Salivary gland tumours usually present as a lump or swelling in the affected gland which may or may not have been present for a long time. The lump may be accompanied by symptoms of duct blockage (e.g. xerostomia). Usually, in their early stages it is not possible to distinguish a benign tumour from a malignant one. One of the key differentiating symptoms of a malignant growth is nerve involvement. For example signs of facial nerve damage (e.g facial palsy) are associated with malignant parotid tumours. Facial pain, and paraesthesia are also very often associated with a malignant tumours. Other red flag symptoms which may suggest malignancy and warrant further investigation are fixation of the lump to the overlying skin, ulceration and induration of the mucosa.

Due to the diverse nature of salivary gland tumours, many different terms and classification systems have been used. Perhaps the most widely used currently is that system proposed by the World Health Organization in 2004, which classifies salivary neoplasms as primary or secondary, benign or malignant, and also by tissue of origin. This system defines five broad categories of salivary gland neoplasms:

Benign epithelial tumors

- Pleomorphic adenoma

- Warthin's tumor

- Myoepithelioma

- Basal cell adenoma

- Oncocytoma

- Canalicular adenoma

- Lymphadenoma

- "Sebaceous lymphadenoma"

- "Nonsebaceous lymphadenoma"

- Ductal papilloma

- "Inverted ductal papilloma"

- "Intraductal papilloma"

- "Sialadenoma papilliferum"

- Cystadenoma

- Malignant epithelial tumors

- Acinic cell carcinoma

- Mucoepidermoid carcinoma

- Adenoid cystic carcinoma

- Polymorphous low-grade adenocarcinoma

- Epithelial-myoepithelial carcinoma

- Clear cell carcinoma, not otherwise specified

- Basal cell adenocarcinoma

- Sebaceous carcinoma

- Sebaceous lymphadenocarcinoma

- Cystadenocarcinoma

- Low-grade cribriform cystadenocarcinoma

- Mucinous adenocarcinoma

- Oncocytic carcinoma

- Salivary duct carcinoma

- Salivary duct carcinoma, not otherwise specified

- Adenocarcinoma, not otherwise specified

- Myoepithelial carcinoma

- Carcinoma ex pleomorphic adenoma

- Mammary analogue secretory carcinoma

- Carcinosarcoma

- Metastasizing pleomorphic adenoma

- Squamous cell carcinoma

- Large cell carcinoma

- Lymphoepithelial carcinoma

- Sialoblastoma

- Soft tissue tumors

- Hemangioma

- Hematolymphoid tumors

- Hodgkin lymphoma

- Diffuse large B-cell lymphoma

- Extranodal marginal zone B cell lymphoma

- Secondary tumors (i.e. a tumor which has metastasized to the salivary gland from a distant location)

Others, not included in the WHO classification above, include:

- Intraosseous (central) salivary gland tumors

- Hybrid tumors (i.e. a tumor displaying combined forms of histologic tumor types)

- Hybrid carcinoma

- Others

- Others

- Keratocystoma

- Sialolipoma

Presents as painless, slow-growing mass that is firm or hard. Most appear clinically as mixed tumors.

Pain is the most common symptom, followed by either sensorineural or conductive hearing loss, tinnitus or drainage (discharge). A mass lesion may be present, but it is often slow growing.

Epithelial-myoepithelial carcinoma, abbreviated EMCa, is a rare malignant tumour that typically arises in a salivary gland and consists of both an epithelial and myoepithelial component. They are predominantly found in the parotid gland

and represent approximately 1% of salivary gland tumours.

EMCas are diagnosed by examination of tissue, e.g. a biopsy.

Its appearance is very similar to adenomyoepithelioma of the breast, which may be the same tumour at a different anatomical site.

The histologic differential diagnosis includes adenoid cystic carcinoma and pleomorphic adenoma.

The signs and symptoms are similar to other malignant salivary gland tumours; however, it may have been preceded by an appreciable mass that was long-standing and did not appear to be growing.

Findings that suggest a malignant salivary gland tumour include rapid growth, facial weakness (due to facial nerve compression), pain, skin ulceration, fixation of the mastoid tip

and parasthesias.

This tumor only affects the outer 1/3 to 1/2 of the external auditory canal as a primary site. If this area is not involved, the diagnosis should be questioned. The most common tumor type is ceruminous adenoid cystic carcinoma and ceruminous adenocarcinoma, NOS.

Ductal carcinoma is a type of tumor that primarily presents in the ducts of a gland.

Types include:

- Mammary

- Ductal carcinoma in situ

- Invasive ductal carcinoma

- Pancreatic ductal carcinoma

Mucoepidermoid carcinoma is the most common type of minor salivary gland malignancy in adults. Mucoepidermoid carcinoma can also be found in other organs, such as bronchi, lacrimal sac and thyroid.

Mucicarmine staining is one stain used by pathologist for detection.

The treatment is simple excision and exclusion of a malignant neoplasm.

Sebaceous lymphadenoma is a tissue diagnosis, e.g. salivary gland biopsy.

It may be confused with a number of benign and malignant neoplasms, including Warthin tumour, mucoepidermoid carcinoma and sebaceous lymphadenocarcinoma.

