title: Salivary gland carcinomas.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  Despite several developments, salivary gland carcinomas remain a heterogeneous group of tumours challenging both pathologists and clinicians.
authors: Department of Oral and Maxillofacial Surgery, Regensburg University, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany. tobias.ettl@ukr.de
authors: Tobias
authors: T
authors: Ettl
authors: Stephan
authors: S
authors: Schwarz-Furlan
authors: Martin
authors: M
authors: Gosau
authors: Torsten E
authors: TE
authors: Reichert
mesh_terms: D001706:Biopsy; D059186:Chemoradiotherapy, Adjuvant; D002869:Chromosome Aberrations; D038524:Diffusion Magnetic Resonance Imaging; D015972:Gene Expression Regulation, Neoplastic / Q000235:genetics; D006801:Humans; D008207:Lymphatic Metastasis / Q000235:genetics / Q000473:pathology; D064847:Multimodal Imaging; D037981:Neck Dissection; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010307:Parotid Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000473:pathology / Q000601:surgery; D049268:Positron-Emission Tomography; D011379:Prognosis; D012307:Risk Factors; D012468:Salivary Gland Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D012469:Salivary Glands / Q000473:pathology / Q000601:surgery; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography