Benign nonodontogenic tumors /endodontic courses

BENIGN
NON ODONTOGENIC TUMOURS
Post graduate
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
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Neoplasm(Willis definition 1952)
A Neoplasm can be defined as
‘an abnormal mass of tissue,
the growth of which exceeds
and is uncoordinated with that of the normal tissues
and persists in the same excessive manner
after cessation of the stimuli which evoked the change’

Benign Tumors
1. Slow growing
2. Uncoordinated growth
3. limited Growth Potential
4. Spread by Direct Extension
5. Resemble the tissue of origin,
histologically.

Indian Dental academy
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• Leader continuing dental education
• Offer both online and offline dental courses

Benign Non-Odontogenic Tumors
– classified based on tissue of origin

Benign non-odontogenictumors
 Benign tumors of Epithelial tissue origin
Benign tumors of Connective tissue origin:
 Benign tumors of Muscle tissue origin
 Benign tumors of Nerve tissue origin
 Benign tumors of Salivary gland origin
 Benign tumors of Bone
 Angiogenic Benign tumors
 Lymphatic Benign tumors

Benign tumors of Epithelial tissue
origin
 Squamous papilloma
 Keratoacanthoma

Squamous Papilloma
 It is a benign proliferation of stratified squamous epithelium,
resulting in a papillary or verruciform mass.
 Caused by HPV (Human papilloma virus).
 HPV types 6 and 11.
 HPV comprises a large family (>100) of double stranded
DNA viruses of papova virus subgroup –A.
 HPV can be identified by in situ hybridization, PCR and
immuno-histochemical analysis.
 These viruses have a incubation period of 3 to 12 months.

Papilloma

Clinical features:
 Tongue, lips, buccal mucosa, labial mucosa and rarely in
hard palate.
 Soft, painless, usually pedunculated, exophytic nodule with
numerous finger like surface projections that impart a
cauliflower or wartlike appearance.
 At any age.
 Projections may be pointed or blunted.
 Lesions appear whitish, slightly red or normal depending on
amount of surface keratinisation.
 Lesions are usually solitary and enlarges so rapidly

• The common wart or verruca vulgaris, is a frequent tumor
of the skin analogous to oral papilloma.
• HPV 2, HPV 4 and HPV 40.
• Clinically pointed or verruciform surface projections, a
very narrow stalk.
• White in colour.
• Contagious.
• Oral lesions appear to arise through autoinoculation by
finger sucking or fingernail biting.

Treatment
 Surgical excision including the base of the lesion.
 Recurrence is rare.

DD
 Verruca vulgaris
 Condyloma acuminatum

keratoacanthoma
 Self –healing carcinoma, molluscum pseudo-
carcinomatosum, molluscum sebaceum, verrucoma.
 Common low-grade malignancy that originates in the
pilosebaceous glands.
 It clinically and histologically resembles epidermoid
carcinoma and it is frequently mistaken as cancer.

Etiology
 Genetic and viral – both etiological factors have been
demonstrated.
 HPV 9, 11, 13, 16, 18, 24, 25, 33, 37 and 57.
 Trauma and chemicals such as coal tar and mineral oil.

Clinical features:
 Age and sex: 50 to 60 year age and common in males.
 Site : intraoral lesion is uncommon. If present, mostly on
the lips. On sun-exposed areas.
 Appearance: The lesion appears as an elevated umbilicated
or crateriform with depressed central core. And appears as
dome shaped.
 Lip: on the lower lip the tumor shows smooth, raised,
rolled borders with a central plug of hard keratin.

 Color : It is yellowish brown in color.
 Size : It grows to a size of 1 to 2 cms.
 Signs: lesion appear fixed to the surrounding tissues.
 Progress: it begins as a small, firm nodules that develop to
full size over a period of 4 to 8 weeks and persist as static
lesions for another 8 weeks. After that it undergoes
spontaneous regression over the next 6 to 8 weeks by
expulsion of keratin core with resorption of the mass.

keratoacanthoma

Differential dignosis
 Keratinizing squamous cell carcinoma – cancerous lesion
usually fails to exhibit a smooth, round, regularity which is
present in keratoacanthoma.
 Actinic keratosis.
 Verrucous carcinoma.
 Warty dyskeratoma – are usually small i.e. <0.5 cm as
compared to keratoacanthoma.

