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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 9  |  Issue : 2  |  Page : 67-73

A demographic study of salivary gland tumors


1 Department of Oral Pathology and Microbiology, Government Dental College and Hospital, Mumbai, India
2 Department of Oral Pathology and Microbiology, Government Dental College and Hospital, Nagpur, Maharashtra, India

Date of Web Publication18-Jun-2018

Correspondence Address:
Manisha Aba Sardar
Department of Oral Pathology and Microbiology, 301, 3rd Floor, Government Dental College and Hospital, St George Hospital Campus, P. D. Mellow Road, Near CSMT, Mumbai - 400 001, Maharashtra
India
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DOI: 10.4103/srmjrds.srmjrds_57_17

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  Abstract 

Background: Salivary gland lesions, especially the neoplastic lesions constitute a highly heterogeneous histopathologic group. Several studies have reported a significant difference in the global distribution of salivary gland tumors, but no formal study has been carried out in this part of the globe. Objectives: The objectives were: (1) retrieval of salivary gland tumors from the files of Department of Oral Pathology and Microbiology, Government Dental College and Hospital (GDC and H), Nagpur, to analyze the relative frequency of individual salivary gland tumors and (2) to correlate the various salivary gland tumors according to age, sex, location, and duration and compare the findings of this study with studies conducted in other countries. Materials and Methods: This is a retrospective study of all salivary gland tumors retrieved from the files of Department of Oral Pathology and Microbiology, GDC and H, Nagpur. Data thus collected archives were analyzed. Results: Out of total 75 cases, 29 pleomorphic adenoma, 8 basal cell adenoma, 16 mucoepidermoid carcinoma, 5 adenoid cystic carcinoma, 4 acinic cell carcinoma, 4 adenocarcinoma, 2 polymorphous low-grade adenocarcinoma, and single case each of cyst-adenoma, basal cell adenocarcinoma, epimyoepithelial carcinoma, salivary duct carcinoma, carcinoma in ex-pleomorphic adenoma, malignant myoepithelioma, and mucinous adenocarcinomas were reported. These cases were analyzed considering the parameters such as age, sex, location, duration, radiographic findings, and histopathological appearances. These were compared with studies conducted in other parts of the world. Conclusion: In conclusion, the data and results presented herein were similar to previously published reports in other countries and other areas of India and globe. However, some differences were observed, these differences can be attributed to racial factors, the pathology centers of sample collection and the duration of the studies.

Keywords: Benign tumors, malignant tumors, salivary gland tumors


How to cite this article:
Sardar MA, Ganvir S M, Hazarey V K. A demographic study of salivary gland tumors. SRM J Res Dent Sci 2018;9:67-73

How to cite this URL:
Sardar MA, Ganvir S M, Hazarey V K. A demographic study of salivary gland tumors. SRM J Res Dent Sci [serial online] 2018 [cited 2018 Jul 15];9:67-73. Available from: http://www.srmjrds.in/text.asp?2018/9/2/67/234592


  Introduction Top


Life goes on without saliva, but it becomes less pleasurable. Of all the tissues in the human body, perhaps the salivary glands have the most histologically heterogeneous group of tumors and the greatest diversity of morphologic features among their cells and tissues. Although the salivary, sweat, apocrine, and mammary glands all have similar phylogeny and cellular phenotypes, many lesions are unique to the salivary glands.[1]

Tumors of the salivary glands constitute an important area in the field of oral and maxillofacial pathology. Although such tumors are uncommon, they are by no means rare.[2] Salivary gland tumors are reported to represent between 1% and 5% of all head-and-neck tumors. Of these, 75%–85% the found in the major and 10% to 20% in the minor salivary glands with a ratio of 5:1. Various series from around the world report annual incidence for all salivary glands tumors to be between 0.4 and 13.5 cases/100,000.[1] However, the incidence of malignant salivary gland tumors is considerably higher in minor salivary glands. The smaller the salivary gland, the greater the probability it will harbor a malignant neoplasm.

