imaging of salivary gland tumours

INTRODUCTION

ANATOMY AND PHYSIOLOGY

IMAGING METHODS

bull BENIGN

bull MALIGNANTNEOPLASMS

Introduction

bull Saliva is a clear alkaline somewhat viscid secretion from the parotid submandibular sublingual and smaller mucous glands of the mouth - Dorlandrsquos Medical Dictionary

bull Saliva is a clear taste less odorless slightly acidic viscous fluid consisting of secretions from the parotid submandibular amp mucous glands of oral cavity - Stedmanrsquos Medical Dictionary

SALIVARY GLANDS

MAJOR SALIVARY GLANDS (paired structures)

PAROTID

SUBMANDIBULAR (SUBMAXILLARY)

SUBLINGUAL

MINOR SALIVARY GLANDS (diffusely scattered in oral cavity)

BUCCAL (cheek)

PALATINE (palate)

LABIAL (lip)

LINGUAL (tongue)

Secrete 10 of total volume of saliva

Account for about 70 of mucus secreted

Parotid

Glands of Von r

Mucous

Serous

Mixed

Labial amp Buccal Glands

Glossopalatine

Palatine

Posterior tongue

Submandibular amp Sublingual

Anterior tongue

Parotid

Glands of Von Bender

5

Types of Salivary Glands

Development of Salivary Glands

bull Individual salivary glands arise as a proliferation of oral epithelial cells forming a focal thickening that grows into the underlying ectomesenchyme

bull Continued growth results in the formation of a small bud connected to the surface by a trailing cord of epithelial cells with mesenchyme condensing around the bud

bull Clefts develop in the bud forming two or more new buds continuation of this process called branching morphogenesis produces successive generations of buds and a hierarchical ramification of the gland

bull Parotid glands begin development at 4-6 weeks IU

bull Submandibular glands 6 weeks IU

bull Sublingual and minor glands 8-12 weeks IU

bull The cells of the secretory end pieces and ducts attain maturity during last two months of gestation

bull The glands continue to grow postnatally with the volume proportion of acinar tissue increasing and the volume proportion of ducts connective tissue and vascular elements decreasing up to 2 years of age

Anatomy

Parotid Gland

bull Para around otic ear

bull Largest of the glands 14-28g

bull Situated below the external acoustic meatus between the ramus of the mandible and the sternomastoid

bull The investing layer of the deep cervical fascia forms a capsule for the gland ndash parotid capsule

bull The parotid gland is composed of adipose and glandular tissues in nearly equal proportions

bull The parotid gland is divided into the larger superficial and smaller deep lobes by the retromandibular or facial vein

bull It is located posterior to the ramus of mandible and drains via the Stensons duct traversing superficial to the masseter muscle and passing through the buccinator muscle before finally opening into the oral cavity at the ipsilateral 2ndmaxillary molar

bull The distal part of facial nerve and its terminal branches passes through the parotid parenchyma

bull Multiple nodes are located superficially and within the parotid gland

bull Accessory parotid gland is noted in 20 subjects and is usually located anterior to the main parotid and superior to the Stensonsduct draining in to the latter through an accessory duct

External Featuresbull Resembles a three sided pyramid the apex of the pyramid is

directed downwards

bull Gland has four surfacesndash Superior (base of the pyramid)

ndash Superficial

ndash Anteromedial and

ndash Posteromedial

bull The surfaces are separated by three bordersndash Anterior

ndash Posterior

ndash Medial

Relations of the Gland

bull APEX ndash It overlaps the posterior belly of the digastric

ndash The cervical branch of the facial nerve and the two divisions of the retromandibular vein emerge through it

bull SUPERIOR SURFACEndash Is small and concave

ndash Related to cartilaginous part of external acoustic meatus posterior part of TMJ superficial temporal vessels and auriculotemporal nerve

bull ANTEROMEDIAL SURFACEndash Grooved by posterior border of ramus

ndash Related to the masseter TMJ posterior border of ramus medial pterygoid muscle and emerging branches of facial nerve

bull POSTEROMEDIAL SURFACEndash Molded to the mastoid amp styloid process

ndash Related to the sternomastoid and posterior belly of digastric styloid process and its structures

ndash External carotid artery enters the gland through this surface

bull SUPERFICIAL SURFACE

ndash Covered by skin superficial fascia with superficial parotid lymph nodes parotid fascia and deep parotid lymph nodes

bull From the anterior border emerges

ndash Parotid duct

ndash Terminal branches of facial nerve

Parotid Duct

bull Thick walled 5cm long

bull Emerges from the middle of the anterior border of the gland

bull Runs forward and slightly downwards on the masseter where it is relatedto the upper and lower buccal branch of the facial nerve and theaccessory parotid gland

bull At the anterior border of the masseter it turns medially to pierce thebuccal pad of fat buccopharyngeal fascia and the buccinator to runforward between the muscle and the oral mucosa

bull Before finally piercing it opposite the crown of the upper second molar

Blood Supplybull Arterial supply External carotid artery and its

branchesbull Venous drainage External jugular vein

Nerve Supply

PARASYMPATHETIC SUPPLY

Inferior salivatory nucleus

9th cranial nerve

Otic ganglion

Auriculotemporal nerve

Gland

SYMPATHETIC SUPPLY

Vasomotor

Plexus around the external carotid artery

Lymphatic Drainage

bull Drains first to the parotid lymph nodes then to the upper deep cervical lymph nodes

bull (a) Diagram shows the location of the Stenon duct 1 = parotid gland 2 = Stenonduct 4 = masseter muscle 5 = surface of the mandible 6 = buccal muscle large arrow = retromandibular vein and external carotid artery(b) Panoramic US image shows a dilated Stenon duct in a patient with sialolithiasis and inflammation 1 = inflamed left parotid gland 2 = dilated Stenon duct 3 = stone 4 = masseter muscle 5 = surface of the mandible 6= buccal muscle large arrow = retromandibular vein and external carotid artery

bull This illustration represents a horizontal section through the lateral portion of the pharynx and mandible at the level of the mastoid process The parotid gland is traversed by the facial nerve and the deep portion of the gland narrows and is bounded by the posterior of the ramus of the mandible muscles of the styloid process and medial pterygoid muscle Right Tumors that arise within the deep portion of the gland may expand into the lateral pharyngeal space and produce swelling of the lateral pharyngeal wall

bull This lateral view of the head shows the anatomic position and relationship of the parotid and submandibular glands to the ear zygomatic arch mandible and masseter muscle The parotid gland duct (Stensens duct) crosses the masseter muscle and penetrates the buccal tissues Lobules of accessory parotid tissue are located along the course of the duct

Non-contrast axial CT image show normal appearing parotid (white arrows) gland in a young subject

SUBMANDIBULAR GLAND

bull Also called submaxillary gland

bull The submandibular gland is the second largest salivary gland and is located in the floor of the mouth adjacent to the posterior body of mandible along the free edge of the mylohyoid muscle

bull Partially enclosed between two layers of the deep cervical fascia

bull In submandibular triangle formed by anterior and posterior bellies of digastric muscle and inferior margin of mandible- Weighs 50 of parotid gland

bull The amount of adipose tissue is relatively lower than that of parotid gland The lingual nerve and submandibular ganglion are noted superficial to the submandibular gland while the hypoglossal nerve lies deep to it

bull It drains through the Whartons duct in the anterior sublingual region at the papilla in paramidline location