Treatment
 It often resolves spontaneously without treatment.
 The lesion may be treated by surgical excision as the scar
remaining from excision will be more cosmetic than that
resulting from spontaneous regression .

Benign tumors of connective tissue
origin
 Oral fibromas
 Giant cell fibroma
 Myxofibroma
 Peripheral ossifying fibroma
 Central ossifying fibroma
 Central giant cell granuloma
 Giant cell tumor of bone
 Lipoma
 Myxoma
 Chondroma
 Osteoma

Fibroma
 Most common benign soft tissue tumor in the oral cavity.
 Most of these lesions are infact hyperplasia or reactive
proliferation of fibrous tissue.

Clinical features:
 It can occur at any age but it is common in 3rd 4th and 5th
decades.
 Female predilection.
 Site : it occurs on gingiva, tongue, buccal mucosa and palate.
 Appearance : it is most often sessile dome shaped or slightly
pedunculated with smooth contour.
 Consistency : it can range from soft and myxomatous to
firm and elastic.

Fibroma

Differential diagnosis
 Myxofibroma – it is softer on palpation when compared
to fibroma.
 Neurofibroma
 Neurilemoma
 Giant cell fibroma.
 Minor salivary gland tumors.

Treatment :
 Conservative surgical excision.
 Recurrence is extremely rare.

Giant cell fibroma
 It is a well described benign hyperplastic lesion of oral
mucosa.
 First described by Weathers and Callihan in 1974.
Clinical features:
 It occurs at any age
 It is common in gingiva followed by tongue, palate, buccal
mucosa and lips
 Asymtomatic.
 It appears usually small, raised, peduculated, papillary
lesion less than 1cm in diameter.

DD
 squamous papilloma
 irritation fibroma
 pyogenic granuloma

Treatment
 Surgical excision
 Recurrence is rare

Myxofibroma
 Some areas of Fibroma undergo myxomatous
degeneration
Clinical features:
 It is most commonly seen on palate, lip and gingiva.
 It is softer than fibroma and appears less pale.

Differential diagnosis:
 Plexiform neurofibroma – it is spongy and fluctuant.
Treatment :
 Complete excision

Peripheral Ossifying Fibroma
 Ossifyjng fibroid epulis
 Peripheral exophytic growths that exclusively occur in
interdental gingiva, which appears pale pink to cherry red.
 According to some, these develop from pyogenic granulomas
that undergo fibrous maturation and subsequent calcification.
 Predominently seen in young adults.
 Most common in female population.
 Most common in anterior region (Incisor – Cuspid region).www.indiandentalacademy.com

Peripheral ossifying fibromas

Radiographic features
 there is no apparent underlying bone involvement visible
on the radiographs.
 on rare ocassion, there may be superficial erosion of the
bone.

Treatment
 Surgical excision
 The mass should be excised down to periosteum as the
recurrence is more likely if the base of the lesion is
allowed to remain.

 Fibrous hyperplasia
 Peripheral giant cell granuloma

Central ossifying fibroma
 It is a central neoplasm of bone.
 There is considerable similarity and even overlap in the
histologic features of central cementifying fibroma.
 These two are separate benign tumors identical in nature
except for the cell undergoing proliferation.
 Osteoblasts in the case of ossifying fibroma and
cementoblasts in cementifying fibroma.

Clinical features:
 It occurs in any age but, more common in young adults
and females.
 Most common in the mandible.
 It is relatively slow growing tumor, asymptomatic until
the growth produces a noticeable swelling and mild
deformity.
 Displacement of teeth may be an early C/F.
 As it is slow growing the cortical plates of bone and
overlying mucosa or skin are invariably intact.

COF - Mandible

 The neoplasm presents extremely variable R/G appearance
depending upon its stage of development.
 The lesion is always well circumscribed and demarcated
from the surrounding bone.
 In early stages, COF paradoxically appears as a radiolucent
lesion.
 As the tumor bone apparently matures, there is increasing
calcification hence, radiolucent areas become flecked with
opacities.
 Ultimately the lesion appears as radiopaque mass

Treatment
 Conservative surgical excision.