Warthin's tumor primarily affects older individuals (age 60–70 years). There is a slight male predilection according to recent studies. The tumor is slow growing, painless, and usually appears in the tail of the parotid gland near the angle of the mandible. In 5–14% of cases, Warthin's tumor is bilateral, but the two masses usually are at different times. Warthin's tumor is highly unlikely to become malignant.

The gland most likely affected is the parotid gland. In fact, it is the only tumor virtually restricted to the parotid gland. Though much less likely to occur than pleomorphic adenoma, Warthin's tumor is the second most common benign parotid tumor.

Carcinoma ex pleomorphic adenoma, abbreviated ca ex PA, is a type of cancer typically found in the parotid gland. It arises from the benign tumour pleomorphic adenoma.

Its prognosis depends on the stage. Early tumour have essentially a benign behaviour.

Salivary gland oncocytomas are most common in ages 70–80, females, the parotid gland (85–90%), and are firm, slowly growing, painless masses of less than 4 cm. They may be bilateral.

Myoepitheliomas are diagnosed from an examination of the tissue by a pathologist.

Pleomorphic adenoma is a common benign salivary gland neoplasm characterised by neoplastic proliferation of parenchymatous glandular cells along with myoepithelial components, having a malignant potentiality. It is the most common type of salivary gland tumor and the most common tumor of the parotid gland. It derives its name from the architectural Pleomorphism (variable appearance) seen by light microscopy. It is also known as "Mixed tumor, salivary gland type", which describes its pleomorphic appearance as opposed to its dual origin from epithelial and myoepithelial elements.

Adenoid cystic carcinoma (sometimes referred to as adenocyst, malignant cylindroma, adenocystic, adenoidcystic, ACC or AdCC.) is a rare type of cancer that can exist in many different body sites. This tumor most often occurs in the salivary glands, but it can also be found in many anatomic sites, including the breast, lacrimal gland, lung, brain, bartholin gland, trachea, and the paranasal sinuses.

It is the third most common malignant salivary gland tumor overall (after mucoepidermoid carcinoma and polymorphous low grade adenocarcinoma). It represents 28% of malignant submandibular gland tumors, making it the single most common malignant salivary gland tumor in this region. Patients may survive for years with metastases because this tumor is generally well-differentiated and slow growing. In a 1999 study of a cohort of 160 ACC patients, disease specific survival was 89% at 5 years but only 40% at 15 years, reflecting deaths from late-occurring metastatic disease.

The tumor is usually solitary and presents as a slow growing, painless, firm single nodular mass. Isolated nodules are generally outgrowths of the main nodule rather than a multinodular presentation. It is usually mobile unless found in the palate and can cause atrophy of the mandibular ramus when located in the parotid gland. When found in the parotid tail, it may present as an eversion of the ear lobe. Though it is classified as a benign tumor, pleomorphic adenomas have the capacity to grow to large proportions and may undergo malignant transformation, to form carcinoma ex-pleomorphic adenoma, a risk that increases with time (9.5% chance to convert into malignancy in 15 years). Although it is "benign" the tumor is aneuploid, it can recur after resection, it invades normal adjacent tissue and distant metastases have been reported after long (+10 years) time intervals.

An oncocytoma is an epithelial tumor composed of oncocytes, large eosinophilic cells having small, round, benign-appearing nuclei with large nucleoli.

Oncocytoma can arise in a number of organs.

Hidradenocarcinoma (also known as malignant hidradenoma, malignant acrospiroma, clear cell eccrine carcinoma, or primary mucoepidermoid cutaneous carcinoma) is a malignant adnexal tumor of the sweat gland. It is the malignant variant of the benign hidradenoma. It may develop de novo or in association with an existent hidradenoma.

This type of tumor typically develops in older individuals (after age 40).

Myoepithelioma of the head and neck, also myoepithelioma, is a salivary gland tumour of the head and neck that is usually benign.

As the name suggests, it consists of myoepithelial cells. Classically, they are found in the parotid gland or palate. A similar tumor type may be found in the tongue, referred to as ectomesenchymal chondromyxoid tumor.

Ectopic salivary gland tissue which is located in sites other than the normal location is variously described as aberrant, accessory, ectopic, heterotopic or salivary gland choristoma.

Basophilic, bland cells similar to acinar cells. Growth pattern: solid - acinar cells, microcytic - small systic spaces mucinous or eosinophilic, papillary-cystic - large cystic lined by epithelium, follicular - similar to thyroid tissue.

These tumors which resemble serous acinar cells vary in their behavior from locally aggressive to blatantly malignant.

It can also appear in the breast. The pancreatic form of acinic cell carcinoma is a rare subtype of exocrine pancreatic cancer. Exocrine pancreatic cancers are the most common form of pancreatic cancer when compared to endocrine pancreatic cancer.

Acinic cell carcinomas arise most frequently in the parotid gland. Other sites of primary tumors have included the submandibular gland and other major and minor salivary glands. There have been rare cases of primary tumors involving the parapharyngeal space and the sublingual gland.