✅ Benign Neoplasms
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80% of all salivary gland tumours arise in the parotid gland
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Of these, ~80% are benign
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Growth rate ≠ malignancy: rapid growth doesn't always imply malignancy
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Facial nerve involvement = red flag for malignancy
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Benign tumors are more common in women (except Warthin's)
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Median age: 5th decade
🧪 Benign Tumour Types
| Tumour | Features |
|---|---|
| Pleomorphic adenoma (benign mixed tumour) | Most common (~80%). Involves epithelial + myoepithelial cells. Lobulated, slow-growing, not well-encapsulated. Risk of malignant transformation (2–10%) and recurrence if capsule is violated. |
| Warthin tumour | 2nd most common benign tumour (5%). Occurs in older males, often bilateral or multicentric. Cystic with lymphoid tissue. Rare malignant change. |
| Monomorphic adenoma | <5% of tumours. Single cell type. Includes oncocytoma, basal cell adenoma, canalicular adenoma, myoepithelioma. Slow-growing. |
| Haemangioma | Commonest parotid tumour in infants (<1 year). Highly vascular. May regress spontaneously. Rarely becomes malignant. |
🔥 Malignant Tumours of the Parotid
| Type | Features |
|---|---|
| Mucoepidermoid carcinoma | Most common parotid malignancy (30%). Low-grade types less aggressive. |
| Adenoid cystic carcinoma | Perineural invasion with skip lesions. High risk of visceral metastasis. 5-year survival: ~35%. |
| Carcinoma ex-pleomorphic adenoma | Arises from long-standing pleomorphic adenoma. |
| Acinic cell carcinoma | Intermediate malignancy. Possible perineural spread. 5-year survival: ~80%. |
| Adenocarcinoma | Arises from secretory units. Risk of nodal + distant spread. Prognosis depends on stage. |
| Lymphoma | May occur with Warthin’s tumours. Large, rubbery mass. Diagnosis via nodal biopsy. Treated medically (chemo ± radiotherapy). |
🧬 Diagnostic Workup
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Plain X-ray: rule out stones
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Sialography: ductal anatomy
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FNAC: essential for diagnosis
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CT/MRI: for malignancy assessment
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Superficial parotidectomy: diagnostic + therapeutic for most benign lesions
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Malignancy → formal resection (avoid excisional biopsy)
🩺 Treatment
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Benign tumors → Superficial parotidectomy
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Malignant tumors → Radical/extended radical parotidectomy
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Facial nerve resection if involved
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Neck dissection if nodal spread suspected
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🧾 Other Parotid Conditions
| Condition | Features |
|---|---|
| HIV-associated lymphoepithelial cysts | Bilateral, multicystic swelling. Low malignancy risk. Managed conservatively. |
| Sjogren syndrome | Autoimmune. Bilateral painless enlargement, dry eyes/mouth. Lymphocytic infiltrates. ↑ Lymphoma risk. |
| Sarcoidosis | Parotid involved in ~6%. Usually bilateral, painless, with possible xerostomia. Conservative management if isolated. |
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