Superficial Part

bull It hasndash Inferiorndash Lateral andndash Medial surfaces

Relations

bull INFERIOR SURFACE covered by ndash Skinndash Platysmandash Cervical branch of facial nervendash Deep fasciandash Facial veinndash Submandibular lymph nodes

bull LATERAL SURFACEndash Submandibular fossandash Medial pterygoid musclendash Facial artery

bull MEDIAL SURFACE may be divided into three partsndash Anterior part related to mylohyoid muscle nerves and vesselsndash Middle part hyoglossus styloglossus lingual nerve submandibular ganglion

hypoglossal nervendash Posterior part styloglossus stylohyoid ligament 9th nerve

Deep Partbull Small in sizebull Lies deep to the mylohyoid and superficial to the hyoglossus and

styloglossusbull Posteriorly it is continuous with the superficial part around the posterior

border of the mylohyoidbull Anteriorly it extends up to the posterior end of the sublingual gland

Submandibular Ductbull Thin walled 5cm longbull Emerges at the anterior end of the deep part of the glandbull Runs forward on the hyoglossus between lingual and hypoglossal nervesbull It opens on the floor of the mouth on the summit of the sublingual

papilla at the side of the frenulum of the tongue

Blood Supply and Lymphatic Drainage

bull Arterial supply Facial artery

bull Venous drainage Common facial or lingual vein

bull Lymph Passes to the submandibular lymph nodes

Nerve Supply


Superior salivatory nucleus

7th cranial nerve

submandibular ganglion

CN VII nerve

Gland

SYMPATHETIC SUPPLY

Vasomotor

Plexus around the facial artery

bull (a) US image shows a nondilated Wharton duct (arrow) in a slim patient Arrowheads = submandibular gland 1 = mylohyoid muscle (b)Diagram shows the course of the Wharton duct (arrow) Arrowheads = submandibular gland 1 = mylohyoid muscle 2 = sublingual gland

SUBLINGUAL GLAND

Sublingual Glandbull Smallest of the three major glands

bull Almond shaped and weighs about 3-4 g

bull Lies above the mylohyoid muscle and below the mucosa of the floor of the mouth

bull Medial to the sublingual fossa and lateral to genioglossus

Sublingual gland

bull The Whartons duct and lingual nerve separate the sublingual gland from the medial genioglossusmuscle

bull It opens via multiple ducts usually 20 in number (known as ducts of Rivinus) directly into the floor of mouth along sublingual papillae and folds

bull Occasionally some of the ducts unite to form the Bartholins duct that drain into the Whartons duct

bull 15 ducts emerge from the gland most of which open directly into the floor of the mouth

bull A few join the submandibular duct

bull Blood supply from lingual and submentalarteries

bull Nerve supply is same as that for submandibular gland

Minor salivary glands

bull - Except for the gingiva and anterior hard palate minor salivary glands (500-1000 1-5 mm each) are located throughout the submucosa of the oral cavity- More numerous in posterior hard palate- Each salivary unit has its own simple duct- Most of these minor salivary glands are mucinous with the main exception of Ebnerrsquosglands which are serous glands located in the circumvallate papillae of the tongue

Innervation

bull Salivary glands are innervated either directly or indirectly by the parasympathetic and sympathetic arms of the autonomic nervous system Both result in increased amylase output and volume flow

bull Parasympathetic innervation to the salivary glands is carried via cranial nerves The parotid gland receives its parasympathetic input from the glossopharyngeal nerve (CN IX) via the otic ganglion while the submandibular and sublingual glands receive their parasympathetic input from the facial nerve (CN VII) via the submandibular ganglion

bull Direct sympathetic innervation of the salivary glands takes place via preganglionic nerves in the thoracic segments T1-T3 which synapse in the superior cervical ganglion with postganglionic neurons that release norepinephrine which is then received by β-adrenergic receptors on the acinar and ductal cells of the salivary glands leading to an increase in cyclic adenosine monophosphate (cAMP) levels and the corresponding increase of saliva secretion

SALIVARY GLAND FUNCTION

SECRETION OF SALIVA

bull DIGESTIVE ENZYMES

bull MOISTENING OF FOOD

bull PROTECTIVE FUNCTION

PATHOLOGY AND IMAGING

bull The common clinical indications of salivary gland imaging are pain and swelling

bull Imaging is useful in identifying the masses of salivary glands and also in differentiating them from the massespathologies of adjacent cervical spaces especially parapharyngeal masticator and submental spaces and mandibular lesions

bull Nodal masses peripheral nerve schwannomas and masseteric hypertrophy may mimic tumors of salivary glands clinically

bull In proven cases of salivary gland tumors imaging helps in delineating the extent of the lesion and invasion of adjacent cervical spaces skull base mandible and nervesmeninges

bull The disease of major salivary gland can be broadly categorized into the inflammatory neoplastic systemic and congenital conditions

Imaging Armamentarium for Salivary Gland Imaging Includes

bull Plain radiography

bull Sialography (conventional CT MRI)

bull High-resolution ultrasonography (HRUS)

bull Computed tomography (CT)

bull Magnetic resonance imaging (MRI)

bull Radionuclide scintigraphy

ReferrencePictorial essay Salivary gland imaging Rajul Rastogi et al

Plain Radiography

bull This is the simplest oldest and cheapest way of studying the salivary glands It is useful in detecting ductal calculi calcifications (as in hemangioma and lymph nodes) and adjacent osseous lesions Only one-fifth of the salivary ductal calculi are radiolucent

bull Parotid gland radiography requires posteroanterior projection with extended chin open mouth and cheeks blown out to delineate Stensons duct lesion

bull Submandibular gland radiography requires posteroanteriorand ipsilateral oblique projection with extended chin open mouth and tongue depressed by patientsrsquo finger

bull Plain radiograph of the submandibular region in AP (A) and lateral oblique (B) projection showing soft tissue swelling associated with a small calculus (arrow) visible on lateral oblique view taken with depressed tongue

Sialography

bull It refers to the evaluation of the ductal system of the salivary glands It is considered the gold standard technique for studying the ductal morphology

bull It is commonly used for parotid and submandibular glands and its main indication is chronic sialadenitis unrelated to sialolithiasis

bull Acute sialadenitis is a contraindication for sialography Irregular pooling of contrast and ductal obstruction without presence of calculus are indirect signs of malignancy

bull Sialography is rarely used for sublingual imaging because of numerous small ducts opening directly into the floor of mouth

bull Sublingual glands may however be visualized in an anatomic variation where the Bartholins duct is outlined following injection of the contrast medium into the Whartons duct

bull This test is performed by injecting oil water soluble iodine containing contrast solution into the Stensonrsquos Whartonrsquos duct

bull Water soluble diatrizoate meglumine and iodipimide meglumine are preferred because of their low viscosity and ease of injection Water soluble agents also cause very little foreign body reaction

bull This imaging modality is very rarely used in sublingual imaging because the ducts are numerous and small

bull They open directly to the floor of the mouth Sublingual Sialography is possible only in patients with anatomic variations like filling up of Bartholinrsquos duct from injection of Whartonrsquos duct during submandibular Sialography

bull Since about 80 of salivary gland calculi are radio opaque plain film study is a must before Sialography

Procedure

bull Stensonrsquos duct Whartonrsquos duct is progressively dilated gently Infiltration of local anesthetic agent may be necessary Sialographic canula is connected to a contrast laden syringe and is inserted into the duct After fluoroscopically verifying the position of the canula the contrast material is slowly injected Irregular contrast pooling and ductal obstruction are considered features of malignancy

bull Conventional sialographyof submandibular (A) and parotid glands (B) showing ductal system

bull However 3DCT performed especially with cone-beam CT following injection of the contrast medium into the ductal system without intravenous injection of contrast can provide images similar to or better than conventional sialography and is often referred to as CT sialography

bull MR Sialography by contrast delineates the ductal system of the gland without injection of ductalintravenous contrast by utilizing the highly fluid-sensitive sequences similar to that used for magnetic resonance cholangiopancreatography(MRCP)

bull MR Sialography can be performed in patients of acute sialadenitis Prior administration of a sialogogue agent may improve ductal visualization in MR Sialography

bull MR Sialography has poor spatial resolution as compared to conventional sialography

bull MR sialography shows bilateral Stemsons duct (arrows)