The biological behavior of salivary glands as summarized by Ackerman del Regato is “The usual tumor of salivary glands is a tumor in which the benign variant is less benign than the usual benign tumor and the malignant variant is less malignant than the usual malignant tumors.”[3]

Aims and objectives

The study was undertaken with following aims and objectives:

  1. Retrieval of salivary gland tumors from the files of Department of Oral Pathology and Microbiology, Government Dental College & Hospital (GDC and H), Nagpur, to analyze the relative frequency of individual salivary gland tumors
  2. To correlate the various salivary gland tumors according to age, sex, location, and duration and compare the findings of this study with studies conducted in other countries.



  Materials and Methods Top


The study was conducted in the Department of Oral Pathology and Microbiology, GDC and H, Nagpur. Of total 75 cases, 29 pleomorphic adenoma, 8 basal cell adenoma, 16 mucoepidermoid carcinoma, 5 adenoid cystic carcinoma, 4 acinic cell carcinoma, 4 adenocarcinoma, 2 polymorphous low-grade adenocarcinoma, and single case each of cystadenoma, basal cell adenocarcinoma, epimyoepithelial carcinoma, salivary duct carcinoma, carcinoma in ex-pleomorphic adenoma, malignant myoepithelioma, and mucinous adenocarcinomas were reported. These cases were analyzed considering the parameters such as age, sex, location, duration, radiographic findings, and histopathological appearances. These were compared with studies conducted in other parts of the world.

Statistical analysis was done using statistical software Stata version 8.0.


  Observations and Results Top


Clinical analysis

A total of 75 cases of salivary gland tumors were studied out of 9000 cases retrieved from the Registry of Department of Oral Pathology, GDC and H, Nagpur, during the period of 28 years. Thus, the overall annual frequency of all salivary gland tumors was found to be 2.77% and relative frequency of all salivary gland tumors was 0.003% [Table 1].
Table 1: Frequency of benign and malignant tumors of salivary glands

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Benign and malignant salivary gland tumors occurred more or less with equal frequency. Minor salivary glands were found to be more commonly involved by neoplasms as compared to major salivary glands [Table 1].

Analysis of benign salivary gland tumors

Thus, it has been found that out of 38 cases of benign tumors analyzed, major salivary gland comprised only four benign tumors all of which has occurred exclusively in the parotid gland, whereas other two major glands were found to be free of any neoplastic involvement [Table 2].
Table 2: Analysis of benign tumors of major salivary glands

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In four cases (unknown) site was not mentioned on the biopsy form. Thus, it was found that pleomorphic adenoma was the most common tumor of the minor salivary glands followed basal cell carcinoma and cystadenoma.

Palate was found to be the most common site with 23 cases (38.3%) followed by the buccal mucosa and labial mucosa and was also found to be statistically significant (P< 0.01) [Table 3].
Table 3: Analysis of benign tumors of the minor salivary gland

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Thus, [Table 4] shows that the malignant tumors involved both the parotid and submandibular gland. The number of cases, which involved submandibular gland was more as compared to parotid gland whereas sublingual gland showed no involvement.
Table 4: Analysis of malignant tumors of major salivary glands

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Mucoepidermoid carcinoma was the most commonly occurring malignant tumor mainly involving parotid gland.

Submandibular salivary gland was found to be involved by one or two cases of polymorphous low-grade adenocarcinomas, adenocarcinomas, adenoid cystic carcinoma, mucoepidermoid carcinoma, and salivary duct carcinoma. Thus, [Table 5] shows that almost all malignant tumors involved minor salivary glands, in which mucoepidermoid carcinoma was the most common tumor followed by adenoid cystic carcinoma, acinic cell carcinoma, and adenocarcinomas.
Table 5: Analysis of malignant tumors of minor salivary glands

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Similar to benign tumors, palate was the most commonly involved site followed by retromotar pad area [Graph 1].



