Adenoma of the salivary gland: causes, symptoms and methods of treatment

Few think about where saliva isgland. While it regularly performs its functions and does not cause discomfort, it does not pay much attention. Adenomas of salivary glands can differ in their histological and morphological structure. They, like other tumors, are malignant and benign. Benign tumors develop rather slowly and do not show discomfort or other symptoms. Malignant tumors grow rapidly, they give screenings to neighboring organs and tissues, cause pain and damage to the nerves of the face.

Definition

Where is the salivary gland? First of all, it should be noted that this is a paired alveolar-serous organ located under the skin down and anterior to the auricle. Its main function is the secretion and accumulation of saliva. In the liquid, a large amount of sodium and potassium chlorides, as well as amylases. It creates an acidic environment in the oral cavity with a pH below 6. During the day, both glands can separate up to half a liter of saliva.

Adenomas of the salivary gland are benign,intermediate or malignant neoplasms, which are formed from small or large salivary glands. Among all the tumor processes, the percentage of salivary glands is about one percent. This is a fairly high figure. Changes can begin at any age, but most often this happens in the middle and old age (40-60 years), and women are twice as likely as men.

Neoplasms are prone to malignancy, relapse and metastasis, and therefore are of interest to dentists and maxillofacial surgeons.

Causes

Why there is an adenoma of the salivary gland, to the endis unknown. Doctors have speculation that the appearance of the tumor can be associated with the previous trauma of this area or inflammatory diseases, as well as with mumps (mumps). But not all patients in the history have such cases.

Some scientists insist that the cause of the tumorsalivary gland can be a congenital tissue dystopy. In addition, do not discount such oncogenic viruses as Epstein-Barr, cytomegalovirus (especially 16, 18, 31 and 32-type) and herpes simplex virus.

But this is not all cases when it can developadenoma of the salivary gland. The reasons must be sought in the lifestyle of a person (chewing tobacco or using drugs), his habitat and work (excessive insolation, frequent irradiation of the head and neck, radiation therapy for thymus or thyroid disease). There is an opinion that the pathology is associated with an increase in cholesterol, a lack of vitamins in food and hormonal disorders.

It is believed that workers at the wood processing, metallurgical and chemical industries (deposition of heavy metal salts), hairdressers are at risk.

Classification by TNM

For convenience in diagnosing and treating salivary gland adenoma, an international classification is used that facilitates the determination of the stage of the process:

1. T (tumor) - tumor size:
   - T0 - it was not possible to identify the adenoma;
   - T1 - diameter of the tumor less than 2 cm;
   - T2 - diameter up to 4 cm, but outside the gland does not go out;
   - T3 - size from 4 to 6 cm, the facial nerve is not affected;
   - T4 - diameter greater than 6 cm, is distributed to neighboring tissues, affects the cranial nerves.
2. N (nodes) - regional lymph nodes:
   - N0 - no metastases;
   - N1 - one node is affected, tumor up to 3 cm;
   - N2 - several nodes are affected, tumor size - from 3 to 6 cm;
   - N3 - many nodes are affected, the diameter of the lesion is more than 6 cm.
3. M (metastasis) - metastases:
   - M0 - there are no distant metastases;
   - M1 - there are distant metastases.

Thanks to such a system, it was possible to simplify the diagnosis and predict the development of the disease. And the alphanumeric code allows you to use it in any country in the world.

Morphological classification

The adenoma of the parotid salivary gland is of several species, differing in histological and morphological structure:

