Salivary gland tumours: A 16-year review at Jos …
Nigerian Journal of Clinical & Biomedical Research
Salivary gland tumours: A 16-year review
at Jos University Teaching Hospital, Jos
1
EC Otoh, 2BM Mandong, 1IS Danfillo, 1PH Jalo
1
Regional Center for Oral Health Research and Training
Initiatives (RCORTI), Jos, Nigeria
2
Department of Histopathology, Jos University Teaching
Hospital (JUTH), Jos, Nigeria
Correspondence:
Dr. Emmanuel Chukwuka Otoh
Basic Science & Research Division
Regional Centre for Oral Health Research & Training
Initiatives (RCORTI) for Africa
3, CBN Road, PMB 2067 Jos, Plateau State, Nigeria
Tel:+234 -73 - 462901 / +234-73- 612750/
+234 803 635 7247 / Fax:+234 -73 - 462901
E-mail: ecotoh@yahoo.co.uk
Key words: salivary gland, neoplasia, radiation,
pleomorphic adenoma, Nigeria
SUMMARY
There is a dearth of information on the history of
salivary gland tumours in northern Nigeria and the
objective of this study is to document the
epidemiology of salivary gland tumours as seen at the
Jos University Teaching Hospital (JUTH), Jos, Plateau
State, Nigeria. It is designed as a retrospective study
and made use of the duplicate histology reports and
case notes of all reported cases of salivary gland
tumours seen at the JUTH over a period of 16 years
which were retrieved from the histopathology
department of the hospital. Information on sociodemographic characteristics, histological type and
relevant clinical parameters were extracted and
entered for data analysis using the Brititsh Association
of Head & Neck Oncologists (BAHNO) Minimum
Dataset for Cancers. A total of 117 cases of
histologically confirmed salivary gland tumours were
seen during the period. The benign-malignant ratio
was 2.7:1 and the parotid gland was the most affected
site (52.1%). Pleomorphic adenoma (89.4%) and
mucoepidermoid carcinoma (22.6%)
respectively,
were the most common benign and malignant
tumours reported. Mucoepidermoid carcinoma occurs
commonly between the 2nd and 5th decades of life with
no gender predilection while pleomorphic adenoma
Volume 1? Number 1 ? 2006
51
Nigerian Journal of Clinical & Biomedical Research
occurs usually between the 2nd and 3rd or 4th decades of
life; with a fairly equal gender distribution (M : F= 1 :
1.2). Although there were greater delays in the
presentation of benign cases (30.4 24.2 months) in
comparison with malignant cases (12 6.9 months), the
difference was not statistically significant (p=0.09).
INTRODUCTION
Geographical variations in the prevalent site and type
of salivary gland tumours have been reported in the
literature.1-6 The commonly involved sites include the
parotid and sub-mandibular glands and the minor
salivary glands of the palate, with the sublingual gland
being the least affected.2,3,5,6
The commonly reported tumours (benign and
malignant) include pleomorphic adenoma,
mucoepidermoid carcinoma, adenocystic carcinoma,
carcinoma ex-pleomorphic adenoma and adenocarcinoma.4,5,7,8,9,10 Studies in Nigeria and Africa showed
that salivary gland cancers constitute between 2.8%
and 10% of all head and neck malignancies.1,2,5,9
Certain risk factors, like radiation exposure, have been
associated with the development of malignant salivary
gland tumours.11 Most studies in Africa showed a
delay by patients in reporting to the hospital, with
most presenting with the late stage disease (stage
III/IV), whereas early reporting in developed
countries has greatly improved the survival of patients
diagnosed with these tumours.1,5,6,10,12,13
An earlier study of salivary gland tumours in
northern Nigeria decried the poor record of the
natural history of tumours in northern Nigeria due to
the long distances patients had to travel for treatment
and loss of patients to follow up.8 The commencement
of histopathology services at JUTH in 1986 was
expected to increase the number of referrals for biopsy
from the areas in north central Nigeria served by the
hospital. This study documents the epidemiology of
salivary gland neoplasia in the areas served by the
hospital.
