These may be immediately apparent clinically because of their more aggressive behaviour. Adenoid cystic carcinoma sometimes presents as a very slowly growing, painless mass of many years' duration. Epidermoid carcinoma occurs usually in adults but in the rare case in children the disease can be highly malignant.

Adenocarcinoma and undifferentiated carcinoma are usually aggressive. There is a particular tendency for salivary gland carcinomas, especially of the mucoepidermoid type, to infiltrate and spread along the perineural spaces. Eventually, all the characteristics of malignancy, including adherence to and infiltration of surrounding structures such as skin, muscle, and bone, develop. With parotid gland cancer, facial nerve malfunction is common. Submandibular gland cancers are more difficult to recognize pre-operatively.

Lymphoid tissue occurs within the parotid and submandibular glands where it may be involved with secondary carcinomatous spread, for example from the lung and breast. This also explains the occurrence of lymphoma, apparently within the salivary glands. Most commonly, however, there are other adjacent lymph nodes involved and biopsy confirms the diagnosis.

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