High-resolution Ultrasonography

bull It is a quick and noninvasive method of evaluating parotid and submandibular glands Both glands appear homogeneously hyperechoicon HRUS and retromandibular vein can be noted within the parotid gland

bull It is performed by a high-frequency linear (7-10 MHz) transducer

bull It helps in differentiating cystic from solid lesions and also aids in guiding the exact site of Fine N eedle A spiration C ytology (FNAC) in suspected salivary gland lesions

bull It fails to demonstrate the parotid gland in its entirety because of intervening mandible It also does not clearly demonstrate the intraglandular facial nerve branches

bull HRUS images showing normal parotid and submandibular glands (top row) and retromandibularvein in the parotid gland (arrow)

bull When combined with color Doppler imaging it helps in assessing the vascularity and nature of the lesion (malignant lesions of salivary glands are highly vascular as compared to their benign counterparts ndash peripheral vascularity with hypovascular central area in the tumoral lesion is highly suggestive of pleomorphic adenoma)

bull RI and PI values of greater than 07 and 12 respectively coupled with high PSV (greater than 443 cms) ill-defined margins and nodal involvement with central vascularity are highly indicative of malignant salivary gland lesion

bull In experienced hands it helps in differentiating intra-parotid nodes from true intraparenchymal lesions picking soft calcificationsdiffuse lesions and detecting major ductal dilatation with intraductal calculi

bull However it cannot optimally evaluate the deep lobe of the parotid gland

HRUS images show altered echopattern of the parotid gland with ductal dilatation (thin arrow) and small calculus (thick arrow) at its terminal end

CT and MRI

bull These cross-sectional studies help in true and near complete imaging of the salivary glands

bull MRI because of its multiplanar capability and higher soft tissue resolution has an upper hand over CT in demonstrating the extent of lesion and their perineuralmeningeal spread

bull However CT (especially cone-beam CT) demonstrates the osseous lesionsextension and calcificationcalculus better than MRI

bull Noncontrast CT may be enough in cases of sialolithiasis However ductal system is not optimally evaluated by any of these techniques

bull Non-contrast axial CT image showing submandibular sialolithiasis on right side (white arrow) and normal gland on left side

bull Non-contrast T2W axial amp coronal images (top row) and T1W axial and coronal images showing parotid (thick white arrows) and submandibular glands (thin white arrow)

bull These studies are often performed after intravenous injection of the contrast media for better delineation of the anatomy and the extent of lesion

bull Diffusion-weighted (DW) images and gadolinium-enhanced dynamic MR (Gd-MRI) imaging have proven to be very useful in differentiating benign from malignant tumors

bull DW images can be used to calculate apparent diffusion coefficient (ADC) values which are different for different salivary gland tumors

bull Gd-MR with dynamic imaging using 120 s as cut-off for time to peak enhancement and 30 wash-out ratio can differentiate benign and malignant tumors as the latter take less time for peak enhancement and show rapid wash-out

bull Plateau type of timendashintensity curve in dynamic Gd-MR coupled with low ADC values is also highly suggestive of malignancy

bull Proton MR Spectroscopy has also been described for differentiation of benign from malignant tumors by some authors

bull Cholinecreatinine ratios are significantly lower in malignant than in benign salivary gland tumors

PET Scanbull Very sensitive for metastatic LN lt 8mmbull Helpful for previously treated H + N cancersbull Positron emission tomography (PET) imaging using 2-deoxy-2-[18F]

fluoro-d -glucose (FDG) can be used to differentiate benign from malignant tumors of the salivary glands as the former appear as cold spots with the exception of Warthins tumor and oncocytoma

PETCT Scanbull Has increased value in salivary gland tumour stagingbull Pittsburgh study(55pts) showed

bull sensitivity of 744bull specificity of 100

Angiography or MRI-Angiobull Can be used to assess carotid artery involvement

Radionuclide Imaging

bull It is a rarely used technique for salivary gland imaging Sodium pertechnetate (Tc[99]) is actively concentrated and secreted by salivary gland cells while it is not taken up by majority of neoplastic lesions hence the latter appear as cold spots Warthins tumor is an exception to the rule and appears as a hot spot

bull Actively dividing cells take up Gallium-67 hence it is useful in detecting diffuse inflammatoryneoplastic processes such as sarcoidosis and lymphoma

Salivary Gland Neoplasms

bull Diverse histopathology

bull Relatively uncommon

ndash 2 of head and neck neoplasms

bull Distribution

ndash Parotid 80 overall 80 benign

ndash Submandibular 15 overall 50 benign

ndash SublingualMinor 5 overall 40 benign

Staging

bull AJCC Cancer Staging Manual (sixth edition)

bull Based on tumor size local extension of tumor nodal metastasis and distant metastasis

bull Histologic grade patient age and tumor site are important additional factors that should be considered in future staging systems

TNM

TX Primary tumor cannot be assessed

T0 No evidence of primary tumor

T1 Tumor 2 cm or less in greatest dimension without gross

extraparenchymal extension

T2 Tumor more than 2 cm but not more than 4 cm in greatest

dimension without gross extraparenchymal extension

T3 Tumor more than 4 cm andor tumor having gross


T4a Tumor invades skin mandible ear canal andor facial nerve

T4b Tumor invades skull base andor pterygoid plates andor encases

carotid artery

TNM

NX Regional lymph nodes cannot be assessed

N0 No regional lymph node metastasis

N1 Metastasis in a single ipsilateral lymph node 3 cm or less in

greatest dimension

N2a Metastasis in a single ipsilateral lymph node more than 3 cm but

not more than 6 cm in greatest dimension

N2b Metastasis in multiple ipsilateral lymph nodes none more than 6

cm in greatest dimension

N2c Metastasis in bilateral or contralateral lymph nodes none more

than 6 cm in greatest dimension

N3 Metastasis in a lymph node more than 6 cm in greatest dimension

TNM

MX Distant metastasis cannot be assessed

M0 No distant metastasis

M1 Distant metastasis

Stage GroupingStage I T1 N0 M0

Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0

Stage IVB T4b Any N M0

Any T N3 M0

Stage IVC Any T Any N M1

Histologic Grade

bull Histologic grading is applicable only to some types of salivary gland cancer (mucoepidermoid carcinoma adenocarcinoma not otherwise specified)

bull In most instances the histologic type defines the grade (ie salivary duct carcinoma is high grade basal cell adenoma is low grade)

bull Benign Neoplasmsndash First branchial cleft cysts

ndash Hemangiomas

ndash Lymphangiomas

ndash Pleomorphic adenomasbull Carcinoma ex pleomorphic adenoma

bull Carcinosarcoma

bull Metastasising mixed tumour

ndash Warthins tumour

ndash Rare bull Oncocytomas

bull Myoepitheliomas

bull Monomorphic adenomas

bull Basal cell carcinoma

ndash Lipomas

First branchial cleft cysts

First branchial cleft cysts typically manifest in middle aged women with a history of recurrent parotid gland infection unresponsive to antibiotics Occasionally a fistula can be observed at the angle of the mandible First branchial cleft cysts account for 8 of all branchial complex anomalies These cysts occur in or directly adjacent to the parotid gland At ultrasound (US) these cysts may look solid due to internal haemorrhage or infection Colour Doppler does not show any flow suggesting the cystic nature of the lesion At CT or MRI after administration of contrast medium the cyst wall may be thickened and enhance due to infection Increased signal intensity on T1-weighted sequences suggests prior bleeding or infection

