Tumors of Orofacial Region

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Tumors Tumors of of orofacial orofacial region region
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Pseudotumors Pseudotumors of of orofacial orofacial region region
True True tumors tumors of of orofacial orofacial region region
Odontogenic Odontogenic tumors tumors
Soft tissue and bone tumors Soft tissue and bone tumors
Epitelial Epitelial tumors tumors
Salivary Salivary gland gland tumors tumors
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Pseudotumors Pseudotumors of of orofacial orofacial region region
mostly mostly the the jaw jaw cysts cysts
classified in several categories depending on histogenesis and etiology
True cysts True cysts
Odontogenic cysts ( Odontogenic cysts (arising arising from from the epithelium involved in the process of the epithelium involved in the process of
teeth teeth development development) )
From the rest From the rests s of of Malassez Malassez (periapical, residual cyst) (periapical, residual cyst)
From From t the he reduced reduced enamel epithelium ( enamel epithelium (dentigerous dentigerous, , eruption eruption, , paradent paradental al) )
From From dental dental lamina lamina ( (rests rests of of Serres Serres) ) (odontogenic keratocyst, lateral (odontogenic keratocyst, lateral
periodontal cyst) periodontal cyst)
Non Non- -odontogenic odontogenic cysts cysts
Developmental Developmental cyst cyst
P Pseudocysts seudocysts
Post Post- -traumatic bone cyst traumatic bone cyst
Aneuryzmatická bone cyst Aneuryzmatická bone cyst
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Odontogenic Odontogenic cysts cysts ( (cysts cysts derivated derivated from from rests rests of of Malassez Malassez) )
Rests Rests of of Malassez Malassez – – rests rests of of Hertwig's Hertwig's Epithelial Root Sheath Epithelial Root Sheath
Periapical Periapical cyst cyst ( (radicular radicular) )
Residual Residual cyst cyst
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Periapical Periapical ( (radicular radicular) ) cyst cyst
Located at the root tips of nonvital teeth
Activation: necrosis of the pulp, advanced tooth caries, chronic pulpitis
Remnants of Hertwig’s epithelial root sheath proliferate due to the
inflammatory stimulus
subsequent liquefaction necrosis in the center of these enlarged
epithelial nests
lined by nonkeratinising squamous epithelium
may be thin and atrophic but
mucous cells may be present
inflammatory changes in the underlying
connective tissue
cholesterol clefts with adjacent giant cells
hyaline Rushton bodies
residual cyst is radicular cyst that is
retained in jaws after removal of the
associated tooth
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Odontogenic Odontogenic cysts cysts ( (cysts cysts derivated derivated from from reduced reduced enamel enamel
epithelium epithelium) )
Follicular Follicular ( (dentigerous dentigerous
cyst cyst) )
Eruption Eruption cyst cyst
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Odontogenic Odontogenic cysts cysts ( (cysts cysts derivated derivated from from reduced reduced enamel enamel
epithelium epithelium) )
Follicular Follicular ( (dentigerous dentigerous
cyst cyst) )
Eruption Eruption cyst cyst
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Dentigerous Dentigerous ( (follicular follicular) ) cyst cyst
Developmental cyst
surrounds the crown of an unerupted tooth and is attached to
the neck of this tooth
Usually associated with the maxillary canine or the mandibular
third molar tooth
accumulation of fluid between the reduced enamel epithelium
and the crown surface or between the layers of the enamel
epithelium itself
no epithelial proliferation is needed to form this cyst
thin epithelial lining - two to three cells thick
resembles the reduced enamel epithelium
mucus-producing cells as well as ciliated cells are more common
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Eruption Eruption cyst cyst
type of dentigerous cyst located in the gingival soft tissues
overlying the crown of an erupting tooth
appear as blue-stained blisters of the oral mucosa
cyst rupturing with progressive eruption of the associated tooth
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Odontogenic Odontogenic cysts cysts ( (from from dental dental lamina lamina remnants remnants – – rests rests of of
Serres Serres) )
Odontogenic Odontogenic keratocyt keratocyt