METHOD
JUTH is one of the referral hospitals for histopathology
in the North Central Zone of Nigeria and receives
biopsy samples from both public and private hospitals
in the North Central Zone (Plateau, Nassarawa, Benue,
Kogi states and some states in the North Eastern Zone
52
Volume 1 ? Number 1 ? 2006
(Bauchi and Taraba states), with an approximate
population of about 14 million.
The ethical clearance for the study was obtained
from the Ethical Committee of JUTH. Only
histologically diagnosed salivary and extra-salivary
gland tumours were included in the study.
Socio-demographic information and history of
patient management (age, sex, occupation, ethnic
group, history of habits; history of symptoms, dates of
referral and 1st appointment, pre-treatment and
histological TNM staging of lesion, clinical and
histological diagnosis, dates of biopsy and dates of
biopsy report; definitive treatments and date of
discharge) were retrieved from pathology and medical
records of patients from January 1987 (the
commencement of histopathological services at JUTH)
until December 2002 were reviewed. The information
obtained were entered into data entry forms designed
and modified according to the pattern developed for
the British Association of Head and Neck Oncologists
(BAHNO) Minimum Dataset.14 The tumours recorded
were as classified by the 3rd Edition of the International
Classification of Diseases Oncology (ICD-O).15
The information was analyzed statistically using
the Microsoft Office 2000? Excel Package; SPSS 11+
and the STATCALCR statistical package of the Epi Info
Version 6.0 (1993). The students t test, Yates
corrected, and Fishers exact tests were used to
determine areas of significant associations between
nominal variables such as prevalence rate and
duration of symptoms and to compare means in this
study with the reported findings from previous
studies. A p-value of 0.05 or less was considered
significant.
RESULTS
A total of 117 cases of histologically diagnosed salivary
and extra-salivary gland tumours were seen during
the period of study with a benign-malignant ratio of
2.7:1. Of these 117 tumours, 85 (72.6%) were benign,
while 32 (27.4%) were malignant. Plemorphic
adenoma (89.4%) was the most common benign
tumour and muco-epidermoid carcinoma (18.6%) the
most common malignant tumour seen. The prevalence
of other tumours is as shown in table 1.
Nigerian Journal of Clinical & Biomedical Research
The major salivary glands (67.5%), especially the
parotid gland (52.1%), were the most affected sites.
The intra-oral minor salivary glands were less affected
(5.1%), with the palate and unspecified intra-oral
glands constituting 1.7% each. No malignancy was
reported in any minor salivary gland site (table 1).
The age and sex distribution at presentation
among the patients presenting with salivary and extrasalivary gland tumours is shown in table 2. The mean
age at presentation was 34.2 19.0 years with a range
of 5-90 years. Majority of the benign tumours (58.8%)
occurred during the 2nd-4th decades of life with a malefemale ratio of 1 : 1.2. Pleomorphic adenoma was more
commonly reported in the 2nd and 3rd decades of life,
with a peak in the 2nd decade (table 2). Its overall mean
age of occurrence was 29.95 15.3 years (males = 31.9
18.2 years; females = 28.4 12.5 years).
Malignant tumours occurred most commonly in
the 4th-5th decades of life with an equal sex distribution.
Mucoepidermoid carcinoma was reported commonly
in the 2nd and 5th decades of life, with an overall mean
age of occurrence of 36 14.4 years (males = 29.3 15.3
years; females = 6 5.7 years) (table 2).
The duration of symptoms is defined in this study
as the interval between the onset of symptoms and the
date of reporting at the hospital. Patients with benign
tumours of the major salivary glands delayed about
2.5 times longer than those with malignant lesions
(p=0.09). Specifically, patients diagnosed with
pleomorphic adenoma delayed for twice as long as the
patients diagnosed with its malignant variant (table 3).
DISCUSSION
The ratio of benign to malignant tumours is relatively
higher (p>0.05) than previously reported for Nigeria
and Tanzania1,2,5,10 (see table 4).
Table 1. Salivary gland tumours by ICD-O codes
Tumours
Major Salivary Glands
Minor Salivary Glands
Unspecified
glands
Total No.