In four cases, details of age and sex were not mentioned in the biopsy form. Benign tumors were found in a relatively younger age group than the malignant tumors. The age range for benign tumors was 16 years to 70 years with a peak in the third and fourth decade, whereas that for the malignant tumors was 11 years to 65 years with a peak in the sixth decade. Although males with malignant tumors were on an average 9.8 years older than males with benign tumors (42.7 years vs. 52.5 years), a slightly greater age difference between the age of females with benign tumors and malignant tumors was found, that is, about (31.2 years vs. 44.4 years) [Table 6] and [Graph 2].
Table 6: Analysis of age and gender

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Thus, [Table 6] shows that a slight male predilection was seen with a ratio for benign tumors being 1.3:1 and for malignant tumors 1.5:1 [Graph 3].



Other findings

Radiographic findings of salivary gland tumors were noncontributory, but one case of acinic cell carcinoma exhibited irregular osteolytic lesion involving ascending part of the ramus, and it was diagnosed as intraosseous acinic cell carcinoma.

In three cases of mucoepidermoid carcinoma, one case of adenoid cystic carcinoma and in one case of basal cell adenocarcinoma, submandibular lymph node involvement was present.

One patient of mucoepidermoid carcinoma succumbed to disease within 3 years of diagnosis of tumor.


  Discussion Top


Tumors of the salivary glands constitute an important area in the field of oral and maxillofacial pathology. A number of investigators have published their findings on salivary gland neoplasms, but a comparison of these studies is often difficult. Some studies have been limited to only the major glands or have not included all the minor salivary gland sites. In addition, the ever-evolving classification system makes an evaluation of some older studies difficult, especially when we try to compare them with more recent analyses. Not withstanding these difficulties, it is still helpful to compare these studies because they provide a good overview of salivary neoplasia in general.[2]

The present study was carried out in the Department of Oral Pathology and Microbiology, GDC and H, Nagpur. A total of 75 cases from the Oral Pathology Registry, which were diagnosed as salivary gland tumors, were selected for retrospective analysis.

The annual incidence of salivary gland tumors varies around the world from approximately 0.4–13.5/100,000 people. Salivary gland neoplasms account for <3% of all the neoplasms occurring in the head-and-neck region and are therefore relatively rare. Various authors have studied the incidence rate of salivary gland tumors. According to Frazell,[4] one of the first investigators, salivary gland tumors account for 5% of all tumors, while Spiro et al.[5],[6] and Leegard and Lindeman [7] gave incidences of 6.5% and 2%, respectively, for all head-and-neck tumors. Loke [8] studied the population of Malaysia which composed of three main racial groups and found that among the tumors at all sites, the proportion of salivary gland tumors was 4.1% among Malayas, 2.3% among Chinese, and 1.7% among Indians. According to Uchendu et al., salivary gland tumors accounted for 1.43% of all neoplasm seen at the histopathology unit of the University of Benin Teaching Hospital.[9]

In the present study, the overall annual frequency of all salivary gland tumors is 2.77% and relative frequency is 0.003%. Thus, these findings correlate well with Leegard and Lindeman.[7]

Out of these 75 cases, 15 (20%) cases involved major salivary glands including benign and malignant tumors, whereas 60 (80%) cases were in the minor salivary gland including benign and malignant tumors. This is in contrast to almost all the previous studies by Spiro,[6] Eveson and Cawson,[10] Seifert et al.,[11] Thackray and Lucas,[12] and Ellis et al.[13] and Laishram et al.[14] who found definitely higher percentage of major salivary gland tumors as compared to minor salivary gland tumors. In the present study, we found that there was greater incidence of minor salivary gland tumors as compared to major salivary gland tumors.

Benign salivary gland tumors

In the present study, we found that 50% of parotid tumors were benign, all of which were diagnosed as pleomorphic adenoma.

This is in contrast to almost all the previous studies by Eveson and Cawson,[10] Thackray and Lucas,[12] Ellis et al. (US, 1991),[13] Laishram et al.,[14] Eneroth,[15] Foote and Frazell,[16] and wherein benign tumors accounted for 65.3% to 85.39%.