Lateral Lateral periodontal periodontal cyst cyst
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Odontogenic Odontogenic keratocyst keratocyst
Frequently Frequently affects affects mandible mandible – – last last third third of of mandible mandible and ramus and ramus
Typically Typically located located in in bone with possible bone destruction bone with possible bone destruction
Recurrence rate 25 Recurrence rate 25- -60% (like ameloblastoma) 60% (like ameloblastoma)
Gorlin Gorlin- -Goltz syndrome Goltz syndrome - - multiple OKC, AD, n multiple OKC, AD, ne evoid basal cell void basal cell
carcinomas, mil carcinomas, milias ias, ,
thin epithelial layer thin epithelial layer (6 (6- -10 10 cells cells) ) with parakeratosis with parakeratosis
basal cell layer basal cell layer
no inflammatory reaction no inflammatory reaction
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Nonodontogenic Nonodontogenic cysts cysts ( (developmental developmental cysts cysts) )
Fissural cysts:
Median mandibular cyst (median
alveolar), Median palatal cyst
Globulomaxillary cyst
Nasolabial cyst (nasoalveolar)
Lateral cysts, Branchiogenic cysts
Remnants of epithelial ducts
Nasopalatine duct cyst (incisive canal
cyst, nasopalatine canal cyst)
Ductus thyreo-glossus cyst
Dermoid cyst
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Nasopalatine duct cyst
Midline cyst near the incisive foramen
intraosseous lesion
from nasopalatine duct remnants
epithelial lining (squamous,
respiratory, with or without mucous
cells, cuboidal, ...)
chronic inflammatory infiltrate
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Nasolabial cyst
in the soft tissue, beneath the ala of
the nose
from parts of nasolacrimal duct
pseudostratified collumnar epithelium
mucous cells
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Dermoid cyst
medial cyst in the neck region, base of the oral cavity
teratoma
epithelium: squamous epithelium
fibrous capsule may contain sweat and sebaceous glands, hair
follicles, ...
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Pseudotumors Pseudotumors of of orofacial orofacial region region
True True tumors tumors of of orofacial orofacial region region
Odontogenic Odontogenic tumors tumors
Epitelial Epitelial tumors tumors
Salivary Salivary gland gland tumors tumors
Soft Soft tissue tissue and bone and bone tumors tumors
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Odontogenic Odontogenic tumors tumors
group of lesions that arises from the odontogenic tissue. They develop
from the epithelial part of the tooth germ, the ectomesenchymal part,
or from both.
Epithelial Epithelial odontogenic odontogenic tumors tumors
Ameloblastoma Ameloblastoma
Odontogenic Odontogenic tumors tumors from from connective connective tissue tissue
Odontogenic Odontogenic fibroma fibroma
Odontogenic Odontogenic myxoma myxoma
Cementoblastoma Cementoblastoma
Mixed Mixed odontogenic odontogenic tumors tumors
Odontoma Odontoma
Ameloblastic Ameloblastic fibroma fibroma
Malignant Malignant
Malignant Malignant ameloblastoma ameloblastoma
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Ameloblastoma Ameloblastoma
Tumor grows slowly; typical is locally aggressive behaviour, but do not metastasise
most common odontogenic tumour
mandible (molars) 75%, 20-40y
Deformating the face, loosening of teeth
X-ray - as multilocular cyst
Rare metastatic – malignant ameloblastoma
polycystic amelobalstoma - unicystic ameloblastoma (younger patients)
Histologically
anastomosing epithelial strands and fields or discrete epithelial islands
peripheral cells at the border with the adjacent fibrous stroma are columnar, with
nuclei usually in the apical half of the cell body away from the basement membrane
tumour infiltrates into the adjacent cancellous bone
spread into soft tissues is highly unusual
follicular follicular type type – – tumor tumor islands islands in in fibrous fibrous stroma stroma
plexiform plexiform type type – – forming forming net net ( (the the farmer farmer pattern pattern) )
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Odontogenic Odontogenic tumors tumors
group group of of lesions lesions that that arises arises from from the the odontogenic odontogenic tissue tissue. . They They
develop develop from from the the epithelial epithelial part part of of the the tooth tooth germ germ, , the the
ectomesenchymal ectomesenchymal part, or part, or from from both both. .
