Histological examination of the salivary glands in Moscow

Detailed description of the study

Salivary gland cancer is a malignant tumor of the salivary gland formed from epithelial cells. Tumors of the parotid salivary glands (PST) are a rare type of neoplasm. They mainly develop between the ages of 20 and 40. More common in men than in women. Tumors are usually located in the soft tissues of the face and often cause serious cosmetic defects, causing paresis of the facial nerve.

The main risk factors for developing salivary gland cancer are:

1. Chronic inflammatory diseases of the oral cavity;
2. Hormonal imbalances;
3. Genetic disorders;
4. Smoking;
5. Nutritional factors (low vitamin content, high fat content in food).

Most often the tissues of the parotid salivary gland are affected - 80%, less often the tumor develops in the tissues of the submandibular salivary gland - 15%, sublingual or minor salivary gland.

The following options for the development of pathology are distinguished:

1. Primary cancer (from the tissues of the gland itself);
2. Secondary cancer (metastasis or germination from neighboring organs).

According to histological parameters, tumors of the salivary glands represent the most heterogeneous group of human neoplasms. More than half of them are benign formations.

Benign neoplasms of the parotid salivary glands are detected in more than 30% of patients who complain, malignant ones - in 65%. Among the morphological types of benign tumors of the parotid salivary gland, the most commonly diagnosed are pleomorphic adenoma (a benign formation that forms in the glandular epithelium), adenolymphoma, lipoma and a very rare adenoid cystic tumor (formed by epithelial cells lining the lumen of the gland).

Malignant tumor formations are most often represented by: mucoepidermoid cancer (formed by cells secreting mucus and epithelium) and adenocarcinoma. Acinic cell carcinoma also occurs, which mainly affects the tissue of the parotid salivary gland.

Usually, during examination of patients, palpation reveals a dense, painless formation in the area of ​​the salivary glands, which, according to patients, grows generally very slowly. In approximately a third of cases, pain may be present.

The “gold standard” for diagnosing tumors of the salivary glands is aspiration puncture of the tumor followed by histological examination of the obtained material, carried out before surgery or intraoperatively. The diagnostic value of this method is up to 90%, because the tissue of the affected area is studied directly under a microscope.

Aspiration puncture (biopsy) is performed using a special needle under ultrasound control. The study allows you to confirm or clarify the diagnosis, track the growth dynamics of the tumor and analyze the changes that occurred during tumor therapy.

During histological examination, three indicators are assessed:

1. Tumor size and extent of its spread (T);
2. The presence of damage to regional lymph nodes by metastases (N);
3. Determination of metastases in other organs and tissues (M).

Based on the degree of malignancy, there are three types of tumors:

1. High differentiation, when the cells are similar to glandular epithelial cells, such formations grow slowly and often have a favorable prognosis;
2. Low differentiation, when cells are very different from normal, is characterized by rapid growth and early metastases;
3. Medium differentiation.

Types and functions of salivary glands

Salivary glands are paired organs that differ in location:

• large parotid - located on the side of the lower jaw, under the left and right ears. They produce saliva containing high concentrations of potassium and sodium chlorides;
• large submandibular - adjacent to the lower jaw, have an excretory duct in the area of ​​the lingual frenulum, produce saliva with a low acid index;
• large sublingual - located in the oral cavity under the mucous membrane, secrete alkaline saliva containing protein saturated with mucin (high molecular weight glycoproteins).

The minor salivary glands are located on the mucous membrane of the cheeks, lips, and tongue.

The role of the salivary glands is to secrete a fluid that contains special enzymes and is involved in the digestive process. They also perform the following functions:

• exocrine - production of proteins, fluids;
• endocrine - produce biologically active substances;
• excretory - participation in the removal of metabolic products from the body.

References

1. Malignant tumors of the salivary glands, Clinical guidelines. Association of Oncologists of Russia, 2021. - 55 p.
2. Balkanov, A.S., Bychenkova, O.A., Sipkin, A.M. and others. Combined treatment of parotid salivary gland cancer. Almanac of Clinical Medicine, 2021. - No. 4. - P. 309-313.
3. Polyakov, V.G., Shishkov, R.V., Ermilova, V.D. and others. Children's Oncology, 2004. - No. 1. - P. 45-47.
4. Carlson, E., Schlieve, T. Salivary Gland Malignancies. Oral and maxillofacial surgery clinics of North America, 2021. - Vol. 31(1). — P. 125-144.

Bougienage during examination of the salivary gland duct

Examination of patients with diseases of the salivary glands requires certain skills from the dentist, since often the first symptoms of this disease are inflammatory processes in the oral cavity.

After collecting anamnesis, visual and palpation examination, the following may be prescribed:

• sialometry using the Andreeva method - after making a bougienage into the duct of the salivary gland, a cannula (special tube) is inserted through which saliva is collected for quantitative and qualitative research;
• sialography (contrast x-ray diagnostics) - 1 - 2 ml of iodolipol or other iodine-containing substance, heated to a temperature of 37 - 40 degrees, is injected into the ducts of the salivary glands using a blunt needle. The mouth of the duct is first bougiened with a conical probe. An x-ray is taken immediately;
• pantomosialography (contrast x-ray diagnostics of several glands at once) - this procedure helps to determine the ongoing hidden inflammatory process of paired salivary glands, narrowing or widening of the ducts;
• digital (digital) subtraction sialography - performed with the introduction of a contrast agent.

Complications

Despite the fact that treatment of salivary gland adenoma does not pose a serious problem, it is important to remember that untimely removal of the tumor can lead to a number of complications. The most serious of them is the transformation of a benign neoplasm into a malignant one. Unlike malignant tumors, salivary gland adenoma can exist asymptomatically, only in some cases causing facial asymmetry. Therefore, if you detect the slightest swelling, you must immediately consult a doctor. Timely removal of the tumor will prevent many very unpleasant problems.

The most common postoperative complications:

• the risk of developing Frey's syndrome (occurs when autonomic nerve fibers are damaged, accompanied by redness and sweating of the operated area of ​​the face);
• a feeling of dry mouth when the gland is completely removed.

Observation and regular consultations with a doctor can reduce all postoperative complications to a minimum.

Preparation

Typically, an ultrasound of the salivary glands is preceded by a consultation with a general practitioner. At the initial appointment of a patient with pain symptoms in the glandular area, the doctor examines visually, collects a detailed history and diagnoses using palpation. Next, the patient will be asked to undergo laboratory tests or undergo an ultrasound scan. There is no need to specially prepare for an ultrasound of the salivary glands. It is completely painless and does not cause radiation exposure to the patient’s body. Ultrasound diagnostics are easily tolerated by people of any age. There are only a few recommendations for obtaining a more informative ultrasound examination. Before going to see a specialist, it is recommended to stop eating food 3-4 hours in advance, and to thoroughly clean the oral cavity before performing the diagnosis.

Treatment

Removal of a salivary gland adenoma is a simple surgical operation; the prognosis for treatment in most cases is favorable. The only difficulty that can be encountered during treatment is damage to the facial nerve. However, a solution has been found for this problem.

To gain access to the tumor, the surgeon dissects the facial nerve by carefully lifting it upward. Only after this the tumor is removed. Removal of the node is carried out within a few minutes in the maxillofacial departments of dental clinics. If the results of histological analysis of the tissues of the removed tumor confirm its benign nature, no additional treatment will be required.

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With best wishes, Chief Scientific Consultant of the All-Russian Center for Eye and Plastic Surgery, Honored Doctor of the Russian Federation, Professor Ernst Muldashev