11: Salivary pathology Flashcards
von ebner salivary glands – where, what secretions
tongue beneath circumvallate and foliate papillae; primarily serous
salivary glands in tongue beneath circumvalate and foliate papillae and their secretions
von ebner, primarily serous
ventral tongue salivary glands and secretions
blandin-nuhn, serous
blandin-nuhn salivary glands – where, what secretions
ventral tongue, serous
salivary gland aplasia syndromes
treacher collins, hemifacial microsomia, lacrimo-auriculo-dento-digital syndrome (LADD)
can also be isolated
LADD genetics and clinical
FGF10 mutation
salivary and lacrimal gland aplasia, cup shaped ears, dental/digital anomalies
salivary and lacrimal gland aplasia, cup shaped ears, dental/digital anomalies
what is and genetics
LADD
FGF10 mutation
superficial mucoceles location
soft palate and retromolar pad
superficial mucoceles which conditions
lichen planus, lichenoid drug reactions, GVHD, tartar control toothpaste
connective tissue reaction to extravasated mucus
granulation
origin of ranula
sublingual gland (body or ducts of Rivini)
CT/MRI sign of submandibular ranula
tail sign
plunging ranula dissects though
mylohyoid muscle
salivary duct cyst location
upper lip
systemic treatment for multifocal ductal ectasia
erythromycin and chlorhexidine
most common sialolithiasis and histo look
submandibular
tortuous duct and mucoid secretion
types of sialadenitis and causes
infections - viral-mumpsm bacterial - S aureus
non-infectious – Sjogrens, RT, sarcoid
chronic sclerosing sialadenitis in submandibular leading to gland enlargement – evaluate for what
Kuttner tumor (IgG4) – eval for sclerosing pancreatitis
how do bacteria cause sialadenitis
retrograde spread from reduced flow (dehydration, medication) or block (sialolith, tumor)
sialadenitis most commonly where and presentation
fever and pus, usually parotid
surgical mumps
after abdominal surgery, when patient is kept without food/fluids and receives atropine
after abdominal surgery, when patient is kept without food/fluids and receives atropine
surgical mumps
sausaging of stensen’s duct – what is, what modality, what diagnosis
dilation and strictures from scar tissue in sialadenitis on sialography
subacute necrotizing sialadenitis histo, demographic, ulceration
no squamous metaplasia, mixed acute and chronic inflammation, younger patients, does not ulcerate
cheilitis glandularis what is
swelling and eversion of lower lip due to hypertrophy and inflammation of glands
swelling and eversion of lower lip due to hypertrophy and inflammation of glands
cheilitis glandularis
cheilitis glandularis etiologues
UV damage, tobacco, syphilis, poor hygiene, hereditary
forms of cheilitis glandularis
simple, superficial suppurative (Baelz’s disease)m deep suppurative (cheilitis glandularis apostematosa)
Baelz’s disease
superficial suppurative cheilitis glandularis
cheilitis glandularis apostematosa aka
deep suppurative
true sialorrhea causes
aphthae, new dentures, GERD (water brash), rabies, heavy metal poisoning, medications for alzheimers
relative sialorrhea what is and causes
can’t keep saliva in mouth: Down’s, cerebral palsy, Parkinson’s, prior surgery
idiopathic paroxysmal sialorrhea presentation
short episodes 2-5min, prodrome of nausea and epigastric pain
xerostomia how ofetn
25% of adult population
xerostomia causes
developmental (SG aplasia)
water/metabolite (reduced intake, vomit, hemorrhage)
iatrogenic (drugs, RT, CT), systemic disorders (SS, sarcoidosis, diabetes, HIV, HCV, GVHD) and local (reduced mastication, smoking, mouth breathing)
benign lymphoepithelial lesion aka
lymphoepithelial sialadenitis, Mikulicz disease
painless enlargement of salivary glands, usually unilateral
pts may or may not have clinical sjogren
mikulicz syndrome what is
salivary gland enlargement from other causes (eg sarcoidosis)
benign lymphoepithelial lesion histo
lymphocytic sialadenitis + epimyoepithelial islands (ductal preservation with epithelial proliferation)
malignant lymphoepithelial lesion aka, histo, cause
aka lymphoepithelial carcinoma
poorly differentiated salivary ca with prominent lymphoid stroma, EBV, de novo or from BLEL
primary sjogrens =
sicca syndrome = dry eyes + mouth