Epithelial Epithelial odontogenic odontogenic tumors tumors
Ameloblastoma Ameloblastoma
Odontogenic Odontogenic tumors tumors from from connective connective tissue tissue
Odontogenic Odontogenic fibroma fibroma
Odontogenic Odontogenic myxoma myxoma
Cementoblastoma Cementoblastoma
Mixed Mixed odontogenic odontogenic tumors tumors
Odontoma Odontoma
Ameloblastic Ameloblastic fibroma fibroma
Malignant Malignant
Malignant Malignant ameloblastoma ameloblastoma
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Odontogenic Odontogenic fibroma fibroma
peripheral peripheral or or central central tumor tumor with with the the dominant dominant fibrous fibrous component component
odontogenic odontogenic fibroma fibroma ( (with with
odontogenic odontogenic epithelium epithelium) )
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Odontogenic Odontogenic fibroma fibroma
The lesion is seen within the jaw as well as in the gingiva
Odontogenic fibroma consists of fibroblasts lying in a background
of myxoid material with collagen fibres that may vary from
delicate to coarse
Odontogenic epithelium, may occur.
Only rarely is the epithelial component so conspicuous that
differentiation between odontogenic fibroma and ameloblastoma
may be difficult.
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Odontogenic Odontogenic myxoma myxoma
rare rare tumor, tumor, growing growing in in the the bone bone with with the the locally locally agressive agressive
behaviour behaviour
maxilla maxilla a a mandibula mandibula
erosion into the surrounding erosion into the surrounding
area (sinus) area (sinus)
swelling, pain swelling, painless less growth growth
X X- -ray: resembling ray: resembling honeycomb honeycomb
curettage curettage or or block resection block resection
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Cementoblastoma Cementoblastoma
benign, well circimscribed tumor, heavily mineralised cementum
masses connected to the apical root
rare rare tumor tumor
20 20- -30 y 30 y patients patients
molars molars a a premolars premolars
pain pain – – tooth tooth is is vital vital
vascular, loose-textured fibrous tissue
surrounds coarse trabeculae of basophilic
mineralised material bordered by plump cells
with large but not atypical nuclei.
Mitotic figures are rare
Also, osteoclastic giant cells may be present
Th Th: : tooth tooth extraction extraction
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Odontogenic Odontogenic tumors tumors
group of lesions that arises from the odontogenic tissue. They develop
from the epithelial part of the tooth germ, the ectomesenchymal part,
or from both.
Epithelial Epithelial odontogenic odontogenic tumors tumors
Ameloblastoma Ameloblastoma
Odontogenic Odontogenic tumors tumors from from connective connective tissue tissue
Odontogenic Odontogenic fibroma fibroma
Odontogenic Odontogenic myxoma myxoma
Cementoblastoma Cementoblastoma
Mixed Mixed odontogenic odontogenic tumors tumors
Odontoma Odontoma
Ameloblastic Ameloblastic fibroma fibroma
Malignant Malignant
Malignant Malignant ameloblastoma ameloblastoma
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Odontoma Odontoma
70% 70% odontogenic odontogenic tumors tumors, , hamartoma hamartoma
the the differenciation differenciation into into dontoblast dontoblast and and ameloblast ameloblast ( (dentin dentin and and enamel enamel
production production) ) is is present present
benign benign process process
10 10- -20 y 20 y life life, , maxilla maxilla
Histologically Histologically: :
Complex form
well delineated mass of dental hard tissues in a irregular arrangement
(dentin, enamel, cementum)
stroma consists of mature fibrous connective tissue
Compound Compound form form
malformation consisting of tiny teeth
may vary in number from only a few to numerous
do not resemble normal teeth
normal arrangement of centrally placed fibrovascular pulp tissue surrounded
by dentin with enamel in the crown area and cementum in the root part.
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Odontogenic Odontogenic tumors tumors
group of lesions that arises from the odontogenic tissue. They develop
from the epithelial part of the tooth germ, the ectomesenchymal part,
or from both.
