Health& Medicine

1. Radiological imaging of
salivary gland diseases.
Dr/ ABD ALLAH NAZEER. MD.

5. Imaging modalities available to assess salivary glands include:
Plain film radiography.
Sialography.
CT scan.
MRI.
Diagnostic ultrasound.
Nuclear scintigraphy.
These imaging modalities play an important role in evaluating
a patient with pain, swelling, or other symptoms related to
possible salivary gland disorders. Imaging helps in
differentiating lesions of salivary glands from those of
parapharyngeal space, masticator space, and mandible,
submandibular and submental spaces. In addition to localizing
the lesion, it also aids in determining the extent of disease,
involvement of skull base, mandible, and neural spread in case
of malignant lesions.

6. Plain film radiographs: were used to determine salivary gland abnormalities
before the development of more sophisticated imaging techniques. It is the
least sensitive of all the imaging modalities. It is least expensive and readily
available. It will readily demonstrate calculi. It also helps in differentiating
bony / cartilaginous lesions that may mimic salivary gland pathology.
Salivary glands should be imaged in multiple planes. Attempt should be made
to isolate calcification / overlying calculi from bony mandible. Plain film
imaging is useful in evaluating calculi, detecting calcification in
hemangiomas, and evaluation of lymph nodes.
Plain film imaging of parotid region should be performed with the patient
positioned with extended chin, open mouth posterioanterior view with cheek
blown out. This method will help in imaging stenson’s duct. In viewing
submandibular region an extended chin, open mouthed lateral view is
obtained. The patient is instructed to depress the tongue with his finger.
Sialography:
It was first performed by Arcelin in 1913. He used bismuth as the contrast
media. He demonstrated submandibular gland calculus using this imaging
technique. Before the advent of modern imaging modalities, Sialography was
the mainstay in diagnosing inflammatory and neoplastic lesions of salivary
glands. Because of their greater sensitivity.

7. CT scan: This has revolutionized salivary gland imaging. It provides precise
anatomical detail and is routinely used as a primary imaging modality in salivary
gland lesions. It is very useful in evaluating salivary gland calculi and associated
adnexal inflammation. It is inferior to Sialography in studying the ductal system.
Parotid gland CT density is highly variable. It tends to be intermediate between fat
and muscle. The submandibular glands have less fat than the parotids. Their
density is closer to that of muscle.
CT of parotid gland is obtained by using thin section slices in axial and rarely
coronal images. This is usually performed after intravenous injection of contrast
solution. Mild enhancement of parotid gland takes place after contrast injection.
Images are usually filmed with conventional soft tissue windows. Bone windows
are useful for evaluating calcification, calculi formation, or adjacent bone
involvement.
MRI: Usually is complementary to CT because of its excellent soft tissue delineation
capability. It is better than CT in differentiating parotid from extra parotid masses.
CT / MRI have replaced Sialography in the evaluation of salivary gland. Sialography
will give some indication about whether a mass is intrinsic / extrinsic to the gland.
Digital subtraction Sialography is still a favoured imaging modality in detection of
sialolithiasis within Stensen and Wharton’s ducts.
Sialography is contraindicated in cases of acute infections of salivary glands.

8. It fails to demonstrate the parotid gland in its entirety because of intervening
mandible. It also does not clearly demonstrate the intraglandular facial nerve
branches.
Color Doppler studies of salivary glands indirectly identifies malignant lesions of
salivary glands as these lesions boast high vascularity in comparison with their
benign counterparts.
Radionuclide imaging: Is rarely used to evaluate salivary glands. Sodium
pertechnetate (technetium 99m) is the commonly used element. This isotope is
concentrated and excreted by salivary glands. Since most salivary gland tumors do
not accumulate the radionuclide, a tumor mass will appear as a filling defect on
this scan. Tumors like warthin’s readily take up pertechnetate resulting in
formation of “Hot spots”.
Gallium 67 citrate is useful for studying inflammatory / neoplastic disease of
salivary glands and adjacent areas. Since Gallium 67 is actively taken up by
actively dividing cells, excessive gallium accumulation is seen in inflammatory and
neoplastic processes like sarcoidosis / lymphoma etc.
Ultrasonography: High resolution Ultrasonography (7.5 – 10 MHz) of parotid and
submandibular salivary glands is actually a quick and non invasive method for
assessing these glands. It helps in the assessment of vascularity of the gland,
whether the lesion is solid or cystic. It also helps in accurately guiding the FNAC
needle to perform biopsy from the suspected lesion.

