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Salivary Gland Tumors PowerPoint Presentation

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Description : Check out this medical presentation on cancer titled "Salivary Gland Tumors" to know about the salivary gland tumors, how to diagnose those, the natural course of the disease, what treatment to offer in the disease, its prognosis and its limitations.

Tags : Cancer, Salivary Gland, Pathology, structural elements, staging, pleomorphic adenomas, oncocytic tumors, acinous cell tumors, Mucoepidermoid tumors, squamous cell carcinomas, Pleomorphic Adenoma, Warthins Tumor, Monomorphic Adenoma, Basal Cell Adenoma, Malignant Salivary Gland Tumors, Mucoepidermoid Carcinoma, Adenoid Cystic Carcinoma, Acinic Cell Carcinoma, Hodgkins Lymphoma,

Published on : May 05, 2021 | Views : 3798 | Downloads : 5

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Slide 1-

1 Salivary Gland Tumors Professor Ravi Kant MS, FRCS (Edin), FRCS (Glasg), FRCS (Ireland), DNB, FACS, FICS, FAIS, FAMS
Slide 2-

2 Objectives Setting : CME Audience : PG Time duration : 20 minutes Evidence based
Slide 3-

3 Objectives Why How to diagnose The Natural Course of disease What treatment to offer Prognosis Limitations
Slide 4-

4 Etiology-1 Epstein - Barr Virus Childhood Irradiation Nutritional deficiencies UV Exposure Genetic
Slide 5-

5 Etiology-2 Wood & silica dust exposure Kerosene users HIV-BLL Benign Lymphoepithelial lesion HIV-NHL, Kaposi’s, Ad Cy, Protection: dark yellow vegetables & liver
Slide 6-

6 Familial occurrence of acinic cell carcinoma of the parotid gland. 13: Arch Pathol Lab Med 1999 Nov;123(11):1118-20 Depowski PL, USA.
Slide 7-

7 Epstein-Barr virus infection in salivary gland tumors in children and young adults. Cancer 2000 Jul 15;89(2):463-6 Venkateswaran L, Department of Hematology-Oncology, St. Jude Children's Research Hospital,Memphis, Tennessee, USA.
Slide 8-

8 Signs of malignancy-1 Painless mass Nerve involvement Dysphagia Skin ulceration Sudden increase in size
Slide 9-

9 Signs of malignancy-2 Symptoms of surrounding structure involvement Mild intermittent pain Numbness- mucosal, tongue, 7 n, 9,10,11,12 cranial nerve
Slide 10-

10 DD-deep lobe Oral neoplasm (+/- fat plane on CT or MR) Parapharyngeal neoplasm Lymphoma Neurogenic tumor Paraganglioma
Slide 11-

11 Investigations FNAC >90% specificity, sensitivity MR =ideal for deep lobe MR Angio CT-3D sialography 99 m Tc scan for Warthin’s, Oncocytoma, Acinic, Adeno
Slide 12-

12 Investigations SPECT / FDG PET for No Neck ICA + balloon occlusion test+XeCT Frozen section biopsy 95%√ Perineural invasion LN mets Surgical margins Type of CA or benign 67%√
Slide 13-

13 MR>CT Tumor-salivary gland interface Benign Vs malignant 7 n or Perineural evaluation Intracranial extension of tumor DD; Parapharyngeal tumors DD; Neurogenic tumors
Slide 14-

14 MR>CT : Perineural spread Replacement of normal perineural fat with tumor Enhancement with gadolinium Increased size of nerve Bony erosion Sclerotic margins Widening of crania base channels
Slide 15-

15 CT>MR for bone erosion CE-CT is better than non CE Base of skull involvement Mandible erosion
Slide 16-

16 New strategy for the diagnosis of parotid gland lesions utilizing 3D sialography. Comput Aided Surg 2000;5(1):42-5 Kosaka M, Kamiishi H, Japan.
Slide 17-

