1	MALIGNANT SALIVARY GLAND TUMORS Mucoepidermoid carcinoma Adenoid cystic carcinoma Acinic cell carcinoma
2	Mucoepidermoid Carcinoma Malignant salivary gland tumor is of varying degree of aggressiveness composed of mucous secreting and stratified squamous epithelial cells and lacking a capsule.
3	Mucoepidermoid Carcinoma CLINICAL FEATURES: Adulthood tumor Significant female predilection SITE: 50% MEC occur in the parotid gland (arising in superficial lobe) 20% occur on the palate Rest of the lesions arising from the minor salivary glands with the buccal mucosa, lips, tongue and retro molar areas to be the favored sites. C/F.. Cont..d
4	Mucoepidermoid Carcinoma The tumor may be movable, which is an uncommon feature for a malignant tumor. High grade lesions are often fixed to the adjacent tissues. Their size is 1-4 cm when diagnosed. There may be facial weakness due to VII nerve involvement.
5	Mucoepidermoid Carcinoma
6	Mucoepidermoid Carcinoma HISTOPATHOLOGY: They have three dominant cell types Mucinous, epidermoid and intermediate Their cells are arranged in the nests and diffuse sheets that may surround cystic spaces There is no capsule, but the edge of the tumor is well-demarcated
7	Mucoepidermoid Carcinoma There may be focal areas of malignant cells infiltrated into the normal salivary tissue Tumors predominant mucous cells and more cystic spaces are classified as low grade (with limited metastatic potential) Those with solid sheets and fewer mucous secreting cells and high proportion of stratified squamous epithelium are classified as high grade tumors
8	Mucoepidermoid Carcinoma
9	Mucoepidermoid Carcinoma LOW GRADE / HIGH GRADE
10	Mucoepidermoid Carcinoma TREATMENT/PROGNOSIS: Low grade tumors follow a benign course whereas high grade show distant metastasis to the regional lymph nodes as well ( cervical lymph nodes) Treatment of primary malignancy is managed with surgery followed by radiotherapy to the primary site. Prognosis depends on the histological grade of the malignancy.
11	ADENOID CYSTIC CARCINOMA
12	ADENOID CYSTIC CARCINOMA It is a malignant salivary gland tumor composed of cuboidal cells in a solid cribriform tubular pattern ACC is one of the most deceptive and frustrating tumor of the head and neck region ORIGION: ACC arises from intercalated duct reserve cells or the terminal tube complex
13	ADENOID CYSTIC CARCINOMA CLINICAL FEATURES: Peak incidence is in sixth decade of life with slight female predilection 50-70% cases reported are in the minor salivary glands, the major glands that are affected are the parotid glands In major salivary glands, the clinical appearance is that of a unilocular mass, which is firm on palpation There might be some pain and tenderness
14	ADENOID CYSTIC CARCINOMA The lesion has a slow growth rate. Facial nerve paralysis or weakness maybe the initial symptom Bone invasion occurs frequently. There are no radiographic changes initially as there is infiltration through the marrow spaces Metastasis is often seen in lungs The tumor has tendency to invade the perinural spaces
15	ADENOID CYSTIC CARCINOMA HISTOPATHOLOGY: Slight microscopy will reveal cribriform or cylindro-matous pattern (Swiss cheese pattern) Areas of necrosis with solid clusters of cells indicate more aggressive form of the disease The individual tumor cells are cuboidal small with a disproportionate large nuclei
16	ADENOID CYSTIC CARCINOMA There are no mitotic figures There is formation of pseudocystic spaces that contain variety of acellular substances Myoepithelial cells may represent a minor part of the cellular component
17	ADENOID CYSTIC CARCINOMA
18	ADENOID CYSTIC CARCINOMA
19	ADENOID CYSTIC CARCINOMA
20	ADENOID CYSTIC CARCINOMA
21	ADENOID CYSTIC CARCINOMA TREATMENT/PROGNOSIS: Primary lesion always requires surgical innervation in the parotid gland with resection in the form of superficial parotidectomy or deep lobulectomy Post surgical radiotherapy has shown promising results Multiple agent chemotherapy has shown some promise in the management of the patients with metastatic disease 5 years survival rate is approximately 70% After 15 years, the rate drops to 10% only.