salivary glands radiology

Definition of Salivary Gland

Disease
Dental diagnosticians have responsibility for

detecting disorders of the salivary glands

A familiarity with salivary gland disorders and
applicable current imaging techniques is an
essential element of the clinician s
armamentarium .

Salivary gland disease

inflammatory disorders
Inflmmatory disorders are acute or chronic and may be secondary to ductal obstruction
by sialoliths, trauma, infection, or space-occupying lesions such as neoplasia.

Non inflammatory disorders

are metabolic and secretory abnormalities associated with diseases of

nearly all the endocrine glands, malnutrition, and neurologic disorders.
.space-occupying

masses

are cystic or neoplastic; the neoplasms are benign or

malignant.

Clinical Signs and

Symptoms
Diseases of the major salivary glands may

have single or multiple clinical features.

Pain and altered salivary flow may be present.
The periodicity and longevity of these
symptoms are important in the differential
diagnosis,
a review of the medical history and physical
condition of the patient may provide
important information.

Differential Diagnosis
Parotid Gland Area- of Salivary
Enlargements
UNILATERAL
Bacterial sialadenitis
Sialodochitis
Cyst
Benign neoplasm
Malignant neoplasm
Intraglandular lymph node
Masseter muscle
hypertrophy
Lesions of adjacent osseous
structures

BILATERAL

Bacterial sialadenitis
Viral sialadenitis (mumps)
Sjgren syndrome
Alcoholic hypertrophy
Medication-induced
hypertrophy (iodine, heavy
metals)
Human immunodefi ciency
virus associated
multicentric
cysts
Masseter muscle
hypertrophy
Accessory salivary glands
Temporomandibular joint

Differential Diagnosis
Submandibular Area- of Salivary Enlargements

UNILATERAL
Bacterial
sialadenitis
Sialodochitis
Fibrosis
Cyst
Benign neoplasm
Malignant
neoplasm

BILATERAL
Bacterial
sialadenitis
Sjgren syndrome
Lymphadenitis
Branchial cleft
cyst
Submandibular
space infection

Applied Diagnostic Imaging

of the Salivary Glands
Diagnostic imaging of salivary gland disease

may be undertaken to differentiate

inflammatory processes from neoplastic
disease .
diffuse disease from focal suppurative
disease, identify and localize sialoliths, and
demonstrate ductal morphology
anddetermine the anatomic location of a
tumor, in addition , differentiate benign from
malignant tumor .

PLAIN FILM
RADIOGRAPHY
Plain film radiography is a fundamental part of

the examination of the salivary glands and

may provide sufficient information to preclude
the use of more sophisticated and expensive
imaging techniques .
It has the potential to identify unrelated
pathoses in the areas of the salivary glands
that may be mistakenly identified as salivary
gland disease, such as resorptive or
osteoblastic changes in adjacent bone .

PLAIN FILM
RADIOGRAPHY
Panoramic and conventional posteroanterior (PA) skull

radiographs may demonstrate bony lesions, thus eliminating

salivary pathosis from the differential diagnosis.
Unilateral or bilateral functional or congenital hypertrophy of the

masseter muscle may clinically mimic a salivary tumor. A plain

film extraoral radiograph may demonstrate a deep antegonial
notch, overdeveloped mandibular angle, and exostosis on the
outer surface of the angle in cases of masseter hypertrophy.
Plain film radiographs are useful when the clinical impression,

supported by a compatible history, suggests the presence of

sialoliths
(stones or calculi).

INTRAORAL
RADIOGRAPHY
Sialoliths in the anterior two thirds of the submandibular duct are

typically imaged with a cross-sectional mandibular occlusal projection

The posterior part of the duct is demonstrated with an over-the-

shoulder occlusal projection view, where the directing cone is

placed on the shoulder and central
ray directed in an anterior direction through the angle of the
mandible, with the patient s head tilted to the unaffected side
and rotated back .
Parotid sialoliths are more difficult to demonstrate than the
submandibular variety as a result of the tortuous course of
Stensen duct around the anterior border of the masseter and
through the buccinator muscle. As a rule, only sialoliths anterior to
the masseter muscle
can be imaged on an intraoral film.

