Salivary glandtype adenomas

J.W. Eveson

Among glandular tumours of the sinonasal tract, about one-quarter of cases are benign, and practically all of them are salivary gland-type neoplasms {1039}. For details see Chapter 5 on 'Tumours of salivary glands'.

ICD-O codes

Pleomorphic adenoma 8940/0

Myoepithelioma 8982/0

Oncocytoma 8290/0

Pleomorphic adenoma

Most patients are between 20 and 60 years of age. Signs and symptoms are non-specific, and include unilateral nasal obstruction, epistaxis and a discernible mass. The tumour may resorb bone and extend into the maxillary sinuses. Most cases arise from the submucosa of the bony or cartilaginous nasal septum, but some arise in the lateral nasal wall {483,974,1210,1506}. The size varies from 0.5-5 cm {483} and tumours usually form polypoid, sessile swellings. Microscopically, they are unencapsulat-ed, and tend to be cellular with predominance of modified myoepithelial cells often of plasmacytoid hyaline type; stromal elements are sparse. Exceptionally, focal skeletal muscle differentiation can occur {1419}. If treated by wide surgical excision, recurrence is uncommon {483}.

Myoepithelioma

Myoepithelioma, including the spindle cell variant, of the sinonasal tract is very rare {188}.

Oncocytoma

Oncocytomas of the sinonasal tract are rare, and most arise from the nasal septum {1039}. They are usually small, but some extend posteriorly and can cause bone resorption {470,480,998}. The nasolacrimal duct may be involved, causing unilateral epiphora and purulent rhinorrhoea {555}. Those examples that have behaved aggressively {470} are more appropriately considered low-grade oncocytic adenocarcinomas rather than adenomas {449,605,1044}.

Squamous Cell Carcinoma Nasal Cavity
Fig. 1.34 Pleomorphic adenoma of nasal cavity. Tumour is circumscribed, and lies above the cartilage.
Pleomorphic Adenoma
Fig. 1.35 Pleomorphic adenoma of nasal cavity. Tumour typically rich in modified myoepithelial cells.
Pleomorphic Adenoma Nasal Cavity
Fig. 1.36 Pleomorphic adenoma A A highly cellular tumour with myxochondroid matrix material (lower left). The cells are monotonous and plasmacytoid. B The myxochondroid matrix has a lacunar space (left), while short trabeculae of epithelial cells are seen within a more myxoid area.
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