17 3D sialography:advantages-1 (1) The structure of the acinar surface is visualized in detail. (2) The 3D structure of the entire parotid system from Stensen's duct to the gland is shown in one image.
Slide 18-

18 3D sialography:advantages-2 (3)The parotid gland can be assessed in the context of the bony architecture of facial bones. (4) The surface structure of the parotid gland can be understood very easily, like a scanning electron micrograph.
Slide 19-

19 BLL Sjogren’s Mikulicz HIV asso. Malignancy = K,NHL,AC Observe as benign Low dose RT Parotidectomy as assoc malignancy
Slide 20-

20 Warthin’s = Papillary cyst Adenolymphoma Benign Kerala coast Favour tail of parotid 10% bilateral Hot on isotope scan Older man, bilateral, left alone
Slide 21-

21 Pleomorphic – components Myxoid Mucoid Chondroid Epithelial Other
Slide 22-

22 Proliferative activity in recurrent pleomorphic adenoma MIB1 antibody against the cell proliferation associated nuclear antigen (Ki-67 antigen). The proliferation index (MIB1 positive cells per 100 cells)
Slide 23-

23 Proliferative activity in recurrent pleomorphic adenoma Epithelial differentiation as a possible origin for recurrence. Bankamp DG : Laryngorhinootologie 1999 Feb;78(2):77-80
Slide 24-

24 Proliferative activity in recurrent pleomorphic adenoma Tongue like projections, Pseudocapsule 7 n palsy Skull base involvement Locally invasive Recurrence even multiple
Slide 25-

25 Pleomorphic adenoma Malignant transformation Locally dangerous No enucleation, only Wide margin of tissue = Superficial parotidectomy
Slide 26-

26 Pleomorphic adenoma & Adjuvant RT Spill Residual Recurrent, Nerve encasing Deep lobe involvement Rx→Postoperative Radiotherapy
Slide 27-

27 T T1 <2 cm T2 >2-4 cm T3 >4-6 cm T4 >6 cm
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28 N No N1 <3 cm,ipsilateral single N2 A >3-6 cm,ipsilateral single B <6cm,ipsilateral multiple C <6cm, bilateral N3 >6 cm
Slide 29-

29 LN Preauricular- Squamous Melanoma Not parotid Intraparotid
Slide 30-

30 M Mo -distant mets M1 +distant mets
Slide 31-

31 M Lung 40% Adenoid Cystic 30% Malignant Mixed Also with Acinic cell SM:P::2:1 Lung mets In AdCy can live up to 20 years
Slide 32-

32 Mode of Spread Expansion Local infiltration Lymphatics Perineural infiltration Seedling in the tumor and skin
Slide 33-

33 Probability of cancer
Slide 34-

34 HP & Site : %
Slide 35-

35 HP & Site : %
Slide 36-

36 Acinic-1 16% of Parotid of all acinic; 81% in Parotid 3% of all salivary 5th decade Bilateral More in Females
Slide 37-

37 Acinic-2 Types- four types 1. Solid, 2. Microcytic, 3. Papillary-cystic, & 4. follicular Papillary cystic 100% mortality Solid has equally worse prognosis Node +, Nerve+, Margin +,T3-T4 = poor prognosis
Slide 38-

38 Acinic-3 5,10,15 yr survival in %= 100,87,65 Local recurrence 15% Distant Mets 10% Facial palsy 0-8% Regional N0-16% Adjuvant RT in T3,T4, N+ Improper Rx = recurrence rate 75%, N+ 25%
Slide 39-

39 Adenoid Cystic-1 Billroth 1854 Cylindroma Minor 31%, Submand 41% Perineural invasion in 80%, ↑ if >1cm Types: Tubular, Cribriform and Solid Solid has worst prognosis, High grade or low grade 10 yr survival in high grade is 0%
Slide 40-

40 Adenoid Cystic-2 Prognosis- T, Bone invasion, Nerve+, Grade,DNA ploidy, best with tubular LN+ is rare <8%, lethal 6% @10 yr No role of elective neck dissection Site 10 yr survival = 29% parotid, 7% paranasal
Slide 41-