Haemangiomas

Haemangiomas manifest as unilateral parotid swelling shortly after birth A bluish discoloration of the skin can often be seen These lesions are the most common benign salivary gland masses in children with a female predilection

They are classified as capillary or cavernous at pathology About 90 represent congenital capillary haemangiomas which spontaneously regress until adolescence Cavernous haemangiomas are rare manifest in older children and do not undergo resolution

At CT or MRI capillary haemangiomas are seen as welldefinedmasses with strong enhancement Flow voids due to prominent vasculature are often present in or around the mass

Axial grey-scale ultrasound shows

a solid hypoechoic well-circumscribed mass (arrows) involving superficial and deep lobes of the parotid gland

Power Doppler ultrasound shows marked vascularity within the mass consistent with hemangioma

Transverse section of the masseter muscle reveals a hypoechoic compressible vascular mass diagnosis - hemangioma

T1-weighted axial (A) and T2-weighted axial images with fat saturation demonstrate enlargement and replacement of the left parotid gland by a cystic-appearing lesion

The lesion remains well encapsulated and has an enlarged flow void in the retromandibular vein consistent with a hemangioma

Lymphangiomas

Lymphangiomas are congenital malformations of the

lymphatic system with an incidence of 90 at the age of

2 years Infection or haemorrhage may occur however

in contrast to haemangiomas spontaneous regression is

rare

At imaging lymphangiomas consist of cystic areas

and thin septations but also solid enhancing portions

Haemorrhage can lead to fluid levels with variable signal

intensities depending on the duration of the bleeding

Hypoechoic septated compressible lesion with no detectable flow on Colour Doppler assessment Lymphangioma of the neck was histologically proven

CT scan (A) and T2-weighted MR image (B) with fat saturation demonstrate a cystic nonenhancing lesion replacing the left parotid gland

There is extension beyond the capsule into the floor of the mouth and into a retropharyngeal location consistent with a lymphangioma

Pleomorphic Adenomabull Most common of all salivary gland

neoplasmsndash 70 of parotid tumors

ndash 50 of submandibular tumors

ndash 45 of minor salivary gland tumors

ndash 6 of sublingual tumors

bull 4th-6th decades

bull FM = 3-41

bull The alternative term mixed tumours is attributed to the histological heterogeneity suggesting a variety of imaging findings

bull Slow-growing painless mass

bull Parotid 90 in superficial lobe most in tail of gland

bull Minor salivary gland lateral palate submucosal mass

There are three malignancies associated with pleomorphic adenoma

(1) The carcinoma ex-pleomorphic adenoma

ndash The carcinoma ex-pleomorphic adenoma is a malignant change of a benign mixed tumour or a malignant tumour in a patient who previously underwent surgery for a pleomorphic adenoma

ndash Carcinoma ex-pleomorphic adenomas have a high metastatic rate varying from 25 to 76 into regional lymph nodes lungs bones and brain

(2) The rarer variant the true malignant mixed tumour (carcinosarcoma)

ndash The carcinosarcoma is rare and has a bad prognosis

(3) The metastasising mixed tumour

ndash The metastasising lsquobenignrsquo mixed tumour is the rarest variant

ndash Metastases may be multiple and occur in the lung bone and soft tissue often over decades

Small benign mixed tumours are usually hypointense in T1- and hyperintense in T2-weighted sequences Inhomogeneity is seen in larger tumours whereas low signal intensity on T2-weighted images may be observed in carcinoma ex-pleomorphic adenomas

bull Gross pathology

ndash Smooth

ndash Well-demarcated

ndash Solid

ndash Cystic changes

ndash Myxoid stroma

bull Histologyndash Mixture of epithelial myopeithelial and

stromal componentsndash Epithelial cells nests sheets ducts

trabeculaendash Stroma myxoid chrondroid fibroid osteoidndash No true capsulendash Tumor pseudopods

Imaging findings

bull Usually depend on tumour size

bull Small tumours

ndash more homogeneous and well defined

ndash strong enhancement after contrast medium administration in CT and MRI

bull Larger tumours

ndash pedunculated outgrowth from the main lesion (lobulated contour)

ndash more heterogeneous including necrotic and haemorrhagic areas

bull The recurrence rate varies between 1 - 50 depending on the initial surgical procedure

bull Recurrences are often multiple and clustered

bull Radiographic features

ndash Although findings do depend on tumour size in general they are well circumscribed rounded masses most commonly located within the parotid gland

ndash When they arise from the deep lobe of the parotid they can appear entirely extraparotid seen in the parapharyngeal space without a fat plane between it and the parotid and widen the stylomandibular tunnel

ndash Pleomorphic adenomas can also arise from salivary rest cells in the parapharyngeal space itself without connection to the parotid gland

bull Ultrasound

ndash Typically hypoechoic May show a lobulated distinct border +- posterior acoustic enhancement

ndash Ultrasound is also useful in guiding biopsy (both FNAC and core biopsies) but needs to be carried out with care to avoid facial nerve damage

bull Doppler

ndash Vascularization in pleomorphic adenomas is often poor or absent (even when the sensitive power Doppler mode is used) but may be abundant After inadequate surgery pleomorphic adenomas often recur usually multifocally

Longitudinal section through the left parotid gland demonstrates a lobulated mass in the superficial lobe of the gland distorting the capsule There is associated distal acoustic enhancement Note marked heterogeneity of internal architecture Biopsy confirmed this lesion to represent a pleomorphicadenoma The mandible is indicated by arrowheads

Ultrasound image shows well defined hypoechoic structure with slightly lobular contours increased through-transmission of ultrasound and mild vascularity

Pleomorphic adenoma

CTSmoothly marginated or lobulated homogeneous small spherical mass is the most common appearance When larger they can be heterogeneous with foci of necrosis Small regions of calcification are common 1When small enhancement tends to be prominent In larger tumours enhancement is less marked but can demonstrate delayed enhancement

MRIThey are commonly seen as well-circumscribed and homogeneous when small Larger tumours may be heterogeneousT1 - usually of low intensityT2

usually of very high intensity (especially myxoid type) 6

often have a rim of decreased signal intensity on T2-weighted images representing the surrounding fibrous capsule

T1 C+ (Gd) - usually demonstrates homogeneous enhancement

Angiography (DSA)Typically hypovascular

(a) Transverse early phase helical CT scan shows multinodular heterogeneous enhancement of the mass The central portion (short arrows) of the mass is more strongly enhanced than is the peripheral area (long arrow) of the mass (b)Transverse delayed phase CT scan shows slightly increased enhancement of the two parts of the tumor which are labeled as in a (c) Coronal image obtained 7 minutes after contrast material injection shows that the multinodular enhancement of the tumor(arrows) has disappeared and become homogeneous

Pleomorphic Adenoma

bull Treatment complete surgical excision

ndash Parotidectomy with facial nerve preservation

ndash Submandibular gland excision

ndash Wide local excision of minor salivary gland

bull Avoid enucleation and tumor spill

Warthinrsquos Tumor

bull AKA (adenolymphoma or papillary cystadenoma lymphomatosum)

bull 6-10 of parotid neoplasms

bull Older Caucasian males

bull 10 bilateral or multicentric

bull 3 with associated neoplasms

bull Presentation slow-growing painless mass

bull Warthin tumours present as well-circumscribed partly cystic partly solid lesions in CT or MRI often located in the tail of the parotid gland

bull Enhancement after contrast medium administration is often relatively poor

bull In the differential diagnoses of multiple lesions metastases lymphoma or inflammatory disease must be considered