 Fibrous dysplasia
 Other Fibro-osseous lesions at mixed stage.

Fibrous dysplasia
 Diffuse and rectangular.
 Blends with surrounding
normal bone.
 Jappears more fusiform.
 2nd to 3rd decade.
 more common in maxilla.
 Ground glass/ orange
peel/finger print/wispy
cotton.
COF
 Round and localized.
 Sharply defined margins
 Dome shaped and nodular.
 3rd to 5th decade.
 More common in mandible.
 Appears mottled with
mixed R/O & R/L.

Central giant cell granuloma
 It was first described by Jaffe in 1953.
 Jaffe believed that the jaw lesions were not true neoplasms
and represented a local reparative reaction.
 Because the clinical behavior of many of these lesions has
been inconsistent with a reparative process, the term
“reparative” has been omitted today.
 It is a Benign lesion that usually occurs in the Mandible
and the Maxilla.

WHO definition:
“An Intraosseous lesion consisting of cellular fibrous tissue containing
multiple foci of hemorrhage, aggregations of multinucleated giant cells
and occasionally trabeculae of woven bone.”
Classification:
 The central giant cell granuloma was classified as a True
Neoplasm and a reactive proliferate process at the same
time because of its Histologic features, dynamic Biologic
characteristics, and variable clinical patterns.
 Based on its clinical behavior, CGCG has been classified as
one of the following:
1 Nonaggressive.
2 Aggressive

clinical features:
 Age: Normally it appears before the age of 30.
 CGCG occurs most commonly in young adults and has a
female predilection
 The clinical behavior of CGCG can vary from benign to
rather aggressive.
 The clinical behavior of the lesion varies from an
asymptomatic osteolytic lesion that grows slowly without
expansion, to an aggressive, painful process accompanied by
root resorption, cortical bone destruction, and extension
into the soft tissues.

Site:
 In 72.2% of the Male patients with CGCG, the, lesion was
located in the mandible and in males 27.8% in the Maxilla.
 In 61.7% of the Female Patients, the lesions appeared in
the mandible.
 Occurs twice as often in the Mandible than in the Maxilla
and can be confined to the tooth-bearing areas of the jaws.

Nonaggressive type
characterized by
 a slow
 asymptomatic growth Non
perforating
 Rarely causing Root
resorption.
 low tendency to recur.
Aggressive type characterized
by
 Pain,
 Rapid Growth,
 Expansion
 Perforation of cortical bone,
 Radicular resorption.
 high tendency to reccur.
 destroys bone,
 resorbs teeth,
 displace anatomical structures:
Teeth,
Mandibular canal,
Floor of maxillary antrum.

Central giant cell granuloma

Radiographic Features :
 CGCGs were small Apical Lesions and Large
Multilocular Lesions with a diameter of more than 4 cm.
 It appears as Unilocular radiolucency as often as with a
Multilocular one ,the majority of CGCGs proved to be
unilocular (57.7%) and only 42.3% multilocular.
 Root resorption as a sign of local aggressive biologic
behavior was evident in 60% of the aggressive lesions,
which is more frequent than in other reports.

Treatment
 The traditional treatment of CGCG of the jaws has
been Surgical Excision either by curettage or en bloc
resection, depending on the following factors:
Aggressive versus Nonaggressive behavior,
location, size, and radiographic appearance.
 Therefore, the surgical approach is based on the
clinical and radiographic characteristics of each case.
 Other treatments have included radiation and
systemic injections of calcitonin.

CEOT Ossifying Fibroma
Ameloblastic Fibroma
Odontogenic myxoma

The following Protocol was used in
each patient:
1. Pretreatment Biopsy to establish the diagnosis.
2. Laboratory investigations of parathyroid hormone (PTH),
calcium, and phosphorus to rule out hyperparathyroidism.
Blood cell count and differential count were measured.
3. Intralesional injections of a solution of Kenacort-A
(10mg/mL, triamcinolone aqueous suspension )and
either Lidocaine 2% with epinephrine 1:200,000,
Marcaine, or Bupivacaine, 50% mixture by volume.
The solution was administered with a 5-cm disposable
syringe with a 1 in 22G needle in all the cases.

