Salivary Gland Tumors, Major, Benign Workup

  • Author: Fadi Chahin, MD; Chief Editor: John Geibel, MD, DSc, MA   more...
 
Updated: Dec 1, 2011
 

Laboratory Studies

Perform a WBC count to investigate for any evidence of leukocytosis and shift that might indicate a possible infectious process or lymphoproliferative disease.

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Imaging Studies

Imaging studies are most helpful in the diagnostic evaluation.[1] MRI is the most sensitive test for establishing the borders of soft tissue tumor extension. CT scan and MRI findings, in most circumstances, cannot be used to differentiate benign from malignant disease reliably. Note the images below.

Dense, small, solid lesions in the parotid glands Dense, small, solid lesions in the parotid glands (more on the left side than on the right) in a patient with lymphoma. This is representative of lymphomatous involvement of the glands. Ill-defined masses in the parotid glands bilateralIll-defined masses in the parotid glands bilaterally, proven to be large B-cell lymphoma in this patient with known Sjögren disease. Large B-cell lymphoma in a patient with known SjögLarge B-cell lymphoma in a patient with known Sjögren disease. Large B-cell lymphoma in a patient with known SjögLarge B-cell lymphoma in a patient with known Sjögren disease. Bilateral, solid, inhomogeneous parotid gland massBilateral, solid, inhomogeneous parotid gland masses that are larger on the left side than on the right, with minimal necrosis. These were caused by lymphoma.
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Diagnostic Procedures

FNA may aid in the diagnosis of SGTs. The availability of an experienced cytologist is a prerequisite in this case. FNA can be helpful in identifying nonneoplastic masses that respond to medication and in identifying lymphomas and metastatic masses. FNA findings provide evidence for a preoperative diagnosis that is 70-80% accurate. The final pathologic diagnosis is always established based on findings from surgical excision.

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Histologic Findings

See Clinical.

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Contributor Information and Disclosures
Author

Fadi Chahin, MD  Aesthetic and Reconstructive Surgery, Private Practice

Fadi Chahin, MD is a member of the following medical societies: American College of Surgeons, American Society of Plastic and Reconstructive Surgery, and American Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Matthew R Kaufman, MD, FACS  Partner, The Institute for Advanced Reconstruction at the Plastic Surgery Center

Matthew R Kaufman, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Society of Plastic Surgeons, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Thabet Abbarah, MD, FACS  Consulting Staff, Department of Otolaryngology, North Oakland Medical Centers

Thabet Abbarah, MD, FACS is a member of the following medical societies: American College of Surgeons

Disclosure: Nothing to disclose.

Chadi Chahin, MD  Consulting Staff in Vascular and Interventional Radiology, Glendale Adventist Medical Center

Chadi Chahin, MD is a member of the following medical societies: American College of Radiology and Society of Interventional Radiology

Disclosure: Nothing to disclose.

Specialty Editor Board

Sanjiv S Agarwala, MD  Chief of Oncology and Hematology, St Luke's Cancer Center, St Luke's Hospital and Health Network; Professor, Temple University Shool of Medicine

Sanjiv S Agarwala, MD is a member of the following medical societies: American Association for Cancer Research, American Society for Head and Neck Surgery, American Society of Clinical Oncology, Eastern Cooperative Oncology Group, and European Society for Medical Oncology

Disclosure: BMS Honoraria Speaking and teaching; Novartis Consulting fee Consulting; Merck Consulting fee Consulting

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

David L Morris, MD, PhD, FRACS  Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia

David L Morris, MD, PhD, FRACS is a member of the following medical societies: British Society of Gastroenterology

Disclosure: RFA Medical None Director; MRC Biotec None Director

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA  Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital

John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract

Disclosure: AMGEN Royalty Consulting; ARdelyx Ownership interest Board membership

References

  1. Dumitriu D, Dudea S, Botar-Jid C, Baciut M, Baciut G. Real-time sonoelastography of major salivary gland tumors. AJR Am J Roentgenol. Nov 2011;197(5):W924-30. [Medline].

  2. Cho HW, Kim J, Choi J, Choi HS, Kim ES, Kim SH, et al. Sonographically guided fine-needle aspiration biopsy of major salivary gland masses: a review of 245 cases. AJR Am J Roentgenol. May 2011;196(5):1160-3. [Medline].

  3. Beahrs OH, Adson MA. The surgical anatomy and technic of parotidectomy. Am J Surg. Jun 1958;95(6):885-96. [Medline].

  4. Przewozny T, Stodulski D, Stankiewicz C. Major salivary gland disorders in children and adolescents. Otolaryngol Pol. Sep 2011;65(5):350-356. [Medline].

  5. Buxton RW, Maxwell JH, French AJ. Surgical treatment of epithelial tumors of the parotid gland. Surg Gynecol Obstet. Oct 1953;97(4):401-16. [Medline].

