|Year : 2022 | Volume
| Issue : 3 | Page : 291-295
Histopathological study of salivary gland tumors: a tertiary care hospital-based study
Pankaj R Pande1, Amitkumar B Pandav2, Vijay R Bhosale1
1 Department of Pathology, Prakash Institute of Medical Sciences and Research, Uran Islampur 415409, Maharashtra, India
2 Department of Pathology, Government Medical College, Miraj 416410, Maharashtra, India
|Date of Submission||27-Mar-2022|
|Date of Acceptance||21-Jun-2022|
|Date of Web Publication||29-Sep-2022|
Dr. Amitkumar B Pandav
Department of Pathology, Government Medical College, Miraj 416410, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: Salivary gland tumors (SGTs) are relatively uncommon and show a wide variety of morphological heterogeneities. The incidence of SGTs is said to be affected by geographical and racial factors. Histopathological diagnosis plays a major role in the diagnosis of these neoplasms. Objectives: This study investigated the incidence of SGTs and histopathological features of various SGTs, aimed at knowing the epidemiological pattern of these tumors and comparing the results of our study with other studies of SGTs in the literature. Materials and Methods: A retrospective study was conducted on SGTs at the Pathology Department of the Government Medical College and Hospital for a period of 5 years. Clinical and demographic data were documented and analyzed concerning histopathologic type. Results: A total of 86 SGTs were identified, 65.12% of which were classified as benign and 34.88% as malignant. Most tumors occurred in the parotid gland (59.14%). Pleomorphic adenoma (PA) was the most common tumor (56.98%), followed by mucoepidermoid carcinoma (MEC) (17.44%). The tumors occurred more often in men (51.16%) than in women (48.84%). Conclusion: SGTs exhibit broad morphological heterogeneity and these tumors are rare. The parotid gland is the most common location, and PA is the most frequent benign tumor. MEC followed by adenoid cystic carcinoma is the most common malignancy of the salivary gland.
Keywords: Mucoepidermoid carcinoma, pleomorphic adenoma, salivary gland tumors
|How to cite this article:|
Pande PR, Pandav AB, Bhosale VR. Histopathological study of salivary gland tumors: a tertiary care hospital-based study. MGM J Med Sci 2022;9:291-5
|How to cite this URL:|
Pande PR, Pandav AB, Bhosale VR. Histopathological study of salivary gland tumors: a tertiary care hospital-based study. MGM J Med Sci [serial online] 2022 [cited 2023 Feb 6];9:291-5. Available from: http://www.mgmjms.com/text.asp?2022/9/3/291/357466
| Introduction|| |
Salivary gland neoplasms represent the most complex and diverse group of tumors encountered, especially by the head and neck oncologist. These tumors are relatively uncommon and consist of 3–10% of head and neck neoplasms. The incidence ranges from 0.8% to 5% of all tumors of the body. Any of the salivary glands, major or minor, may be the seat of tumor formation, but the major glands and, in particular, the parotids are the most affected. The palate is the most frequent site of minor salivary gland tumors (SGTs). Most studies have shown geographic variation in the incidence and microscopic types of salivary gland neoplasms.,
This study intended to examine the histopathological features of various SGTs, knowing the incidence of SGTs aimed at knowing the epidemiological pattern of these tumors, and to compare our outcomes with other studies done elsewhere.
| Materials and methods|| |
The present study of SGTs was undertaken at the Department of Pathology, Government Medical College and Hospital, Miraj, Maharashtra, India which is a major tertiary healthcare institution with approval obtained from the Institutional Ethical Committee. This is a 5-year retrospective study of all SGT biopsies received at our hospital. The clinicopathologic data were collected from indoor case papers and biopsy requisition forms. All specimens were fixed in 10% formalin, then processed into paraffin-embedded sections, and stained with hematoxylin and eosin. Special stains such as periodic acid Schiff (PAS), Alcian blue (AB), and Mucicarmine (MC) were employed whenever necessary. All of the SGTs were histologically reviewed and reclassified independently by at least three pathologists based on the latest World Health Organization (WHO) classification.
| Results|| |
We received a total of 26,996 surgical specimens. Out of these, 6749 were reported as tumors located at the various sites of the body. Of these 6749 tumors, 86 were in the salivary gland constituting an incidence of 1.27% of the tumors all over the body. Benign tumors were more frequently encountered than the malignant ones, and the incidence of benign tumors was almost twice that of malignant tumors. In the present study, the maximum incidence of SGTs was noticed in the fourth decade. Only a single case was observed in the first decade. The youngest patient was 7 years of age, whereas the oldest one was 80 years. Frequencies of various salivary gland neoplasms according to age and sex are shown in [Table 1].