But according to the above-mentioned five large well-known series of the major salivary gland tumors, pleomorphic adenoma is the most common benign tumor which accounted for 53%–76.8%, but this is in contrast to our findings, where pleomorphic adenomas accounted for 26.6% of all major salivary gland tumors.

In the present study, we reported 60 tumors of the minor salivary gland, in which 38 cases (56.6%) tumors were benign. These findings correlated with findings of other studies, that is, Eveson and Cawson,[10] Ellis et al.,[13] and Waldron et al.[17] It has also been found by various authors – Eveson and Cawson,[10] Ellis et al.,[13] and Waldron et al.[17] and that pleomorphic adenoma was the most common benign minor salivary gland tumor, in which 73.5% cases were pleomorphic adenoma. The above findings are consistent with our findings, in which 73.5% cases were pleomorphic adenoma. Lopes et al.[18] reported a higher prevalence of malignant tumors in minor salivary glands.

In the present study, benign tumors were seen with a peak in the third and fourth decade (for males, mean – 42.7 years and for females, mean – 31.6 years). Crocker et al. (1970)[19] also found similar age range in case of benign tumors (20–40 years). Studies by Satko et al.[20] in Slovakian population and Ahmad et al.[21] in Kashmir were also comparable to our study.

In case of gender distribution in benign salivary gland tumors, a slight male predilection was seen with a ratio for benign tumors being 1.3:1 which is in correlation with the findings of Leishram et al.[14] and Frade Gonzalez et al.[22] This was in contrast to Crocker et al. (1970)[19] and Kusama et al. (1997)[23],[24],[25],[26] who found female preponderance in benign tumors. Frank Bergman (1969)[27] and Neely MM et al. (1996)[28] found no significant difference in the sex distribution in benign tumors.

The variations in these findings could be attributed to the paucity of cases in our study and possible because parotid and submandibular swellings are not referred to the dental department so frequently.

Malignant salivary gland tumors

In the major malignant salivary gland, 50% parotid tumors were mucoepidermoid carcinoma similar to the findings of Rajesh Singh et al.[15] and Pinkston et al.[29]

This is in contrast to almost all the previous studies by Ellis et al. (US, 1991) 14, Eveson and Cawson,[11] Rajesh Singh et al.,[15] Eneroth (1971),[16] Foote and Frazell,[17] and Thacray and Lucas (1974)[13] in whose studies malignant tumors accounted only for 16.6% to 34.2% of all case of parotid gland involvement.

In the present study, all the submandibular gland tumors were found to be malignant. These constituted two cases each of polymorphous low-grade adenocarcinoma and adenocarcinoma (13.33%), one case (6.66%) each of mucoepidermoid carcinoma, adenoid cystic carcinoma, and salivary duct carcinoma. This is contrary to studies by Ellis et al. (1991),[14] Eveson and Cawson,[11] rajesh singh et al.,[15] Thackray and Lucas,[12] Eneroth (1971),[16] and Foote and Frazell (1953)[17] where malignant tumors varied from 30.3% to 56.1% of all submandibular gland tumors.

According to previous studies, adenoid cystic carcinoma is the most common malignant tumor of the submandibular gland followed by mucoepidermoid carcinoma, squamous cell carcinoma, malignant pleomorphic adenoma, and acinic cell carcinoma. But in our study, adenocarcinoma and polymorphous low-grade adenocarcinoma occurred with equal frequency (13.3%) followed by mucoepidermoid carcinoma, adenoid cystic carcinoma, and salivary duct carcinoma.

But according to the above-mentioned five large well-known series of the major salivary gland tumors, mucoepidermoid carcinoma were the most malignant tumors which accounted for 1.5% to 11.8%, but this is in contrast to our findings in which mucoepidermoid carcinoma accounted for 33.3% of all malignant tumors in the major salivary gland.