Gross pathology

bull Encapsulated

bull Smoothlobulated surface

bull Cystic spaces of variable size with viscous fluid shaggy epithelium

bull Solid areas with white nodules representing lymphoid follicles

Histology

bull Papillary projections into cystic spaces surrounded by lymphoid stroma

bull Epithelium double cell layerndash Luminal cellsndash Basal cells

bull Stroma mature lymphoid follicles with germinal centers

Warthin tumor in the parotid gland in a 45-year-old man (a) Transverse early phase helical CT scan shows a well-defined mass (arrows) in the left parotid gland There is strong enhancement of the tumor with central low attenuation suggestive of a cystic or necrotic area (b) Transverse delayed phase scan shows decreased enhancement of the tumor (arrows)

Bilateral Warthin tumors Bilateral parotid masses (arrows) are seen on this transverse contrast materialndashenhanced fat-saturated T1-weighted spin-echo (SE) (75030 repetition time msececho time msec]) MR image The multiplicity and location at the tail of the parotid gland (near the lower mandible) are typical features of this tumor

Proton density-weighted (200030) MR image shows a 1-cm lesion (arrow) in superficial aspect of left parotid gland

bull Other benign tumours such as oncocytomas myoepitheliomas monomorphic adenomas and basal cell adenomas are relatively rare benign tumours of the parotid gland and lack typical imaging patterns

bull Lipomas however can easily be diagnosed by CT or MRI thanks to their fat content with typical low attenuation values on CT and signal intensities isointense to fat on all pulse sequences on MR imaging

Oncocytoma

bull Rare 23 of benign salivary tumors

bull 6th decade

bull MF = 11

bull Parotid 78

bull Submandibular gland 9

bull Minor salivary glands palate buccal mucosa tongue

Oncocytoma

bull Presentation

ndash Enlarging painless mass

bull Technetium-99m pertechnetate scintigraphy

ndash Mitochondrial hyperplasia

Oncocytoma

bull Grossndash Encapsulated

ndash Homogeneous smooth

ndash Orangerust color

bull Histologyndash Cords of uniform cells and

thin fibrous stroma

ndash Large polyhedral cells

ndash Distinct cell membrane

ndash Granular eosinophilic cytoplasm

ndash Central round vesicular nucleus

A left parotid oncocytoma in a 68-year-old woman

CT scan reveals a large deformable tumor (white asterisk) which extends medially into the parapharyngealspace through the stylomandibulargap

The contour of the tumor is distorted by the styloid process (black arrow) and the left medial pterygoid muscle (black arrowheads)

Monomorphic Adenomas

bull Monomorphic adenomas include basal cell adenoma clear cell adenoma glycogen-rich adenoma and other rare tumors

bull Treatment consists of resection with a margin of normal tissue

Basal cell adenoma Canalicular adenoma

Rarity Most common (18) Relatively less common

Age 6th decade 7th decade

Sex (MF) 11 118

Location Most commonly parotid and minor salivary glands of upper lip

Minor salivary glands of upper lip (74)

Presentation Painless submucosal mass

Characteristics Well circumscribed and encapsulated mass

bull Solid type solid nests of tumour cells present

bull Trabecular type cells in trabecular pattern with vascular stroma

bull Tubular type Multiple duct-like structures and vascular stroma

Well circumscribed with multiple foci

Tubular structures line by columnar or cuboidal cells with vascular stroma

Radiological features lack typical imaging patterns lack typical imaging patterns

A 59-year-old woman with a palpable mass in the left parotid

regionContrast-enhanced axial CT scan shows a round well-defined mass in the superficial lobe of left parotid gland with homogeneous enhancement

Myoepithelioma

bull lt1 of all salivary neoplasms

bull 3rd-6th decades

bull FgtM

bull Minor salivary glands gt parotid gt submandibular gland

bull Presentation asymptomatic mass

Precontrast axial CT scan shows a round well-defined mass (2739 HU) in the superficial lobe of the right parotid gland abutting on the capsule of gland (arrow) B Contrast-enhanced axial CT scan shows the mass (10211 HU) with homogeneous strong enhancement (arrow)

Precontrast axial CT scan shows an indistinct margin mass in the superficial lobe of the left parotid gland abutting on the capsule of the gland with calcification (arrow) B Contrast-enhanced axial CT scan shows the mass with inhomogeneous enhancement It contains a central enhancing nodule (small black arrow) and a nonenhancing peripheral cystic component (white arrow)

MALIGNANT NEOPLASMS

bull Mucoepidermoid carcinomabull Adenoid cystic carcinomabull Acinic cell carcinomabull Polymorphous low grade adenocarcinomabull Adenocarcinomabull Primary squamous cell carcinomabull Salivary duct carcinomabull Primary lymphomabull Godwinrsquos tumorbull Metastases

Mucoepidermoid Carcinoma

bull Most common salivary gland malignancy

bull 5-9 of salivary neoplasms

bull Parotid 45-70 of cases

bull Palate 18

bull 3rd-8th decades peak in 5th decade

bull FgtM

bull Caucasian gt African American


bull Presentation

ndash Low-grade slow growing painless mass

ndash High-grade rapidly enlarging +- pain

ndash Minor salivary glands may be mistaken for benign or inflammatory process

bull Hemangioma

bull Papilloma

bull Tori



ndash Well-circumscribed to partially encapsulated to unencapsulated

ndash Solid tumor with cystic spaces

Lateral view of a parotid sialogram shows a mass that has caused ductal erosion and lack of parenchymal filling

These findings suggest a high-grade malignancy

This patient had a highgrade MEC

Mucoepidermoid carcinoma of theparotid gland

Transverse CT scan shows anill-defined mass (C) that has less attenuation than that of enhancing parotid tissue in the right parotid gland

bull Treatment

ndash Influenced by site stage grade

ndash Stage I amp II

bull Wide local excision

ndash Stage III amp IV

bull Radical excision

bull +- neck dissection

bull +- postoperative radiation therapy

Adenoid Cystic Carcinoma

bull Overall 2nd most common malignancy

bull Most common in submandibular sublingual and minor salivary glands

bull M = F

bull 5th decade

bull Presentation

ndash Asymptomatic enlarging mass

ndash Pain paresthesias facial weaknessparalysis


ndash Well-circumscribed

ndash Solid rarely with cystic spaces

ndash infiltrative

Histology

bull Cribriform pattern

ndash Most common

ndash ldquoswiss cheeserdquo appearance

bull Tubular pattern

ndash Layered cells forming duct-like structures

ndash Basophilic mucinous substance

bull Solid pattern

ndash Solid nests of cells without cystic or tubular spaces

A coronal T1 weighted MR images (repetition timeecho time (TRTE) = 50015) of the sublingual gland tumour

The margin of the tumour is well-defined and the tumour is composed of cystic and solid components The solid area (lingual side) of the tumour shows isointense to the surrounding muscle and extends into the hyperintense cystic area

A coronal fat-saturated T2 weighted image (TRTE = 350096) The tumour is circumscribed by a hypointense fibrous capsule The signal intensity of the tumour is heterogeneous

bull Treatmentndash Complete local excision

ndash Tendency for perineural invasion facial nerve sacrifice

ndash Postoperative XRT

bull Prognosisndash Local recurrence 42

ndash Distant metastasis lung

ndash Indolent course 5-year survival 75 20-year survival 13

Acinic Cell Carcinoma

bull 2nd most common parotid and pediatric malignancy

bull 5th decade

bull FgtM

bull Presentationndash Solitary slow-growing often painless mass

bull Tumors occur in several configurations including cystic papillary vacuolated or follicular




ndash Most often homogeneous

bull Treatment

ndash Complete local excision

ndash +- postoperative XRT

bull Prognosis

ndash 5-year survival 82



Salivary duct carcinoma

bull Uncommon but highly aggressive malignant tumour

bull Mainly of the parotid gland

bull Male predilection

bull Perineural spread as well as lymph node involvement (70) are frequent findings observed in this particular tumour type

bull MR features Ill-defined margins and low to moderately high signal intensity on T2-weighted images could be observed in all patients on MR imaging

bull Differential diagnosis to a benign salivary gland cyst can be difficult on non-contrast images only

