tumores salivares
TRANSCRIPT
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TUMORES GLANDULAS SALIVARES
EPIDEMIOLOGIA
Incidencia Global: 0.8 % de todos los T. Malignos 4% de los T. del Territorio Cervicofacial Etiología ? Relación 3/1 – ( f/m) Localización más frecuente : G. Parótida 80 % G. S. Men. 10 % G. Subx. 9 % G. Subling. 1 %
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Nervio Facial : Tronco Rama Temporofacial Rama Cervicofacial
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TUMORES GLANDULAS SALIVARES Glándulas Salivales Mayores: Parótida (Principales) Submaxilar Sublingual
Glándulas Salivales Menores: Cavidad oral , faringe, ( Accesorias) vía aerodigestiva sup.
SALIVA:
PATOLOGIA: TRAUMATICA INFECCIONES LITIASICA TUMORALES
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TUMORES GLANDULAS SALIVARES EPIDEMIOLOGIA
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TUMORES GLANDULAS SALIVARES
G. Parot. G. Subx G. Subl. G.Men.
T.
M A L I G N O S
T.
BEN IGNOS
80 % 20 %
20 % 80 %
RELACIÓN TUMORAL Y LOCALIZACION
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TUMORES GLANDULAS SALIVARES
DIAGNOSTICO
Clínica P.A.F ( 85 – 90 % de Espec.) Patologia Intra operatoria Imagenología : TAC ( Cortes Ax. y Cor. ) RMN ( Sustracción Grasa Gadolineo). Eco tomografía Sialografia
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TUMORES GLANDULAS SALIVARES
ASPECTOS CLINICOS Tumor indoloro , larga data , levanta el lóbulo de la oreja
Lóbulo Superficial ( Cola y Prolongación anterior ) Lóbulo Profundo ( Examen endo-oral)
Dolor ( 2,5% en T. Benignos -- 25 % en T. Malignos)Parálisis ( 0.6% en T. Benignos -- 20 % en T. Malignos)Fijeza a Planos Adyacentes Ulceración de PielTrísmus Adenopatías Metástasis
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TUMORES DE LA REGION PAROTIDEATUMORES DE LA REGION PAROTIDEA
( Historia Clinica y Exámen de Cabeza y Cuello)
P.A.A.FP.A.A.F
SALIVARES NO SALIVARES
Benignos Malignos Lipomas Quiste Seb.T.Pleomorfo C. Mucoepider. LinfomasT. Whartin C. Adenoideoq. MelanomasT. Monomorfo Adenocarcinomas Mts. De Car.
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TUMORES GLANDULAS SALIVARES
CLASIFICACION HISTOLOGICA
1- ADENOMAS 2- CARCINOMAS 3- NON-EPITHELIAL TUMORS 4- MALIGNANT LYMPHOMAS 5- SECONDARY TUMORS 6- UNCLASSIFIED TUMORS 7- TUMOR-LIKE LESIONS.
W.H.O ( 1990 )
G. SEIFERF
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TUMORES GLANDULAS SALIVARES
1- ADENOMAS
Adenoma Pleomorfo ( Sialoma) Tumor Warthin ( Cistoadenolinfoma) Oncocitoma ( Adenoma Oncocítico ) Adenoma Mioepitelial Adenoma Celulas Basales Adenoma Canalicular Adenoma Sebáceo Papiloma Ductal : Invertido Intraductal Sialoadenoma Papilifero Cistoadenoma : Papilar Mucinoso
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TUMORES GLADULAS SALIVARES
2 - CARCINOMAS
BAJO GRADO:
Carcinomas Mucoepidermoideo Carcinoma Adenoideoquistico ( Cilindroma) Adenocarcinomas de Conductos Terminales Carcinoma en Adenoma Pleomorfo Carcinomas de Celulas Acinares Carcinomas Mioepitelial Carcinoma Sebaceo Adenocarcinoma Papilar
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TUMORES GLANDULAS SALIVARES
2 - CARCINOMAS
ALTO GRADO
Carcinoma Mucoepidermoideo Adenocarcinoma Cilindroma ( Vacuolar - sólida ) Tumores Mixtos : Carcinosarcoma Intracapsular Carcinocarcinoma Otros.