Epithelial Epithelial odontogenic odontogenic tumors tumors
Ameloblastoma Ameloblastoma
Odontogenic Odontogenic tumors tumors from from connective connective tissue tissue
Odontogenic Odontogenic fibroma fibroma
Odontogenic Odontogenic myxoma myxoma
Cementoblastoma Cementoblastoma
Mixed Mixed odontogenic odontogenic tumors tumors
Odontoma Odontoma
Ameloblastic Ameloblastic fibroma fibroma
Malignant Malignant
Malignant Malignant ameloblastoma ameloblastoma
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Malignant Malignant
Malignant Malignant ameloblastoma ameloblastoma ( (mts mts) )
Ameloblastic Ameloblastic carcinoma carcinoma
resembling resembling the the ameloblastoma ameloblastoma, , but but with with cellular cellular atypias atypias
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Pseudotumors Pseudotumors of of orofacial orofacial region region
True True tumors tumors of of orofacial orofacial region region
Odontogenic Odontogenic tumors tumors
Soft Soft tissue tissue and bone and bone tumors tumors
Epitelial Epitelial tumors tumors
Salivary Salivary gland gland tumors tumors
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Soft Soft tissue tissue tumors tumors
mesenchymal mesenchymal tumors tumors
connective connective tissue tissue fibroma fibroma fibrosarcoma fibrosarcoma
cartilage cartilage chondroma chondroma chondrosarcoma chondrosarcoma
fat fat tissue tissue lipoma lipoma liposarcoma liposarcoma
blood blood vessels vessels hemangioma hemangioma hemangiosarcoma hemangiosarcoma
lymphatic lymphatic vessels vessels lymphangioma lymphangioma lymphangiosarcoma lymphangiosarcoma
cross cross- -striated striated m. m. rhabdomyoma rhabdomyoma rhabdomyosarcoma rhabdomyosarcoma
smooth smooth m. m. leiomyoma leiomyoma leiomyosarcoma leiomyosarcoma
... ...
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Bone Bone tumors tumors
by by the the dignity dignity: : benign benign and and malignant malignant
Benign Benign
Osteoma Osteoma
Osteoblastoma Osteoblastoma
Giant Giant cell cell lesions lesions
Aneurysmal Aneurysmal bone bone cyst cyst
Malignant Malignant
Osteosarcoma Osteosarcoma ( (osteogenic osteogenic sarcoma sarcoma) )
Chondrosarcoma Chondrosarcoma
Ewing's Ewing's sarcoma sarcoma
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Benign Benign
Benign Benign fibro fibro- -osseous osseous lesions lesions
Osteoma Osteoma
Osteoblastoma Osteoblastoma
Giant Giant cell cell lesions lesions
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Benign Benign fibro fibro- -osseous osseous lesions lesions
nonneoplastic nonneoplastic intraosseous intraosseous lesions lesions that that replace replace normal normal bone and bone and
consist consist of of cellular cellular fibrous fibrous connective connective tissue tissue
periapical periapical cemental cemental dysplasia dysplasia – – anterior anterior mandible mandible, , asymptomatic asymptomatic, ,
radiolucent radiolucent areas areas
florid florid cemento cemento- -osseous osseous dysplasia dysplasia – – nonsymptomatic nonsymptomatic
fibrous fibrous dysplasia dysplasia – – one one or or many many bones bones, , mild mild malocclusion malocclusion
cherrubism cherrubism – – distant distant facies facies, , symetric symetric, severe , severe malocclusion malocclusion
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Cherrubism Cherrubism
loss loss of of bone in bone in the the mandible mandible replaced replaced by by fibrous fibrous tissue tissue
usually usually the the condition condition fades fades as as the the child child grows grows
deform deform the the affected affected person person's face 's face
causes causes premature premature loss loss of of the the primary primary teeth teeth and and uneruption uneruption of of
the the permanent permanent teeth teeth. .
