Introduction . Statics. Risk factors. survival rate. Staging , Grading. Special investigations. WHO Classification . Most common Benign and Malignant salivary gland Tumors Clinical presentation and prognosis. Surgical Treatment . Summary. Salivary gland tumors account for 2% to 6.5% of all head and neck neoplasms, are more common in female with a peak incidence in their 60s and 70s, but can occur in all age groups. The majority of neoplasms occur in the parotid, and pleomorphic adenoma is the most common benign tumor and mucoepidermoid carcinoma the most common malignant tumor. Irregular margins, bony invasions, the presence of metastatic lymph nodes and perineural spread can all be signs of malignancy. Necrosis can also characterize malignancy. Benign tumors were more common than malignant ones. The prevalent benign tumor was PA, and the prevalent malignant tumors were ACC and MEC. The smaller the gland more likely that a mass is malignant.

1. Benign and
Malignant Salivary
Gland Tumors
Faisal Alzahrani
MSc Oral Surgery
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2. Contants
• Introduction .
Statics.
Risk factors.
survival rate.
• Staging , Grading.
• Special investigations.
• WHO Classification .
• Most common Benign and Malignant salivary gland Tumors
Clinical presentation and prognosis.
Surgical Treatment .
• Summary.
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3. Introduction
• Salivary gland tumors account for 2% to 6.5% of all head and neck
neoplasms, are more common in female with a peak incidence in
their 60s and 70s, but can occur in all age groups.
• The majority of neoplasms occur in the parotid, and pleomorphic
adenoma is the most common benign tumor and mucoepidermoid
carcinoma the most common malignant tumor.
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4. Risk factors
Radiation exposure.
Familial or genetic predisposition.
Tobacco (use for specific tumors).
Viral etiology.
Chemical exposure.
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5. Statics
Cancer Research UK
American Cancer Society
Worldwide, an estimated 53,583 people were diagnosed with salivary gland cancer in 2020. is
However, Salivary gland cancer a very rare cancer.
About 720 people are diagnosed with salivary gland cancer in the UK every year.
It is slightly more common in women than men.
The number of people getting salivary cancer has remained stable in recent years.
In 2020, an estimated 22,778 people died from salivary gland cancer worldwide.
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Cancer Research UK
American Cncer Society 5

6. 6/25/2022 6

7. survival rate
• The 5-year survival rate for salivary gland cancer is 75%.
• Survival rates for people with this type of tumor vary depending on
the type and the extent, or stage, of the cancer.
• If cancer is located only in the salivary gland, the 5-year survival rate
is 94%.
• If the cancer has spread outside the salivary gland to nearby
structures or lymph nodes, the 5-year survival rate is 67%.
• If it is found after the cancer has spread to distant parts of the body,
the 5-year survival rate is 44%.
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8. Staging and grading
• Clinical staging, histologic type and grade, location, cranial nerve
involvement (facial nerve), and patients’ demo Graphics are among
the prognostic factors implicated in salivary gland malignancies.
• Clinical stage, particularly size, is the most critical factor of outcome
rather that the histologic grade with the exception of few tumors.
• Pathological staging (surgical staging).
• Clinical staging refer to (physical-biopsy-imaging).
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9. • T1 :2cm or less
• T2 :2 – 4cm
• T3 :4 – 6cm or extension
• T4 :>6cm or palsy or extension
Tumor (T): How large is the primary tumor? Where is it located?
Node (N): Has the tumor spread to the lymph nodes? If so, where and how
many?
Metastasis (M): Has the cancer spread to other parts of the body? If so,
where and how much?
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• American Joint Committee on Cancer (AJCC) TNM system,
which is based on 3 key pieces of information:

10. • Stage I:
-Noninvasive tumors (T1, T2)
-no spread to lymph nodes
(N0)
-no distant metastasis (M0).
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11. • Stage II:
-An invasive tumor (T3)
-no spread to lymph nodes (N0)
-no distant metastasis (M0).
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12. Stage III:
-Smaller tumors (T1, T2)
-spread to regional lymph nodes
(N1)
-no sign of metastasis (M0).
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13. Stage IV A:
- invasive tumor (T4a) or (T3) with
either
-no lymph node involvement (N0)
-or spread to only a single same-sided
lymph node (N1) or (N2)
-no metastasis (M0).
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14. Stage IV B:
-Any cancer (any T),
-more extensive spread to lymph
nodes (N2, N3),
-no metastasis (M0).
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15. Stage IV C:
Any cancer with distant
metastasis (any T, any N,
and M1).
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16. Grade (G)
• We compares the malignant tissue with healthy tissue.
• If the cancer looks similar to healthy tissue and has different cell
groupings, it is called “differentiated” or a “low-grade tumor.”
• If the cancerous tissue looks very different from healthy tissue, it is
called “poorly differentiated” or a “high-grade tumor.” (anaplastic
carcinoma, carcinoma ex-pleomorphic adenoma, etc.) The cancer’s
grade may help us to predict how quickly the cancer will spread.
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17. Spiro et al. 1989
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• The results were clearly better in patients with low-grade lesions; the
presence of a high-grade tumor had no significant impact on survival
unless the tumor was large (>4 cm in diameter).
• Such as rapid change in size, infiltration, metastasis. These are
currently incorporated into the present staging system of salivary
cancer.

