Uploankar, Alvi, and Begum: Histopathological study of salivary gland lesions-an institutional study


Introduction

Salivary glands are unique among the secretary glands with a more heterogenous group of tumors showing greatest histological diversity. Salivary gland system includes three pairs of major glands – Parotid, Submandibular and Sublingual and many minor glands in the mucosa of the oral cavity, lips, floor of mouth, gingival, cheek, hard and soft palate, tonsillar areas and oropharynx.1 The spectrum of salivary gland lesions is wide and the relative incidence of neoplastic versus non neoplastic lesions is variable in different studies.2 Salivary gland tumors account for 2% of all human neoplasm and relatively uncommon.3 Salivary glands tumors are rare with annual incidence <1/100000 inhabitants. These tumors show wide range of morphological diversity between different tumor types and sometimes within an individual tumor mass. 4 About 65% to 80% arise within the parotid, 10% in the submandibular gland and the remainder in the minor salivary glands including the sublingual gland.5 Tumors have the highest chance of malignancy if they arise from retromolar area(89.7%), floor of mouth(88.2%),tongue(85.7%)and sublingual gland(70.2%) whereas only 20% of all parotid tumors are malignant.6

The aim of the study is to recognize various histopathological patterns of salivary gland lesions, their frequency, age, gender and site wise distribution.

Materials and Methods

The present study “Histopathological study of salivary gland lesions” is carried out in the Department of Pathology, KBNIMS, Kalaburagi. It is a two year retrospective study from November 2018 to November 2020. The blocks were retrieved and sections were cut and stained with Haematoxylin and Eosin. Information regarding age, sex, site, complaints, clinical and radiological findings were recorded from requisitions received in the histopathological department. Special stain PAS was used when required. The tumors were classified into nonneoplastic and neoplastic lesions according to WHO histological typing of salivary gland tumors.

Results

Total 50 cases were included. Both gross specimens and biopsies which were received for histopathological examination, during the period of 2 years i.e from Nov 2018 to Nov 2020 were included. Out of these 50 cases, 27 cases (54%) were diagnosed as non-neoplastic lesions and 23 cases (46%) as neoplastic lesions.

Table 1

Age wise distribution of salivary gland lesions

Age group in years

Percentage

10-20

-

21-30

03(6%)

31-40

26(52%)

41-50

09(18%)

51-60

10(20%)

61-70

02(4%)

Table 2

Sex wise distribution ofsaliwary gland lesions

Male

35(70%)

Female

15 (30%)

Most of the cases showed male predominance and were commonly found between the age group 31-40.

Table 3

Site wise distribution of salivary gland lesions

Paroti D Gland

18(36%)

Submandibular Gland

27(54%)

Minor Saliwary Gland

05(10%)

Most common site involved was submandibular region.

Table 4

Spectrum of non-neoplastic salivary gland lesions

Chronic Sialadenitis

16(32%)

Granulomatous Sialadenitis

03(6%)

Mucocele

05(10%)

Retention cyst

03(6%)

Chronic Sialadenitis was the common non neoplastic salivary gland lesion accounting for32%

Table 5

Spectrum of neoplastic salivary gland lesions

Pleomorphic Adenoma

11(22%)

Warthins tumor

05(10%)

Mucoepidermoid carcinoma

03(6%)

Adenoidcystic carcinoma

02(4%)

Epithelial myoepithelial carcinoma

01(2%)

Acinic cell carcinoma

01(2%)

Pleomorphic adenoma was the most common benign tumor and Mucoepidermoid carcinoma was the most common malignant tumor found in the present study.

One case of mucoepidermoid carcinoma was found in 24 year male in the submandibular region. Rare malignant tumor, Epithelialmyoepithelial carcinoma was diagnosed in 50 year male in the parotid gland.

Figure 1

a: Pleomorphic adenoma composed of chondroid matrix. b: Pleomorphic adenoma composed of epithelial element comprising of tubular, ductal andsquamoid differentiation

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/da0b7a4f-ce94-4e70-8280-e4ee66581f40image1.png
Figure 2

Warthin’s tumor: Blunt papillary projection exhibiting double layer of oncocytic lining cells and underlying lymphoid stroma.

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/da0b7a4f-ce94-4e70-8280-e4ee66581f40image2.png
Figure 3

Epithelialmyoepithelial carcinoma: Tumor cells are arranged in ducts with outer rim of myoepithelial cells and inner layer of ductal cells.

https://typeset-prod-media-server.s3.amazonaws.com/article_uploads/5818c559-cdf8-4a43-a11a-44b19a42afe4/image/04213b6e-b123-4c1f-b6fb-49c513b37313-u1111.png
Figure 4

Mucoepidermoid carcinoma: Clusters of mucous, squamous, intermediate and clear cells.