rare rare autosomal autosomal dominant dominant disease disease of of the the maxilla maxilla and and mandible mandible
Mutations Mutations in in the the SH3BP2 SH3BP2 gene gene have have been been identified identified in in about about 80 80
percent percent of of people people with with cherubism cherubism
Orthodontic Orthodontic treatment treatment
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Osteoma Osteoma / / exostosis exostosis / / torus torus palatinus palatinus
torus torus – – palatinus palatinus, , mandibularis mandibularis
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Osteoma Osteoma / / exostosis exostosis / / torus torus palatinus palatinus
torus torus palatinus palatinus
20% 20% older older patients patients
osseous osseous structure structure lined lined by by epithelium epithelium
ulcerations ulcerations
osteomyelitis osteomyelitis
torus torus mandibularis mandibularis
bilateral bilateral
dentures dentures irritation irritation
osteoma osteoma
solitary solitary – – multilocular multilocular (AD, (AD, Gardner Gardner syndroma syndroma ~ ~ + + intestinal intestinal polyps polyps, ,
cysts cysts a skin a skin fibromas fibromas) )

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Osteoblastoma Osteoblastoma
„ „cellulary cellulary“ “ osteoma osteoma, ,
osteoblastoma osteoblastoma (2cm and more) (2cm and more)
osteoid osteoid osteoma osteoma (0,5 (0,5- -2cm) 2cm)
young young patients patients, , swelling swelling a a pain pain
osteoblasts osteoblasts a a osteoclasts osteoclasts
activation activation + + cellulary cellulary bone + bone +
osteoid osteoid areas areas
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Giant Giant cell cell lesions lesions
many many lesions lesions of of the the mandible mandible and and
maxilla maxilla contain contain giant giant cell cell tissue tissue
peripheral peripheral giant giant cell cell granuloma granuloma
extraossueous extraossueous nodule nodule in in jaws jaws
from from periosteum periosteum and and periodontal periodontal
membrane membrane
30 30- -40 y 40 y women women
focal focal prple prple nodule nodule on on the the gigiva gigiva
aneurysmal aneurysmal bone bone cyst cyst
vessels vessels resembling resembling hemangioma hemangioma
10 10- -20 y pacienti 20 y pacienti
madibla madibla – – ramus ramus
face face deformation deformation / bone / bone fracture fracture
dif.dg.traumatic dif.dg.traumatic bone bone cyst cyst
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Malignant Malignant
Ewing's Ewing's sarcoma sarcoma
Osteosarcoma Osteosarcoma ( (osteogenic osteogenic sarcoma sarcoma) )
1:100.000 1:100.000 people people
cca. 7% in cca. 7% in the the neck neck and face and face area area
retinoblastoma retinoblastoma association association (Rb1 (Rb1 gene gene) )
pain pain?/face ?/face deformation deformation/ /teeth teeth lost lost
normal normal a a abnormal abnormal osteoid osteoid
pleomorfic pleomorfic a a hyperchromic hyperchromic
sarkomatous sarkomatous cells cells
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Ewing's Ewing's sarcoma sarcoma
highly malignant bone tumor (10% of malignant bone tumors) highly malignant bone tumor (10% of malignant bone tumors)
neuroektoderm neuroektodermal al cells cells
ESFT ESFT - - t (11.22) t (11.22) - - EWS/FLI1 EWS/FLI1
human adenovirus type 5 human adenovirus type 5
children and adolescents (not older than 30 years) children and adolescents (not older than 30 years)
fever, leukocytosis, FW fever, leukocytosis, FW
pain and swelling, focal ulceration pain and swelling, focal ulceration
sensitive and chemo sensitive and chemo- -and radiotherapy and radiotherapy
recurrence rate (30% per 5 years) recurrence rate (30% per 5 years)
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Epithelial tumors Epithelial tumors
From squamous epithelium From squamous epithelium
Benign Benign
Papilloma Papilloma
Keratoacanthoma Keratoacanthoma
Benign pigmented lesions Benign pigmented lesions
Peutz Peutz- -Jeghersov Jeghersov syndróm syndróm
Leukoplakia Leukoplakia
Epithelial dysplasia Epithelial dysplasia
Erythroplakia Erythroplakia
Malignant Malignant
Squamous cell carcinoma Squamous cell carcinoma
Basal cell carcinoma Basal cell carcinoma
From glandular epithelium From glandular epithelium
Salivary gland tumors Salivary gland tumors
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Papilloma Papilloma
HPV ( HPV (not allways) not allways)
keratinisating keratinisating / /
nonkeratinizating nonkeratinizating
basal layer basal layer / / spinosa spinosa / /