Pleomorphic adenoma (PA) [Figure 1] and mucoepidermoid carcinoma (MEC) [Figure 2], the commonest benign and malignant tumors in the present series, showed female predilection (55.1% and 66.6%, respectively) whereas in adenoid cystic carcinoma (ACC) male preponderance (71.4%) was noted.
|Figure 1: Pleomorphic adenoma showing epithelial islands with the chondromyxoid matrix. H&E ×40|
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|Figure 2: Mucoepidermoid carcinoma showing nests of pleomorphic epidermoid cells and mucous-producing cells surrounding cystic spaces. H&E ×40|
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In this study, it is evident that adenomas were more common than carcinomas. PA was the most common tumor in the present study which accounted for 56.98% of the cases. Warthin’s tumor (3.49%) [Figure 3], basal cell adenoma (1.16%), and oncocytic adenoma (1.16%) were the other types of adenomas observed. Among the malignant tumors, the MEC was the most common with 17.44% of the cases which was followed by ACC (8.14%) [Figure 4] and squamous cell carcinoma (4.65%). Acinic cell carcinoma (2.33%) [Figure 5], carcinoma ex PA (1.16%), and undifferentiated carcinoma (1.16%) were the other types of carcinomas observed. The non-epithelial tumors were less frequent and a single case each of capillary hemangioma and lipoma was found. It is obvious that the parotid gland was the most frequent site in all the tumors except for ACC which was the most common in minor salivary glands. PA, the most common tumor in the present series, also showed a preference for the parotid gland [Table 2].
|Figure 3: Warthin’s tumor with cystic spaces lined by oncocytic columnar and cuboidal cells in the lymphoid stroma. H&E ×40|
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|Figure 4: Adenoid cystic carcinoma with cribriform pattern in cystic spaces filled with basophilic mucoid material. H&E ×40|
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|Table 2: Frequency and gender distribution of individual salivary gland tumors|
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| Discussion|| |
SGTs are quite rare when compared with the tumors located over other sites in the body, accounting for less than 2% of all tumors in the body. The incidence of SGTs in our study was 1.27% of all the body tumors, which was close to that reported by other studies,, and tallies with that reported by Vandenberg et al., Sharky, and Dandapat et al.
In the present study of 86 SGTs, the parotid gland was the most frequently encountered site with 50 (59.14%) tumors. This was followed by submandibular and minor salivary glands, with 18 (20.93%) cases each. In minor salivary glands, 12 (13.95%) tumors were present in accessory salivary glands such as the nostril, tonsil, floor of the mouth, and tongue [Table 3]. The parotid gland was the most common site of SGTs according to all the authors. We also made a similar observation. A lower incidence in the parotid gland is observed by various foreign authors when compared with the Indian authors, including the present series.,,,
In our study, we came across 56 (65.12%) benign tumors and 30 (34.88%) malignant tumors. Thus, benign tumors were twice more frequent than malignant ones. It can be noted that our observation correlates well with studies from Indian authors and foreign authors.,,,,, PA was the most common SGT, which consists of 56.98% of all tumors. All epidemiological studies on the SGTs have shown a noticeable predominance of PA. The frequency of other malignant epithelial tumors in the present study is almost similar to most Indian and Western reports.,, The incidence of other benign tumors such as Warthin’s tumor, lipomas, and hemangiomas is also close to the other studies. In our present study, a single case of basal cell adenoma has been reported.
In the present study, the average age for benign tumors is 45.5 years whereas for malignant it is 50 years. The maximum incidence observed in the third and fourth decades is consistent with the same noticed by other studies., The lower incidence in the first decade observed in the present study is similar to those in studies by Laishram et al., Thotambailu and Bhandary, and de Oliveira et al. Similarly, lower incidence in the age group 71 years and above observed in the present study is the same as that observed by de Oliveira et al. All the authors observed a higher average age for the malignant tumors when compared with the benign tumors, except for Eveson and Cawson as they considered only primary epithelial neoplasms in their study of 2410 cases. They did not consider primary non-epithelial tumors such as hemangiomas and lipoma, which generally occur in the younger age group and hence the average age for benign tumors was higher than that for malignant tumors. The slight male predominance with an M: F ratio of 1.05:1 observed is comparable with the same noted by Dandapat et al. However, Atarbashi Moghadam et al. and Laishram et al. recorded slight female predilection.
Major salivary glands (63%), especially the parotid gland, harbor the bulk of SGT alike to the average found in the literature. Numerous large studies from Asian countries have shown a similar distribution, with more frequency in the parotid, followed by the minor and submandibular glands. Although most SGT occurs in the major salivary glands, the favored site of MEC in the present study was in both major and minor salivary glands. ACC occurred more common in minor than in major salivary glands. Most other studies have shown ACC to be more common in the minor salivary glands than in the submandibular and parotid glands. Palate was the most common location for both benign and malignant tumors of the minor salivary gland. The literature data validate this finding and show a predominance of malignant tumors in this region. In this study, MEC and ACC presented at the same frequencies. However, in our literature review, they presented at frequencies of 17.44 and 8.14, respectively. The frequency of ex-PA (1.6%) in our study is similar to studies in the literature.,
| Conclusion|| |
This study includes epidemiological data about clinical and histopathological characteristics of SGTs and was compared with other worldwide studies. Learning SGT is challenging as it comprises a large and varied group of lesions characterized by morphological heterogeneity. The results of the present study suggest that benign tumors are most common, especially in parotid glands, and are represented mainly by PA. Women are the most often affected, especially for benign lesions. Regarding malignant tumors, MEC followed by ACC was the most common malignancies of the salivary gland. The results of this study provide significant knowledge regarding the incidence of SGT.