4. The average dosage of the aforementioned solution was 6
ml for adults, which is equivalent to 30 mg of
triamcinolone, and 5 ml for the pediatric patients,which is
equivalent to 25 mg of triamcinolone.
5. The solution was injected by clinically estimating the site
where the cortical bone was more expanded and therefore,
it was thinnest at that point. The bone was not trephinated.
Once inside the lesion, the needle was redirected to inject
small amounts into different areas.
6. The treatment was terminated when there was a significant
amount of resistance caused by the bone being formed and
calcified, thus avoiding the need for trephination.

Calcitonin Treatment:
 Calcitonin-subcutaneous injection-50 IU daily
continued over a year’s period
 Epinephrine-1:1 ratio-6 weeks, once weekly.
 Calcitonon inhibits the activity of multinucleated giant
cells in CGCG which possess specific osteoclast
characteristics of lacunar bone resorption.
 Calcitonon nasal spray 200u/spray once or twice daily
can also be used.

Giant cell tumor of bone
 Synonym : Osteoclastoma.
 It is a distinctive neoplasm of undifferentiated cells.
 Multinucleated giant cells apparently result from fusion of
the proliferating mononuclear cells.

Clinical features:
 It is more common in females and mostly occurs in 3rd
decade.
 Pain of variable severity is a predominant symptom.
 It occurs most commonly in long bones.
 Swelling , weakness, limitation of the joint and
pathologic fracture are common findings.

Treatment
 Removal of the tumor by curettage is the most widely
accepted therapy.
 Secondary malignant change is usually to pure
fibrosarcoma or osteosarcoma.

Lipoma
 Benign tumor of the fat tissue.
 Most common mesenchymal neoplasm, which occurs on the
trunk and proximal portions of the extremities.
 Lipomas in the oral & maxillofacial region are less frequent.
 Pathogenesis is uncertain, but more common in obese people.

Lipoma

Clinical features:
 Oral lipomas are usually soft, smooth-surfaced nodular
masses that can be sessile or pedunculated .
 A subtle or more obvious yellow hue often is detected
clinically, deeper lesions may appear pink.
 Buccal mucosa and buccal vestibule are most common sites
in the oral cavity.
 Tongue, floor of the mouth and lips are less common sites.
 Mostly they occur in middle age and rare in children.

Treatment
 Surgical excision.
 Intramuscular lipomas have a high recurrence rate because
of their infiltrative growth pattern but, this variant is rare
in the oral and maxillofacial region.

 Traumatic fibroma
 Mucocele
 Lymphangioma
 Neurofibroma

Myxoma
 This is a heterogenous group of soft tisssue tumors which
have H/A of abundant myxoid ground substance.
 Myxoid consists of muco-polysaccharides, mainly
hyaluronic acid.
 Stout described myxoma as a true neoplasm made up of
tissue resembling primitive mesenchyme.
 Tumor rarely infiltrates adjacent tissues.

Clinical features:
 Most soft tissue myxomas are deep seated lesions occurring
in the skin or the subcutaneous tissues, GI tract,
GU tract, Liver, Spleen, Parotid gland.
 It can occur at any age without sex predilection.
 Intra oral soft-tissue myxomas are extreme rare lesions.
 Some of the myxomas are nerve sheath myxoma arising
from perineural cells of peripheral nerves.
 Mostly occur in the oral cavity on the tongue buccal
mucosa and retromolar area.

Myxoma

Treatment
 Surgical treatment is necessary.
 Recurrence is common, but this is not of grave concern,
since the tumor does not metastasize.

Chondroma
 It is a benign central tumor composed of mature cartilage
 It is well recognized entity in certain areas of the bony
skeleton.
 It is uncommon in maxilla and mandible.
 Chondroma seldom develops in membrane bones,
particularly if no vestigial cartilaginous rests are present.
 As maxilla and mandible rarely contain such remnants
hence is uncommon.

Clinical features:
 This tumor can occur at any age with out any sex
predilection.
 They occur as a painless slowly progressive swelling of the
jaw.
 It causes loosening of the teeth.
 Overlying mucosa is rarely ulcerated.
 Anterior maxilla b/n central incisors and posterior
mandible, condylar or coronoid process are the most
common sites.
 These may occur peripherally but they come under
choristomas.

