Abstract: Benign and malignant tumors are rare conditions; it wasnot uncommonly occurs in salivary glands and usually presented asa painless mass. The presence of pain and facial nerve palsy mayindicate malignant transformation. Diagnosis is made by imaging andbiopsies.

Objectives: This study aims to know the pattern of Benign andmalignant tumors in salivary glands among Sudanese patients inKhartoum state according to many categories age, gender, clinicalpresentation and diagnosis.

Methods: This is retrospective, cross- sectional, analytic andhospital based study from January 2014 to May 2016. Conductedin Otorhinolaryngological, Head and neck and Oral Maxillofacialhospitals in Khartoum state in Sudan.

Results: The highest percentage of neoplasm is benign morecommonly as pleomorphic adenoma in minor glands. Malignanttumor is commonly affected the parotid glands of predominance inadenoid cystic carcinoma followed by mucoepidermoid carcinoma.

Conclusion: Benign and malignant tumors which occur in salivaryglands were commonly pleomorphic adenoma and adenoid cysticcarcinoma respectively.

Salivary glands benign; Malignant tumors

The salivary gland neoplasm presented with a slowly growing painless masses. Parotid neoplasms most commonly occur in the tail of the gland. Submandibular neoplasms often appear with diffuse enlargement of the gland and sublingual tumors produce a palpable fullness in the floor of the mouth [1,2].

A total of 285 patients were enrolled. Among them, 230 (80.7%) had parotid gland and 55 (19.3%) had submandibular gland masses. Following a definitive histopathological examination, the most common benign tumor was pleomorphic adenoma (52.6%), whereas malignant tumors were mucoepidermoid carcinoma (2%) and squamous cell carcinoma (2%) [3].

Facial paralysis or other neurologic deficit associated with a salivary gland mass indicates malignancy and the significance of painful salivary gland masses is not entirely clear. Pain may be a feature associated with both benign and malignant tumors and it may arise from suppuration or hemorrhage into the mass or from infiltration of a malignancy into adjacent tissue. The suspicious also my include size, mobility, and extent of the mass, as well as its fixation to surrounding structures and tenderness. Facial nerve should be assessed carefully to identify any weakness or paralysis because usually it indicates a malignant lesion with infiltration into the nerve [2]. Minor salivary gland tumors have varied presentations depending on the site of origin. Painless masses on the palate or floor of the mouth are the most common presentation of minor salivary neoplasm [4]. Distinguishing malignant neoplasm from benign one at initial presentation may not be possible until a biopsy is performed. Both types typically present as a painless mass in the gland. Findings that are concerning for malignancy include pain, facial paresis, fixation of the mass to the skin or underlying tissue, and palpable neck lymphadenopathy [4-7].

In another study 67.5% were benign and 32.55% were malignant. The majority of cases occurred in the parotid 67.7% followed by minor glands 22.8% and submandibular gland 9.5%. The tumors affected in the study of four hundred and nine biopsies were performed in 381 patients (ages, 2-97 years; mean, 55.9). There were two minor complications. Biopsy was diagnostic in 98.3%. There were eight false negatives. The diagnostic values for malignancy were: sensitivity 89.6%, specificity 100%, Positive Predictive Value (PPV) 100% and Negative Predictive Value (NPV) 98%. For the detection of neoplasms were: sensitivity 98.7%, specificity 99%, PPV 99.7% and VPN 96.1% [8].

Pleomorphic adenoma was the most common represented 54.2%of all cases, followed by mucoepidermoid ca 13.5%, warthin tumor8.5% and Adenoid cystic carcinoma 7.9% [9].

Shafcat from Kashmir had undertaken a period of two years with particular reference to age, sex, site and histological types as per WHO classification. Out of 100 cases diagnosed on FNAC histopathological examination was done only in 66 cases. Diagnosis correlated with FNAC diagnosis in 65 cases with accuracy of 98.4%. The principal site was the parotid (70%).

Accuracy of ultrasound-guided core-needle biopsy in salivary gland tumours is very high, with a very high sensitivity and an absolutely reliable diagnosis of malignancy. It should be considered the technique of choice when a salivary gland tumours is detected [8].

Pleomorphic adenoma (73%) formed the largest group of tumors in most sites and benign tumors were common in 3^rd & 4^th decades while as malignant tumors were more common in 4^th & 5^th decades. Painless swelling was the commonest presentation and present in 99% cases [7,10]. Ultrasound-guided core-biopsy is the technique of choice in salivary glands nodules

Sensitivity, specificity for detecting neoplasms (which should be resected) are around 99%

Diagnosis of malignancy in core-biopsy is absolutely reliable

A ultrasoundguided core-needle biopsy result of “normal tissue”, however, warrants repeating the biopsy

Complication rate is very low [8].

Sulieman and Shummo founded that a 70% of the salivary gland tumors were parotid tumors, 20% were submandibular tumors and 10% were sublingual tumors and high incidence of malignancy was seen in salivary gland of 47% of cases. The predomince is for male and 5th decade of life showed the high incidence of involvement. The use of tombac (local snuff) appears to have strong relation with the increases of malignant tumors [11].

Fine-needle aspiration biopsy is a safe and simple diagnostic tool for the diagnosis of salivary gland masses and has a relatively high sensitivity and specificity. It may provide valuable information for patient counseling and surgical planning. The major drawbacks include a lower sensitivity than specificity and a relatively high rate of non-diagnostic results [3].

In benign salivary glands tumor women was affected in 61% and male: female ratio was 1:1.6. The parotid gland tumors were frequently in 68.5% with age ranged from 1 to 88 years (median 45 yrs) [7,12]. The most common malignancy is mucoepidermoid carcinoma (10.1%) in second and sixed decade of equal gender distribution M:F ratio and predominately in palate. Squamous cell carcinoma (10.9%) and adenoid cystic carcinoma (21.9%) were most common malignancy in the major and minor gland respectively [6,13]. A positive smoking history in 88% of men. The age distribution increase over each decade 1 (4.8%), 2 (5.5%) and 8 (16%) in parotid gland [14]. Adenoid cystic carcinoma is rare tumor accounting for only 1% of all malignant tumor of oral and maxillofacial region. It account for 22% of all salivary gland malignancies and is one of the most common malignant tumor of the minor salivary glands. It is the most common in fifth and sixth decades of life with male predominance. It is slow growing tumor and usually asymptomatic till it has invaded local nerves and structures with cervical lymph node metastasis [15]. P16 is encoded by the CDKN2A gene, which is recognized as a tumor suppressor due to its inactivation in many types of tumors. However, p16 overexpression is also linked to adverse tumor parameters and it’s overexpression was cell-type dependent in Adenoid cystic carcinomas in the lacrimal gland, while HPV infection was negative. P16 overexpression was unrelated to HPV infection but the mechanism of p16 overexpression needs to be further investigated in ACCs in the lacrimal gland [16].

This retrospective hospital based cross-sectional study from January 2014-May 2016. Study was done in Khartoum ENT hospital, Ibnsina specialized hospital, Khartoum dental teaching hospital and Africa specialized hospital. For 73 patients presented to these hospitals complaining of salivary glands swelling. In this study the authors included all patients presented with salivary gland tumours. And they excluded all patients with secondary metastasis to salivary glands and severely ill patients.

Data collection: Detailed will structured questionnaire was filled for each hospital respondent after obtaining the consent.

Data management and analysis: Data analyzed using statistical Package for Social Sciencel.