Ethical policy and Institutional Review Board statement
The research topic “Clinicopathological study of salivary gland tumors” was undertaken by Pankaj R. Pande, one of the authors for the award of the Degree of MD (Pathology) in November 2021 under the guidance of Dr. Mrs. Molly A. Phansopkar, Associate Professor, Department of Pathology, Government Medical College, Miraj, and Professor and Head, Wanless Hospital, Miraj, Maharashtra, India. It was approved by the Institutional Ethics Committee, Government Medical College, Miraj vide their letter no. GMCM/Eth. Comm/23/2001 dated December 5, 2001.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Hellquist H, Paiva-Correia A, Vander Poorten V, Quer M, Hernandez-Prera JC, Andreasen S, et al
. Analysis of the clinical relevance of histological classification of benign epithelial salivary gland tumours. Adv Ther 2019;36:1950-74.
Guzzo M, Locati LD, Prott FJ, Gatta G, McGurk M, Licitra L Major and minor salivary gland tumors. Crit Rev Oncol Hematol 2010;74:134-48.
El-Naggar AK, Chan JKC, Grandis JR, Takata T, Slootweg PJ, editors. Tumours of salivary glands. In: WHO Classification of Head and Neck Tumours. 4th ed. Lyon: International Agency for Research on Cancer (IARC); 2017. p. 159-202.
Paymaster JC Tumors of salivary glands. Indian J Surg 1955;17:107.
Kaira VB, Lodha SK, Sarcen PM, Utreja SR Benign mixed tumors: A clinicopathological study of 100 cases. Indian J Surg 1982;44:498-504.
Vandenberg HJ Jr, Kambouris A, Pryzybylski T, Rachmaninoff N Salivary tumors. Clinicopathologic review of 190 patients. Am J Surg 1964;108:480-4.
Sharky FE Systematic evaluation of the World Health Organization classification of salivary gland tumors—A clinicopathologic study of 366 cases. Am J Clin Pathol 1977;67:272-8.
Dandapat MC, Rath BK, Patnaik BK, Dash SN Tumors of salivary glands [A review of 42 cases]. Ind J Surg 1991;53:200-4.
Atarbashi Moghadam S, Atarbashi Moghadam F, Dadfar M Epithelial salivary gland tumors in Ahvaz, southwest of Iran. J Dent Res Dent Clin Dent Prospects 2010;4:120-3.
Tilakaratne WM, Jayasooriya PR, Tennakoon TM, Saku T Epithelial salivary tumors in Sri Lanka: A retrospective study of 713 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108:90-8.
Laishram RS, Kumar KA, Pukhrambam GD, Laishram S, Debnath K Pattern of salivary gland tumors in Manipur, India: A 10 year study. South Asian J Cancer 2013;2:250-3.
Thotambailu AM, Bhandary BSK A study of clinicopathological profile of salivary gland swellings. Indian J Otolaryngol Head Neck Surg 2019;71:253-7.
Pons Vicente O, Almendros Marqués N, Berini Aytés L, Gay Escoda C Minor salivary gland tumors: A clinicopathological study of 18 cases. Med Oral Patol Oral Cir Bucal 2008;13:E582-8.
de Oliveira FA, Duarte EC, Taveira CT, Máximo AA, de Aquino EC, Alencar Rde C, et al
. Salivary gland tumor: A review of 599 cases in a Brazilian population. Head Neck Pathol 2009;3:271-5.
Eveson JW, Cawson RA Salivary gland tumours. A review of 2410 cases with particular reference to histological types, site, age and sex distribution. J Pathol 1985;146:51-8.
Ito FA, Ito K, Vargas PA, de Almeida OP, Lopes MA Salivary gland tumors in a Brazilian population: A retrospective study of 496 cases. Int J Oral Maxillofac Surg 2005;34:533-6.
Tian Z, Li L, Wang L, Hu Y, Li J Salivary gland neoplasms in oral and maxillofacial regions: A 23-year retrospective study of 6982 cases in an eastern Chinese population. Int J Oral Maxillofac Surg 2010;39:235-42.
Sando Z, Fokouo JV, Mebada AO, Djomou F, NDjolo A, Oyono JL Epidemiological and histopathological patterns of salivary gland tumors in Cameroon. Pan Afr Med J 2016;23:66.
Lima SS, Soares AF, de Amorim RF, Freitas Rde A [Epidemiologic profile of salivary gland neoplasms: Analysis of 245 cases]. Braz J Otorhinolaryngol 2005;71:335-40.
Kalburge JV, Kalburge V, Latti B, Kini Y Salivary gland tumors: Clinicopathologic analysis of 73 cases. J Cranio Max Dis 2014;3:111-5.
Reinheimer A, Vieira DS, Cordeiro MM, Rivero ER Retrospective study of 124 cases of salivary gland tumors and literature review. J Clin Exp Dent 2019;11:e1025-32.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2], [Table 3]