Underexposed mandibular occlusal radiograph demonstrating

radiopaque sialolith in
Wharton duct. Note the classic laminated appearance.

Periapical radiographs of the same case. The

radiopaque calculus can be localized lingual to the teeth
by applying appropriate object localization
rules

An axial bone algorithm CT image showing a sialolith in

the submandibular duct (arrow).

EXTRAORAL
RADIOGRAPHY
A panoramic projection frequently demonstrates

sialoliths in the posterior duct or reveals

intraglandular sialoliths in the submandibular
gland.
The image of most parotid sialoliths is
superimposed over the ramus and body of the
mandible .
To demonstrate sialoliths in the submandibular
gland, the lateral projection is modified by
opening the mouth, extending the chin, and
depressing the tongue with the index finger.

EXTRAORAL
RADIOGRAPHY
Sialoliths in the distal portion of Stensen duct

or in the parotid gland are difficult to

demonstrate by intraoral or lateral extraoral
views. However, a PA skull projection with the
cheeks puffed out may move the image of the
sialolith free of the bone .

Stereoscopic panoramic plain film

projection.

Over-theshoulder
occlusal projection revealing a sialolith.

Anteroposterior skull view with cheek blown

out to provide air contrast to reveal a parotid
sialolith (arrow).

CONVENTIONAL
SIALOGRAPHY
First performed in 1902, sialography is a radiographic technique

where a radiopaque contrast agent is infused into the ductal system

of a salivary gland before imaging with plain films, fluoroscopy,
panoramic radiography, conventional tomography, or CT.
Sialography remains the most detailed way to image the ductal
system .
The parotid and submandibular glands are more readily studied with
this technique.
A survey or scout film is usually made before the infusion of the
contrast solution into the ductal system .
With this technique, Lipid-soluble (e.g., Ethiodol) or non Lipidsoluble (e.g., Sinografi n) contrast solution is then slowly infused
until the patient feels discomfort (usually between 0.2 and 1.5
ml).

CONVENTIONAL
SIALOGRAPHY
These iodine-containing agents render the ductal system

radiopaque, The image of the ductal system appears as tree

limbs, with no area of the gland devoid of ducts. With acinar
filling, the tree comes into bloom, which is the typical
appearance of the parenchymal opacification phase .
Non lipid-soluble contrast agents are preferred because of reports

of inflammatory reactions subsequent to inadvertent extravasation

of lipid-soluble agents .
Sialography is indicated for the evaluation of chronic inflammatory

diseases and ductal pathoses. Contraindications include acute

infection, known sensitivity to iodine-containing compounds, and
immediately anticipated thyroid function tests.

Sialography
A, Lateral projection of the parotid demonstrating opacification all the
way to the terminal ducts and acini.
B, Anteroposterior projection of the same gland demonstrating
parenchymal blushing from acinar opacifi cation.

Sialogram of Normal Submandibular Gland. This lateral

view demonstrates parenchymal blushing. Normal fine
branching is
visible. Lack of parenchymal blushing at the anteroinferior
margin is
caused by radiographic burnout.

COMPUTED
TOMOGRAPHY
CT is useful in evaluating structures in and

adjacent to salivary glands; it displays both

soft and hard tissues and minute differences
in soft tissue densities .
CT is useful in assessing acute inflammatory
processes and abscesses as well as cysts,
mucoceles, and neoplasia. Calcifications such
as sialoliths are also well depicted with CT.

CT Images with Soft Tissue Algorithm. A, Axial view

demonstrating bilateral enlargement of the parotid glands
(arrowheads).
B, Coronal view of the same patient. The
clinical/histopathologic
diagnosis was autoimmune parotitis.

