ARRS 2022 Abstracts

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E1910. Spitting Images: Anatomy and Pathology of the Major Salivary Glands
Authors
  1. Issa Khoury; Montefiore Medical Center
  2. Jacqueline Bello; Montefiore Medical Center
  3. Keivan Shifteh; Montefiore Medical Center
Background
Eighty percent of salivary gland neoplasms arise in the parotid glands, 10–15% in the submandibular glands and the remainder in the sublingual and minor salivary glands. About 80% of parotid neoplasms are benign but the relative proportion of malignancy increases in smaller glands. About half of submandibular gland neoplasms and most sublingual and minor salivary gland tumors are malignant. CT and MRI play an important role in differentiating salivary gland tumors. In this presentation, we review the normal and variant anatomy of the salivary glands as well as common and rare salivary gland pathologies, including infectious, inflammatory, neoplastic, congenital, and acquired abnormalities. Also, we provide a diagnostic algorithm and discussion of the appropriate differential diagnoses.

Educational Goals / Teaching Points
The goals of this exhibit are to review the normal and variant anatomy of the salivary glands; provide a pictorial review of common and rare salivary gland pathologies, including infectious, inflammatory, neoplastic, congenital, and acquired abnormalities; and provide a diagnostic algorithm and discussion of the appropriate differential diagnoses.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
CT and MRI findings of the salivary glands will be reviewed. Other than an overview of normal and variant anatomy of the parotid, submandibular and sublingual glands, a case-based review of salivary gland pathologies will be discussed using the following classification. Congenital: first branchial cleft cyst, hemangioma, lymphangioma; AVM infection: suppurative parotitis, abscess, sialoadenitis, sialolithasis, sialosis; inflammatory: Kuttner tumor, benign lymphoepithelial cyst, Sjogren’s syndrome, sarcoid; benign tumor: pleomorphic adenoma, Warthin’s tumor, oncocytoma, lipoma; schwannoma malignant tumor: mucoepidermoid ca, adenoid cystic ca, lymphoma, spindle cell sarcoma, acinic cell ca, malignant mixed tumor, metastatic SCCa; acquired: sialocoele, simple and plunging ranula, Wharton’s duct dilatation from subtle FOM SCCa ; miscellaneous: accessory salivary tissue in the mylohyoid boutonniere, post-RT, accessory parotid gland. Also, a diagnostic approach to establishing a differential diagnosis for pathology of the salivary glands will be provided using following features: diffuse versus focal, solitary versus multiple, cystic versus solid.

Conclusion
Following a structured approach to salivary gland pathology one can assist in accurate diagnosis. If a mass is unilateral, shows post-contrast enhancement, has a high T2 signal, and does not invade surrounding tissue planes, it is more likely to be a pleomorphic adenoma in the parotid gland. An intermediate to low T2 signal mass with or without invasion of surrounding tissue planes is more likely to be a malignant mass such as adenocystic or mucoepidermoid carcinoma. Biopsy is the gold standard for diagnosis and cannot be replaced by imaging modalities.