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Benign Tumors of Major Salivary Glands Workup

  • Author: Fadi Chahin, MD; Chief Editor: John Geibel, MD, DSc, MSc, MA  more...
 
Updated: Oct 26, 2015
 

Laboratory Studies

Perform a white blood cell (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 of salivary gland tumors (SGTs).[1, 9] Magnetic resonance imaging (MRI) is the most sensitive test for establishing the borders of soft-tissue tumor extension. In most circumstances, findings from computed tomography (CT) and MRI cannot reliably be used to differentiate benign from malignant disease. (See the images below.) In a study of 46 major SGTs, Aghaghazvini et al found that dynamic contrast-enhanced MRI had potential utility for differentiating SGTs preoperatively, specifically with regard to distinguishing between Warthin tumors and benign non-Warthin tumors.[10]

Heterogeneous, predominantly low-density mass in tHeterogeneous, predominantly low-density mass in the tail of the right parotid gland with minimal thin peripheral enhancement consistent with a Warthin tumor.
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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Biopsy

Fine-needle aspiration biopsy (FNAB) may aid in the diagnosis of SGTs. The availability of an experienced cytologist is a prerequisite in this case. FNAB can be helpful in identifying nonneoplastic masses that respond to medication and in detecting lymphomas and metastatic masses. FNAB findings provide evidence for a preoperative diagnosis that is 70-80% accurate.

Core needle biopsy is an option in this setting.[11] Song et al, in a study comparing FNAB (n=371) with ultrasound-guided core needle biopsy (n=228) in the evaluation of major SGTs, found core needle biopsy to be significantly more sensitive and to provide better tumor subtyping, especially for malignant lesions.[12]

The final pathologic diagnosis is always established on the basis of findings from surgical excision.

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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 Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

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, Society of Interventional Radiology

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.

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, Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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: Received none from RFA Medical for director; Received none from MRC Biotec for director.

Chief Editor

John Geibel, MD, DSc, MSc, 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; American Gastroenterological Association Fellow

John Geibel, MD, DSc, MSc, 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, Society for Surgery of the Alimentary Tract

Disclosure: Received royalty from AMGEN for consulting; Received ownership interest from Ardelyx for consulting.

Additional Contributors

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 Head and Neck Society, European Society for Medical Oncology, American Society of Clinical Oncology, Eastern Cooperative Oncology Group

Disclosure: Received honoraria from BMS for speaking and teaching; Received consulting fee from Novartis for consulting; Received consulting fee from Merck for consulting.

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. 2011 Nov. 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. 2011 May. 196(5):1160-3. [Medline].

  3. Heaton CM, Chazen JL, van Zante A, Glastonbury CM, Kezirian EJ, Eisele DW. Pleomorphic adenoma of the major salivary glands: Diagnostic utility of FNAB and MRI. Laryngoscope. 2013 Jun 18. [Medline].

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

  5. Mohammadi Ghahhari N, Mohammadi Ghahhari H, Kadivar M. GSK3ß and CREB3 gene expression profiling in benign and malignant salivary gland tumors. Iran Biomed J. 2012. 16(3):140-4. [Medline]. [Full Text].

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

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

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

  9. Strympl P, Kodaj M, Bakaj T, Kominek P, Starek I, Sisola I, et al. Color Doppler Ultrasound in the pre-histological determination of the biological character of major salivary gland tumors. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2012 Sep 5. [Medline].

  10. Aghaghazvini L, Salahshour F, Yazdani N, Sharifian H, Kooraki S, Pakravan M, et al. Dynamic contrast-enhanced MRI for differentiation of major salivary glands neoplasms, a 3-T MRI study. Dentomaxillofac Radiol. 2015. 44 (2):20140166. [Medline].

  11. Witt BL, Schmidt RL. Ultrasound-guided core needle biopsy of salivary gland lesions: a systematic review and meta-analysis. Laryngoscope. 2014 Mar. 124 (3):695-700. [Medline].

  12. Song IH, Song JS, Sung CO, Roh JL, Choi SH, Nam SY, et al. Accuracy of Core Needle Biopsy Versus Fine Needle Aspiration Cytology for Diagnosing Salivary Gland Tumors. J Pathol Transl Med. 2015 Mar. 49 (2):136-43. [Medline].

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

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

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

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

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

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

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

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

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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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