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/da0b7a4f-ce94-4e70-8280-e4ee66581f40image4.png
Figure 5

Adenoid cystic carcinoma: Show cribriform pattern.

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/da0b7a4f-ce94-4e70-8280-e4ee66581f40image5.png
Figure 6

Acinic Cell Carcinoma

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/da0b7a4f-ce94-4e70-8280-e4ee66581f40image6.png

Discussion

Total number of salivary gland lesions includes 50 cases. Predominantly the cases were found in the age group of 31-40 which was similar to Syed imtiyaz et al study.

Table 6

Comparative analysis of age wise distribution of salivary gland lesions

Age group

Syed Imtiyaz Hussain et al 7

Richa study7

Present Study

0-10

7%

6.32%

-

11-20

8.86%

-

21-30

21.0%

27.84%

06%

31-40

26.0%

18.98%

52%

41-50

22.0%

12.65%

18%

51-60

14.0%

15.2%

20%

61-70

10.0%

8.86%

04%

71-80

-

81-90

1.26%

-

Table 7

Comparative analysis of salivary gland lesions in males and females.

Study

M:F RATIO

Benign

Malignant

Dave P.N. et al 8

1

1.42

Syed Imtiyaz Hussain et al

1.62

4.28

Kirti N. Jaiswal et al 9

0.7

1.28

Present Study

1.54

1.21

The present study showed male predominance in both benign and malignant salivary gland lesions which was similar to other above mentioned studies

Table 8

Comparative analysis of salivary gland lesions in different studies.

Characteristics

No of Cases

Percentage (%)

Non Neoplastic

Benign

Malignant

Non Neoplastic

Benign

Malignant

Mallepogu Anil Kumar et al 10

15

30

10

27.27%

54.54%

18.18%

Dhanamjeya Rao Teeda et al 11

12

31

10

22.64%

58.49%

18.86%

Malliga .S et al 12

21

53

29

20.4%

51.45%

28.15%

Richa study 1

28

34

17

35.44%

43.03%

21.51%

Present Study

27

16

07

54%

32%

14%

In the present study, non neoplastic lesions were 54% and it was more, compared to other above mentioned studies. Benign tumors were 32% and it was less, compared to other above mentioned studies. Malignant tumors were 14% and it was less, compared to above mentioned studies.

Table 9

Comparative analysis of site wise distribution of salivary gland lesions.

Site

Dhanamjeya Rao Teeda et al 11

Anita Omhare et al 13

Mallepogu Anil Kumar et al 10

Malliga. S et Al 12

Present Study

Parotid Gland

73.5%

48.3%

67.27%

58.25%

36%

Submandibular Gland

16.9%

41.2%

25.45%

29.12%

54%

Minor Salivary gland

9.4%

10.4%

7.27%

12.6%

10%

Most common site involved was Submandibular gland followed by Parotid and minor salivary gland in the present study while other studied showed Parotid gland as commonest site of involvement.

Table 10

Comparative analysis of non-neoplasic Salivary gland lesions

Type of Lesions

Dhanamjeya Rao Teeda et al 11

Anita Omhare et al 13

Mallepogu Anil Kumar et al 10

Present study

Acute Inflammation

-

-

-

Chronic Sialedenitis

5.66%

39.2%

16.36%

32%

Tuberculosis

-

3.33%

-

6%

Cystic Lesion

16.98%

9.2%

10.9%

-

Rannula

-

-

-

-

Retention Cyst

-

-

-

6%

Mucocele

-

-

-

10%

Among nonneoplastic lesions, most common lesion encountered was chronic sialadenitis and it was similar to Anita et al study.

Table 11

Comparative analysis of Benign Salivary gland tumor

Type of Tumors

Dhanamjeya Rao Teeda et al 11

Anita Omhare et al 13

Mallepogu Anil Kumar et al 10

Malliga. S et al 12

Present Study

Pleomorphic Adenoma

45.25%

21.66%

43.63%

41.6%

22%

Warthin’s Tumor

5.66%

0.8%

10.9%

2.1%

10%

Canalicular adenoma

-

-

-

-

-

Myoepithelioma

1.88%

-

-

-

-

Oncocyst adenoma

-

-

-

1%

-

Basal Cell Adenoma

-

-

-

-

-

Monomorphic Adenoma

5.66%

8.33%

-

-

-

Hemangioma

-

1.67%

-

-

-

Neurofibroma

-

-

-

1%

-

Among neoplastic lesions, most common benign lesion encountered was Pleomorphic adenoma and it was similar to Anita et al study.