MAGNETIC RESONANCE
IMAGING
MRI for soft tissue mass details and

localization
Differanciates :
St vs. Ht
Normal vs. abnormal tissue
Identifies facial nerve ( parotid )
Containdications:
-pacemaker
-cochlear implant .

These magnetic resonance images reveal a lymphoepithelial cyst

involving the right
parotid gland. This axial T1-weighted image reveals a welldefined circular lesion involving the right
parotid gland with an internal signal isointense to muscle, and the
matching T2-weighted image

reveals that the lesion has a high internal signal

because of the fluid content

SCINTIGRAPHY (NUCLEAR MEDICINE, POSITRON

EMISSION COMPUTED TOMOGRAPHY)

Selective up take of techntium

Assesees silvary gland function (not anatomy)
Expel technetium after stimulations

Scintigraphy. A, 99m Tc-pertechnetate

scan of the salivary glands (right and left anterior
oblique views) demonstrates increased uptake of
radioisotope in the right parotid gland (black
arrowhead). B, Scintigram taken after administration
of a sialogog (lemon juice) demonstrates
retention of isotope in right parotid gland (white
arrowheads). This is a typical presentation of salivary
stasis, Warthin tumor, or oncocytoma.

ULTRASONOGRAPHY
For superficial , soft tissue swilling
Differentioates cystic vs. solid
Us-guide FNA

Ultrasonography (US) Image of Right Parotid Gland. A

well-delineated solid mass is suggested by echo returns within the
lesion (arrows). US appearance is typical of a benign salivary tumor

Salivary gland disorders

Obstructive and inflammatory disorders

Sialolithiasis
Bacterial sialadenitis
Sialodochitis
Autoimmune sialadenitis

sialolithiasis
** calculus and salivary stones
** Formation of calcified obstruction within salivary gland
duct
** Clinical features :
Chronic retrograde infection
Swelling and pain with eating
Major or minor S.G
Usually one S.G involved
Submandibular S.G >> 83% of the cases

**Raiographic features :
Radiopaque :
* Vary from cigar to oval or round shape
* Homogeneous radiopaque internal structure
Radiolucent : ductal filling defect
** sialography is helpful when obstruction is
undetectable on plain RG .
** CT may also detect minimally calcified
sialoliths not visible on plain films.

Sialography should not be performed if a

radiopaque stone has been shown by plain

radiography to be in the distal portion
of the duct
More than 90% of stones larger than 2 mm

are detected as echo-dense spots in US

images

D/D:
phleboliths
dystrophic calcification of LN
palatine tonnsiliths
Tx:
sialogogs to stimulate saliva secretion.
Sialography may also stimulate discharge .
Surgical removal of the sialolith
Removal of the whole involved S.G

Bacterial sialadentis
Parotitis and sabmandibulitis
Acute or chronic bacterial infection of terminal

acini or parenchyma of S.G

Acute bacterial infections

most commonly affect the parotid gland
Most cases are unilateral
may occur at any age

Clinical features :
swelling
redness
Tenderness
Malaise
Enlarged regional lymph nodes
suppuration may also be noted
Untreated acute suppurative infections typically form abscesses.

Chronic bacterial infection :

can affect any of major S.G
causing extensive swelling and culminating in
fibrosis
may be a consequence of un-Tx acute sialadenitis
or some types of obstruction .
intermittent swelling, pain when eating,
and superimposed infection resulting from
salivary stasis

RG features :

Sialography is contraindicated in acute infections

Epithelial flattening may lead to mildly dilated terminal
ducts and saclike acini, which is demonstrable with
sialography.
even distribution throughout the gland is seen
in recurrent parotitis and autoimmune disorders
US may distinguish between diffuse inflammation and
suppuration
MRI is an appropriate alternative
examination in cases which sialography is
contraindicated

Treatment
attention to oral hygiene
local massage
increased fluid intake
oral sialogogs (sour citrus fruit wedges or
salivary stimulants).
antibiotic regimen may also be indicated.
surgical remedies ranging from partial to total
excision of the gland

