What are the other Names for this Condition? (Also known as/Synonyms)

• Salivary Gland Ductal Papilloma

What is Ductal Papilloma of Salivary Gland? (Definition/Background Information)

• Ductal Papillomas of Salivary Gland are extremely rare and benign tumors arising in the oral cavity and frequently involving the minor salivary glands. A majority of the tumors are seen in adults
• There are 3 types of Salivary Gland Ductal Papillomas and these include:
  • Inverted ductal papilloma of salivary gland
  • Intraductal papilloma of salivary gland
  • Sialadenoma papilliferum of salivary gland
• Generally, the cause of formation of Ductal Papillomas of Salivary Gland is unknown, and no risk factors have been clearly established
• Most tumors are solitary in nature, small, and asymptomatic. Ductal Papilloma of Salivary Gland typically presents as a well-defined mucosal nodule/mass and may be present on the lips, inner lining of the cheeks, or the palate
• The diagnosis of Ductal Papilloma of Salivary Gland can be confirmed through a tissue biopsy. The treatment is a complete surgical removal of the tumor
• The prognosis of Ductal Papilloma of Salivary Gland is generally excellent in most cases, since it is a benign tumor; tumor recurrence is generally uncommon

Who gets Ductal Papilloma of Salivary Gland? (Age and Sex Distribution)

• Ductal Papillomas of Salivary Gland are extremely uncommon tumors
• It is typically present in adults in the age range 25-90 years; however, some are noticed in children too
• Both males and females are affected, though some studies indicate a slight male predominance
• The tumor can affect all races and ethnic groups

Currently, only a few cases of Salivary Gland Ductal Papilloma have been reported worldwide. Since the tumor is uncommon, there is only limited information available in the medical literature.

What are the Risk Factors for Ductal Papilloma of Salivary Gland? (Predisposing Factors)

• No clearly identified risk factors for Ductal Papillomas of Salivary Glands have been established to date
• The human papilloma virus (HPV) and recurrent trauma are noted to play a role in the formation of inverted ductal papillomas

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Ductal Papilloma of Salivary Gland? (Etiology)

Currently, the cause of formation of Ductal Papillomas of Salivary Gland is unknown.

What are the Signs and Symptoms of Ductal Papilloma of Salivary Gland?

The signs and symptoms of Ductal Papilloma of Salivary Gland may include:

• Presence of a well-formed tumor in the mouth; often, the tumor is known to develop over many months and years
• In a majority of the cases, the tumor affects the minor salivary glands; sometimes, the major salivary glands may be involved
• The tumor may appear as a mucosal nodule/mass presenting no pain
• The common areas involved include the lips, inner cheek lining (buccal mucosa), soft/hard palate, and the floor of the mouth
• The tumor size may range from 5-20 mm
• Occasionally, large tumors may cause pain and discomfort

How is Ductal Papilloma of Salivary Gland Diagnosed?

The following exams and procedures may be used in the diagnosis of Ductal Papilloma of Salivary Gland:

• Evaluation of the individual’s medical history and a through physical examination
• Plain X-ray of the head and neck region
• Ultrasound scan of the affected salivary gland
• CT or CAT scan with contrast of the head and neck usually shows a well-defined mass. This radiological procedure creates detailed 3-dimensional images of structures inside the scanned region
• MRI scans of head and neck region: A magnetic field is used to create high-quality pictures of certain parts of the body, such as tissues, muscles, nerves, and bones. These high-quality pictures may reveal the presence of the tumor

Although the above modalities can be used to make an initial diagnosis, a tissue biopsy of the tumor is necessary to make a definitive diagnosis to begin treatment. The tissue for diagnosis can be procured in multiple different ways which include: 

• Fine needle aspiration (FNA) biopsy of the tumor: A FNA biopsy may not be helpful, because one may not be able to visualize the different morphological areas of the tumor. Hence, a FNA biopsy as a diagnostic tool has certain limitations, and an open surgical biopsy may be recommended.  
• Salivary gland core biopsy of the tumor
• Salivary gland open biopsy of the tumor

Tissue biopsy:

• A tissue biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
• Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
• Sometimes, the pathologist may perform special studies, which may include immunohistochemical stains, molecular testing, and very rarely, electron microscopic studies to assist in the diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Ductal Papilloma of Salivary Gland?

Significant complications due to Ductal Papilloma of Salivary Gland are generally not noted. In some cases, the following may be observed:

• Discomfort while speaking, eating, etc.
• Surgery to remove the tumor mass may result in facial nerve palsy (surgical complication)
• Post-surgical wound infection
• Sialadenoma papilliferum of salivary gland is known to recur following surgery in some cases

How is Ductal Papilloma of Salivary Gland Treated?

• A complete surgical excision with clear margins is the preferred mode of treatment of Ductal Papilloma of Salivary Gland. This can result in a cure
• Post-operative care is important: One must maintain minimum activity levels, until the surgical wound heals
• Follow-up following surgery/treatment is recommended

How can Ductal Papilloma of Salivary Gland be Prevented?

• Current medical research has not established a method of preventing the formation of Ductal Papilloma of Salivary Gland
• Regular medical screening at periodic intervals following treatment is beneficial

What is the Prognosis of Ductal Papilloma of Salivary Gland? (Outcomes/Resolutions)

• The prognosis of Ductal Papilloma of Salivary Gland is generally excellent with surgical intervention and complete removal, since it is a benign tumor
• The risk of tumor recurrence following surgery is minimal

Additional and Relevant Useful Information for Ductal Papilloma of Salivary Gland:

There are 3 major types of salivary glands and these include the following:

• Parotid glands, found on the sides of the face
• Submandibular glands located at the back of mouth, on both sides of the jaw
• Sublingual glands that are seen under the floor of the mouth

The salivary glands produce saliva that helps in:

• Lubricating the mouth
• Swallowing
• Protects the teeth against bacteria
• Digestion of food