Benign Tumors of Minor Salivary Glands Workup

Updated: Jun 19, 2015
  • Author: Fadi Chahin, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Workup

Laboratory Studies

A complete blood count (CBC) with differential may sometimes be elevated in the presence of an inflammatory process. This possibility must be excluded.

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Imaging Studies

Some controversy exists regarding the routine use of imaging for small lesions of the superficial lobe of the parotid gland, as imaging findings do not usually alter management. However, computed tomography (CT) or magnetic resonance imaging (MRI) is useful for suspected tumors of the deep lobe of the parotid gland or parapharyngeal space and of the submandibular, sublingual, and minor salivary glands. These imaging studies are useful for evaluating the local and possible regional extension of such tumors, assessing the possibility of invasion of the surrounding tissues, and aiding in planning the surgical resection.

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Biopsy

The utility of fine-needle aspiration biopsy (FNAB) has been well established by Eneroth et al and others, who have advocated its use and reported accuracy rates of 74-90%. [8] Although the procedure is somewhat operator-dependent, it is generally regarded as safe, simple to perform, and relatively inexpensive and results in low morbidity.

Some controversy exists about whether the procedure is warranted for masses in the superficial lobe of the parotid gland, as it is not likely to change the management. However, if the FNAB results are consistent with lymphoma or sialadenitis, for example, a large resection would be unnecessary, alleviating patient and family anxiety.

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Histologic Findings

Benign epithelial tumors

Microscopically, pleomorphic adenomas (benign mixed tumors) are characterized by variable, diverse, structural histologic patterns. Frequently, they have growth patterns of sheets, strands, or islands of spindle and stellate cells, with a myxoid configuration occasionally predominating.

Histologically, the Warthin tumor has a heavy lymphoid stroma and aciniform epithelial cells that line the cystic areas with papillary projections. Malignant transformation has not been observed.

Microscopically, intraductal papilloma (IDP) consists of a cystically dilated duct partially lined with a cuboidal epithelium with complex anastomosing papillary fronds of variable size filling the cystic area. IDP of the minor salivary gland is a rare lesion that has been described only in various case reports. Histologically, the differential diagnosis of IDP includes papillary cystadenoma, which is commonly but erroneously diagnosed as IDP. In papillary cystadenoma, intraductal hyperplasia occurs and the dilated duct contains some papillary folds and projections. However, this occurs much less frequently than in IDP.

Histologically, oxyphil adenomas (oncocytomas) are large and spherical and have a distinct capsule. Uniform cells are arranged in solid sheets.

Benign nonepithelial tumors

Microscopically, hemangiomas are composed of solid masses of cells and multiple anastomosing capillaries that replace the acinar structure of the gland. Because they lack a capsule, they tend to infiltrate neighboring structures.

Histologically, lipomas consist of mature adipose cells with uniform nuclei.

Tumorlike lesions

With necrotizing sialometaplasia, a biopsy helps to rule out a malignant process; otherwise, no treatment is indicated.

Histologically, lymphoepithelial hyperplasia is composed of a diffused, well-organized lymphoid tissue and lymphocytic interstitial infiltrate with obliteration of the acinar pattern.

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