Axial CT scan showing no mass lesion in right submandibular gland (white arrow) but multiple metastatic nodes in right upper neck (open arrows) (B and C) 8F-FDG PET scans showing focal 18F-FDG uptake in submandibular area (black arrow) as well as on right side of upper neck (open arrows) Salivary duct carcinoma of 17 cm arising in right submandibular gland with multiple cervical metastases was demonstrated histologically after surgery (D) Newly diagnosed lung metastasis (arrow) 10 mo after surgery and postoperative radiotherapy

Polymorphous Low-Grade Adenocarcinoma

bull 2nd most common malignancy in minor salivary glands

bull 7th decade

bull F gt M

bull Painless slowly growing indolent submucosal mass

bull Soft tissue of the palate followed by the lips buccal mucosa tongue floor of the mouth and pharynx are the most affected areas

bull The main histological aspects of PLGA are cytological uniformity and a broad spectrum of growth patterns within the same lesion

bull These growth patterns are represented by lobular cribriform tubular trabecular papillary and cystic structures

Squamous Cell Carcinoma

bull 16 of salivary gland neoplasms


bull MF = 21

bull MUST RULE OUTbull High-grade mucoepidermoid carcinoma

bull Metastatic SCCA to intraglandular nodes

bull Direct extension of SCCA

bull This malignancy occurs more often in the submandibular gland than the parotid gland



ndash Unencapsulated

ndash Ulcerated

ndash Fixed

ndash firm indurated mass

bull Proper diagnosis of squamous cell carcinoma requires exclusion of contiguous spread of a squamous cell carcinoma into the gland metastases to the gland and high-grade mucoepidermoid carcinoma

bull There is a high incidence of regional and distant metastases

bull The prognosis for squamous cell carcinoma of the salivary gland is poor

bull Therapy consists of complete surgical resection and postoperative radiation therapy

The typical imaging features are necrotic areas in solid tumours best recognised in fat suppressed T1- weighted MR images after administration of contrast medium or in enhanced CT images

Axial contrast-enhanced CT scan shows a necrotic right parotid mass that has infiltrated the entire gland and the adjacent masseter muscle This patient had an SCC of the parotid gland


bull Treatment

ndash Radical excision

ndash Neck dissection


bull Prognosis



Adenocarcinoma

bull Rare

bull 5th to 8th decades

bull F gt M

bull Parotid and minor

salivary glands

bull Presentation

ndash Enlarging mass

ndash 25 with pain or facial weakness

Adenocarcinoma most commonly occurs in the minor salivary glands followed by the parotid gland This neoplasm represents approximately 15 of malignant parotid neoplasms Adenocarcinomas usually present as a palpable mass They behave aggressively with a strong propensity to recur and metastasize

Grossly adenocarcinoma is firm or hard and attached to the surrounding tissue Microscopically the cylindric cells of variable height form papillae acini or solid masses

Adenocarcinoma can be differentiated from mucoepidermoid carcinoma by the lack of keratin staining

The degree of glandular formation has been used as a means of grading these tumors

Adenocarcinomas can be classified according to their histological findings

bull grade 1 tumours are circumscribed and minimally invasive

bull grade 2 tumours are in between grade 1 and grade 3

bull grade 3 tumours are more solid with a greater mitotic rate





ndash Regional metastasis 27

ndash Distant metastasis 26

ndash 15-year cure ratendash Stage I = 67

ndash Stage II = 35

ndash Stage III = 8

Malignant Mixed Tumors

bull Carcinoma ex-pleomorphic adenomabull Carcinoma developing in the epithelial component

of preexisting pleomorphic adenoma

bull Carcinosarcomabull True malignant mixed tumormdashcarcinomatous and

sarcomatous components

bull Metastatic mixed tumorbull Metastatic deposits of otherwise typical

pleomorphic adenoma

Carcinoma Ex-Pleomorphic Adenoma

bull 2-4 of all salivary gland neoplasms

bull 4-6 of mixed tumors


bull Parotid gt submandibular gt palate

bull Risk of malignant degenerationbull 15 in first 5 years

bull 95 after 15 years

bull Presentationbull Longstanding painless mass that undergoes sudden

enlargement



ndash Poorly circumscribed

ndash Infiltrative

ndash Hemorrhage and necrosis

There is a large nonhomogeneous mass in the left submandibular gland

Septations are present within the mass and there is a lobulated contour

This was a carcinoma ex pleomorphic adenoma


bull Treatment


ndash Neck dissection (25 with lymph node involvement at presentation)


bull Prognosis

ndash Dependent upon stage and histology

Carcinosarcoma

bull Rare lt05 of salivary gland neoplasms

bull 6th decade

bull M = F

bull Parotid

bull History of previously excised pleomorphic adenoma recurrent pleomorphic adenoma or recurring pleomorphic treated with XRT

bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas

ndash Hemorrhage necrosis

ndash Calcification

A 55-year-old woman with carcinosarcomaof tonsillar minor salivary glandorigin

CT scan of the head and cervical regionshows a large 60 3 62 3 75-cmheterogeneously enhancing mass obstructing the oropharynx The mass involves the soft palate and extends into the left parapharyngeal and pharyngeal mucosal spaces the masticator space and the prevertebral space The mass abuts the left carotid space posteriorly displacing the left internal and external carotid arteries (arrows) Nolymphadenopathy is seen

Contrast-enhanced T1-weighted MR image (500251) of the mass shows moderate homogeneous enhancement

Carcinosarcoma

bull Treatment




ndash Chemotherapy (distant metastasis to lung liver bone brain)

bull Prognosis

ndash Poor average survival less than 2 frac12 years

Clear Cell Carcinoma

bull AKA glycogen-rich

bull Palate and parotid

bull 6th-8th decade

bull M = F

bull Histologybull Uniform round or

polygonal cells

bull Peripheral dark nuclei

bull Clear cytoplasm

bull Treatmentbull Complete local excision

Epithelial-Myoepithelial Carcinoma

bull lt 1 of salivary neoplasmsbull 6th-7th decades F gt M

parotidbull Increased risk for 2nd

primarybull Histology

bull Tumor cell nestsbull Two cell typesbull Thickened basement

membrane

bull Treatmentbull Surgical excision

Primary lymphomabull Rare

bull Can only be diagnosed if there is no evidence of intra-or extraglandularnodal involvement

bull These lymphomas are considered as extranodal marginal zone B-cell lymphomas

bull Incidence 1 and 8 of the patients with lymphomas

bull All forms of Hodgkinrsquos and non-Hodgkinrsquos lymphomas have been reported

bull In the case of secondary lymphomatous involvement of the salivary glands the parotid gland is involved in about 80

bull In patients with Sjogrenrsquos syndrome the prevalence of non-Hodgkinrsquos lymphoma is about 44 times greater compared to control subjects therefore lymphoma has to be ruled out by imaging in this particular patient population