Sialodochitis
Ductal sialadenitis
inflammation of the ductal system of the

salivary glands.
Clinical features :
** sialectasia or dilation of ductal system
** sausage-string appearance of the main
duct and its major branches
Tx : as tx of sialadenitis

Lateral view of a sialogram of a

parotid gland demonstrating
a negative fill defect (arrow)
representing a noncalcified sialolith
and prominent intermittent stricture
and dilation of the main and
secondary
ducts, which is typical of advanced
.sialodochitis

Sausage
string
appearance
of
sialodochitis

Autoimmune Sialadenitis
Myoepithelial sialadenitis, Sjgren syndrome,

benign lymphoepithelial Lesion Mikulicz

disease , sicca syndrome,
dacryosialoadenopathia atrophicans, and
autoimmune sialosis
group of disorders that affect the salivary
glands and share an autosensitivity

Clinical features :
** range from recurrent painless swelling of
the salivary glands (usually the parotid gland)
to a stage that includes enlargement of the
lacrimal glands
** xerostomia and xerophthalmia
diagnosis can be made on the basis of any
two of the following three features:
Dry mouth, dry eyes, and rheumatoid
disease.

most common in adults (40- 60 year-old )

90% to 95% female prevalence.
44 times greater risk for development of non-

Hodgkin lymphoma

RG features :
early stages :
** punctate and globular spheric collection
of contrast agent throughout the G >>>> sialectases
**main duct may appear normal, but the intraglandular ducts may be
narrowed or not even evident
As the disease progresses :
** the collections of contrast agent increase in size and are irregular in
shape >> cavitary sialectases
** larger cavities of contrast agent and dilation of
the main ductal system may also be present
**Cavitation and glandular fibrosis are the result of recurrent
inflammation
At the end point of this disorder, complete destruction of the gland occurs

D/D :
chronic bacterial OR granulomatous
infections
multiple parotid cysts associated with (HIV)
infection.

Conventional
Sialography of
Left Parotid.

Lateral projection demonstrates punctate sialectases distribute

throughout the gland, which is suggestive of autoimmune
sialadenitis. Clinical/histopathologic diagnosis was Sjgren
syndrome

Anteroposterior projec
.the same

Sialography of the Left Parotid.

Punctate (small spheric), globular (larger spheric), and cavitary

(larger, irregular) sialectases with some dilation of the main duct
are suggestive of advanced autoimmune disease with
parenchymal destruction with retrograde infection in lateral (A)
and anteroposterior (B) projections.
Clinical/histopathologic diagnosis was Sjgren syndrome

Tx :
Relief of symptoms.
Underlying systemic rheumatoid conditions are
typically treated with anti-inflammatory agents,
corticosteroids, and immunosuppressive therapeutic
agents .
Salivary stimulants
increased fluid intake
artificial saliva and tears
surgically by local or
total excision of the symptomatic gland.

Non-inflammatory
disorders
1- Sialadenosis
2- Cystic Lesions
3- Benign tumers : Benign Mixed Tumor
Warthin Tumor
Hemangioma
4- malignant tumers :
Mucoepidermoid
Carcinoma
Malignant Mixed Tumor

Sialadenosis
Sialosis
nonneoplastic, noninflammatory enlargement

of primarily the parotid salivary glands

usually related to metabolic and secretory
disorders of the parenchyma associated with
diseases of nearly all the endocrine glands ,
protein deficiencies, malnutrition in
alcoholics ,
vitamin deficiencies, and neurologic
disorders

Enlarged affected glands

RG features :

sialography>> may show enlarged

(splayed duct) or normal S.G
CT and MRI>> provide a more
straightforward depiction of the glands but
are nonspecific and require correlation with
the clinical findings and history.