15. Metastasis
Most metastases to the parotid or submandibular gland are from
continuous spread of squamous cell carcinoma of the pharynx or
neck. Hematogenous metastases have been described in carcinoma
of the breast, neck, lung, and kidney and in metastatic melanoma.
Despite the vascularity of the parotid gland, blood borne metastasis
is rare. Lymphatic metastases to the parotid glands also are possible.

17. Malignant salivary gland tumours are staged using the TNM staging
system:
T : Tumour
Tx : primary tumour cannot be assessed
T0 : no evidence of primary tumour
T1
less than or equal to 2cm in maximal diameter
no extra-parenchymal extension
T2
2 - 4cm in maximal diameter
no extra-parenchymal extension
T3
greater than 4cm in maximal diameter OR
any size with extra-parenchymal extension
T4A : direct extension into skin, mandible, ear canal, facial nerve
T4B : direct extension into base of skull, pterygoid plates, or encases
carotid artery.

18. N : Nodes
Nx : nodes cannot be assessed
N0 : no evidence of nodal involvement
N1
single ipsilateral node
< 3cm in maximal diameter
N2A
single ipsilateral node
3 - 6cm in maximal diameter
N2B
multiple ipsilateral nodes
less than 6cm in maximal diameter
N2C
contralateral or bilateral nodes
less than 6cm in maximal diameter
N3 : > 6cm in maximal diameter
M : Metastases
Mx : presence of metastases cannot be assessed
M0 : no evidence of metastases
M1 : distant metastases present

19. Developmental anomalies.
Aberrant salivary glands.
An aberrant or ectopic is salivary gland tissue that develop at
a site where it is not normally found.
Aplasia and hypoplasia.
Aplasia occurs in combination with congenital anomalies.
Hypoplasia in patient with Melkersen Rosenthal syndrome.
Hyperplasia.
Accessory ducts. Most common developmental anomalies.
Atresia, congenital occlusion or absence of one or two major
salivary gland ducts.
Diverticulae, small pouches of ductal system of one of the
major salivary glands.
Congenital fistula.

20. Non-contrast computed tomography axial sections demonstrate bilateral absence of
parotid glands (long arrows) and bilateral submandibular glands (Figure a, small
arrows). (c) Multiplanar Magnetic Resonance (MR) image, coronal sections
demonstrates absence of bilateral submandibular glands (small arrows). (d) Multiplanar
MR axial sections shows absence of bilateral parotid glands (small arrows).

21. Salivary gland scintigraphy (99mTcO4). There was no uptake of technetium after
5, 10, 20, 30 (stimulant administration), and 40 min in all major salivary glands.

22. Enhanced CT axial images in case 2. Axial images on the mandibular angle (A) and the mandibular
foramen levels (B) showing the normal parotid gland on the right side (black arrows) and the absence
of the parotid gland on the left side (white arrows). (C and D) Image on the condylar neck level shows
the hypoplastic parotid gland (black arrows) overlying the masseter and the absence of the gland in
the retromandibular parotid space (white arrow heads), compared with the normal parotid gland on
the contralateral side (white arrows). The hypoplastic parotid gland (black arrows) could be enhanced
during sialography (D). Also note the left maxillary mass (*).

23. Axial and coronal T2WI image showing hypoplastic left parotid
gland with prominent fat. Right parotid gland appears normal.

26. Submandibular gland stone.

27. Plain radiographs.

29. Sialolithiasis, single (A) and multiple (B) in two different patients, as
detected on CT. Small inset on the right (C) shows a multilayer structure
that is observed in the majority of calculi (hydroxyapatite)

30. Submandibular calculi visualized at MR imaging. (a) Transverse T1-weighted SE MR image shows two areas of
low signal intensity (arrows) in the floor of the mouth on the left. (b) These calculi (arrows) are confirmed on
this transverse T2-weighted SE MR image, and the obstructed duct (arrowhead) is evident. Inflammation
around the stones accounts for some peripheral high signal intensity. (c) The duct (arrowhead) can also be
seen on this contrast-enhanced, T1-weighted, fat-saturated, spoiled gradient-echo MR image. The walls
enhanced, presumably due to inflammation (sialodochitis). (d) There was coincidental sialadenitis of the left
submandibular gland seen as enlargement and high signal intensity on this transverse, fat-saturated, T2-
weighted fast SE MR image. Note intraglandular ductal dilatation (arrows).

