commonly investigated molecular targets in SGCs. Their expression seems not to be linked to its pathogenetic role in the development of SGCs, but more to the histogenetic origin of the tumor cells. Various targeted agents, such as imatinib, cetuximab, gefitinib, trastuzumab, had been used for exploring new treatment for salivary gland tumours, but on account of the rare incidence of salivary gland tumours, the number of cases available on targeted therapy for analysis is relatively small. [18]

Epidemiology

Little is known about the total incidence of salivary gland tumours as most benign tumours go unrecorded in national cancer registries. [3] The majority of salivary tumours are benign (65-70%). [4] Within the parotid gland 75 - 80% of tumours are benign. Around 50% of the tumours found in the submandibular glands are benign. Sublingual gland tumours are very rare but if present, they are most likely to be malignant. [4] [19] Saku et al. in 1997 [20] and Venturi [21] [22] in 2021, reported the causal role for ionizing radiation in salivary gland tumorigenesis, particularly for mucoepidermoid carcinoma.

In the United States, salivary gland cancers are uncommon with an incidence rate of 1.7 in 100000 between 2009 and 2013. [23]

See also

Related Research Articles

<span class="mw-page-title-main">Thyroid neoplasm</span> Medical condition

Thyroid neoplasm is a neoplasm or tumor of the thyroid. It can be a benign tumor such as thyroid adenoma, or it can be a malignant neoplasm, such as papillary, follicular, medullary or anaplastic thyroid cancer. Most patients are 25 to 65 years of age when first diagnosed; women are more affected than men. The estimated number of new cases of thyroid cancer in the United States in 2023 is 43,720 compared to only 2,120 deaths. Of all thyroid nodules discovered, only about 5 percent are cancerous, and under 3 percent of those result in fatalities.

<span class="mw-page-title-main">Salivary gland</span> Exocrine glands that produce saliva through a system of ducts

The salivary glands in many vertebrates including mammals are exocrine glands that produce saliva through a system of ducts. Humans have three paired major salivary glands, as well as hundreds of minor salivary glands. Salivary glands can be classified as serous, mucous, or seromucous (mixed).

<span class="mw-page-title-main">Adenocarcinoma</span> Medical condition

Adenocarcinoma is a type of cancerous tumor that can occur in several parts of the body. It is defined as neoplasia of epithelial tissue that has glandular origin, glandular characteristics, or both. Adenocarcinomas are part of the larger grouping of carcinomas, but are also sometimes called by more precise terms omitting the word, where these exist. Thus invasive ductal carcinoma, the most common form of breast cancer, is adenocarcinoma but does not use the term in its name—however, esophageal adenocarcinoma does to distinguish it from the other common type of esophageal cancer, esophageal squamous cell carcinoma. Several of the most common forms of cancer are adenocarcinomas, and the various sorts of adenocarcinoma vary greatly in all their aspects, so that few useful generalizations can be made about them.

<span class="mw-page-title-main">Parotid gland</span> Major salivary gland in many animals

The parotid gland is a major salivary gland in many animals. In humans, the two parotid glands are present on either side of the mouth and in front of both ears. They are the largest of the salivary glands. Each parotid is wrapped around the mandibular ramus, and secretes serous saliva through the parotid duct into the mouth, to facilitate mastication and swallowing and to begin the digestion of starches. There are also two other types of salivary glands; they are submandibular and sublingual glands. Sometimes accessory parotid glands are found close to the main parotid glands.

<span class="mw-page-title-main">Adenoma</span> Type of benign tumor

An adenoma is a benign tumor of epithelial tissue with glandular origin, glandular characteristics, or both. Adenomas can grow from many glandular organs, including the adrenal glands, pituitary gland, thyroid, prostate, and others. Some adenomas grow from epithelial tissue in nonglandular areas but express glandular tissue structure. Although adenomas are benign, they should be treated as pre-cancerous. Over time adenomas may transform to become malignant, at which point they are called adenocarcinomas. Most adenomas do not transform. However, even though benign, they have the potential to cause serious health complications by compressing other structures and by producing large amounts of hormones in an unregulated, non-feedback-dependent manner. Some adenomas are too small to be seen macroscopically but can still cause clinical symptoms.