Tx :
identifying the cause of the metabolic or
secretory disorder
Conservative tx : local massage
increased fluid intake
oral sialogogs

Sialadenosis

34-year-old female with hypothyroidism. (a) Digital sialogram

right parotid gland shows attenuated main duct and the
intraparenchymal branches. (b) AxialT2weighted image
demonstrates symmetrically enlarged parotid glands without
any focal lesion

Cystic lesion:

cysts of the salivary gland are rare (less

than 5% of all salivary gland mass)
-most commonly occure unilaterally in
parotid gland
-they may be
congenital(branchial),lymphoepithelial,de
rmoid or acqurid including mucous
retention cysts
-may be intraglandular or extraglandular

Cystic neoplasmMucous extravationpseudo cysts : lack

epithelial lining and result from ductal

rupture
Ranulas: are retention cysts usully occure
as result of obstruction sublingual duct
Benign lymphoepithelial cysts: sequelae
of cystic degeneration of salivary
inclusion within lymph nodes
Multicentric parotid cysts associated with
HIV

Radiographic features:
cystic lesion typically appear as well-

circumscribed ,nonenhancing(with
contrast)
low density areas when examined on CT
appear as well-circumscribed,high-signal
areas on 2T-weighted MRI

Cont
when imaged with us,cysts are sharply
marginated and echo free as dark area
treatment : typically surgical , involving
local or total excision of the gland

benign tumors

-relatively uncommon
-occur in less than 0.003% of the population
-3% of all tumors
-80% of salivary tumors arise in the parotid
-5% in the submandibular
-1% sublingual
-10%-15% minor salivary gland
-most are bengine or low-grade

malignancies
-high-grade malignancies are uncommon

Cont
the chance of neoplasm of major salivary

glands being directly with the size of the

gland
Radiographic features:
-Benign tumors and low-grade malignancies

may have a similar appearance

-well-defined margins, which are most
apparent on CT or MRI examinations
-tumor to appear more radiopaque because
the vascularity of the tumor is greater than
that of the adjacent salivary gland tissue

cont
-benign masses are typically less echogenic
than parenchyma, sharply defined, and of
essentially homogeneous echo strength and
density
-Sialography may suggest a space occupying
mass when the ducts are compressed or
smoothly displaced around the lesion (the
ball-in-hand appearance)

Treatment
typically surgical
the parotid gland may be either partially

or totally excised
submandibular and sublingual glands are
in variably totally excised

Benign mixed tumor

Pleomorphic adenoma
a neoplasm arising from the ductal epithelium of

major and minor salivary glands exhibiting

epithelial and mesenchymal components.
The benign mixed tumor accounts for 75% of all
salivary gland tumors
typically occurs in the fifth decade of life as a
slow-growing, unilateral, encapsulated,
asymptomatic mass
A slight female predilection exists
Recurrence occurs in 50% of cases after excision
Malignant transformation is reported in up to
15% of untreated cases

Radiographic feature:

sharply circumscribed in frequently lobulated

and essentially round homogeneous lesion that

has a higher density than the adjacent
glandular tissue
Calcifications within the tumor are commonly
seen and are well depicted on CT
This tumor has various tissue signals in different
MRI techniques
Foci of low signal intensity (dark areas) usually
represent areas of fibrosis or dystrophic
calcifications
If a calcification is present (signal void) the
diagnosis favors a benign mixed tumor

CT and MRI Images of a( Pleomorphic

Adenoma)
In the T2-weighted image, note the
increased signal of the tumor, which is
now hyperintense to muscle.

cont
In the axial MRI T1-weighted image, the
tissue signal of the tumor is isointense
with muscle

In the axial CT soft tissue algorithm

cont

image, note the well-defined periphery

(black arrows).
the internal density that is less than
surrounding muscles. The remaining
parotid gland (white arrow) is displaced
laterally

Warthin tumor:
Papillary cystadenoma lymphomatosum,

adenolymphoma, and lymphomatous

adenoma
benign tumor arising from proliferating
salivary ducts trapped in lymph nodes
during embryogenesis of the salivary
gland

