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Oral Path Exam 2 > 11: Salivary Gland Pathology > Flashcards

11: Salivary Gland Pathology Flashcards

1
Q

What is a rare inflammatory condition of minor glands causing lower lip swelling and subsequent eversion caused by hypertrophy and inflammation? What group is it most common in?

A

Cheilitis Glandularis; middle- to older-aged men

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2
Q

What are the 3 levels of Cheilitis Glandularis?

A

Simple, Superficial Supurative (Baeltz’s Disease), Deep supurative

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3
Q

Superficial supurative Cheilitis Glandularis and Deep Supurative Cheilitis Glandularis have what involvement and symptoms?

A

Bacterial involvement w/ inflammation, swelling, suppuration, ulceration

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4
Q

What specifically is inflamed and dilated in cheilitis glandularis? What does this cause?

A

The openings of the minor glands; Pressure on the glands may produce mucopurulent secretions

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5
Q

What is tx of persistent cheilitis glandularis?

A

Vermillionectomy

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6
Q

What are about 1/3 of cheilitis glandularis ass’d with? What is commonly the specific cause?

A

Squamous cell carcinoma; changes in actin

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7
Q

If I say excess salivation, you think:

A

Sialorrhea

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8
Q

What are episodes of excess salivation for 2-5 min associated with prodrome of nausea and epigastric pain?

A

Idiopathic Paroxysmal Sialorrhea

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9
Q

T/F. Patients with sialorrhea have excess saliva.

A

F. Not an overproduction, but lack of neuromuscular control of saliva.

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10
Q

What three patient populations may have sialorrhea?

A

Mentally retarded, those with neuromuscular disorders (e.g. CP), or those with surgical resection of the mandible

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11
Q

What are four treatments for sialorrhea?

A

Anticholinergics, Transdermal scopolamine, Surgery if muscular involvement, GERD meds if a factor

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12
Q

What are the first, second, and third leading causes of Xerostomia? What are seven other causes?

A

Drugs; anxiety/emotions, fluid/electrolyte deficiency, Xray/BMT/Chemo, Autoimmunity, Aging, Smoking and Mouth Breaking (General: iatrogenic, developmental, H20 imbalance, systemic disease, or local factors)

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13
Q

What’s the drug rule for xerostomia?

A

If it’s an anti drug (e.g. antidepressant) it causes xerostomia (also beta blockers and Gerd)

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14
Q

What are five consequences of xerostomia?

A

Thirst, Caries, Thick mucus, Microfloral shift and sleep may be affected

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15
Q

What are three “drug” tx for xerostomia? Other tx (6)?

A

Pilocarpaine (5mg tabs), Biotene or Prevident 5000; sip water frequently, avoid alcohol (mouthwash), humidify sleeping area, lubricate lips, fluoride supplementation, change meds, etc.

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16
Q

What infection is seen with Xerostomia?

A

Candidiasis and cervical/root caries

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17
Q

This is a cause of Xerostomia that is normally a unilateral swelling of the parotid gland.

A

Benign lymphoepithelial lesion

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18
Q

Although pilocarpaine helps xerostomia, when is it contraindicated?

A

Narrow-angle glaucoma

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19
Q

What is the chronic, systemic autoimmune disease that principally involves the salivary and lacrimal glands resulting in xerostomia, xeropthalmia (dry eyes)?

A

Sjogrens

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20
Q

What is dry eyes and dry mouth without another autoimmune disorder called?

A

Sicca (primary Sjogrens)

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21
Q

What is xeropthalmia of Sjogren Syndrome called?

A

Keratoconjunctivitis sicca

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22
Q

Secondary Sjogren Syndrome means? What is typically the other autoimmunity? Predilection?

A

There’s another autoimmune component involved; rheumatoid arthritis; middle-aged females

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23
Q

Symptoms associated with Sjogren syndrome (or any xerostomia) (7)?

A

Red tender oral mucosa, Angular cheilitis, Candidiasis, Cervical Decay, Difficulty swallowing, Altered taste, Retrograde bacterial sialadenitis

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24
Q

Sialographic appearance of Sjogren’s?

A

Fruit-laiden branchless tree: punctate sialectasia and lack of normal aborization of ductal system

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25
Q

What is the tear test for Sjogren Syndrome?

A

Schirmer test (<5mm tears for 5 min = Keratoconjuctivitis sicca)

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26
Q

What are two histopathologic aspects of Sjogren’s Syndrome?

A

Lympocytic infiltrate and epimyoepithelial islands; lymphocytes replace glands except for ducts (which become the epimyoepithelial islands)

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27
Q

What are four treatments for Sjogren’s?