31. Sialadenitis is bacterial infection of a salivary gland, usually due to an
obstructing stone or gland hyposecretion. Symptoms are swelling, pain,
redness, and tenderness. Diagnosis is clinical. CT, ultrasonography, and
MRI may help identify the cause. Treatment is with antibiotics.
Etiology
Sialadenitis usually occurs after hyposecretion or duct obstruction but may
develop without an obvious cause. The major salivary glands are the
parotid, submandibular, and sublingual glands. Sialadenitis is most
common in the parotid gland and typically occurs in patients in their 50s
and 60s, in chronically ill patients with xerostomia, in those with Sjögren
syndrome, and in those who have had radiation therapy to the oral cavity.
Adolescents and young adults with anorexia are also prone to this
disorder. The most common causative organism is Staphylococcus aureus;
others include streptococci, coliforms, and various anaerobic bacteria.
Symptoms and Signs
Fever, chills, and unilateral pain and swelling develop. The gland is firm
and diffusely tender, with erythema and edema of the overlying skin. Pus
can often be expressed from the duct by compressing the affected gland
and should be cultured. Focal enlargement may indicate an abscess.

32. Mumps is an acute, contagious, systemic viral disease, usually
causing painful enlargement of the salivary glands, most commonly
the parotids. Complications may include orchitis,
meningoencephalitis, and pancreatitis. Diagnosis is usually clinical;
all cases are reported promptly to public health authorities.
Treatment is supportive. Vaccination is effective for prevention.
The causative agent, a paramyxovirus, is spread by droplets or
saliva. The virus probably enters through the nose or mouth. It is in
saliva up to 7 days before salivary gland swelling appears with
maximal transmissibility just before the development of parotitis. It
is also in blood and urine and, if the CNS is involved, in CSF. One
attack usually confers permanent immunity.
Mumps is less communicable than measles. It occurs mainly in
unimmunized populations, but outbreaks among largely immunized
populations have occurred. A combination of primary vaccine
failure (failure to develop immunity after vaccination) and waning
immunity may have played a part in these outbreaks.

33. Acute parotitis. US (longitudinal (A) and transverse (B)) shows an
enlarged, hypoechoic gland with multiple hypoechogenic areas
corresponding to acinic dilatations. Color Doppler register is increased (C).

34. Acute right-sided parotitis. Transverse, contrast-enhanced, fat-saturated, T1- weighted SE
MR image shows marked enhancement of the right parotid gland (thick and thin arrows)
compared with the left. The superficial subcutaneous tissue is also inflamed.

35. HIV-related lesions. Transverse, contrast-enhanced CT scan depicts a right
sided parotid cyst (straight arrow) and multiple small nodules in the left
parotid gland (curved arrow) in this patient who was HIV positive but had
not fulfilled criteria for acquired immunodeficiency syndrome.

36. Sialolithiasis and sialadenitis, as seen on color Doppler ultrasound of the
submandibular gland. Two small calculi, 2 and 3mm in size, respectively
(arrows), are seen as hyperechoic structures with posterior shadowing. The
increased vascularization of the slightly enlarged gland should be noted.

37. Recurrent sialadenitis of the parotid gland: ultrasound
and magnetic resonance sialography findings.

38. Parotid sialadenitis.

40. Sialadenitis whit abscess. a) Axial T2-W. b) Axial T1. c) Axial postcontrast T1W show an ill-
defined inhomogeneous signal intensity involving the left parotid gland with periferic
enhanced and central necrosis. d, e) Transverse DW images obtained with a b factor of 0
s/mm2 and 1000 s/mm2 show a mass with high signal intensity. f) Axial ADC map shows
lower signal intensity and the lesion was incorrectly diagnosed as a malignant lesion.

41. Viral parotitis (mumps) on US. Image A) represents the two pairs of glands
on a longitudinal view, with pathological enlargement of the right parotid,
whereas image B) shows the asymmetry in a transverse view.

43. Ranula: Postcontrast computed tomography study at the level of the
floor of the mouth demonstrating a hypo attenuating cystic lesion in
the left sublingual space extending into the submandibular space
without enhancement, consistent with a plunging or diving ranula.

44. Plunging or cervical Ranula:

45. Left sublingual space extending to the submandibular space
consistent with a plunging ranula (arrow).

47. Lipoma. Computed tomography scan through the left parotid
demonstrates a fat-attenuation mass within the tail of the parotid gland.
Lipomas are common benign soft tissue neoplasms but they are found very
rarely in the parotid gland. Surgical intervention in these tumors is
challenging because of the proximity of the facial nerve, and thus knowledge
of the anatomy and meticulous surgical technique are essential.