Undifferentiated Carcinoma

bull Lymphoepithelialbull Eskimos parotid F gt M

familial

bull Asian submandibular M gt F

bull Large-cellbull Bimodal peaks

bull M gt F

bull Parotid

bull Small-cellbull 6th-7th decades

bull MF = 161

bull parotid

Metastases

bull Metastases to salivary glands are mainly observed in the parotid gland due to the presence of intraglandular lymph nodes which drain the face external ear and scalp

bull Skin malignancies (melanoma squamous cell carcinomas) are the most common primary tumours metastasising to the salivary glands therefore careful clinical examination has to be performed

bull However other malignancies such as renal cell carcinomas lung breast and gastrointestinal carcinomas can also metastasise to the parotid gland or periparotid lymph nodes

US image shows an oval well-defined homogeneous tumor with even margins (arrows) in the right submandibular gland the parenchyma of the gland (arrowheads) has been changed by therapeutic neck irradiation Despite its benign features the tumor proved to be a metastasis from a squamous cell carcinoma at the base of the tongue

Power Doppler US image shows a metastasis (arrowheads) to the superficial lobe of the parotid gland (arrows) from a melanoma The tumor is lobulated inhomogeneous and virtually anechoic with posterior acoustic enhancement and chaotic mainly peripheral vessel segments

Represents a manifestation of autoimmune disease in the salivary glands

This benign entity may be difficult to distinguish from malignant tumours due to bull its focal characterbull contrast medium enhancement bull its irregular margins

The benign lymphoepithelial lesion (BLEL) or Godwinrsquos tumour

Conclusions

bull Hugely diverse histopathology

bull Accurate pathologic diagnosis does influence management

bull Relatively rare malignancies

bull Utilize preoperative studies when indicated

Introduction

bull Saliva is a clear alkaline somewhat viscid secretion from the parotid submandibular sublingual and smaller mucous glands of the mouth - Dorlandrsquos Medical Dictionary

bull Saliva is a clear taste less odorless slightly acidic viscous fluid consisting of secretions from the parotid submandibular amp mucous glands of oral cavity - Stedmanrsquos Medical Dictionary

SALIVARY GLANDS


PAROTID


SUBLINGUAL


BUCCAL (cheek)

PALATINE (palate)

LABIAL (lip)

LINGUAL (tongue)



Parotid

Glands of Von r

Mucous

Serous

Mixed


Glossopalatine

Palatine

Posterior tongue


Anterior tongue

Parotid


5











Anatomy

Parotid Gland












directed downwards


ndash Superficial


ndash Posteromedial


ndash Posterior

ndash Medial














ndash Parotid duct


Parotid Duct








Nerve Supply



9th cranial nerve

Otic ganglion


Gland

SYMPATHETIC SUPPLY

Vasomotor


Lymphatic Drainage






SUBMANDIBULAR GLAND







Superficial Part


Relations














Nerve Supply



7th cranial nerve


CN VII nerve

Gland

SYMPATHETIC SUPPLY

Vasomotor



SUBLINGUAL GLAND





Sublingual gland










Innervation





SECRETION OF SALIVA


















Plain Radiography





Sialography











Procedure



















CT and MRI


























bull Distribution




Staging




TNM











carotid artery

TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions





SALIVARY GLANDS


PAROTID


SUBLINGUAL


BUCCAL (cheek)

PALATINE (palate)

LABIAL (lip)

LINGUAL (tongue)