A

Supportive; eye and mouth lubrication
Oral hygiene products that contain lactoperoxidase, lysozymge & lactoferrin (biotene and oral balance)
Fluoride applications (prevident)
Sialogogues (pilocarpine and cevimeline)

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28
Q

What is the noninflammatory disorder characterized by salivary gland enlargement, especially parotid, usually do to some underlying systemic problem?

A

Sialadenosis/Sialosis

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29
Q

What are three general causes of sialadenosis? Four specific causes?

A

Neurogenic, endocrine, or nutritional; Diabetes Mellitus, general malnutrition, alcoholism & bulimia

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30
Q

What actually goes wrong in sialadenosis?

A

Deregulation of autonomic innervation of salivary acini with excessive accumulation of secretory granules (enlargement)

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31
Q

What is a locally destructive inflammatory condition of salivary glands caused by ischemia that leads to local infarction? What is the main problem?

A

Necrotizing sialometaplasia; it mimics a malignant process clinically and microscopically

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32
Q

What are six predisposing factors of necrotizing sialometaplasia?

A

Trauma, Injections, Ill-fitting dentures, URI, adjacent tumors, previous surgery

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33
Q

What are two ways to differentiate Necrotizing Sialometaplasia from Oral Cancer?

A

Location and cleaner borders around the lesion (cancer has ragged borders)/glands are present but simply an outline

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34
Q

Where is necrotizing sialometaplasia typically found?

A

Unilaterally on the palate salivary glands (squamous cell carcinoma rarely found there)

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35
Q

What demographic typically has necrotizing sialometaplasia?

A

Mid 40-year old males

36
Q

Tx for necrotizing sialometaplasia?

A

Biopsy and no treatment, will resolve in 5-6 weeks

37
Q

What is the course of necrotizing sialometaplasia?

A

Initially: non-ulcerated swelling (may have pain or parathesia);
2-3 weeks: necrotic tissue will slough w/ crater like ulcer (1-5cm); heals 5-6 weeks

38
Q

Most common:

  1. Benign salivary gland tumor (neoplasm)
  2. Location for salivary gland tumor
  3. Intraoral location of salivary gland tumor
A
  1. Pleimorphic adenoma
  2. Parotid
  3. Palate
39
Q

What is the benign vs. malignant percentages for salivary gland tumors based on location?

A

Parotid: 80% benign, 20% malignant Submand/palatal/Buccal: 50/50
Sublingual: 20% Benign, 80% malignant
Upper lip glands: 80% benign, 20% malignant
Lower lip glands: 20% benign, 80% malignant

40
Q

What is the most common malignancy in the parotid?

A

Mucoepidermoid carcinoma

41
Q

Where is the most common location for the pleimorphic adenoma? What age group?

A

Superficial lobe of the parotid with swelling over ramus in front of ear; 30-50yo

42
Q

In what five locations are the mucoepidermoid carcinoma the most salivary gland tumor?

A

Parotid, Lower lip, retromolar pad, floor of mouth or tongue

43
Q

What are the three most common extra oral places of the pleimorphic adenoma? Intraoral?

A
  1. Parotid, submandibular gland, minor glands

2. Palate, upper lip, and buccal mucosa

44
Q

What are three characteristics of pleimorphic adenoma? What is rare with PA?

A

Painless, slow growing, firm mass that becomes less mobile with growth; facial palsy and pain are rare

45
Q

What is the radiographic character of pleimorphic adenoma?

A

Well-circumscribed border and encapsulated (malignancy would have irregular border and more moth-eaten)

46
Q

T/F. Xerostomia is a function of age.

A

F. Age does not affect xerostomia so much as when we age, we take more medications (and GERD) which typically have drying effects

47
Q

What are intraoral clinical findings of pleimorphic adenoma? What places have immobile and mobile lesions?

A

Posterior lateral aspect of palate- presents as smooth surface dome shaped mass; immobile=hard palate and mobile=lip and buccal mucosa

48
Q

What is the treatment of pleimorphic adenoma?

A

Surgical excision cures most (95%);

49
Q

Tumor that is exclusive to parotid gland?

A

Warthin Tumor

50
Q

Who is most common to get Warthin Tumor?

A

Males (8x), 50-60 yo, and smokers

51
Q

Where is a warthin tumor never found? In parotid, where specifically found?

A

Minor salivary glands; tail of parotid near angle of mandible

52
Q

What is the histology associated with the Warthin Tumor?

A

Double row of oncocytes with adjacent lymphoid stroma; ductal epithelium

53
Q

What are four characteristics of warthin tumor? How do you tx?