keratinocytes keratinocytes
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Keratoacanthoma Keratoacanthoma
predilection for the face, hands predilection for the face, hands
solitary solitary nodule nodule, fast growth, possible spontaneous regression , fast growth, possible spontaneous regression
solid papule with a central hollow, filled with keratin solid papule with a central hollow, filled with keratin
central keratinization, hyperkeratosis seems embedded in the central keratinization, hyperkeratosis seems embedded in the
epidermis, but bounded epidermis, but bounded by by normal epidermis normal epidermis; ; at the base of at the base of the the
i infiltrative growing nfiltrative growing may be present may be present, possibly mitotic activity but , possibly mitotic activity but
no atypical mitoses, small abscesses in the epithelium, the no atypical mitoses, small abscesses in the epithelium, the
inflammatory infiltrate inflammatory infiltrate
elderly elderly
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Epithelial tumors Epithelial tumors
From squamous epithelium From squamous epithelium
Benign Benign
Papilloma Papilloma
Keratoacanthoma Keratoacanthoma
Benign pigmented lesions Benign pigmented lesions
Peutz Peutz- -Jeghersov Jeghersov syndróm syndróm
Leukoplakia Leukoplakia
Epithelial dysplasia Epithelial dysplasia
Erythroplakia Erythroplakia
Malignant Malignant
Squamous cell carcinoma Squamous cell carcinoma
Basal cell carcinoma Basal cell carcinoma
From glandular epithelium From glandular epithelium
Salivary gland tumors Salivary gland tumors
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Peutz Peutz- -Jeghers syndrome Jeghers syndrome
AD AD
formation of benign polyps in the gastrointestinal formation of benign polyps in the gastrointestinal - - hamart hamarthomas homas
( (risk risk intususcepcia!!) intususcepcia!!)
hyperpigmented maculae of the lips and mucosa hyperpigmented maculae of the lips and mucosa
dif.dg. hyperpigmentation: Addison's disease (adrenal insuf.) dif.dg. hyperpigmentation: Addison's disease (adrenal insuf.)
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Epithelial tumors Epithelial tumors
From squamous epithelium From squamous epithelium
Benign Benign
Papilloma Papilloma
Keratoacanthoma Keratoacanthoma
Benign pigmented lesions Benign pigmented lesions
Peutz Peutz- -Jeghersov Jeghersov syndróm syndróm
Leukoplakia Leukoplakia
Epithelial dysplasia Epithelial dysplasia
Erythroplakia Erythroplakia
Malignant Malignant
Squamous cell carcinoma Squamous cell carcinoma
Basal cell carcinoma Basal cell carcinoma
From glandular epithelium From glandular epithelium
Salivary gland tumors Salivary gland tumors
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Leukoplakia Leukoplakia
"white "white coatings at the mocous of oral cavity coatings at the mocous of oral cavity, which can not be , which can not be
wiped off and wiped off and classified classified as as other disease" other disease"
precancer precancerosis osis! !
smoking!, alcohol, chron. smoking!, alcohol, chron. candidosis candidosis, HPV, EBV ... , HPV, EBV ...
homogeneous homogeneous - - flat, uniform, white flat, uniform, white areas areas
non non- -homogeneous homogeneous - - irregular, nodular irregular, nodular areas areas + erythroplakia + erythroplakia
clinical diagnosis, has a characteristic histologic correlate clinical diagnosis, has a characteristic histologic correlate
acanthosis acanthosis = thickening of the spinous layer of squamous = thickening of the spinous layer of squamous
epithelium epithelium
h hyperkeratosis yperkeratosis = thickening of the = thickening of the keratin keratin layer layer
atrophy atrophy – – erythroplakia erythroplakia
may lead to may lead to
dysplasia and CIS dysplasia and CIS
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Squamous cell carcinoma Squamous cell carcinoma
malignant epithelial tumors malignant epithelial tumors
smoking, sunlight, alcohol, chron. smoking, sunlight, alcohol, chron.irritation irritation, viruses , viruses
older age, 90% men older age, 90% men
mostly lower mostly lower lip lip and tongue and tongue
f first irstly ly, the exophytic growth, slow , the exophytic growth, slow growth growth and and late late metastases metastases
(in (in tongue tongue the the early early in ingrowth growth into the into the blood vessels and blood vessels and
metastasis to the lung metastasis to the lung can be found can be found) )
may exulcer may exulcerate ate
The The endofytic form endofytic form does exist does exist! !