(%)
Parotid
Submnd
Subling
Palate
Lip
Mouth
Extra-SG
Tonsils
Pleomorphic adenoma
31
12
1
2
1
1
4*
1
Monomorphic adenoma
3
-
-
-
-
--
-
-
-
3 (2.6)
Warthins tumour
-
-
-
-
-
1
-
-
1
2 (1.7)
23
76 (64.9)*
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Nigerian Journal of Clinical & Biomedical Research
Schwannoma
1
-
-
-
-
-
-
-
-
1 (0.85)
Cavernous lymphangioma
-
1
-
-
-
-
-
-
-
1 (0.85)
Cavernous hemangioma
1
-
-
-
-
-
-
-
-
1 (0.85)
Lymphangioma
1
-
-
-
-
-
-
-
-
1 (0.85)
Mucoepidermoid carcinoma
5
1
-
-
-
-
-
-
1
7 (5.9)
Adenoidcystic carcinoma
3
2
-
-
-
-
-
-
-
5 (4.3)
Squamous cell carcinoma
3
-
-
-
-
-
-
-
-
3 (2.5)
Acinic cell tumour
4
-
-
-
-
-
-
-
-
4 (3.4)
Ca. Ex Pleomorphic adenoma
3
1
-
-
-
-
-
-
-
4 (3.4)
Adenocarcinoma
1
-
-
-
-
-
-
-
-
1 (0.85)
Adenolympho carcinoma
1
-
-
-
-
-
-
-
-
1 (0.85)
Undiff. carcinoma
1
-
-
-
-
-
-
-
1
2 (1.7)
Unspecified carcinoma
3
-
-
-
-
-
-
-
-
3 (2.5)
Lymphoepithelioma
-
-
-
-
-
-
-
-
1
1 (0.85)
Non Hodgkins lymphoma
-
-
-
-
-
-
-
-
1
1 (0.85)
61
17
1
2
1
2
4
1
28
117
(52.1)
(14.4)
(0.85)
(1.7)
(0.85)
(1.7)
(3.4)
(0.85)
(23.7)
(100)
Other benign tumours
Total
TOTAL
(%)
* Includes 4 cases in other minor salivary gland sites like the Eye (2), Max. Antrum (1) and Neck (1)
Table 2a. Age and gender distribution of salivary gland tumours benign tumours
Age group
Pleomorphic adenoma
Sex
Male
Monomorphic adenoma
Female
Gender
not specified
Male
Female
Male
Female
Age
0-10
11-20
21-30
31-40
41-50
51-60
61-70
71-80
81-90
Unspecified adult
Unspecified age
2
6
6
5
2
3
1
1
4
4
13
10
7
3
1
4
1
3
1
-
1
1
-
1
1
-
2
1
1
1
4
19
18
13
5
4
1
2
1
9
9
Total
34
39
3
1
2
2
4
85
Table 2b. Age and gender distribution of salivary gland tumours C malignant tumours
Age group
Sex
Mucoepidermoid carcinoma
Adenoidcystic carcinoma
Other malignant neoplasms
Total
M
F
U
M
F
U
M
F
Age
0-10
-
-
-
-
-
-
-
-
11-20
1
-
1
-
-
-
-
1
3
21-30
1
-
-
-
-
-
1
2
4
54
Volume 1 ? Number 1 ? 2006
Nigerian Journal of Clinical & Biomedical Research
31-40
-
-
-
-
-
-
4
2
6
41-50
-
3
-
1
1
-
1
-
6
51-60
-
-
-
-
1
-
-
2
3
61-70
-
-
-
-
-
-
1
1
2
71-80
-
-
-
-
-
-
1
-
1
81-90
-
-
-
-
-
-
1
1
2
Unspecified adult
1
-
-
-
-
-
1
-
2
Unspecified age
-
-
-
1
-
1
-
1
3
Total
3
3
1
2
2
1
10
10
32
Table 3. Duration of symptoms by site and tumour type
Site
Histological type
Duration of symptoms (months)
All salivary glands
benign
malignant
30.4 24.2
12 6.9
Parotid gland
benign
malignant
27.3 28.2
12 6.9
Submandibular gland
benign
malignant
30 20.8
Minor salivary glands
benign
malignant
42 25.5
Tumours
Duration of symptoms (months)
Pleomorphic adenoma
32.1 24.5
Carcinoma. ex pleomorphic adenoma
16.3 7.1
Relative to head and neck cancers, the 4.4%
prevalence of malignant salivary gland tumours in this
study is lower (p ................
................
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