 Roentgenogram shows an irregular radiolucent or mottled
area in the bone.
 Chondroma is a destructive lesion and causes root
resorption of the teeth adjacent to it.

Treatment
 Surgical excision as the tumor is radio-resistant.
 The tumor is of considerable clinical importance as it has
more propensity to undergo malignancy.

Osteoma
 Benign neoplasm characterized by a proliferation of either
compact or cancellous bone, usually in the endosteal or
periosteal location.

Clinical features:
 It is an uncommon lesion in the oral cavity.
 It can occur at any age mostly in young adults.
 The tumor of periosteal origin manifests itself as a
circumscribed swelling of the jaw.
 It is a slow growing tumor.
 The tumor of endosteal origin is slower topresent clinical
manifestations, since considerable growth must occur
before there is expansion of the cortical plates.
 Multiple osteomas of the jaws as well as long bones and
skull are characteristic manifestations of Gardner’s
syndrome.
 Rarely, pain is associated with this tumor.

 The central lesion usually appears with in the jaw as a well-
circumscribed radiopaque mass.
 Sometimes., this may be diffuse,then it must be
differentiated from chronic sclerosing osteomyelitis.
 Periosteal form of the disease is manifested as a sclerotic
mass.

Treatment
 Surgical excision if the tumor if it is causing difficulty or
if a prosthetic appliance is to be constructed, particularly
when the tumor lies close to the surface of the alveolar
bone.
 Recurrence is extremely rare.

Benign tumors of Nerve tissue origin
 Neurofibroma
 Neurilemmoma
 MEN syndrome

Neurilemmoma
 Synonym : Schwannoma
 It is a benign neural neoplasm of schwann cell origin.
 It is relatively uncommon, although 25-48% cases occur in
head and neck region.

Neurilemoma in the floor of the
mouth

Clinical and radiographic features:
 It is a slow-growing, encapsulated tumor that typically
arises in association with a nerve trunk.
 As it grows it pushes the nerve aside.
 Lesion is more common in young and middle aged adults.
 Tongue is most common location for oral neurilemomas.
 Rarerly, tumor arises centrally with in bone and may
produce bony expansion.
 Pain and paresthesia are usual for intrabony tumors.

Treatment :
 Surgical excision.
 Recurrence and malignant transformation is extremely rare.

Neurofibroma
 It is a most common type of peripheral nerve neoplasm.
 It arises from a mixture of cell types, including schwann
cells and perineural fibroblasts.

Clinical and radiographic features:
 They arise as solitary tumors or be a component of
neurofibromatosis.
 Most common in young adults.
 They present as solitary, slow- growing, soft, painless lesions
which vary in size from small nodules to larger masses.
 Skin is the most frequent location.
 Intraorally tongue and buccal mucosa are the most common
sites.
 Rarely, tumor arise centrally within bone.

Neurofibroma in the ventral surface
of the tongue

Treatment
 Local surgical excision.
 Malignant transformation of solitary neurofibromas can
occur.

 Traumatic fibroma
 Neurilemoma
 Traumatic neuroma
 Amyloidosis

MEN syndrome
 Multiple endocrine neoplasia syndrome.
 It is characterised by tumors of neuroendocrine origin.
 Synonym : MEN III or multiple mucosal neuroma
syndrome.
 It was initially described by Wagemann in 1922.

 The disease is associated with -
1.Adrenal pheochromocytoma
2.Medullary thyroid carcinomas
3.Diffuse alimentary tract ganglioneuromatosis
4.Multiple small submucosal neuroma nodules of the upper
aerodigestive tract.
 The affected individual has a tall, lanky, marfanoid body type,
with a narrow face with muscle wasting.
 Adrenal and thyroid tumors do not present until puberty.
 MEN syndromes are caused by mutations of the RET proto-
oncogene, an imporatant regulator of neural crest
development and the receptor of gliadelivered neurotrophic
factor (GNAD)

Clinical features:
 The oral mucosal neuroma of this disease presents as a 2-7
mm yellowish white, sessile, painless nodule of the lips,
anterior tongue and buccal commissures.
 Usually there are 2-8 neuromas with deeper lesions having
normal coloration.
 More neuromas in the lips and produce enlargement –
“Bumpy lip” appearance.
 Similar nodules are seen on the eyelids, producing eversion
of the lid and also on sclera.