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Basal cell carcinoma Basal cell carcinoma
skin tumor (predominantly on the face) skin tumor (predominantly on the face) – – proliferation of the proliferation of the
cells similar to the immature cells of the basal layer of the cells similar to the immature cells of the basal layer of the
epidermis (but arises from hair follicule) epidermis (but arises from hair follicule)
variable histological features variable histological features
grows predominantly endophytic, with the dermis infiltration, an grows predominantly endophytic, with the dermis infiltration, and d
surface exulceration (ulcus rodens) surface exulceration (ulcus rodens)
without metastasis (semimalignant), locally destructive, with without metastasis (semimalignant), locally destructive, with
relapses relapses – – the adequate surgical extirpation with the the adequate surgical extirpation with the
histopathological examination of the borders is necessary histopathological examination of the borders is necessary
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Tumors Tumors of of salivary salivary glands glands
relatively rare tumors with an incidence 1 relatively rare tumors with an incidence 1- -3/100.000 3/100.000
A Affect ffect in in 70% 70% the the major glands (parotid gland 70% major glands (parotid gland 70% - - benign, benign,
sublingual 70% sublingual 70% - - malignant) malignant)
in in 30% 30% affect affect small glands small glands
Histomorfologic Histomorfologically ally highly variable highly variable appearance appearance (glands, ducts (glands, ducts - -
basal and reserve cells, basal and reserve cells, myoepithelial myoepithelial cells) cells)
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Tumors Tumors of of salivary salivary glands glands
Benign Benign tumors tumors
Pleomorfic Pleomorfic adenoma adenoma
Monomorfic Monomorfic adenoma adenoma
Adenolymphoma Adenolymphoma
Onkocytoma Onkocytoma
Malignant Malignant tumors tumors
Mukoepidermoid Mukoepidermoid carcinoma carcinoma
Adenocystic Adenocystic carcinoma carcinoma ( (cylindroma cylindroma) )
Adenocarcinoma Adenocarcinoma
Carcinoma Carcinoma from from acinous acinous cells cells
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Pleomorphic Pleomorphic adenoma adenoma
most most common common salivary salivary gland gland tumor, tumor, usually usually affects affects
parotid parotid of of women women, 20 , 20- -60 r 60 r
Slow Slow growth growth, , painless painless, face , face deformating deformating
unfixed unfixed, , circumscribed circumscribed, , nodular nodular, soft , soft consistancy consistancy
encapsulates encapsulates proliferation proliferation ( (fibrous fibrous capsule capsule) )
ductal ductal and and myoepithelial myoepithelial cells cells supported supported by by stroma stroma with with
mucoid mucoid, , myxoid myxoid or or chondroid chondroid appearance appearance
( (myxochondroepithelioma myxochondroepithelioma) )
Myoepithelial Myoepithelial cells cells and and epithelial epithelial cells cells form form areas areas or or
sheets sheets, , may may be be rarely rarely cribriform cribriform or or tubular tubular
growing growing into into capsule capsule, , recurrency recurrency, , possible possible malignant malignant
variant variant – – the the biological biological behaviour behaviour is is difficult difficult to to analyze analyze
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Monomorphic Monomorphic adenoma adenoma
The group of benign tumors formed by proliferation of epithelial The group of benign tumors formed by proliferation of epithelial
cells of one type with a characteristic arrangement cells of one type with a characteristic arrangement
Properties similar to PA, less recidivism Properties similar to PA, less recidivism
ba bas socellul ocellular ar adenoma adenoma
nests of tumor cells separated by fibrous nests of tumor cells separated by fibrous stroma stroma
in in the the centre are centre are the the cuboidal cuboidal cells resembling cells resembling strat.basale strat.basale of of the the
epidermus epidermus
canalicular canalicular adenoma adenoma
• • anastomo anastomosing sing sheets sheets forming the forming the canalicules canalicules – – formed formed by a layer of by a layer of
cylindrical cylindrical to to cuboidal cuboidal cells cells
• • myxomat myxomatous ous hypocellular stroma with dilated capillaries hypocellular stroma with dilated capillaries
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Adenolymphoma Adenolymphoma ( (Warthin's Warthin's Tumor, Tumor, Papillary Papillary Cystadenoma Cystadenoma
Lymphomatosum Lymphomatosum) )
benign benign, , slowly slowly growing growing tumor tumor
lower lower pole pole of of the the parotid parotid, , accounting accounting 2 2- -10% 10% of of all all SGT SGT
males males, over 50y , over 50y
unfixed unfixed, , circumscribed circumscribed
On palpation a solid, painless, smooth surface, elastic, On palpation a solid, painless, smooth surface, elastic,
fluctuating fluctuating
Papillary Papillary proliferation proliferation ( (epithelial epithelial part) part) with with inner inner
and and outer outer layer layer of of epithelial epithelial cells cells
lymphoid lymphoid stroma stroma organized organized in in follicules follicules
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Oxyphilic Oxyphilic adenoma adenoma ( (Oncocytoma Oncocytoma) )
rare benign tumours
predominantly tumours of those over middle age, women, usually in the
seventh or eight decade
parotid glands
slow-growing and may rarely be bilatera.
