Malignant Salivary Gland Neoplasm - clinicopathological Study

ENT 14 (1), 2008 5 Bangladesh J of Otorhinolaryngology 2008; 14(1) : 1-5 Original Articles Malignant Salivary Gland Neoplasmclinicopathological Study Mohammed Shafiqul Islam1 , Md. Azharul Islam2 , Md. Abdus Sattar3, AFM Ekramuddula3, Hossain Imam Al Hadi2 Abstract: Salivary gland neoplasm constitute about 10% of all head & neck neoplasm which represent 3% of all neoplasm of the body. In this study 50 patients of salivary gland neoplasm were studied to observe the frequency & clinicopathological pattern. Among 50 cases, 39(78%) were parotid neoplasm, 4 (8%) were submandibular neoplasm and 7 (14%) were minor salivary gland neoplasms. Among the parotid neoplasms, 13 (33.33%) were malignant neoplasms. Whereas in the submandibular neoplasm 2 (50%) were malignant neoplasms and for minor salivary glands tumour 4 (57.14%) were malignant neoplasms. Forty nine cases undergone some form of surgery. Most of them were treated by superficial or total conservative parotidectomy or radical parotidectomy/ submandibular gland excision with or without block dissection. Key word: Salivary gland neoplasm, Adenoid cystic carcinoma, Facial nerve. Introduction Cancer is one of the few disease still unconquered inspite of relentless efforts of the scientists all over the world. It causes about 12% deaths throughout the world.1 several histological types of malignancy affecting the salivary glands, of which being relatively lower in the parotid gland. Malignancy is far more frequent in the submandibular, sublingual and minor salivary glands. So far it is known, a complete study for frequency of malignancy in salivary gland neoplasm was not carried out previously in our country. This study was carried out to find the frequency of malignancy among salivary gland neoplasms, their histological types, age and sex distribution of the patient, probable aetilogical factors, symptoms, specific site of malignancy and compare the findings with those of previous studies carried out in our country and abroad. Neoplasm of the salivary gland is an ancient disease. It was first described by kareka in 1952. Throughout the world salivary gland neoplasm constitute about 10% of all head and neck neoplasms which represents 3% of all neoplasm in the body.2,3 Among the salivary gland neoplasms, parotid gland is the commonest site (about 75%)4, of these almost 80% are benign and 80% of benign tumours are plemoriphic adenomas.5 Submandibular gland is the second most common site of neoplasm constituting about 10 to 19%.6 Tumours of the sublingual and minor salivary glands are uncommon representing about onetenth of all neoplasm of salivary glands.7 Materials and Method : This was a cross sectional study carried out in the department of Otolaryngology-Head & Neck Surgery of BSMMU & DMCH during the period of September, 2006 to March, 2007. Study has been carried out on a total number of 50 patients of salivary neoplasm of different age group. Data were collected by taking history, physical examination & necessary investigation. It is important to have a proper broad based study of neoplasm of salivary gland to find out incidence of malignancy among salivary neoplasms. There are 1. 2. 3. OSD, DG Health, deputed in BSMMU, Dept. of Otolaryngology-Head & Neck Surgery, BSMMU, Dhaka. Associate Professor, Dept. of Otolaryngology-Head & Neck Surgery, BSMMU, Dhaka. Assistant Professor, Dept. of Otolaryngology-Head & Neck Surgery, BSMMU, Dhaka. Aims and Objectives 1. To see the frequency of malignancy among salivary gland neoplasms, 2. . To see the demographic features of the cases. ENT 14 (1), 2008 6 Bangladesh J of Otorhinolaryngology 3. Vol. 14, No. 1, April 2008 To observe the clinical presentation, specific site of origin, histological types of the malignancy, frequency of lymphatic metastasis. Results The present series of 50 cases included the varieties of salivary gland tumours both benign and malignant. But no tumour of sublingual gland was found at that time and likewise does not included in this series. Out of all cases, parotid tumours (both benign and malignant) was 39 (78%), submandibular tumour was 4 (8%) and minor salivary gland was 7 (14%) in numbers. Carcinoma was common in older age groups and rare in children but benign neoplasm in children and adolescent was not so uncommon. Highest incidence of tumours were found in 5th decade (50-60 yrs) of life as found in 26% of cases. Next common age incidence have been noted in 3rd decade of life 22%. The most common and constant presentation was swelling. It was found in all of the cases i.e.100%. Pain was important symptom of malignancy. Overall 13 patients had pain, out of which 9 in parotid gland malignancy, 1 in submandibular and 3 in minor salivary gland malignancy. Facial nerve paralysis was found in 3 cases, all were in parotid gland malignancy. There were 5 cases who showed lymphatic metastasis 3in parotid malignancy and 2 in submandibular gland malignancy. Most of the tumours of parotid malignancy were in stage-3 (61.54%) and all submandibular gland malignancy (2) were in stage-3. Minor salivary gland presented equal number in stage-2 (50%) and stage3 (50%). Table-I Age distribution (n = 50) Age in years No of case Percentage Out of total 39 parotid tumours, 26(66.67%) were benign and 13(33.33%) were malignant tumours and minor salivary gland shows 3(42.86%) benign and 4(57.14%) malignant tumours whereas submandibular gland shows 2(50%) benign and 2(50%) malignant tumours. 10-20 yrs. 2 4% 21-30 yrs. 10 20% 31-40 yrs. 11 22% 41-50 yrs. 10 20% 51-60 yrs. 13 26% Out of 13 malignant parotid tumours, 10 (25.64%) were mucoepidermoid carcinoma, and 3 (7.70%) were carcinoma in pleomorphic adenoma. In case of submandibular gland tumour, out of 2 benign tumours all were pleomorphic adenoma (50%) and out of 2 malignant tumours all were adenoid cystic carcinoma. 61-70 yrs. 2 4% 71-80 yrs. 2 4% Total 50 100% Out of 7 minor salivary gland tumours 3 were benign (42.86%) and 4 were malignant (57.14%). The malignant being 2 (28.57%) adenoid cystic carcinoma and 2 (28.5%) adenocarcinoma. Most of patients (n= 24) were admitted in hospital within 4-8 years of their first symptoms. The second largest group of patients (n= 13) were admitted within 2-4 years of appearance of 1st symptoms. Table – II Frequency of location of different tumour (n = 50) Incidence of tumour No of cases Percentage Parotid gland 39 78% Submandibular gland 4 8% Minor salivary gland 7 14% Sublingual gland - - Table-III Frequency of benign and malignant tumours Gland of origin Type of tumour Parotid gland Benign Malignant Benign Malignant Benign Malignant Submandibular gland Minor salivary gland 2 No. of cases Percentage 26 13 2 2 3 4 66% 33.33% 50% 50% 42.86% 57.14% ENT 14 (1), 2008 7 Malignant Salivary Gland Neoplasm-clinicopathological Study Mohammed Shafiqul Islam et al Table-IV Histopathological Types Tumour Type Parotid gland Su (...truncated)