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Salivary gland carcinomas

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Abstract

Introduction

Salivary gland carcinomas are rare tumours of heterogeneous morphology that require distinctive surgical and adjuvant therapy.

Methods

Relevant studies were electronically searched in PubMed and reviewed for innovative and important information.

Results

Recent insights in genetic alterations like chromosomal aberrations, expression of receptor tyrosine kinases, malfunction of tumour suppressor genes or DNA promoter methylations increased the knowledge about aetiology and pathogenesis. New histological subtypes are recognised, and a three-tiered grading system seems reasonable. Ultrasound remains the basic diagnostic imaging procedure. New developments comprise the diffusion-weighed magnetic resonance imaging, while fluorodeoxyglucose positron emission tomography/computed tomography shows good diagnostic accuracy in detecting distant metastases and local recurrence. Fine-needle aspiration cytology helps in differentiating a neoplasia from a non-neoplastic lesion while being unreliable in recognising malignancy. In contrast, additional core needle biopsy and/or intraoperative frozen section diagnosis increase the accuracy in diagnosing a malignant lesion. Conservative parotid surgery with nerve monitoring remains state-of-the-art. Free flaps or musculoaponeurotic flaps are proposed for prevention of Frey’s syndrome. As parotid cancer often shows skip metastases, complete ipsilateral neck dissection (level I–V) is indicated particularly in high-grade lesions. Adjuvant radio(chemo)therapy increases local tumour control, whereas overall survival is not necessarily improved. Current results of systemic chemotherapy or targeted therapy in advanced tumour stages are disappointing.

Conclusion

Despite several developments, salivary gland carcinomas remain a heterogeneous group of tumours challenging both pathologists and clinicians.

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Correspondence to Tobias Ettl.

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This paper is partly presented at the Update–Symposium “MKG UpDate” within the German Society of Oral and Maxillofacial Surgery (DGMKG), Wiesbaden, Germany, 28–29 January 2011.

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Ettl, T., Schwarz-Furlan, S., Gosau, M. et al. Salivary gland carcinomas. Oral Maxillofac Surg 16, 267–283 (2012). https://doi.org/10.1007/s10006-012-0350-9

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