Well Well circumscribed circumscribed, , red red- -brown brown color color
From From large large oxyphilic oxyphilic cells cells with with granular granular cytoplasm cytoplasm – – oncocytes oncocytes
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Tumors Tumors of of salivary salivary glands glands
Benign Benign tumors tumors
Pleomorfic Pleomorfic adenoma adenoma
Monomorfic Monomorfic adenoma adenoma
Adenolymphoma Adenolymphoma
Onkocytoma Onkocytoma
Malignant Malignant tumors tumors
Mukoepidermoid Mukoepidermoid carcinoma carcinoma
Adenocystic Adenocystic carcinoma carcinoma ( (cylindroma cylindroma) )
Adenocarcinoma Adenocarcinoma
Carcinoma Carcinoma from from acinous acinous cells cells
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Mucoepidermoid Carcinoma
most common, form 4.8% of all salivary gland tumours, most common
types of post-irradiation salivary gland tumours
parotid, peak age incidence is in the fifth decade.
locally invasive locally invasive growth growth, destructive, metastases, often quickly, painfully , destructive, metastases, often quickly, painfully
less malignant variants less malignant variants – – recurrency recurrency
Well differentiated adenocarcinoma G1 Well differentiated adenocarcinoma G1
consists of squamous epithelial cells and mucus consists of squamous epithelial cells and mucus- -producing cells producing cells
cystic formations lined by mucin cystic formations lined by mucin- -producing cells producing cells
sheets sheets of squamous of squamous- -epithelial cells epithelial cells
Poorly differentiated adenocarcinoma G3 Poorly differentiated adenocarcinoma G3
consists predominantly consists predominantly from from epithelial squamous cell epithelial squamous cell
w without cystic formations, pleomorphic cells ithout cystic formations, pleomorphic cells
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Adenoid Cystic Carcinoma ('Cylindroma')
More More common common in in minor salivary salivary glands glands, , the palate is by far the most
peak age incidence is in the sixth decade (range 12-72 years) and the
female to male ratio is 1.3
Slow growth, but pain Slow growth, but painful ful and facial nerve palsy and facial nerve palsy
late appearance of recurrences, but f frequent, metastases, worse requent, metastases, worse
prognosis prognosis
Perineur Perineura al dissemination l dissemination - - PAIN PAIN
Poorly encapsulated, gray Poorly encapsulated, gray- -white color white color, , growing growing into into the surrounding the surrounding
tissue tissue
Typical cribriform adenoid cystic carcinomas
Consists of cylindrical cavit Consists of cylindrical cavities ies filled with hyaline masses and filled with hyaline masses and
connective connective tissue tissue with capillaries with capillaries
Myoepit Myoepith hel elial ial cells cells
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Acinic Acinic cell cell carcinoma carcinoma
Arises Arises from from acinic acinic cell cells s
Parotide Parotide, women , women
Low Low- -grade malignanc grade malignancy y, but often recurs , but often recurs
Well Well- -circumscribed, circumscribed, unfixed unfixed
Cells Cells: : mucinous, serous, seromucin mucinous, serous, seromucinous ous
in different structures (solid, mikrocystic, papillary in different structures (solid, mikrocystic, papillary- -cystic, cystic,
follicular) follicular)
Cells with abundant basophilic Cells with abundant basophilic granular cytoplasm granular cytoplasm
Cells with Cells with vacuolated vacuolated cytoplasm cytoplasm
Eosinophilic cells with Eosinophilic cells with centrally located centrally located nucleus nucleus