Clinical
features
the second most common benign
neoplasm of the salivary glands
accounting for 2% to 6% of the parotid
tumor
slow-growing, painless, round-to-ovoid
mass
In 20% of cases the tumors are multiple
Typically afflicts males older than 40
years and may be unilateral or bilateral

Radiographic features:
CT and MRI are the preferred techniques
not specific and istypical of benign salivary

tumors
On CT, this tumor may be of either soft
tissue or cystic density
On MRI, it is heterogeneous and may
demonstrate hemorrhagic foci
characteristically intensely hot on 99m
Tcpertechnetate scans
The US presentation of Warthin tumor is that
of a solid mass (anechoic), if the massis not
cystic

CONT
An axial soft tissue algorithm CT image of
a case of bilateral
Warthin tumor, a large tumor involving
the left parotid (white arrow) and a much
smaller tumor on the right side (black
arrow)

Hemangioma:
Vascular nevus
a benign neoplasm of proliferating

endothelial cells (congenital

hemangioma) and vascular
malformations, including lesions resulting
from abnormal vessel morphogenesis

Clinical features:
the most frequently occurring nonepithelial

salivary neoplasm, accounting for 50% of

the cases
85% arise in the parotid gland
the most common salivary gland tumor
during infancy and childhood
The average age at diagnosis is 10 years.
occurring in the first two decades of life 65%
They are frequently unilateral and
asymptomatic
A 2:1 female-to-male predilection exists

Treatment:
by local excision for those who do not

undergo spontaneous remission

radiographic features:
Phleboliths are common
They appear as discrete soft tissue calcifications

with a radiolucent center

best identified on plain films and CT
The CT presentation of hemangioma is a soft tissue
mass that is well distinguished from surrounding
tissue
On MRI the tumor has a signal similar to that of
adjacent muscle onT1-weighted images and a very
high signal on T2-weighted images
US usually demonstrates well-defined margins in the
hemangioma
Phleboliths image as multiple hyperechoic areas
within the body of the gland itself

Malignant tumor:
About 20% of tumors in the parotid are

malignant
50% to 60% of submandibular tumors
90% of sublingual tumors
60% to 75% of minor salivary gland
tumors

Radiographic features:
variable and is related to the grade,

aggressiveness, location, and type of

tumor
ill-defined margins, invasion of adjacent
soft tissues (such as fats paces), and
destruction of adjacent osseous
structures are considered to be typical
indicators of malignancy

Treatment:
typically surgical
Low-grade malignant tumors of the

parotid gland may be either partially or

totally excised
Submandibular and sublingual glands are
invariably totally excised
High-grade tumors may require radical
neck dissection
Combinations of surgery, the rapeutic
radiation, and chemotherapy may also be
used

Mucoepidermoid Carcinoma:
a malignant tumor composed of a

variable admixture of epidermoid and

mucous cells arising from the ductal
epithelium of the salivary glands

Clinical features :
the most common malignant salivary gland

tumor (35%) most commonly the parotid gland.

the rest are found in the minor glands, with the
palate
being the most frequent location
A wide age range exists, with the highest
prevalence in the fifth decade of life
A slight predilection for females exists
The low-grade variety rarely metastasizes
movable, slowly growing, painless nodule
It is usually only 1 to 4 cm in diameter
The prognosis is good; the 5-year survival rate
is greater than 95%

CONT.
high-grade tumors often cause facial pain and

paralysis, have ill-defined margins and are relatively

immobile
Metastasis by blood and lymph are common
with recurrence in half the patients after excision
The prognosis is poor and varies with the histologic
grade; the 5-year survival rate may be as low as 25%

Radiographic features:
low-grade mucoepidermoid carcinoma may

present a lobulated or irregularly sharply

circumscribed appearance on contrast
enhanced CT or MRI
Cystic are a may present and, rarely,
calcifications may be seen
high-grade mucoepidermoid carcinom
atypically relies on the appearance of irregular
margins and ill-defined form when the mass is
examined with CT or MRI
In CT images, the tumor as an irregular
homogeneous mass, slightly denser than the
gland parenchyma

