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Malignant salivary gland neoplasms represent 3–4% of head and neck malignancies and <0.5% of all cancers diagnosed yearly in the United States, with an incidence of only 1–2 per 100,000 individuals. Unlike the more common mucosal head and neck cancers, which, in general, are attributed to excessive tobacco and alcohol use, specific carcinogenic factors for malignant salivary gland growths have not been as clearly identified. Viral infections, radiation, environmental exposure, and genetic factors have been hypothesized as causes. Malignant salivary gland tumors are classified by the World Health Organization as carcinomas, nonepithelial tumors, lymphomas, metastatic or secondary tumors, and unclassified tumors (Table 19–1).

Table 19–1. World Health Organization Classification of Salivary Gland Malignant Neoplasms.

Only 20–25% of parotid gland neoplasms, approximately 45–50% of submandibular gland neoplasms, and > 70% of sublingual and minor salivary gland neoplasms are malignant. However, because 75–80% of salivary gland neoplasms are located in the parotid gland, this gland is still the most common salivary gland to be affected with a malignant neoplasm; a ratio of 40:10:1 is cited for malignant tumors of the parotid, submandibular, and sublingual glands, respectively.

Table 19–2 shows the histologic types of malignant salivary gland disease in order of frequency. The disease site also is important for predicting the histology. Mucoepidermoid carcinoma is most common in the parotid gland. Approximately half of malignant submandibular gland neoplasms are adenoid cystic carcinomas. Minor salivary gland malignant neoplasms are most often adenoid cystic carcinomas and adenocarcinomas. Prognosis varies according to histologic type, stage, and primary site.

Table 19–2. Frequency of Salivary Gland Malignant Neoplasm by Histologic Type.

The salivary gland unit is depicted in Figure 19–1. The acinus is located at the distal end of ...

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