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TUMORES GLANDULA SALIVARES
3 - TUMORES NO EPITELIALES
Hemangiomas – Linfangiomas – HemangiopericitomasSchwannomas ( neurinomas)Neurofibromas LipomasSarcomas : Histiocitoma Schwannoma maligno Rabdomiosarcomas.
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TUMORES GLANDULA SALIVARES
4 - LINFOMAS
No Hodgkin ( 85 % )
Hodgkin : Predominio Linfocitario Esclerosis Nodular Deplesión Linfocitaria
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TUMORES GLANDULAS SALIVARES
5 - TUMORES SECUNDARIOS
Carcinoma Epidermoide Carcinomas de Células Pequeñas Carcinomas Indiferenciados ( Nasofaringeo) Carcinoma de Células Claras Melanomas Neoplasias Tiroideas Carcinoma Lobular o Ductal.
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TUMORES GLANDULAS SALIVARES
6 - TUMOUR – LIKE
SialoadenosisOncocytosisSialometaplasia Necrotizante ( Infarto )Lesión Linfoepitelial BenignaQuistes SalivaresSialoadenitis Crónica Esclerosante ( T. Kuttner )Hiperplasia Quistica Linfoides en H.I.V
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TUMORES GLANDULAS SALIVALES
TUMOR PLEOMORFO No Cápsulado, asienta en Cola de Parótida, Lóbulo Superficial, Crecimiento Lento y Asintomático
Sólido Pseudópodo Satelitosis I II III
Tipo : Celular ( Tendencia a Malignizarse) Mixoideo ( Tendencia a Recidiva )
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TUMORES GLANDULAS SALIVALES
T. Pleomorfo T. Whartin Sialoma – T. Mixto Cistoadenolinfoma
Pseudocapsula Capsula únicos 10% bilateral Sólidos Quísticos Blandos Duros Lóbulo superficial Cola de Parótida 40 a 70 años 60 a 70 años ------- Fumadores mas frecuente en mujeres Hombres Parotidectoria superficial Enucleación Puede Recidiva No recidiva Puede malignizarse No se malignizan
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TUMORES GLANDULAS SALIVARES
TRATAMIENTO RADIOTERAPIA
Tumores Alto Grado de Malignidad Metástasis Ganglionar Tumor en Lóbulo Profundo Tumor Adyacente al Nervio o Periostio Márgenes Comprometidos Ruptura del Tumor Intraoperatorio Tipo Histológico: Mucoepidermoideo Cilindroma Carcinoma Escamoso Carcinoma Indiferenciado Recidiva en Adenoma Pleomorfo
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TUMORES GLANDULAS SALIVARES
TRATAMIENTO QUIRURGICO
Biopsia Enucleación ( warthin) Parotidectomia Polar ( Superior – Inferior ) Parotidectomia Superficial Parotidectomia Total ( con o sin Conservación N.F ) Parotidectomia Total + VAC + Reconstrucción Injertos : nervio - grasa – piel Colgajos vecindad : piel – muscular Colgajos Pediculados Colgajos libres Otros
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TUMORES GLANDULAS SALIVARES
COMPLICACIONES
Inmediatas: Hemorragias Seromas – Sialomas Fístulas Salivales Infecciones
Mediatas: Parálisis – Paresias Síndrome Freí ( 10 %) Fístulas Hundimientos Queloides
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NGA
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Tumor de Warthin
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Gl. SubmaxilarGl. Parótida Gl. Sublingual
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TUMORES GLANDULAS SALIVARES
DIAGNOSTICO
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