<span class="mw-page-title-main">Adenoid cystic carcinoma</span> Medical condition

Adenoid cystic carcinoma is a rare type of cancer that can exist in many different body sites. This tumor most often occurs in the salivary glands, but it can also be found in many anatomic sites, including the breast, lacrimal gland, lung, brain, Bartholin gland, trachea, and the paranasal sinuses.

An oncocytoma is a tumor made up of oncocytes, epithelial cells characterized by an excessive amount of mitochondria, resulting in an abundant acidophilic, granular cytoplasm. The cells and the tumor that they compose are often benign but sometimes may be premalignant or malignant.

<span class="mw-page-title-main">Warthin's tumor</span> Medical condition

Warthin's tumor, also known as papillary cystadenoma lymphomatosum, is a benign cystic tumor of the salivary glands containing abundant lymphocytes and germinal centers. It is named for pathologist Aldred Scott Warthin, who described two cases in 1929.

<span class="mw-page-title-main">Pleomorphic adenoma</span> Medical condition

Pleomorphic adenoma is a common benign salivary gland neoplasm characterised by neoplastic proliferation of epithelial (ductal) cells along with myoepithelial components, having a malignant potentiality. It is the most common type of salivary gland tumor and the most common tumor of the parotid gland. It derives its name from the architectural Pleomorphism seen by light microscopy. It is also known as "Mixed tumor, salivary gland type", which refers to its dual origin from epithelial and myoepithelial elements as opposed to its pleomorphic appearance.

<span class="mw-page-title-main">Acinic cell carcinoma</span> Medical condition

Acinic cell carcinoma is a malignant tumor representing 2% of all salivary tumors. 90% of the time found in the parotid gland, 10% intraorally on buccal mucosa or palate. The disease presents as a slow growing mass, associated with pain or tenderness in 50% of the cases. Often appears pseudoencapsulated.

Salivary gland–like carcinomas of the lung generally refers a class of rare cancers that arise from the uncontrolled cell division (mitosis) of mutated cancer stem cells in lung tissue. They take their name partly from the appearance of their abnormal cells, whose structure and features closely resemble those of cancers that form in the major salivary glands of the head and neck. Carcinoma is a term for malignant neoplasms derived from cells of epithelial lineage, and/or that exhibit cytological or tissue architectural features characteristically found in epithelial cells.

<span class="mw-page-title-main">Sebaceous lymphadenoma</span> Medical condition

Sebaceous lymphadenoma is a benign tumour of the salivary gland.

<span class="mw-page-title-main">Myoepithelioma of the head and neck</span> Medical condition

Myoepithelioma of the head and neck, also myoepithelioma, is a salivary gland tumour of the head and neck that is usually benign. When malignant, which is exceedingly rare, they are known as malignant myoepithelioma or Myoepithelial carcinoma, and they account for 1% of the salivary tumors with poor prognosis.

<span class="mw-page-title-main">Epithelial-myoepithelial carcinoma</span> Medical condition

Epithelial-myoepithelial carcinoma (EMCa) is a rare malignant tumour that typically arises in a salivary gland and consists of both an epithelial and myoepithelial component. They are predominantly found in the parotid gland and represent approximately 1% of salivary gland tumours.

A sialoblastoma is a low-grade salivary gland neoplasm that recapitulates primitive salivary gland anlage. It has previously been referred to as congenital basal cell adenoma, embryoma, or basaloid adenocarcinoma. It is an extremely rare tumor, with less than 100 cases reported worldwide.

<span class="mw-page-title-main">Ceruminous adenocarcinoma</span> Medical condition

Ceruminous adenocarcinoma is a malignant neoplasm derived from ceruminous glands of the external auditory canal. This tumor is rare, with several names used in the past. Synonyms have included cylindroma, ceruminoma, ceruminous adenocarcinoma, not otherwise specified (NOS), ceruminous adenoid cystic carcinoma (ACC), and ceruminous mucoepidermoid carcinoma.

