International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 07 Issue 17, September, 2015

Pages: 45-51

Date of Publication: 11-Sep-2015


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HISTOPATHOLOGICAL STUDY OF SALIVARY GLAND LESIONS

Author: Dave P.N., Parikh U.R., Goswami H.M., Jobanputra G.P., Panchal N.V., Shah A.M.

Category: Healthcare

Abstract:Objective: The aim of the present study is to determine the incidence of Parotid gland lesions and study their morphology. Material and Method: A study of 60 cases of Parotid gland tumors from January 2012 to December 2014 was carried out in pathology department of our hospital. A tissue bit was taken after detailed clinical history and physical examination. After routine tissue processing and H and E staining, histopathological diagnosis was made. Results: Prevalence of salivary gland tumors in our study was 0.47 %. Benign salivary gland tumors comprised 71.6 % of all parotid gland tumors and malignant tumors accounted for 28.4 %. Pleomorphic adenoma was 46.67% and Mucoepidermoid carcinoma was11.67% of all Parotid gland neoplasms. Most of the benign neoplasms occurred in 3rd decade, while the malignant neoplasms more common in 5th decade. Males were more commonly affected than females. Conclusion: Parotid gland tumors are relatively less common and they exhibit a wide variety of microscopic appearances even within one particular lesion. Accurate diagnosis is essential as parotid gland neoplasms have diverse clinical and prognostic outcomes.

Keywords: Salivary gland, Pleomorphic adenoma, Warthin tumour

Full Text:

INTRODUCTION

Parotid gland is the site of origin of many non neoplastic and neoplastic lesions. Parotid gland tumors are a morphologically and clinically diverse group of neoplasm, which may present significant diagnostic and management challenges because of their relative frequency, the limited amount of pretreatment information available and wide variety of biological behavior with different pathological lesions.1 Although accounting for less than 5% of all neoplasms, parotid gland tumors are of importance because of similar presentation i.e. swelling of particular gland whether lesion is neoplastic and non neoplastic.1 They can show striking range of morphologic diversity between different tumor types and sometimes within an individual tumor mass. In addition, hybrid tumors, dedifferentiation and propensity for some benign tumors to progress to malignancy can confound histopathological interpretation. Parotid gland tumors are rare, with overall incidence in the world of approximately 2.5 to 3 cases per 1, 00,000 per year. Malignant parotid gland tumors account for more than 0.5% of all malignancies and approximately 3 to 5% of all head and neck cancers.2 Most patients with malignant parotid gland tumors present in the sixth or seventh decade of life with mean age for malignant lesions is 55 to 65 years while benign lesions typically develop at least a decade earlier at mean age of 45 years.2 The parotid gland is most common location of salivary gland neoplasms which accounts for 75-80% of cases. Benign tumors are much more frequent than malignant ones, benign tumors constitute (54-79%) as compared to malignant tumors (21-46%). Most frequently encountered tumor is Pleomorphic Adenoma and Mucoepidermoid Carcinoma being the most common malignant tumor. Little is known about the etiology of parotid gland tumors and high risk populations have not been identified. An in creased incidence of benign mixed tumors and other neoplasms has been observed following childhood therapeutic irradiation. There are no reliable criteria to differentiate on clinical grounds the benign from malignant lesions, so morphological evaluation is necessary. The first attempt at classification came in 1841 in the form of thesis by A. Agrwal.3 In 1859 Billorth published valuable articles describing parotid tumors histologically.

AIMS AND OBJECTIVES

• To study prevalence of Parotid gland tumors during period of 3 years.

• To study age, sex distribution of various parotid gland tumors and compare with findings of other workers.

• To study histomorphological (gross and microscopic) aspect and record the spectrum of morphological features of these lesions.

• To correlate clinical diagnosis with that of histological features.

• To differentiate benign from malignant conditions.

MATERIALS AND METHODS

A study of 60 cases of Parotid gland tumors from January 2012 to December 2014 was carried out in pathology department of our hospital. This study includes neoplastic lesions of the parotid glands. The specimens consisted of open biopsies, superficial parotidectomies and total parotidectomies with or without draininig lymph nodes. After detail history and clinical examination were noted from the original request forms, specimens were fixed in formalin and sections were taken from the lesion, its margins, surrounding tissue and lymph nodes if any. Sections were processed in automated tissue processor and embedded in paraffin after gross examination. The paraffin blocks were cut and stained with hematoxylin and eosin and in selected cases special stains like PAS was done. These slides were examined under low power and high power magnification. The details of cellular architecture, encapsulation, perineural and vascular patterns and surrounding areas were studied. The tumors were classified according to (WHO) World Health Organisation’s histological typing of salivary gland tumors. Data acquired from examination of each specimen was processed in systematic manner. The collected data were analyzed statistically and results obtained are compared with existing studies in the literature.

