Transcript
CLASSIFICATION OF PAROTID GLAND
TUMOURSPLEOMORPHIC ADENOMA
ANATOMYPara- around
otis-ear
Largest salivary gland
Parts – superficial (80%) , deep (20%)
Duct – Stensen’s
HISTOLOGY
FACIAL NERVE
FACIOVENOUS PLANE OF PATEY
BLOOD SUPPLY: External carotid artery
VENOUS DRAINAGE : External jugular vein
LYMPHATIC DRAINAGE : Deep cervical nodes
CLASSIFICATION OF PAROTID GLAND TUMOURS
EPITHELIAL( 90%)
NONEPITHELIAL HemangiomaLymphangiomaNeurofibroma
• MALIGNANT LYMPHOMA – NHL TYPE
EPITHELIAL (90%)BENIGN (ADENOMAS)
Pleomorphic adenomaMonomorphic adenoma
Warthin’s tumour (adenolymhoma)Oncocytoma ( oxyphil adenoma )Basal cell adenoma
EPITHELIAL ( 90% )MALIGNANT
LOW GRADE Acinic cell
carcinomaAdenoid cystic
carcinomaLow grade
mucoepidermoid carcinoma
• HIGH GRADE• Adenocarcinoma
•Squamous cell carcinoma
•High grade mucoepidermoid carcinoma
CASEA 45 yr old femaleC/0 – slow growing, painless
swelling below the left side of ear for the past 5 months
O/e – 5x3 cm,oval, lifting the ear lobule
No localised warmth, not tender Surface-smooth, Margins- well
defined. Retromand groove oblit. Variable consistency. Mobile Not adherent to skin, masseter
muscle No signs suggestive of facial N inv Examination of oral cavity is
normal
FNAC : shows ductal cells, chondromyxoid matrix and myoepithelial cells
DIAGNOSIS : PLEOMORPHIC ADENOMA
PLEOMORPHIC ADENOMAMIXED TUMOUR
SITE : MC: PAROTID GLAND ( 90%)- MC –Tail of gland
Submandibular gland (7%) Minor salivary glands-MC : Palate
Occurs more commonly in females (3:1) AGE : any age . MC : 40-50yrs Usually unilateral
PATHOLOGYBENIGN TUMORTumor capsule-well formed, but incompleteTiny excrescences (pseudopods) project
outside.Give rise to recurrences.
GROSS :CUT SECTION:
MICROSCOPIC APPEARANCE2 groups of cells :Well differentiated
epithelial cells-acini/cords/sheets
Spindle/stellate cells Abundant intercellular
mucoid material-resembles cartilage
Pleomorphic stromaNo necrosisRarity of mitotic figures
CLINICAL FEATURES Painless slow growing swellingIn the parotid both lobes involved. If only deep
lobe involved – DUMB BELL TUMOURDysphagia if deep lobe is involvedDeviation of uvula&pharyngeal wall towards
midline-deepDeep lobe swelling passes through PATEY’S STYLOMANDIBULAR TUNNELRaised ear lobuleCannot be moved abv zygomatic bone-CURTAIN
SIGNFACIAL NERVE NOT INVOLVED
INVESTIGATIONFNAC – IMPORTANT AND DIAGNOSTIC
OPEN BIOPSY – CONTRAINDICATEDDUE TO : chance of injury to facial nerve,seedling & high chance of recurrence,Parotid fistula formation
CT SCAN
MRI
MANAGEMENTTumor is RADIO RESISTANTSURGERY :ENUCLEATION –avoided. High recurrence.
TOC : SUPERFICIAL PAROTIDECTOMY – PATEY’S OPERATION( if supf lobe alone involved)
TOTAL CONSERVATIVE PAROTIDECTOMY (If both lobes involved)
FACIAL NERVE IS PRESERVED
COMPLICATIONS
RECURRENCE ( 1 – 5 %)
MALIGNANCY3-5 % IN EARLY TUMORS10% IN LONG DURATION( >15
YRS)
RECURRENCE AFTER SURGERYDUE TO : SpillageInadequate marginRetained pseudopodsMulticentricityImproper technique
Recurrent tumor is multinodular without capsule
Marker to predict recurrence : MUC1/DF3
CARCINOMA IN EX PLEOMORPHIC ADENOMALong standing Pl.adenoma-malignant
transformationRecent increase in sizePain , nodularityInvolvement of skin, ulcerationInvolvement of masseterInvolvement of facial nerveNeck lymph nodeRestriction of jaw movements
TAKE HOME MESSAGEMOST COMMON TUMOUR OF PAROTID
FACIAL NERVE IS NOT INVOLVED
TOC : SUPERFICIAL PAROTIDECTOMY
FACIAL NERVE IS PRESERVED.
CARCINOMA IN EX PLEOMORPHIC ADENOMA.
THANK YOU
FOR
LISTENIN
G
PATIENTLY
-AISHWARYA. G
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