<span class="mw-page-title-main">Carcinoma ex pleomorphic adenoma</span> Medical condition

Carcinoma ex pleomorphic adenoma is a type of cancer typically found in the parotid gland. It arises from the benign tumour pleomorphic adenoma.

<span class="mw-page-title-main">Parotidectomy</span> Surgical removal of the parotid gland

A parotidectomy is the surgical excision (removal) of the parotid gland, the major and largest of the salivary glands. The procedure is most typically performed due to neoplasms (tumors), which are growths of rapidly and abnormally dividing cells. Neoplasms can be benign (non-cancerous) or malignant (cancerous). The majority of parotid gland tumors are benign, however 20% of parotid tumors are found to be malignant. Parotidectomy is performed mostly by oral and maxillofacial surgeon and ENT surgeon.

Chronic sclerosing sialadenitis is a chronic (long-lasting) inflammatory condition affecting the salivary gland. Relatively rare in occurrence, this condition is benign, but presents as hard, indurated and enlarged masses that are clinically indistinguishable from salivary gland neoplasms or tumors. It is now regarded as a manifestation of IgG4-related disease.

Vulvar tumors are those neoplasms of the vulva. Vulvar and vaginal neoplasms make up a small percentage (3%) of female genital cancers. They can be benign or malignant. Vulvar neoplasms are divided into cystic or solid lesions and other mixed types. Vulvar cancers are those malignant neoplasms that originate from vulvar epithelium, while vulvar sarcomas develop from non-epithelial cells such as bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Epithelial and mesenchymal tissue are the origin of vulvar tumors.