18. special investigations
• Biopsy (TRU CUT)
• Ultrasound-guided needle biopsy FNAB, is the most commonly
employed diagnostic modality for assessment of the pathology
of salivary masses.
• Ultrasound( ultrasonography will establish if the mass related to
the salivary gland or lymph nodes
• Computed tomography CT scan
• Positron emission tomography PET scan
• Magnetic resonance imaging (MRI) better for soft tissue
contrast.
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21. Tumours Of Salivary Gland
Bengin
Pleomorphic adenoma
Warthin tumour
Other adenoma
Malignant
Mucoepidemoid carcinoma
 Low and high grade (facial nerve)
Adenoid cystic carcinoma(chees)
Polymorphous low-grade
adenocarcinoma (Polymorphous
adenocarcinoma)
Acinc cell carcinoma(develop in the acinar cells
which produce saliva).
Adenocarcinmoa
Malignant mixed tumour
Squamous cell carcinoma
Undifferentied carcinoma
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22. Benign Tumors
Pleomorphic Adenoma
(Benign Mixed Tumor)
Warthin’s Tumor
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23. Pleomorphic
Adenoma (PA)
• Is the most common benign tumor
• They are more common between the 40s and 50s
• Referred as mixed tumor :the tumor has three
components: an epithelial, myoepithelial cell, and
mesenchymal components.
• Parotid glands (85%) followed by minor salivary glands
(10%) and the submandibular glands (5%)
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24. Pleomorphic Adenoma (PA)
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25. Important Points
• Painless, slow growing, mobile masses. Not involving
facial nerve.
• A carcenoma arising in a peolmorphic adenoma is
referred as carcinoma ex pelomorohic adenoma or
malignant mixed tumor.
• Bad actor
• High recurrence rate becouse the failure to recognize it
is protusions from the main mass into the surroding
tissue at the time of surgery.
• Risk of seeding
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26. Carcinoma Ex Pelomorohic Adenoma Or
Malignant Mixed Tumor
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27. Warthin’s Tumor
• Accounts for 5% to 7% of epithelial salivary gland
neoplasms.
• Vast majority found in the parotid, with bilateral
involvement in 4% to 6% of the cases
• Old age
• Associated with cigarette smoking and radiation
• The clinical presentation is that of a doughy painless
mass often found in the tail of the parotid
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28. Warthin’s Tumor
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29. Treatment Of Benign
Parotid Tumor
• The traditional surgical approach to benign
parotid tumors is a superficial parotidectomy
(SP) and that for deep lobe tumors is a total
parotidectomyn( ).
• Modern modifications include partial
superficial parotidectomy and selective deep
lobe parotidectomy
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30. Treatment of Benign tumors of the
submandibular and minor salivary glands
• A submandibular gland adenoma should be removed in continuity with the gland.
• The situation to be avoided is an adenectomy for apparent sialoadenitis when
the lesion is a malignant tumor.
• Most present as rubbery lumps and the diagnosis can be established by FNAC or
ideally a dermatological punch biopsy.
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31. Malignant tumors
Mucoepidermoid carcinoma & intraosseous
form of mucoepidermoid carcinoma
Polymorphous low-grade adenocarcinoma
(Polymorphous adenocarcinoma)
Adenoid cystic carcinoma
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32. Mucoepidermoid Carcinoma
• Is the most common malignant salivary
gland tumor.
• This tumor makes up 10% of major gland
tumors (mostly parotid) and 20% of minor
gland tumors (mostly palatal).
(Mean age is 45 years.
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33. Mucoepidermoid Carcinoma
• Clinical feature Presentation is a
submucosal mass that may be painful
or ulcerated.
• The mass may appear to have a
bluish shade because of the mucous
Content within the lesion.
(B) Mucoepidermoid carcinoma of the palate with
ulceration.
A) Mucoepidermoid carcinoma of the palate. Note the
bluish color from mucin content.
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34. 6/25/2022 34

