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Surgery

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Salivary Gland

Question
29 out of 80
 

The most common tumour of the minor salivary gland is:



A Mucoepidermoid carcinoma

B Acinic cell carcinoma

C Adenoid cystic carcinoma

D Pleomorphic adenocarcinoma

Ans. C Adenoid cystic carcinoma (Ref Bailey 26/e p723, 25/e p752; Devita 9/e p777-778; Cancer of the Head and Neck by Suen and Myer 4/e p487-489)

Adenoid Cystic Carcinoma

• Second MC malignant tumor after mucoepidermoid carcinoma

• MC malignant tumor in submandibular, sublingual and minor salivary glands?

a. MC site of origin is in minor salivary glands located in oral cavity (hard palate) followed by sinonasal tract

b. MC type is Cribriform pattern, and is characterized by "Swiss-Cheese" appearance

c. It has neurotropic properties, MC involved nerves are facial nerve, mandibular (V3) and maxillary branches of trigeminal nerve.

• Skip lesions along nerves are common, leading to treatment failure, because of difficulty in treating full extent of invasion.

• May grow along haversian system of bone without showing bone destruction

• It is treacherous tumor as it appears benign even when it is malignant

Clinical Features

• Characterized by its tendency to invade perineural tissues and lymphatics, thus causes pain (which may be prominent and early symptom) and facial nerve paralysis

• High incidence of distant metastasis but indolent growth

a. Incidence of distant metastasis is correlated with stage of disease (size of primary tumor and status of LNs)

b. MC site of metastasis is lung, lung metastasis are usually multiple and prolonged survival without treatment is not unusual

Diagnosis

• Best diagnostic modality is FNAC

• MRI is radiological IOC as it detects early perineural spread and intracranial extension?

Treatment

• Radical excision (irrespective of benign appearance) with largest cuff of normal tissues around the boundaries of tumor (poorly in capsulated with infiltrating nature.

• Post-op radiotherapy should be given if margins are positive".

Salivary Gland Flashcard List

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