Lecture notes for medical students

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2. Classification

3. Classification
A) Epithelial (90%)
1) Adenomas
Pleomorphic adenoma
Monomorphic adenoma(Adenolymphoma)
2) Carcinomas
Mucoepidermoid carcinoma ( most common)
Acinic cell Ca.
Adenoid cystic Ca.
Adenocarcinoma
Sq. cell Ca.
Ca. in ex pleomorphic adenoma

4. Benign tumors

5. Benign tumors
- Painless
- Slow growing
- No facial nerve involvement

6. Aetiology

7. Aetiology
Radiation
Smoking (Warthin’s tumor)
Genetics – loss of alleles of chromosomes in
12q, 8q, 17q
Environment & diet – Def. of vit A, industrial agents like nickel,
cadmium, hair dyes, silica, preservatives
Infective – Mumps, EBV, chronic sailadenitis
Recurrent inflammation dysplasia carcinoma

8. Adenolymphoma
-

9. Adenolymphoma
- Warthin’s Tumor/ Papillary Cystadenolymphomatosum
- Misnomer – Neither malignant nor Lymphoma
- 5-15% of Parotid tumor (2nd most common tumor)
- Smoking – 8 times more risk
- Mostly in the lower pole & overlies the angle of mandible

10. - Usually involve only the superficial lobe
- More common in male, elderly and in whites
- No malignant transformation
 Microscopy –:
- Cystic/Glandular spaces
- Lined by columnar epithelium
- Abundant lymphoid tissue in the stoma

11. Investigations:

12. Investigations:
- FNAC
- Tc99 scan – Hot spot (due to high mitochondrial
content)
Treatment:
- Superficial parotidectomy

13. Mucoepidermoid Ca.

14. Mucoepidermoid Ca.
- Most common malignant tumor of the parotid
- Occurs both in minor & major glands
- Slow growing attaining large size
- High grade – Epidermoid cells mainly –regional & distant
spread
- Low grade – Mucous cells mainly – regional nodes spread.

15. TNM staging of malignant salivary tumors (AJCC 7th edition)

16. TNM staging of malignant salivary tumors (AJCC 7th edition)
Primary tumor (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
T1 Tumor 2 cm or smaller in greatest dimension, with or without
extraglandular extension into the orbital soft tissue
T2 Tumor larger than 2 cm but not larger than 4 cm in greatest dimension
T3 Tumor larger than 4 cm in greatest dimension
T4 Tumor invades periosteum or orbital bone or adjacent structures
T4a Tumor invades periosteum
T4b Tumor invades orbital bone
T4c Tumor invades adjacent structures (brain, sinus, pterygoid fossa,
temporal fossa)

17. Regional lymph nodes (N)

18. Regional lymph nodes (N)
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Regional lymph node metastasis
Distant metastasis (M)
MX Distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis

19. Investigations

20. Investigations
FNAC – Confirms possibility of lymphoma/inflammatory mass
CT scan – To see the deep lobe
Bone involvement
Extension into the base of the skull
Parapharyngeal space extension
Neck nodes assessment
MRI - Perineural spread
Bone marrrow involvement

21. Treatment
a)

22. Treatment
a) Surgery
- Total conservative parotidectomy
T1,T2,T3
- Radical Parotidectomy(T4)
- Both lobes
- Facial nerve
- Soft tissues with skin
- Mandibular ramus
- Masseter muscle
Facial N reconstruction – Greater auricular nerve/sural nerve

23. b) Radiotherapy
3-6 weeks after surgery
Delayed for 6 weeks if nerve grafting is done
Dose – 50-70 Gy (1.5 - 2Gy in 5-8 weeks.
c) Chemotherapy
5FU
Cisplatin
Doxurubicin
Epirubicin

24. Parotidectomy
Superficial parotidectomy:
Most common procedure of parotid pathology
With/without hypotensive anesthesia
Reduce blood loss
Improve visual surgical field

25. Parotidectomy

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