A

Slow-growing, painless, nodular mass; firm or fluctuant to palpation; conservative excision

54
Q

What is a monomorphic adenoma found almost exclusively in the minor glands of the upper lip?

A

Canalicular adenoma

55
Q

How do you diagnose Sjogren’s?

A

Take a high-powered field and look at the number of periductal lymphocytic clusters; more than +2 clusters may indicate Sjogren’s

56
Q

What are two types of monomorphic adenomas?

A

Canalicular and basal cell adenomas

57
Q

Treatment for monomorphic adenoma?

A

Surgical excision

58
Q

Difference between a Warthin tumor and an Oncocytoma (benign salivary gland tumor in 8th decade)?

A

No lymphoid stroma around the double row of oncocytes

59
Q

What is the histopathology of canalicular adenoma?

A

Monomorphic, single layered cords of columnar or cuboidal epithelium w/ basophilic epithelium

60
Q

What will half of the tumors we see be?

A

Pleimorphic adenoma- will have many stromal elements b/c trying to make ducts (ductal and myoepithelial)

61
Q

Where are most basal cell adenoma found? How tx?

A

Parotid (75%) and then upper lip; surgical excision

62
Q

What is a benign salivary gland tumor composed of large epithelial cells known as oncocytes?

A

Oncocytoma

63
Q

How do tori and salivary glands differ?

A

Tori are on midline and are bony; salivary glands are off the midline and will be firm (not hard)

64
Q

Why do oncocytes swell?

A

Excessive accumulation of mitochondria

65
Q

What is the most common salivary gland tumor carcinoma in children?

A

Mucoepidermoid carcinoma

66
Q

What are the most and second most common site for the mucoepidermoid carcinoma?

A
  1. Parotid and 2. Minor glands of palate
67
Q

If there is an elevated lesion on the palate that is not tooth related, what is it until proven otherwise?

A

Salivary gland tumor

68
Q

What does the grading of mucoepidermoid cells depend upon (3)? Specify for low.

A

Cyst formation, degree of cellular atypia, and relative number of mucous, epidermoid and intermediate cells; cyst formed, minimal atypia, and more mucous-producing cells

69
Q

How do monomorphic and pleimorphic adenomas differ?

A

Mono=just ductal (no stromal tissues found)

70
Q

What is the histology of mucoepidermoid carcinoma?

A

Mucous-producing and epidermoid cells

71
Q

Mucoepidermoid carcinoma is the salivary gland tumor that most commonly…

A

Goes into bone

72
Q

Low vs. high grade mucoepidermoid carcinoma tx?

A

Low: surgical resection with modest margin of surrounding normal tissue w/ good prognosis
High: more resection and possible radiation with a more guarded prognosis.

73
Q

What is a slow growing mass with pain early in the swelling? Why pain?

A

Adenoid cystic carcinoma; perineural invasion

74
Q

What are the classical histology and clinic feature of adenoid cystic carcinoma?

A

Swiss cheese or cylindrical look and perineural invasion

75
Q

What is the surgical consideration of adenoid cystic carcinoma?

A

Relentless, hard to get rid of, doesn’t kill you quickly. Surgery w/ adjunct radiation

76
Q

Where does adenoid cystic carcinoma metastasize to?

A

Lungs and bones

77
Q

What are the three most common malignant salivary gland tumors?

A

Mucoepidermoid carcinoma, adenoid cystic carcinoma and low grade carcinoma

78
Q

What are two malignant salivary gland tumors we should be able to ID histologically?

A

Mucoepidermoid (mucous/epidermoid cells) and adenoid cystic carcinoma (swiss-cheese look)

79
Q

How is Polymorphous Low Grade Adenocarcinoma like Adenoid Cystic Carcinoma?

A

both have perineural invasion, but polymorphous low grade adenocarcinoma perineural invasion does not affect prognosis (low-grade’s pt will not die from it)

80
Q

What is tx for polymorphous low-grade adenocarcinoma?

A

Wide surgical resection with good prognosis

81
Q

What is the third most common malignant salivary gland tumor and is exclusive to the minor salivary glands?

A

Polymorphous low-grade adenocarcinoma; minor salivary glands infers it is more common on palate

82
Q

What does polymorphous histologically look like?

A

“Streaming pattern”

83
Q

What is also know as cylindroma?

A

Adenoid cystic carcinoma

84
Q

What are demographics of adenoid cystic carcinoma?

A

Middle-aged adults

85
Q

Most common:

  1. Gland tumor w/ highest rate of malignancy?
  2. Tumor of upper lip?
  3. Malignant salivary gland neoplasm?
A
  1. Sublingual
  2. Canalicular adenoma
  3. Mucoepidermoid carcinoma

Oral Path Exam 2 (8 decks)

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