35. Intraosseous Form of
Mucoepidermoid
Carcinoma
• May present as a multilocular radiolucency
of the posterior mandible
• with a raised bluish lesion of the retromolar
pad
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36. Treatment
• Low-grade lesions is wide surgical excision
with a margin of uninvolved normal tissue;
• High-grade lesions require more
aggressive surgical removal with surgical
margins and, possibly, local radiation
therapy.
• Low-grade lesions have a 95% 5-year
survival rate.
• High-grade lesions have less than a 40% 5-
year survival rate.
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37. Polymorphous low-grade adenocarcinoma
• The second most common salivary gland malignancy.
• This lesion was first described in 1983; before its
identification
• Many cases were likely Misdiagnosed as adenoid
cystic carcinoma. Due to overlapping histological
features
• The most common site is the junction of the hard
and soft palate
(Polymorphous adenocarcinoma)
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38. Polymorphous Low-grade
Adenocarcinoma
• Clinical feature These tumors present as
Slow-growing, asymptomatic masses that
may become ulcerated.
• The treatment of this tumor is wide
surgical excision, with a relatively high
recurrence rate of 14%.
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39. Adenoid cystic carcinoma
• Third most common intraoral salivary gland
malignancy a mean age of 53 years.
• Clinical feature slow-growing, nonulcerated
masses, with an associated chronic dull pain. And it
can be faster growth rate and higher rate of distant
metastasis.
• The treatment is wide surgical excision, followed, in
some cases, by radiation therapy.
• The prognosis is poor despite aggressive therapy.
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40. Adenoid cystic carcinoma
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41. Treatment Malignant Parotid Tumors
• The object of treatment is to excise the tumor with an adequate rim
of normal tissue ,but this may not be possible because of the complex
anatomy of the parotid area and emphasizes the practical nature of
the 4 cm rule, as adequate surgical clearance of tumor is not possible
with large masses.
• It is for this reason that Adjuvant radiotherapy plays an important
part in the management of salivary gland cancer.
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42. Facial Nerve
• Wherever possible a functioning facial nerve should be retained except
if completely within the tumor. The traditional approach to a malignant
parotid tumor is a total parotidectomy.
• Occasionally parotid lesions may result in facial paralysis as a result of
neurotropism, similar to the polymorphous low-grade
adenocarcinoma, and facial nerve involvement
• In contrast if a facial nerve palsy is already present then a radical
parotidectomy is a logical option.
• If the facial nerve has to be resected, ideally it should be reconstructed
at the same operation.
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43. Clinical signs of
nerve involvement
• Paralysis
• Paresthesia
• Deafness
• Diplopia
• Pain
• Tic
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44. Treatment Of Submandibular Gland
• The literature demonstrates that submandibular gland cancers carry a
20% worse prognosis than malignant tumors in the parotid or mouth.
• Initially this was attributed to a higher incidence of adenoid cystic
carcinomas in the submandibular gland.
• However Spiro showed this not to be the case. An appropriate
oncological procedure as the primary procedure restores the survival
rate to that achieved in both the mouth and the parotid.
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45. Minor Salivary Gland Tumors
• Minor salivary gland cancers within the oral cavity are managed in the
same way as squamous cell carcinomas in the mouth.
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46. Summary
• Irregular margins, bony invasions, the presence of metastatic lymph nodes
and perineural spread can all be signs of malignancy.
• Necrosis can also characterize malignancy.
• Benign tumors were more common than malignant ones.
• The prevalent benign tumor was PA, and the prevalent malignant tumors
were ACC and MEC.
• The smaller the gland more likely that a mass is malignant.
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47. Studies
• Most of the information comes from retrospective studies and
isolated case reports.
• Also, most trials to date have been heterogeneous and have involved
small numbers of patients, so informed decision making is difficult.
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48. Referances
• Ghali, G.E., Larsen, P.E. and Waite, P.D. eds., 2004. Peterson's principles of oral and maxillofacial surgery (Vol. 1, p. 37). London: BC Decker.
• Hupp, J.R., Tucker, M.R. and Ellis, E., 2013. Contemporary Oral and maxillofacial surgery-E-book. Elsevier health sciences.
• Andersson, L., Kahnberg, K.E. and Pogrel, M.A. eds., 2012. Oral and maxillofacial surgery. John Wiley & Sons.
• Friedman, E.R. and Saindane, A.M., 2013. Pitfalls in the staging of cancer of the major salivary gland neoplasms. Neuroimaging Clinics, 23(1), pp.107-
122.
• Galdirs, T.M., Kappler, M., Reich, W. and Eckert, A.W., 2019. Current aspects of salivary gland tumors–a systematic review of the literature. GMS
Interdisciplinary plastic and reconstructive surgery DGPW, 8.
• Goyal, G., Mehdi, S.A. and Ganti, A.K., 2015. Salivary gland cancers: biology and systemic therapy. Oncology, 29(10), pp.773-773.
• Sama, S., Komiya, T., & Guddati, A. (2021). Advances in the Treatment of Mucoepidermoid Carcinoma. World Journal Of Oncology, 13(1), 1-7.
• Monga, S., Malik, J.N., Sharma, A.P. and , S., 2014. Diagnostic Dilemma of Polymorphous Low Grade Adenocarcinoma of Hard Palate. Journal of Case
Reports, 4(1), pp.91-94.
• Sung, H, Ferlay, J, Siegel, RL, Laversanne, M, Soerjomataram, I, Jemal, A, Bray, F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and
mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021: 71: 209- 249. https://doi.org/10.3322/caac.21660
• https://www.cancerresearchuk.org/about-cancer/salivary-gland-cancer/risks-
causes#:~:text=About%20720%20people%20are%20diagnosed,remained%20stable%20in%20recent%20years.
• Spiro, R.H., 1986. Salivary neoplasms: overview of a 35‐year experience with 2,807 patients. Head & neck surgery, 8(3), pp.177-184.
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49. Thank you
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