In the present study, we reported 60 tumors of the minor salivary gland, in which 43.4% were malignant. These findings correlated with the findings of other studies, that is, Ellis et al.,[13] Waldron et al.,[17] and Eveson and Cawson (1985).[10] However, this is in sharp contrast to the commonly quoted 80% malignancy rate reported in Spiro's study of 607 patients from Memorial Sloan Kettering Cancer Center. Spiro states in his articles that his data may be biased by his patient population.[6] Lopes et al.[18] reported a higher prevalence of malignant tumors in minor salivary glands.

It has also been found by various authors – Ellis et al.,[13] Waldron et al.,[17] and Eveson and Cawson [10] that mucoepidermoid carcinoma followed by adenoid cystic carcinoma are the most common malignant tumors of minor salivary glands. The above findings are consistent with our findings, in which 38.4% cases were of mucoepidermoid carcinoma followed by adenoid cystic carcinoma.

In the present study, malignant tumors were reported in the fourth to sixth decade of life (for males, mean – 52.5 years and for females mean – 44.6 years). Crocker et al. (1970),[19] Satko et al.[20] in Slovakian population, and Ahmad et al.[21] in Kashmir also found similar age range in case of malignant tumors (40–60 years).

As far as the gender distribution is concerned a slight male predilection was seen with a ratio for malignant tumors 1.5:1 which is in correlation with the findings of Frade Gonzalez et al.,[21] Li LJ et al.,[30] and Toida et al.[31] However, this was in contrast to Crocker et al. (1970)[19] and Kusama et al. (1997)[23] who found female preponderance in malignant tumors. Bergman 1969)[27] and Neely MM et al. (1996)[28] found no significant difference in the sex distribution in malignant tumors. However, the age profile in African studies was much younger than the Western Literature.[32]

According to a retrospective study of 201 cases of intraoral salivary gland tumors by Isacsson and Shear [33] the patient in the malignant/potentially malignant group were significantly older than those in the benign group. In the present study, we also found the same results.

In the present study, the palate was the most common site followed by buccal mucosa, labial mucosa, retromolar area, and other sites. This is consistent with observations made by Eveson and Cawson,[10] Waldron et al.,[17] and Ellis et al.[13] where the palate was involved in 42% to 54% of all cases.

The disparity in the result of our study and above studies can be attributed to the regional differences or the size of the samples used in each study.


  Conclusion Top


Salivary glands because of their unique position, complex histogenesis, diverse histopathology, and clinical significance can link the dental profession with the medical profession. However, neoplasms of salivary glands are neglected by ENT surgeons and ignored by the Dentists.

A total of 75 cases of salivary gland tumors were studied, out of a total of 9000 cases reported in the Registry of Oral Pathology. Thus, the overall annual frequency of all salivary gland tumors was found to be 2.77% with relative frequency of 0.003%.

Of the 75 tumors studied, benign and malignant tumors were found with almost equal frequency. Benign tumors constituted 50.6% and malignant tumors 49.7%. Minor salivary glands were found to be more commonly involved (80%) as compared to major salivary gland. In major salivary gland tumors, both the parotid gland and submandibular gland were involved with equal frequency. The palate was the most common site in case of minor salivary gland tumors. In both major and minor salivary gland tumors, pleomorphic adenoma and mucoepidermoid carcinoma were the most common benign and malignant tumors, respectively.

Benign tumors were found in a relatively younger age group than the malignant tumors. The age range for benign tumors was 16 years to 70 years with a peak in the third and fourth decade, whereas that for the malignant tumors was 11 years to 65 years with a peak in the sixth decade. Although males with malignant tumors were on an average 9.8 years older than males with benign tumors (42.7 years versus 52.5 years), a slightly greater age difference between the age of females with benign tumors and malignant tumors was found, that is, about (31.2 years versus 44.4 years).

In case of benign and malignant tumors, there was a male predilection with a ratio of approximately 1.5:1.

In conclusion, the data and results presented herein were similar to previously published reports in other countries and other areas of India. However, some differences were observed, these differences can be attributed to racial factors, the pathology centers of sample collection, and the duration of the studies.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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