References

  1. 1 2 Zaleski, Michael P.; Kalhor, Neda; Moran, Cesar A. (November 2020). "Mucous Gland Adenoma: The Spectrum of Growth Patterns and the Diagnostic Challenges". Advances in Anatomic Pathology. 27 (6): 371–379. doi:10.1097/PAP.0000000000000283. ISSN   1072-4109. PMID   32909967. S2CID   221622196.
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  4. 1 2 3 Mehanna, Hisham; McQueen, Andrew; Robinson, Max; Paleri, Vinidh (23 October 2012). "Salivary gland swellings". BMJ. 345: e6794. doi:10.1136/bmj.e6794. ISSN   1756-1833. PMID   23092898. S2CID   373247.
  5. 1 2 "Salivary gland tumors: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 28 October 2019.
  6. ↑ "Salivary Gland Cancer". MedicineNet.
  7. ↑ Vaishali H Anand et al. FNAC and Histopathology of Salivary Gland Tumors. SEAJCRR. 2014 Feb 3(1):609-618
  8. ↑ Mounika, C (7 March 2016). "Salivary Gland Tumors". SlideShare.
  9. ↑ Lee YY, Wong KT, King AD, Ahuja AT (June 2008). "Imaging of salivary gland tumours". Eur J Radiol. 66 (3): 419–36. doi:10.1016/j.ejrad.2008.01.027. PMID   18337041.
  10. ↑ Psychogios, Georgios; Rueger, Holger; Jering, Monika; Tsoures, Eleni; Künzel, Julian; Zenk, Johannes (September 2019). "Ultrasound can help to indirectly predict contact of parotid tumors to the facial nerve, correct intraglandular localization, and appropriate surgical technique". Head & Neck. 41 (9): 3211–3218. doi:10.1002/hed.25811. ISSN   1043-3074. PMID   31179604. S2CID   182948983.
  11. 1 2 Steve C Lee (22 December 2022). "Salivary Gland Neoplasms". Medscape. Updated: Jan 13, 2021
    Diagrams by Mikael Häggström
  12. 1 2 Barnes L (23 December 2008). Surgical Pathology of the Head and Neck. Vol. 1 (3rd ed.). Taylor & Francis. p. 511. ISBN   978-0-8493-9023-4.
  13. ↑ Barnes L (2005). "Chapter 5: Tumors of the salivary glands (chapter authors: Eveson JW, Auclair P, Gnepp DR, El-Naggar AK)" (PDF). Pathology and Genetics of Head and Neck Tumours. International Agency for Research on Cancer, World Health Organization. p. 210. ISBN   978-92-832-2417-4.
  14. ↑ Douglas JG, Koh WJ, Austin-Seymour M, Laramore GE (September 2003). "Treatment of salivary gland neoplasms with fast neutron radiotherapy". Arch. Otolaryngol. Head Neck Surg. 129 (9): 944–8. doi: 10.1001/archotol.129.9.944 . PMID   12975266.
  15. ↑ Laramore GE, Krall JM, Griffin TW, Duncan W, Richter MP, Saroja KR, Maor MH, Davis LW (September 1993). "Neutron versus photon irradiation for unresectable salivary gland tumors: final report of an RTOG-MRC randomized clinical trial. Radiation Therapy Oncology Group. Medical Research Council". Int. J. Radiat. Oncol. Biol. Phys. 27 (2): 235–40. doi:10.1016/0360-3016(93)90233-L. PMID   8407397.
  16. ↑ Krüll A, Schwarz R, Engenhart R, Huber P, Lessel A, Koppe H, Favre A, Breteau N, Auberger T (1996). "European results in neutron therapy of malignant salivary gland tumors". Bull Cancer Radiother. 83 Suppl: 125–9s. doi:10.1016/0924-4212(96)84897-3. PMID   8949764.
  17. ↑ Creagan, ET; Woods, JE; Schutt, AJ; O'Fallon, JR (1 December 1983). "Cyclophosphamide, adriamycin, and cis-diamminedichloroplatinum (II) in the treatment of advanced nonsquamous cell head and neck cancer". Cancer. 52 (11): 2007–10. doi:10.1002/1097-0142(19831201)52:11<2007::AID-CNCR2820521106>3.0.CO;2-T. PMID   6684986. S2CID   2813393.
  18. ↑ Mino M, Pilch BZ, Faquin WC (December 2003). "Expression of KIT (CD117) in neoplasms of the head and neck: an ancillary marker for adenoid cystic carcinoma". Mod. Pathol. 16 (12): 1224–31. doi: 10.1097/01.MP.0000096046.42833.C7 . PMID   14681323.
  19. ↑ "About salivary gland cancer | Salivary gland cancer | Cancer Research UK". www.cancerresearchuk.org. Retrieved 17 November 2017.
  20. ↑ Saku T, Hayashi Y, Takahara O, Matsuura H, Tokunaga M, Tokunaga M, Tokuoka S, Soda M, Mabuchi K, Land CE (1997). "Salivary gland tumors among atomic bomb survivors, 1950-1987". Cancer. 15 (79 (8)): 1465–75. doi:10.1002/(SICI)1097-0142(19970415)79:8<1465::AID-CNCR4>3.0.CO;2-A. PMID   9118025. S2CID   11199713.,
  21. ↑ Venturi, Sebastiano (January 2021). "Cesium in Biology, Pancreatic Cancer, and Controversy in High and Low Radiation Exposure Damage—Scientific, Environmental, Geopolitical, and Economic Aspects". International Journal of Environmental Research and Public Health. 18 (17): 8934. doi: 10.3390/ijerph18178934 . PMC   8431133 . PMID   34501532. CC-BY icon.svg Text was copied from this source, which is available under a Creative Commons Attribution 4.0 International License.
  22. ↑ Venturi, S. | Correlation of Diabetes, Salivary gland cancer and Pancreatic Cancer with Iodine and Cesium Radionuclides| Researchgate | December| 2022 | https:// www.researchgate.net/profile/Sebastiano-Venturi-4/publication/366530240
  23. ↑ American Cancer Society (2017). Cancer Facts and Figures 2017, Special Section: Rare Cancer in Adults. Atlanta: American Cancer Society.

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