48. Lipomas. (a) Although the attenuation of this patient’s parotid glands is low due to
fatty infiltration on this transverse CT scan, a palpable (see marker superficially)
lipoma (L) in the left parotid gland was appreciated. (b) This lipoma (arrow),
hyperintense on this transverse T1-weighted SE (600/11) MR image, was
extraglandular but still contained by the deep cervical fascia surrounding the gland.

49. Sublingual gland epidermoid cyst (white arrows).

50. Contrast-enhanced coronal CT image (A) shows submandibular
mucocele on right side (thick white arrow) while axial CT image (B)
shows right sublingual gland mucocele (thin white arrows)

51. Left parotid hemangioma

52. Bilateral parotid hemangiomas.

53. Hemangioma as a hyperintense mass at the left parotid gland.

56. Sjögren syndrome in a 49-year-old woman. Computed tomography shows
that the parotid glands are bilaterally diffusely enlarged and markedly
heterogeneous in density, with a suggestion of multiple small lucencies.

57. Sjögren disease. While both parotid glands (arrowheads) show cystic
changes in and enlargement of the gland on this coronal T2-weighted SE
MR image, the left side also shows periparotid adenopathy (arrow).

59. Benign lymphoepithelial lesions (BLL or BLEL), also misleadingly known
as AIDS-related parotid cysts (ARPC), are mixed solid and cystic lesions which
enlarge the parotid glands, and are usually associated with cervical lymph node
enlargement, and nasopharyngeal lymphofollicular hyperplasia. Despite their
aforementioned alternative name, BLL are seen usually in HIV positive patients
without AIDS, and are not an AIDS defining illness. It is relatively common in the
HIV population, with 5% of patients eventually developing BLL.
BLLs are only rarely seen in the submandibular glands or sublingual glands.
Pathology:
Thought to arise from dilatation of intraglandular ducts from obstruction due to
lymphoid hypertrophy. They are bilateral in 20 % of cases.
Radiographic features:
well circumscribed cystic spaces, may demonstrate thin rim enhancement on post
contrast MRI ultrasound demonstrates these 'cystic' lesions to actually have
multiple small septations, and commonly also small mural nodules (40%)
a vascular pedicle may be seen entering the cystic region
BLLs are usually seen associated with other sites of lymphoid hyperplasia ,
including: prominent nasopharyngeal adenoidal tissue : seen in 35% of HIV
positive patients posterior triangle lymphadenopathy abnormal bone marrow
signal.

62. Benign-lymphoepithelial-lesions-in-HIV.

65. Mycobacterium tuberculosis infection within the left parotid gland.

66. Two cases of primary parotid tuberculosis mimicking parotid neoplasm

67. Pleomorphic adenomas (also known as benign mixed tumour
(BMT)) are the most common salivary gland tumours.
Epidemiology
Pleomorphic adenomas account for 70-80% of benign salivary gland
tumours and are especially common in the parotid gland . Patients
are typically in their middle age, and prior head and neck irradiation
is a risk factor for the development of these tumours.
Clinical presentation
Patients typically present with a smooth painless enlarging mass.
Distribution
Distribution among the salivary glands is as follows:
parotid gland - 84% : commoner in the superficial lobe
submandibular gland - 8%
minor salivary glands - 6.5%
widely distributed including the nasal cavity, pharynx, larynx,
trachea
sublingual glands - 0.5%

68. Radiographic features
CT: Smoothly marginated or Lobulated homogeneous small spherical
mass is the most common appearance. When larger they can be
heterogeneous with foci of necrosis. Small regions of calcification are
common .
When small enhancement tends to be prominent. In larger tumours
enhancement is less marked, but can demonstrate delayed enhancement.
MRI: They are commonly seen as well-circumscribed and homogeneous
when small. Larger tumours may be heterogeneous.
T1 - usually of low intensity
T2, usually of very high intensity (especially myxoid type)
often have a rim of decreased signal intensity on T2-weighted images
representing the surrounding fibrous capsule
T1 C+ (Gd) - usually demonstrates homogeneous enhancement
Ultrasound: Typically hypoechoic. May show a lobulated distinct border
+/- posterior acoustic enhancement.
Ultrasound is also useful in guiding biopsy (both FNAC and core biopsies)
but needs to be carried out with care to avoid facial nerve damage .
Angiography (DSA): Typically hypovascular.