Lab – investigations
 When a medullary thyroid carcinoma is present, serum
and urinary calcitonin levels are elevated.
 When a pheochromocytoma is present theremay be
increase in the serum levels of vanillylmandelic acid
(VMA) and altered epinephrine/nor-epinephrine ratios.

Treatment
 Mucosal neuromas are asymptomatic and self-limiting.
 Surgical excision can be done for aesthetic purposes.
 Other family members should be evaluated for MEN –III.

Benign tumors of Muscle tissue
origin
 Leiomyoma
 Rhabdomyoma

Leiomyoma
 Leiomyomas are benign tumors of the smooth muscle that
most commonly occur in the uterus, G.I.tract and skin.
 Leiomyomas of the oral cavity are rare, most of these
probably have their origin from smooth muscle. The three
types are:
1. Solid leiomyomas
2. Vascular leiomyomas
3. Epithelioid leiomyomas
 Almost all the oral tumors are either solid or vascular in
type.

Clinical & Radiographic features:
 It can occur at any age and is usually a slow growing firm
mucosal nodule.
 Solid type are typically normal in colour and angiomyomas
may exhibit a blue hue.
 Most common sites are lips, tongue, palate and cheek which
together account for 80% of cases.

Treatment
 Local surgical excision

Rhabdomyoma
 Benign neoplasms of skeletal muscle are called
“Rhabdomyomas”.
 Rhabdomyomas of head and neck can be divided in to
two categories:
1.Adult type
2. Fetal type

Adult 1.Adult typehabdomyo
- Most common in males and middle aged people.
- Most common sites are floor of the mouth, soft palate and
ventral surface of the tongue.
- Tumor appears as a nodular mass.
- Laryngeal and pharyngeal tumors often lead to airway
obstruction.
Fetal 2. Fetal typerhabdomyo
- Usually occur in young children.
- Most common locations are face and pre-auricular region.

Treatment
 Both the variants are treated by surgical excision.

Benign tumors of salivary glands
 Pleomorphic adenoma
 Basal cell adenoma
 Warthin’s tumor
 Oncocytoma
 Canalicular adenoma
 Ductal papilloma

Pleomorphic adenoma
 Synonym : Benign Mixed tumor
 Most common salivary neoplasm.mino
 It is derived from a mixture of ductal and myoepithelial
elements.
 Both the terms pleomorphic adenoma and mixed tumor
used to describe the unusual histopathologic features.but
neither term is entirely accurate.

Pleomorphic adenoma

Clinical features:
 It appears as a painless, slow growing, firm mass.
 It is more common in females and occurs b/n 3rd and 5th
decade.
 Most tumors of the parotid occur in the superficial lobe and
present as a swelling overlying the mandibular ramus infront
of the ear.
 Facial palsy and pain are rare.
 Initially the tumor is movable but becomes less mobile as it
grows larger. If neglected the lesion can grow to large
proportions.
 About 10% of parotid mixed tumors occur within the deep
lobe of the gland beneath the facial nerve.
 Sometimes, these lesions grow in medial direction b/n the
ascending ramus and stylo-mandibular ligament, resulting in a
dumbbell shaped tumor that appears as a mass of the lateral
pharyngeal wall or soft palate. www.indiandentalacademy.com

 Tumors of the hard palate usually are excised down to the
periosteum, including the overlying mucosa.
 The palate is the most common site for minor gland mixed
tumors, accounting for 60% of the intraoral examples.
 This is followed by the upper lip (20%) and buccal mucosa
(10%).
 Palatal tumors always occur on the posterolateral aspect of
the palate, presenting as smooth surfaced, dome –shaped
masses.
 If the tumor is traumatized, secondary ulceration may
occur.

Treatment and Prognosis
 These tumors are best treated by surgical excision.
 For lesions in the superficial lobe of the parotid gland,
Superficial Parotidectomy with Identification and
preservation of the facial nerve is recommended.
 For lesions in the deep lobe of the parotid, total
Parotidectomy is usually necessary, also with the
preservation of the facial nerve.
 Submandibular tumors are best treated by total removal of
the gland with the tumor.