Table 12

Comparative analysis of malignant Salivary gland tumor

Type of Tumors

Dhanamjeya Rao Teeda et al 11

Anita Omhare et al 13

Mallepogu Anil Kumar et al 10

Malliga. S et al 12

Present study

Mucoepidermoid Carcinoma

9.43%

6.66%

7.27%

22.9%

06%

Acinic cell carcinoma

-

3.33%

-

-

02%

Adenocystic Carcinoma

3.77%

1.66%

3.63%

4.2%

04%

Myoepithelial Carcinoma

-

-

-

-

02%

Salivary duct Adenocarcinoma

1.88%

0.8%

-

-

-

Carcinoam ex pleomorphic adenoma

1.88%

3.33%

3.63%

6.25%

-

Mammary analog secretory carcinoma

-

-

-

-

-

High grade B cell extranodal Non Hodgkins Lymphoma

-

-

-

-

-

Poorly differentiated Carcinoma

1.88%

-

3.63%

-

-

Among neoplastic lesions, most common malignant lesion encountered in the present study was Mucoepidermoid carcinoma and it was similar to Anita et al study. Epithelial myoepithelial carcinoma, a rare tumor was also found in our study.

Conclusion

Histopathological examination remain gold standard for diagnosis of salivary gland lesions, it helps to differentiate between nonneoplastic and neoplastic lesions and deciding course of management. Hence the study was carried out.

Source of Funding

No financial support was received for the work within this manuscript.

Conflict of Interest

The authors declare they have no conflict of interest.

References

1 

RD Patel Histopathological Study of Salivarygland LesionsNatl J Integr Res Med20191056774

2 

G Pachori S Chandra NA Bihari N Kasliwal Histopathological spectrum of salivary gland lesions in Ajmer region, Rajasthan, IndiaInt J Res Med Sci20197727081310.18203/2320-6012.ijrms20192904

3 

O Ochicha M Sani A Mhammed Patients diagnosed with stage 4 cancer strong reason to believe in DSRCIJPR20095244736

4 

SS Bobati BV Patil VD Dombale Histopathological study of salivary gland tumorsJ Oral Maxillofac Pathol2017211465010.4103/0973-029x.203762

5 

V Kumar AK Abbas J C Aster Head and neckRobins Cotran Pathological Basis Dis9272748

6 

C Fletcher Tumors of salivary gland 5th Edn.2Elsevier20202440

7 

S Imtiyazhussain F Gulshanakhter B Sideeq R Iqbal R Reshi FarzanaManzoor and Arshi Beg. Histopathological Spectrum Of Salivary Gland Tumours: A Hospital Based StudyInt J Adv Res201752191222

8 

KN Jaiswal SP Johari AC Shrivastav V Anuradha Shirkhande Study of Salivary gland neoplasms Indian Medical GazetteMARCH201596100

9 

V. V. Belikov N. P. Vabishchevich P. N. Vabishchevich U. V. Katishkov N. A. Mosunova Material property databaseMath Models Computer Simulations2015729510010.1134/s2070048215020027

10 

A Mallepogu CR Sekhar Histopathological Study of Neoplastic and Nonneoplastic Lesions of Salivary Gland: An Institutional Experience of 5 YearsInt J Sci Stud20174126972

11 

SS Malliga Correlative Cytological and Histopathological Study of Lesions of Salivary Gland Int J Sci Res20165875861

12 

DR Teeda MP Akarsh P Sindhura SA Vramya Histopathological Study of Salivary Gland LesionsIOSR J Dent Med Sci2016156806

13 

A Omhare S Kumar Singh Jitendra Singh Nigam, and Ankit Sharma Cytohistopathological Study of Salivary Gland Lesions in Bundelkhand RegionPathol Res Int201480426515



jats-html.xsl

© 2021 Published by Innovative Publication Creative Commons Attribution 4.0 International License (creativecommons.org)


  • Article highlights
  • Article tables
  • Article images

View Article

PDF File   Full Text Article


Downlaod

PDF File   XML File   ePub File


Digital Object Identifier (DOI)

Article DOI

https://doi.org/10.18231/j.jdpo.2021.007


Article Metrics






Article Access statistics

Viewed: 105

PDF Downloaded: 43