Parotid

Glands of Von r

Mucous

Serous

Mixed


Glossopalatine

Palatine

Posterior tongue


Anterior tongue

Parotid


5











Anatomy

Parotid Gland












directed downwards


ndash Superficial


ndash Posteromedial


ndash Posterior

ndash Medial














ndash Parotid duct


Parotid Duct








Nerve Supply



9th cranial nerve

Otic ganglion


Gland

SYMPATHETIC SUPPLY

Vasomotor


Lymphatic Drainage






SUBMANDIBULAR GLAND







Superficial Part


Relations














Nerve Supply



7th cranial nerve


CN VII nerve

Gland

SYMPATHETIC SUPPLY

Vasomotor



SUBLINGUAL GLAND





Sublingual gland










Innervation





SECRETION OF SALIVA


















Plain Radiography





Sialography











Procedure



















CT and MRI


























bull Distribution




Staging




TNM











carotid artery

TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions





Parotid

Glands of Von r

Mucous

Serous

Mixed


Glossopalatine

Palatine

Posterior tongue


Anterior tongue

Parotid


5











Anatomy

Parotid Gland












directed downwards


ndash Superficial


ndash Posteromedial


ndash Posterior

ndash Medial














ndash Parotid duct


Parotid Duct








Nerve Supply



9th cranial nerve

Otic ganglion


Gland

SYMPATHETIC SUPPLY

Vasomotor


Lymphatic Drainage






SUBMANDIBULAR GLAND







Superficial Part


Relations














Nerve Supply



7th cranial nerve


CN VII nerve

Gland

SYMPATHETIC SUPPLY

Vasomotor



SUBLINGUAL GLAND





Sublingual gland










Innervation





SECRETION OF SALIVA


















Plain Radiography





Sialography











Procedure



















CT and MRI


























bull Distribution




Staging




TNM











carotid artery

TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions














Anatomy

Parotid Gland












directed downwards


ndash Superficial


ndash Posteromedial


ndash Posterior

ndash Medial














ndash Parotid duct


Parotid Duct








Nerve Supply



9th cranial nerve

Otic ganglion


Gland

SYMPATHETIC SUPPLY

Vasomotor


Lymphatic Drainage






SUBMANDIBULAR GLAND







Superficial Part


Relations














Nerve Supply



7th cranial nerve


CN VII nerve

Gland

SYMPATHETIC SUPPLY

Vasomotor



SUBLINGUAL GLAND





Sublingual gland










Innervation





SECRETION OF SALIVA


















Plain Radiography





Sialography











Procedure



















CT and MRI


























bull Distribution




Staging




TNM











carotid artery

TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions





Parotid Gland












directed downwards


ndash Superficial


ndash Posteromedial


ndash Posterior

ndash Medial














ndash Parotid duct


Parotid Duct








Nerve Supply



9th cranial nerve

Otic ganglion


Gland

SYMPATHETIC SUPPLY

Vasomotor


Lymphatic Drainage






SUBMANDIBULAR GLAND







Superficial Part


Relations














Nerve Supply



7th cranial nerve


CN VII nerve

Gland

SYMPATHETIC SUPPLY

Vasomotor



SUBLINGUAL GLAND





Sublingual gland










Innervation





SECRETION OF SALIVA


















Plain Radiography





Sialography











Procedure



















CT and MRI


























bull Distribution




Staging




TNM











carotid artery

TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions












directed downwards


ndash Superficial


ndash Posteromedial


ndash Posterior

ndash Medial














ndash Parotid duct


Parotid Duct








Nerve Supply



9th cranial nerve

Otic ganglion


Gland

SYMPATHETIC SUPPLY

Vasomotor


Lymphatic Drainage






SUBMANDIBULAR GLAND







Superficial Part


Relations














Nerve Supply



7th cranial nerve


CN VII nerve

Gland

SYMPATHETIC SUPPLY

Vasomotor



SUBLINGUAL GLAND





Sublingual gland










Innervation





SECRETION OF SALIVA


















Plain Radiography





Sialography











Procedure



















CT and MRI


























bull Distribution




Staging




TNM











carotid artery

TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions


















ndash Parotid duct


Parotid Duct








Nerve Supply



9th cranial nerve

Otic ganglion


Gland

SYMPATHETIC SUPPLY

Vasomotor


Lymphatic Drainage






SUBMANDIBULAR GLAND







Superficial Part


Relations














Nerve Supply



7th cranial nerve


CN VII nerve

Gland

SYMPATHETIC SUPPLY

Vasomotor



SUBLINGUAL GLAND





Sublingual gland










Innervation





SECRETION OF SALIVA


















Plain Radiography





Sialography











Procedure



















CT and MRI


























bull Distribution




Staging




TNM











carotid artery

TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions





Parotid Duct








Nerve Supply



9th cranial nerve

Otic ganglion


Gland

SYMPATHETIC SUPPLY

Vasomotor


Lymphatic Drainage






SUBMANDIBULAR GLAND







Superficial Part


Relations














Nerve Supply



7th cranial nerve


CN VII nerve

Gland

SYMPATHETIC SUPPLY

Vasomotor



SUBLINGUAL GLAND





Sublingual gland










Innervation





SECRETION OF SALIVA


















Plain Radiography





Sialography











Procedure



















CT and MRI


























bull Distribution




Staging




TNM











carotid artery

TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions







Nerve Supply



9th cranial nerve

Otic ganglion


Gland

SYMPATHETIC SUPPLY

Vasomotor


Lymphatic Drainage






SUBMANDIBULAR GLAND







Superficial Part


Relations














Nerve Supply



7th cranial nerve


CN VII nerve

Gland

SYMPATHETIC SUPPLY

Vasomotor



SUBLINGUAL GLAND





Sublingual gland










Innervation





SECRETION OF SALIVA


















Plain Radiography





Sialography











Procedure



















CT and MRI


























bull Distribution




Staging




TNM











carotid artery

TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions





Lymphatic Drainage






SUBMANDIBULAR GLAND







Superficial Part


Relations














Nerve Supply



7th cranial nerve


CN VII nerve

Gland

SYMPATHETIC SUPPLY

Vasomotor



SUBLINGUAL GLAND





Sublingual gland










Innervation





SECRETION OF SALIVA


















Plain Radiography





Sialography











Procedure



















CT and MRI


























bull Distribution




Staging




TNM











carotid artery

TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions









SUBMANDIBULAR GLAND







Superficial Part


Relations














Nerve Supply



7th cranial nerve


CN VII nerve

Gland

SYMPATHETIC SUPPLY

Vasomotor



SUBLINGUAL GLAND





Sublingual gland










Innervation





SECRETION OF SALIVA


















Plain Radiography





Sialography











Procedure



















CT and MRI


























bull Distribution




Staging




TNM











carotid artery

TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions











Superficial Part


Relations














Nerve Supply



7th cranial nerve


CN VII nerve

Gland

SYMPATHETIC SUPPLY

Vasomotor



SUBLINGUAL GLAND





Sublingual gland










Innervation





SECRETION OF SALIVA


















Plain Radiography





Sialography











Procedure



















CT and MRI


























bull Distribution




Staging




TNM











carotid artery

TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions





Relations














Nerve Supply



7th cranial nerve


CN VII nerve

Gland

SYMPATHETIC SUPPLY

Vasomotor



SUBLINGUAL GLAND





Sublingual gland










Innervation





SECRETION OF SALIVA


















Plain Radiography





Sialography











Procedure



















CT and MRI


























bull Distribution




Staging




TNM











carotid artery

TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions

















Nerve Supply



7th cranial nerve


CN VII nerve

Gland

SYMPATHETIC SUPPLY

Vasomotor



SUBLINGUAL GLAND





Sublingual gland










Innervation





SECRETION OF SALIVA


















Plain Radiography





Sialography











Procedure



















CT and MRI


























bull Distribution




Staging




TNM











carotid artery

TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions






SUBLINGUAL GLAND





Sublingual gland










Innervation





SECRETION OF SALIVA


















Plain Radiography





Sialography











Procedure



















CT and MRI


























bull Distribution




Staging




TNM











carotid artery

TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions









Sublingual gland










Innervation





SECRETION OF SALIVA


















Plain Radiography





Sialography











Procedure



















CT and MRI


























bull Distribution




Staging




TNM











carotid artery

TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions











Innervation





SECRETION OF SALIVA


















Plain Radiography





Sialography











Procedure



















CT and MRI


























bull Distribution




Staging




TNM











carotid artery

TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions






SECRETION OF SALIVA


















Plain Radiography





Sialography











Procedure



















CT and MRI


























bull Distribution




Staging




TNM











carotid artery

TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions



















Plain Radiography





Sialography











Procedure



















CT and MRI


























bull Distribution




Staging




TNM











carotid artery

TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions






Sialography











Procedure



















CT and MRI


























bull Distribution




Staging




TNM











carotid artery

TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions












Procedure



















CT and MRI


























bull Distribution




Staging




TNM











carotid artery

TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions






















CT and MRI


























bull Distribution




Staging




TNM











carotid artery

TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions


























bull Distribution




Staging




TNM











carotid artery

TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions





Staging




TNM











carotid artery

TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions





TNM











carotid artery

TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions





TNM




greatest dimension








TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions





TNM





Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions






Stage II T2 N0 M0

Stage III T3 N0 M0

T1 N1 M0

T2 N1 M0

T3 N1 M0

Stage IVA T4a N0 M0

T4a N1 M0

T1 N2 M0

T2 N2 M0

T3 N2 M0

T4a N2 M0


Any T N3 M0


Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions





Histologic Grade




ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions






ndash Hemangiomas

ndash Lymphangiomas


bull Carcinosarcoma







ndash Lipomas



Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions







Haemangiomas










Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions











Lymphangiomas





rare














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions














bull FM = 3-41
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions
















ndash Smooth


ndash Solid


ndash Myxoid stroma




Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions





Imaging findings


bull Small tumours



bull Larger tumours









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions









bull Ultrasound



bull Doppler




Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions







Pleomorphic adenoma








Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions












Pleomorphic Adenoma






Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions





Warthinrsquos Tumor










Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions








Gross pathology

bull Encapsulated




Histology









Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions










Oncocytoma


bull 6th decade

bull MF = 11

bull Parotid 78



Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions





Oncocytoma

bull Presentation




Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions





Oncocytoma





thin fibrous stroma














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions














Sex (MF) 11 118













Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions







Myoepithelioma



bull FgtM





MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions







MALIGNANT NEOPLASMS






bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions









bull Palate 18


bull FgtM



bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions






bull Presentation




bull Hemangioma

bull Papilloma

bull Tori










bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions














bull Treatment











bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions








bull M = F

bull 5th decade

bull Presentation






ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions








ndash infiltrative

Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions





Histology


ndash Most common





bull Solid pattern













bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions
















bull 5th decade

bull FgtM







bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions









bull Treatment



bull Prognosis














bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions















bull 7th decade

bull F gt M








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions








bull MF = 21








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions








ndash Ulcerated

ndash Fixed









bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions












bull Treatment




bull Prognosis



Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions





Adenocarcinoma

bull Rare


bull F gt M


salivary glands

bull Presentation


















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions




















ndash Stage II = 35

ndash Stage III = 8







pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions











pleomorphic adenoma









enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions













enlargement




ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions








ndash Infiltrative






bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions









bull Treatment




bull Prognosis


Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions





Carcinosarcoma


bull 6th decade

bull M = F

bull Parotid


bull Presentation

Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions





Carcinosarcoma



ndash Infiltrative

ndash Cystic areas


ndash Calcification




Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions








Carcinosarcoma

bull Treatment





bull Prognosis





bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions








bull 6th-8th decade

bull M = F


polygonal cells









membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions










membrane











familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions














familial



bull M gt F

bull Parotid


bull MF = 161

bull parotid

Metastases









Conclusions





Metastases









Conclusions










Conclusions





imaging of salivary gland tumours

Health & Medicine

parotid glands

gland parotid

accessory parotid gland

main parotid

parotid parenchyma

minor glands

smaller mucous glands

weeks iusubmandibular