1. Epithelial tumor. Can develop from the tissues of both large and small salivary glands. It is characterized by proliferation of epithelium in the lumen of the ducts in the form of papillae, crooked and tubular structures.
2. Monomorphic adenoma. Benign formation, consisting of glandular tissue. It develops imperceptibly, mainly in elderly men. Has a round or oval shape of elastic consistency.
3. Adenolymphoma repeats morphologically the monomorphic adenoma, but inside the glands it also contains lymph.
4. The sebaceous adenoma is a clearly defined tumor,formed from several nests of cystically altered sebaceous cells. Can develop at any age. It is painless, has a yellowish color. After removal, never gives metastasis.
5. Canal adenoma consists of prismaticepithelial cells that assemble into bundles. The average age of patients with this type of tumor is 65 years. In addition to the salivary gland, the adenoma also affects the upper lip and cheek.
6. Basal cell adenoma. Benign, consisting of basal cells. Typically, this is a small dense white knot. Do not recur and not malignant.
7. Pleomorphic adenoma of the salivary glands can growup to large sizes, bumpy and dense. Usually benign, but at later stages can appear malignant cells. Inside it contains liquid and fibroblasts. It is susceptible to surgical treatment, but because of the proximity to the facial nerve, surgeons can have difficulties.

Symptoms

Benign adenoma of the parotid salivaryThe gland develops very slowly, sometimes for years. It does not cause any subjective sensations, but over time it can make a person asymmetric. This is the reason for going to the doctor. After removal, such tumors can recur in 6 percent of cases. If the neoplasm is closely located to the pharyngeal process of the parotid salivary gland, then this can cause disruption of swallowing, ear pain and triasm of the masticatory muscles.

How does intermediate salivary adenoma appear?glands? Symptoms of it are similar to both benign and malignant tumors. It is characterized by rapid infiltrative growth, destroying the tissues around itself. It can recur and give distant metastases to the lungs and bone tissue.

Malignant neoplasms arise asindependently, and after malignization of a benign tumor. Grow quickly, penetrating into surrounding tissues. The skin above the tumor is red, hot, taut. Can be ulcerated. Typical pain, malfunction of the masticatory muscles, an increase in neighboring lymph nodes and the presence of metastases.

Diagnostics

The tumor of the salivary gland is quite easy to detect. To do this, you need to check with the dentist and oncologist, collect complaints and find out the history of the disease. Particular attention should be paid to the morphology of the tumor, its size, consistency and mobility.

From instrumental research is carried outradiography of the bones of the skull, ultrasound of the salivary glands, sialography (see the patency of the gland ducts) and sialoscintigraphy (for the detection of distant metastases). The most reliable method is a puncture of the gland with subsequent examination of the smear, as well as biopsy of tissues for histological and pathomorphological examination.

To clarify the prevalence of the process may need CT salivary glands, chest X-ray or individual bones.

Treatment of benign tumors

If the patient is diagnosed as benignthe formation of the salivary glands, then it is a direct road to the surgeon. For a long time there have been developed techniques for "harvesting" such tumors. A small incision is made over the capsule of the affected gland, the adenoma is mobilized and removed. The doctor at the same time tries not to damage the contents of the tumor. Such an intervention is called "ex-cholization".

Removed tissue is necessarily given to macro- andmicroscopic examination to confirm the diagnosis. The facial nerve is never removed, since it is rarely affected. If the tumor develops in the submaxillary glands, then both the neoplasm and the gland are removed.

Treatment of malignant tumors

Complex combined treatment requiresmalignant adenoma of the salivary gland. How is the operation? Even before the intervention, it is necessary to conduct a course of gamma therapy to reduce the size of the tumor, as well as to prevent the occurrence of regional and distant metastases. Immediately, the operation is carried out one month after the radiation therapy.

Some authors recommend fullremoval of parotid glands together with branches of the facial nerve with a single block, together with extirpation of regional lymph nodes. If at the examination it was revealed that the tumor had grown into the bone tissue of the lower jaw, then this area also needs to be resected. But before the operation, you need to think about how to mobilize the rest of the bone.

In advanced cases, only palliative radiation therapy is recommended, since the tumor can not be removed due to too loose tissues.

Forecast

For benign tumors after theThe surgical treatment forecast for life and health is favorable. The probability of recurrence is low, only one and a half percent. Malignant tumors are extremely unfavorable. Cure the patient can only be in twenty percent of cases, and even after this there is a danger that the tumor will reappear. Metastases to other organs are found in almost half the cases.