 With adequate surgery, the prognosis is excellent, with a
cure rate of more than 95%.
 The risk of recurrence is less for tumors of minor glands.
 Conservative enucleation of parotid tumors often results in
recurrence, with management of these lesions made
difficult as a result of multifocal seeding of the primary
tumor bed.
 Malignant degeneration is a potential complication,
resulting in carcinoma.
 The risk of malignant transformation is probably small
around 5% of all cases.

Oncocytoma
 Synonym: Oxyphilic adenoma.
 It is a benign salivary gland tumor composed of large
epithelial cells known as “Oncocytes”.
 It is a rare salivary neoplasm, representing approximately
1% of all salivary gland tumors.

Clinical features:
 The oncocytoma is predominently a tumor of older adults,
with apeak prevalence in the eight decade of life.
 It is more common in female population.
 85% to 90% occur in major salivary glands especially the
parotid gland.
 The tumor appears as a firm, slowly growing, painless
mass that rarely exceeds 4 cm in diameter.
 Parotid oncocytomas occur in the superficial lobe and are
clinically indistinguishable from other benign tumors.

Treatment and prognosis
 These are best treated by surgical excision.
 In the parotid gland, this usually entails partial
parotidectomy.
 Submandibular tumors are best treated by total removal of
the gland with the tumor.
 Tumors of minor salivary glands should be removed with a
small margin of normal surrounding tissue.
 The prognosis after removal is good, with low rate of
recurrence.

Warthin’s tumor
 Synonym: Papillary cyst adenoma lymphomatosum.
 It is a benign neoplasm that occurs almost exclusively in the
parotid gland.
 It represents the second most common benign parotid
tumor, accounting for 5% to 14% of all parotid neoplasms.
 A traditional hypothesis suggests that they arise from
heterotopic salivary gland tissue found within the parotid
lymphnodes
 Studies have demonstrated that strong association between
the development of this tumor and smoking.

 Smokers have a eightfold greater risk for Warthin tumor
than do Non-smokers.
 Epstein-barr virus also have been implicated in the
pathogenesis of Warthin tumor.

Clinical features:
 It usually appears as a slowly growing painless, nodular
mass of the parotid gland
 It may be firm or fluctuant on palpation.
 The tumor most frequently occurs in the tail of the parotid
near the angle of the mandible.
 In 5% to 14% of cases it occurs bilaterally – unique feature
of Warthin’s tumor.
 These bilateral tumors occur at different times.
 In rare instances, warthin’s tumor occur with in the
submadibular gland and minor salivary glands
 It occurs most commonly in adults, with a peak prevalence
in the 6th and 7th decades of life.

 Surgical removal is the treatment of choice .
 Recurrence rate is around 6% to 12%.
 Malignant transformation is very rare.

Canalicular adenoma
 It is an uncommon tumor that occurs almost exclusively in
the minor salivary glands.
 It comes under Monomorphic adenoma as it has uniform
microscopic structure.

Clinical features:
 It has striking predilection for the upper lip, with nearly
75% occuring in this location.
 It is the second most common tumor of the upper lip and
rarely occurs in the buccal mucosa.
 Occurs in older females with peak prevalence in the 7th
decade of life.
 It appears as a slowly growing, painless mass.
 It may be firm or fluctuant on palpation.
 The overlying mucosa appears bluish and can be mistaken
for mucocele.

Canalicular adenoma

Treatment & Prognosis
 It is treated by local surgical excision.
 Recurrence is uncommon.

Basal cell adenoma
 Benign salivary tumor that derives its name from the
basaloid appearance of the tumor cells.
 It is a rare neoplasm that represents only 1% to 2% of all
salivary tumors.

Clinical features:
 It is primarily a tumor of parotid gland with around 75% of all
cases.
 Minor salivary glands represent the second most common site,
specifically the glands of upper lip and buccal mucosa.
 Most common in older females around 7th decade.
 It appears as slowly growing, freely movable mass similar to
pleomorphic adenoma.

 Complete surgical excision
 Recurrence is rare
 Malignant counter part of this tumor is basal cell
adenocarcinoma.

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