RESULTS

During the period of January, 2012 to December 2014; a total of 12587 specimens received for histopathological examination. Out of which 60 specimens were of salivary gland tumors, representing 0.47 %. Thus, the Prevalence of salivary gland tumors in our study was 0.47%.In each case, detailed clinical history, physical examination and gross examination was recorded. Out of 60 cases 43 (71.6%) were benign while 17 (28.4%) were malignant (Table I and Graph I). In case of benign tumors pleomorphic adenoma (46.67 %) was the most common followed by warthin’s tumor (16.67%) while in case of malignant tumors Mucoepidermoid carcinoma (28.4 %) was the most common (Table II and Graph II). The parotid gland neoplasm presented over a wide range of age from 8 years to 79 years. From age wise distribution, benign tumors were noted in age range from 8 to 71 years with mean age of 39.5 years and mostly common in 4thdecade of life. Our youngest patient was 8 year old while the eldest patient was 71 year of age. Malignant tumors were noted in age range of 18 to 79 years with mean age of 48.5 years and common from 5th decade onwards (Table III). In our study, male preponderance is seen for all parotid gland tumors with M: F ratio of 1.14:1. For malignant neoplastic lesions M:F ratio is 1.42:1, for benign neoplastic lesions M:F ratio is 1.04:1 (Table IV). The most common symptom encountered during the study was swelling at the angle of the mandible (100%). The disparity between the total number of cases and the total number of symptoms and signs is because many patients presented with more than one signs and symptoms. Pain and tenderness, rapid enlargement of the mass, palpable cervical lymph nodes and skin ulceration were the other clinical features noticed. No facial paralysis was seen in our study (Table V).

DISCUSSION

This present study was conducted over a period of 3 years from January 2012 to December 2014 in one of the tertiary care teaching hospital. Study of 60 cases was done with respect to incidence, age, sex and clinical presentation, gross and microscopic features. The results obtained were compared with those of previous studies of well known workers in this study and the significant differences and similarities in results are discussed below. In our study, among benign tumors, Pleomorphic adenoma was the most common benign tumor and Mucoepidermoid carcinoma was the most common among malignant tumors as comparable to G C Fernandes et al. The total number of biopsies received during the study period was 12587. Thus, parotid gland tumors were quite rare as compared to the other tumors located over other sites in the body. Prevalence in our study is lower as compared to the incidence observed by Solange et al4 (2005) and Amos et al5 (2007). The benign tumors were more common than malignant tumors in our study. All authors agreed the same. In terms of relative proportions, present study correlates with other studies (Table 6) Ito et al6 , Edda et al7 , Ahmed et al8 and Nagarkar et al9 (Table VI). Benign tumors are seen at lower age compared to malignant tumors. Present study correlates with Edda et al7 and Ahmed et al8 . In our study, M:F ratio in all parotid gland tumors is 1.14:1 suggesting slight male preponderance. These findings are consistent with Erik G et al10and Ahmed et al8 . In case of benign lesions there is equal sex distribution while in case of malignant lesions male predominance is noted. Our study is comparable with Mohd ayub11. In our study, Pleomorphic adenoma is the commonest benign tumor involving the parotid gland while in case of malignant tumours, Mucoepidermoid carcinoma is the most common, which is also comparable to other studies (Table VII).

SUMMARY AND CONCLUSION

• Parotid gland tumors are relatively less common and they exhibit a wide variety of microscopic appearances even within one particular lesion. Accurate diagnosis is essential as parotid gland neoplasms have diverse clinical and prognostic outcomes.

• Prevalence of salivary gland tumors in our study was 0.47 %.

• Benign tumors were common than malignant tumors.

• Benign salivary gland tumors comprised 71.6 % of all parotid gland tumors and malignant tumors accounted for 28.4 %.

• Pleomorphic adenoma was the commonest and accounted for 46.67%of all Parotid gland neoplasms.

• Mucoepidermoid carcinoma was the commonest malignant tumor accounted for 11.67% of all parotid gland tumors followed by Adenoid cystic carcinoma comprising of 3.33% of all parotid gland tumors.

• Most of the benign neoplasms occurred in 3rd decade, while the malignant neoplasms more common in 5th decade.

• Males were more commonly affected than females. For all parotid gland tumors M: F ratio was of 1.14:1. For malignant neoplastic lesions M: F ratio was 1.42:1, for benign neoplastic lesions M:F ratio was 1.04:1.