CONT
..
high-grade mucoepidermoid carcinoma
has homogeneous low signal intensity
(dark) on T1-weighted images, but T2weighted images are more heterogeneous
and intense(brighter) than T1-weighted
images but still slightly darker (low signal)
relative to the surrounding tissues
Cavitary sialectasia and ductal
displacement may be noted on
sialographic images of this tumor

Malignant Mixed Tumor:

Carcinoma ex mixed tumor, carcinoma ex

pleomorphic adenoma and malignant

pleomorphic adenoma
composed of three distinct types of
tumors
The most common is carcinoma ex mixed
tumor which arises from the epithelial
components of a preexisting benign
mixed tumor

CONT .
The other two, which are extremely

rare :
1-true malignant mixed tumor (from
both epithelial and mesenchymal
components of a mixed tumor)
2-the metastasizing mixed tumor,
which appears histologically benign
but behaves in a malignant fashion

These four axial CT and magnetic resonance

images depict an adenoid cystic carcinoma of

the right submandibular gland. Note
the well-defined periphery, making it difficult
to differentiate from a benign tumor The
internal density of the tumor in this soft
tissue algorithm
CT image is almost equal to the remaining
gland

CONT..
The tissue signal in this T1weighted magnetic resonance
image is very slightly less than
the remaining gland

a T2-weighted magnetic resonance image,

the high signal of the tumor contrasts
with the remaining gland

.CONT
a T1-weighted postgadolinium, fat-

saturation image, the tumor has a

higher signal than in the remaining
gland

Clinical features:
typically begins as a slowly growing mass

that suddenly undergoes rapid

proliferation
often accompanied by pain and facial
paralysis
Metastasis is early and the prognosis is
unfavorable

Radiographic features:
The presentation of this tumor is similar

to that of the high-grade mucoepidermoid

carcinoma
MRI is usually superior to CT for tumor
definition

OTHER MALIGNANT AND

METASTATIC
TUMORS
Although the incidence of other malignant
tumors of the major salivary glands is low, a
significant variety exists in their histogenesis
Of all malignant salivary gland tumors, 23%
are adenoid cystic carcinomas
the majority of these neoplasms develop in
the minor salivary glands
Adenocarcinoma accounts for 6.4% of all
salivary gland malignancies
with acinic cell carcinoma, primary
lymphoma, and squamous cell carcinoma
occurring with even less frequency

CONT.
cell carcinoma occurring with even less frequency
Pain, paresthesia and even paralysis may be present,

especially in high-grade tumors

Tumor spread may be by direct invasion or metastasis
Metastasis of tumors of the salivary glands is not
unusual
Metastatic lesions in the parotid gland are more
common
Most metastatic lesions of the parotid gland occur
through the lymphatic system and include squamous
cell carcinoma, lymphoma, and melanoma
metastasis from the lung, breast, kidney, and
gastrointestinal tract has been reported

Radiographic features:
nonspecific and similar to that of the high-

grade mucoepidermoid carcinoma

US may demonstrate echo-free cystic areas
in adenoid cystic carcinomas.

CONT .
This axial soft tissue algorithm CT image reveals an

adenocarcinoma of the left parotid gland.

Almost all the gland has been replaced by this ill-

defined tumor that has some peripheral

enhancement .
and lower density internal structure, likely

representing necrotic regions

CONT.
Ultrasonography. The mass in the
submandibular gland(arrows) demonstrates a
heterogeneous hypoechoic pattern compared
with the adjacent tissue.
The histopathologic diagnosis was adenoid
cystic carcinoma

CONT.
Contrast-enhanced axial soft tissue algorithm CT
image
demonstrating a mass in right parotid gland with
a poorly marginated.
heterogeneous, slightly lobulated appearance
(white arrows).
Poorly defined margins suggest a low-grade
malignancy rather than benign tumor , although
the CT appearance of both is similar .
Histopathologic diagnosis was low-grade
mucoepidermoid carcinoma

CONT.