69. Pleomorphic adenoma of the right parotid A: Computed tomography (CT)
and MRI shows a well-circumscribed low-density mass in the superficial lobe

70. Non-contrast T2 & T1W axial images (upper row) and T2W coronal & DW axial images
(lower row) show pleomorphic adenoma of right parotid gland (white arrows).

71. Pleomorphic adenoma in left submandibular gland. US shows a homogeneous
hypoechoic nodular lesion (*) inside the left submandibular gland. MR images
show hyperintense lesion in T2, hypointense in T1 and with homogeneous
enhancement after de endovenous gadolinium administration (arrows).

72. Pleomorphic adenoma in left submandibular gland. US shows a homogeneous
hypoechoic nodular lesion (*) inside the left submandibular gland. MR images
show hyperintense lesion in T2, hypointense in T1 and with homogeneous
enhancement after de endovenous gadolinium administration (arrows).

75. A Warthin tumour (or papillary cystadenoma lymphomatosum) is a
benign sharply demarcated tumour of the parotid gland. It is
bilateral in 10-15% of cases.
Epidemiology
They are the 2nd most common (up to 10% of all parotid tumours)
benign parotid tumour (after pleomorphic adenoma) and are the
commonest bilateral or multifocal benign parotid tumour. It
typically occurs in the elderly (6th decade). There is a recognised
male predilection. Patients typically present with painless parotid
swelling.
Morphology
They are often multi-centric (20%) and are usually small (1-4 cm).
They have a typically heterogenous appearance on all modalities,
often with cystic components (30%).
Location
Tends to favour the parotid tail region.
Warthin tumour

76. Radiographic features
Has a greater tendency to undergo cystic change than any other salivary gland
tumour .
Ultrasound:
Usually seen as a relatively well defined, ovoid, hyperechoic mass. In some cases
anechoic internal cystic areas may be present. They are often hypervascular.
CT:
can be often seen bilaterally
classic appearance is a cystic lesion posteriorly within the parotid with a focal
tumour nodule
relatively well defined
cystic changes appear as intra lesion at lower attenuation, no calcification
MRI:
Well defined and can be bilateral.
T1 - low to intermediate signal with cyst containing cholesterol components
containing focal high signal.
T2 - heterogenous and variable signal intensity
C+ (Gd) - usually no contrast enhancement .
Scintigraphy:
Often shows uptake with Tc99-pertechnetate, thallium and FDG-PET.

77. Computed tomography of Warthin tumor. A: A large well-defined mass involves
the superficial lobe of the left parotid gland. The mass enhances diffusely. B: At
the level of the parotid tail, areas of lower density (arrowheads) are consistent
with cystic components observed in the posterior aspect of the mass.

78. Bilateral Warthin Tumors of the Parotid Gland on contrast-enhanced CT

80. Bilateral Warthin tumors. Bilateral parotid masses (arrows) are seen on this
transverse, contrast material-enhanced, fat-saturated T1-weighted spin-
echo (SE) MR image. The multiplicity and location at the tail of the parotid
gland (near the lower mandible) are typical features of this tumor

82. Magnetic resonance imaging of an oncocytoma in the right parotid tail.

83. A mucoepidermoid carcinoma is a tumour that usually occurs in the salivary
glands.
Epidemiology
Mucoepidermoid carcinomas are seen throughout all adult age groups, but are
most common in middle age (35-65 years of age) . However, it is the most
common malignant salivary gland tumour of childhood . Overall, mucoepidermoid
carcinomas account for :
2.8-15.5% of all salivary gland tumours
1-10% of all major salivary gland tumours
6.5-41% of minor salivary gland tumours
In the parotid gland they are the most common malignant primary neoplasm.
Clinical presentation
Mucoepidermoid carcinomas most frequently arise in the parotid gland, and
presents as a painless swelling, with or without facial nerve involvement. These
tumours can however be found anywhere there are salivary glands. Overall
distribution across various glands is as follows :
major salivary glands : 50%.
parotid gland : 40%.
submandibular gland : 7%.
sublingual gland : 3%.
minor salivary glands : 50%.