References:

1. Chapter in book: Juan Rosai. Chapter-12 In : Rosai and Ackerman’s Surgical Pathology, Tenth Edition, Volume I, Major and Minor Salivary gland; Mosby; Elsevier; 2011: 817-842.

2. Chapter in book: Stephen Sternberg. Chapter- 20 In : Diagnostic Surgical Pathology, Sixth Edition, Volume I, Salivary gland; Lippincott Williams and Wilkins; Philadelphia; 2015: 906-946.

3. Agrwal RV, Solanki BR, Junnakar RV. Salivary Gland tumor. Ind J cancer 1967;4:209-213.

4. Solange SL, Andrea FS, Rivadaxia FB, Roseana DA. Epidemiologic profile of salivary gland neoplasms: analysis of 245 cases. Rev Bras Otorhinolaryngo 2005: 71(3): 335-340.

5. Amos B, Philip WM, William MC. Relative frequency of intraoral minor salivary gland tumors: a study of 380 cases from Northern California and comparison to reports from other parts of the world. J Oral Pathol Med 2007:36(4): 207-214.

6. F A Ito, P A Vargas, O P de Almeid and M A Lopes, Salivary Gland tumors in Brazilian population: a retrospective study of 496 cases. International journal of oral and maxillofacial surg 2005; 34(5):533-536.

7. Edda A M vahahula, Salivary Gland tumors in Uganda: Clinical Pathological Study. African health sciences. April 2004; 4(1):15-23.

8. Shafkat Ahmed, Mohmmad Lateef, Rouf Ahmad. Clinicopathological study of primary salivary gland tumors in Kashmir. JK Practitioner 2002;9(4):231-233.

9. Nagarkar M Nitin, Bansal Sandeep, Dass Arjun, Singhal k Surinder, Mohan harsh. Salivary Gland tumors: Our experience. Indian J Otolaryngol Head and Neck Surg 2004; 56(1):31-34.

10. Erik G. Kohen, MD; Snehal G Patel, MD; Oscar Lin, MD; Jay O. Boyle, MD; Dennis H.Kraus, MD. Fine needle aspiration biopsy of Salivary Gland lesions in selected patient population; Arch Otolaryngol Head Neck Surg.2004;130-773-778.

11. Mohhmed Ayub Musain, Zahid Sohail, Abbas Zafar and Shoukat Malik, Morphological pattern of Parotid tumors. Journal of the College of Physicians and Surgeons 2008;18 (5):274-277.

12. Kornevs Eglis, Tars Juris, Lauskis Gunars. Treatment of Parotid Gland tumors in Latvian Oncological Center Stomatologija, Baltic Dental and Maxillofacial Journal 2005;7:110-114.

13. Das K Dilip, Petkar A Mahir, Al Mane M Nadra, Sheik A Zaffar and Malik K Mrinmay. Role of Fine Needle aspiration cytology in the diagnosis of swellings in the salivary gland regions: A study of 712 cases. Med Princ Pract 2004; 13: 95-106.

14. Ethundan M, Pratt CA, Macpherson DW. Changing frequency of Parotid Gland Neoplasms: analysis of 560 tumors treated in a district general hospital. Ann R Coll Surg Eng 2002;84:1-6.

15. Schoeman BJ and Clifford SD. The incidence of malignancy in salivary gland neoplasms. South Afr J Surg.2007; 45(4):134- 135

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One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

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Best Article Award

A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma COLAKOGLU entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by Arpita M. et al entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
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List of Awardees

Awardees of COVID-19 Research

Woman Researcher Award

A Study by Neha Garg et al. entitled "Optimization of the Response to nCOVID-19 Pandemic in Pregnant Women – An Urgent Appeal in Indian Scenario" published in Vol 12 issue 09

A Study by Sana Parveen and Shraddha Jain entitled "Pathophysiologic Enigma of COVID-19 Pandemic with Clinical Correlates" published in Vol 12 issue 13

A Study by Rashmi Jain et al. entitled "Current Consensus Review Article on Drugs and Biologics against nCOVID-19 – A Systematic Review" published in Vol 12 issue 09

Emerging Researcher Award

A Study by Madhan Jeyaraman et al. entitled "Vitamin-D: An Immune Shield Against nCOVID-19" published in Vol 12 issue 09

Study by Dheeraj Kumar Chopra et al. entitled "Lipid-Based Solid Dispersions of Azilsartan Medoxomil with Improved Oral Bioavailability: In Vitro and In Vivo Evaluation" published in Vol 12 issue 19


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