  6. Conley J, Arena S. Parotid gland as a focus of metastasis. Arch Surg. 1963;87:69.

  7. Eneroth CM, Franzen S, Zajicek J. Aspiration biopsy of salivary gland tumors. A critical review of 910 biopsies. Acta Cytol. Nov-Dec 1967;11(6):470-2. [Medline].

  8. Chalian A, Weber RS. Salivary gland tumors. In: Winchester DP, Daly JM, Jones RS, Murhpy GP, eds. Cancer Surgery for the General Surgeon. Philadelphia, Pa: Lippincott-Raven; 1999:89-98.

  9. Cross DL, Gansler TS, Morris RC. Fine needle aspiration and frozen section of salivary gland lesions. South Med J. Mar 1990;83(3):283-6. [Medline].

  10. Granick MS, Solomon MP, Hanna DC. Management of benign and malignant salivary gland tumors. In: Georgiade GS, Riefkohl R, Levin LS, eds. Georgaide Plastic, Maxillofacial, and Reconstructive Surgery. 3rd ed. Baltimore, Md: Williams & Wilkins; 1997:155-65.

  11. Hanna EY, Suen JY. Neoplasms of the salivary glands. In: Cummings CW, Fredrickson JM, Harker LA, et al, eds. Otolaryngology: Head and Neck Surgery. Vol 2. 3rd ed. St. Louis, Mo: Mosby; 1998:1255-98.

  12. Nythus L, Lloyd M, Baker R, eds. Anatomy of the parotid gland, submandibular triangle, and the floor of the mouth. In: Mastery of Surgery. 3rd ed. Boston: Little Brown; 1997:293-312.

  13. Seifert G, Sobin LH. The World Health Organization's Histological Classification of Salivary Gland Tumors. A commentary on the second edition. Cancer. Jul 15 1992;70(2):379-85. [Medline].

  14. Sismanis A, Merriam JM, Kline TS, et al. Diagnosis of salivary gland tumors by fine needle aspiration biopsy. Head Neck Surg. Jul-Aug 1981;3(6):482-9. [Medline].

  15. Spiro RH. Salivary neoplasms: overview of a 35-year experience with 2,807 patients. Head Neck Surg. Jan-Feb 1986;8(3):177-84. [Medline].

  16. Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Salivary gland tumors. In: Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 16th ed. Philadelphia, Pa: WB Saunders; 2001:547-52.

 
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Histology of the salivary gland unit.
Coronal MRI demonstrating benign tumor of the parapharyngeal space.
Facial nerves. Note the network between the zygomatic branch and the buccal branch.
Facial nerve branches.
Exposed facial nerve branches after superficial parotidectomy.
Right submandibular benign salivary gland tumor in a 42-year-old woman.
Pictures before and after treatment for a benign mandibular gland tumor. Specimen picture of the gland.
Facial nerves. Note the variations in the nerve sizes and the change of take-off locations of the branches.
Facial nerves. Note the 2 main trunks, frontozygomatic and cervical-marginal-mandibular.
The right parotid gland is slightly larger than the left-side normal variation.
Prominent bilateral parotid glands with homogenous parenchyma normal variation.
Normal right submandibular sialogram.
Normal CT scan after right submandibular sialogram.
Normal CT scan after right submandibular sialogram.
In this patient with a history of parotitis, note the 7-mm lobulated calcification anteriorly within the superficial right parotid gland with focally dilated ducts. Dystrophic calcifications due to remote inflammatory disease are also present bilaterally in the tonsillar fossa.
Note the 12-mm right parotid, smoothly marginated, multilobulated, solid lesion, without focal calcification or necrosis. This was proven to be pleomorphic adenoma.
Note the 2 X 1.5-cm uniformly enhancing, smoothly marginated mass in the superficial right parotid gland without necrosis or calcification, which is consistent with an epithelial neoplasm such as pleomorphic adenoma.
Coronal image of a patient with a history of parotitis.
Heterogeneous, predominantly low-density mass in the tail of the right parotid gland with minimal thin peripheral enhancement consistent with a Warthin tumor.
In this patient with infectious sialoadenitis, note the inhomogeneous, enlarged left submandibular gland with mild thickening of the adjacent platysma.
After radiation treatment of right parotid sialoadenitis.
After radiation treatment of right sialoadenitis.
Nodular and cystic changes in both parotid glands. These changes are stable in this patient with a history of chronic sialoadenitis.
Dense, small, solid lesions in the parotid glands (more on the left side than on the right) in a patient with lymphoma. This is representative of lymphomatous involvement of the glands.
Ill-defined masses in the parotid glands bilaterally, proven to be large B-cell lymphoma in this patient with known Sjögren disease.
Large B-cell lymphoma in a patient with known Sjögren disease.
Large B-cell lymphoma in a patient with known Sjögren disease.
Bilateral, solid, inhomogeneous parotid gland masses that are larger on the left side than on the right, with minimal necrosis. These were caused by lymphoma.
 
 
 
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