41 Adenoid Cystic-3 Adj RT for local control as recurrence 37% No solution to distal mets 40%, up to 20 years Mets to lung 63%, Bone & liver Survival @ 5y =69%, @ 20y=22% even in favorable grade 1/3 free,1/3 dead,1/3 recurrence
Slide 42-

42 Muco epidermoid Gr 1 Well differentiated Gr 2 Moderate Gr 3 Poorly Grade Low or High Death in 5y LGME 6%, HGME 65% Agnor count ά prognosis
Slide 43-

43 Malignant mixed-1 4% = CA Ex pleomorphic =epithelial Risk 1.5% <5y long, 9.5% after 15 y Risk 7% with recurrent Pleomorphic Risk if 20y long, >2cm, age, deep lobe, solitary nodule, previous surg de-novo = carcinosarcoma, 5y =0% S
Slide 44-

44 Malignant mixed-2 < 8mm invasion, 5y survival = 100% > 8mm invasion, 5y survival =<50% Survival 5y=40%,10y=24,15y=19% Regional mets 25%;Distant mets 33% Types:1. CA ex pleo;2. CASA, 3.Metastasizing mixed, 4. Non-invasive
Slide 45-

45 Large Tumors: General Principle: Failure at distant site Role of Postoperative RT Avoid Marked mutilation & Physiological compromise Lung mets not preclude rx of primary
Slide 46-

46 Rx Superficial / Total parotidectomy Save 7th Nerve, if not directly involved ? 56% recurrence even if nerve excised Submandibular triangle resection
Slide 47-

47 LN %
Slide 48-

48 LN % in Clinical No
Slide 49-

49 LN %in Clinical No
Slide 50-

50 LN % in Clinical No
Slide 51-

51 SOHD of Neck- Indications T4 20% vs 4% T3 16% vs 4% High grade ME 49% vs 7% Epidermoid 41% vs 7% Skip 25% L3+ or 4 + but L2- Submandibular 21% vs 9% in P
Slide 52-

52 VII nerve Neuropraxia up to 6 months Interposition of Great auricular Sural
Slide 53-

53 VII nerve Fascia lata sling Muscle transfer Lateral tarsorrhaphy
Slide 54-

54 Adjuvant RT in high grade, LN+, Stage III or IV
Slide 55-

55 Indication for Adjuvant RT-1 In benign Spill Residual Recurrent, Nerve encasing Deep lobe involvement After excision of residual tumor
Slide 56-

56 Indication for Adjuvant RT In malignant Recurrent Residual, positive margin, Narrow margin on facial nerve Multiple nodal involvement Perineural invasion High grade locally aggressive
Slide 57-

57 Indication for adjuvant RT-3 All submandibular tumors -except T1,T2, Acinic or LGME All adenoid cystic tumors All T3, T4, All N+
Slide 58-

58 Adjuvant RT Wedged photon pair Mixed plan= Ipsilateral photon + Electron beam Fast Neutron therapy Brachy therapy
Slide 59-

59 Adjuvant RT: Choice is Fast neutron therapy 67% Vs 26% rr with photon or electron. 2 yr survival 55% vs 13% Therapy of choice in inoperable, recurrent, or residual More toxic Failure due to distant mets 20% vs. loco regional failure in photon
Slide 60-

60 Survival % : 5year
Slide 61-

61 Histology: Survival %
Slide 62-

62 Summary P/E = Mucosal numbness FNAC + MR + 3D CT No role of enucleation in benign- Minimum is supf parotidectomy RND in HGME,T3,T4, AdCy,S Role of Adjuvant RT – yes Fast neutron is best. Chemo ???? As distant mets in 20%
Slide 63-

63 Future Brachy therapy Better than Fast Neutron therapy Reliable tumor marker Newer Imaging modalities SPECT for No ??? Role of any chemo for Rx of distant mets