84. Radiographic features:
Radiographic appearances largely depend on grade, making preoperative imaging
important in planning and counseling.
Ultrasound.
Typically a well circumscribed hypoechoic, with an either part of completely cystic
appearance. The lesion stands out against the relatively hyperechoic normal parotid gland.
CT.
Low grade tumours appear as well circumscribed masses, usually with cystic components.
The solid components enhance, and calcification is sometimes seen. They have
appearances similar to benign mixed tumours.
High grade tumours on the other hand, have poorly defined margins, infiltrate locally and
appear solid.
MRI.
Again, imaging is dependent on grade.
Low grade tumours have similar appearances to benign mixed tumours :
T1 - low to intermediate signal ; low signal cystic spaces
T2 - intermediate to high signal ; cystic areas will be high signal
T1 C+ (Gd) - heterogeneous enhancement of solid components
High grade tumours on the other hand have lower signal on T2 and poorly defined margins
and infrequent cystic areas.
T1 - low to intermediate signal
T2 - intermediate to low signal

85. Mucoepidermoid carcinoma. A: Postcontrast computed tomography axial image demonstrates
a heterogeneously enhancing mass in the superficial lobe of the left parotid gland post to the
ramus of the mandible. Note the irregular and ill-defined margins of the mass. B: T1-weighted
axial image demonstrates the mass, which is isointense to muscle signal intensity. Note that
the mass is well seen because of the hyperintense surrounding signal of the rest of the parotid
gland. C: T2-weighted axial image demonstrates the mass to be of intermediate signal
intensity. D: Postcontrast T1-weighted axial image without fat suppression. Note that the mass
is not seen, as the enhancement of the mass is isointense to the rest of the parotid gland

86. Mucoepidermoid carcinoma. MR images show a lobulated discretely ill-defined
margins tumor (arrow) with periferical enhancement, after the endovenous
gadolinium administration, in the superficial lobe of the left parotid gland.

89. Acinic cell carcinoma. MR shows a well-delimited nodular lesion (arrow) inside
accessory parotid gland, localized lateral to the masseter muscle (M). This lesion
is hyperintense in T2, hypointense in T1 and with homogeneous enhancement
after de endovenous gadolinium administration. The definitive diagnose was
anatomopathological (cystic acinic cell carcinoma),

91. Computed tomography of a recurrent adenoid cystic carcinoma in a 49-year-old
woman who had previous right submandibular gland resection. An irregularly
infiltrating enhancing mass is seen in the floor of the mouth and parapharyngeal
space. Anterior fatty infiltration indicates hypoglossal nerve invasion

93. Adenocarcinoma of the right parotid gland.

95. Carcinosarcoma of the left parotid gland.

97. Axial and coronal contrast enhanced CT. The patient had previous surgery for
squamous cell carcinoma involving the parotid gland, these images demonstrate
recurrence within the parotid space. Note the involvement of the skin.

98. Axial PET-CT images demonstrating FDG avid mass centered on the parotid gland,
with an FDG avid metastatic lymph node evident on the right axial image

99. Lymphomas primary located in the salivary gland tissue are very rare and
constitute about 2–5% of all salivary gland neoplasms. Most cases of
lymphoma involve the major salivary glands, frequently the parotid (50–93%)
and submandibular glands. These neoplasms may arise from an intra-parotid
lymph node or in the gland itself. In the normal parotid gland there are
intraglandular lymph nodes, that is why it is often difficult to make a
distinction between lymphoma arising primarily in the salivary gland and
those of the lymph node origin embedded in the salivary gland. If these lymph
nodes are affected by a malignant lymphoma and the glandular parenchyma
is not, then the lymphoma should be considered as nodal type. The
differential diagnosis is not always easy to do because there are cases of
lymphomas originated from intraglandular lymph nodes and with extensive
parenchyma involvement. We consider a primary salivary gland lymphoma
the cases in which the main disease occur here and the parenchyma of the
gland is involved. The morphology and prognosis are similar for both
origin places . Primary malignant lymphomas of the salivary gland are
predominantly B-cell type lymphomas and they include MALT-lymphoma,
follicular and diffuse large B-cell lymphoma. Salivary gland T-cell lymphomas
are very rare . Anaplastic large cell lymphoma is one of the distinctive
subtypes of non-Hodgkin’s lymphoma of the T-cell phenotype .

101. Non-contrast T1W axial images show intra-parotid adenopathy (white arrows)
with altered appearance in a case of tuberculosis of left parotid gland.

102. Bilateral parotid gland MALT lymphoma in a patient with Sjögren’s and sicca syndrome

103. Metastasis.
Most metastases to the parotid or submandibular
gland are from continuous spread of squamous
cell carcinoma of the pharynx or neck.
Hematogenous metastases have been described in
carcinoma
of the breast, neck, lung, and kidney and in
metastatic melanoma. Despite the vascularity of
the parotid gland, blood borne metastasis is rare.
Lymphatic metastases to the parotid glands also
are possible.

104. Metastasis to the parotid glands

105. Thank You.