secondary sjogrens
sicca syndrome + RA, SLE, biliary cirrhosis
dry eyes in sjogrens aka
keratoconjunctivitis sicca
HLA in sjogrens (primary vs secondary)
HLA-DRw52 both
HLA-DR3 and B8 primary only
fruit laden branchless tree
sialography for sjogrens
rose bengal dye
shows defects on ocular surface epithelium in sjogrens
dye to show ocular surface epithelium defects in sjogrens
rose bengal
test to confirm dry eyes and what’s the metric in sjogrens
schirmer test - <5mm
labs in sjogrens
ANAs, anti-SSA (Ro), anti-SSB (La0, ESR, OgG, RF
sjogrens histo
multifocal lymphocytic sialadenitis (T cells)–> acini destruction
sjogrens biopsy criteria
2+ foci of 50+ lymphocytes within 4mm squared; smokers have fewer foci
risk with sjogrens
40x MALT lymphoma
HIV related parotid cysts presentation
usually bilateral
bilateral parotid cysts consider
HIV related parotid cysts
HIV related parotid cysts histo
cystic spaces lined with squamous epithelium; abundant reactive lymphoid stroma
epimyoepithelial islands and Warthin-Finkeldey giant cells
Warthin-Finkeldey cells
giant cells in HIV related parotid cysts
giant cells in HIV related parotid cysts name
Warthin Finkeldey
Sialadenosis aka, what is and why
sialosis
accumulation of secretory zymogen granules due to innervation disruption
accumulation of secretory zymogen granules due to innervation disruption
Sialadenosis
sialadenosis risk factors
diabetes, malnutrition, alcoholism, bulimia
sialadenosis sialgraphy
leafless tree (compression of finer ducts by hypertrophic acinar cells)
leafless tree sialography why and what
sialadenosis (compression of finer ducts by hypertrophic acinar cells)
adenomatoid hyperplasia of minor salivary glands where and why
mostly on palate (pseudotumor); poss 2/2 chronic trauma
adenomatoid hyperplasia of minor salivary glands histo
coalescing lobules of normal mucinous acini in lamina propria and submucosa
coalescing lobules of normal mucinous acini in lamina propria and submucosa; say, palate
adenomatoid hyperplasia of minor salivary glands
polycystic (dysgenetic) parotid disease where and who
almost always in parotid, bilateral, usually childhood
polycystic (dysgenetic) parotid disease histo
parenchyma diffusely replaced by varying degrees of honeycombed cystic change, lined with a thin layer of flattened epithelium
polycystic (dysgenetic) parotid disease ddx
cystadenoma/carcinoma but they are localized masses
juxtaoral organ of chievitz what, where, function
vestigial organ of the developing parotid gland
bilateral in soft tissue overlying angle of mandible in buccotemporal space
poss mechanosensor in lateral wall of oral cavity – avoid removal
juxtaoral organ of chievitz histo and ddx
2-10 islands of squamoid cells but no keratin
dark stained cells on periphery and clear cells in center
glandular/organoid pattern
ddx: well-diff SCC, MEC, met
necrotizing sialometaplasia causes
local ischemia and infarction
factors: trauma, surgery, infection, dental injection
sclerosing polycystic adenosis where and why
pseudoneoplastic reactive inflammatory process, usually parotid
sclerosing polycystic adenosis histo
multiple densely sclerotic lobules composed of hyalinized collagen around multiple ducts with prominent cystic change
cells: apocrine, sebaceous-like, and paneth-like
has intraluminal rounded projections
salivary gland tumors = where most common, what’s most common
66-75% of all tumors in parotid
66-75% are benign
salivary gland tumor occurrence by location
parotid (66) > minor (palate>upper lip> cheek) > submandibular > sublingual
what percentage of tumors are benign in parotid submandibular minor salivary (overall) sublingual
parotid 66 benign
submandibular 60 benign
minor salivary 50 benign
sublingual 10 benign
minor salivary glands, what percentage of tumors are benign:
upper lip
palate and buccal mucosa
retromolar pad, FOM, tongue, lower lip
upper lip 75 benign
palate and buccal mucosa 50 benign
retromolar pad, FOM, tongue, lower lip 10 benign
most common benign tumor in parotid
pleomorphic adenoma
most common malignant tumor in parotid
mucoep
most common benign tumor in submandibular
pleomorphic adenoma
most common malignant tumor in submandibular
adenoid cystic carcinoma
most common tumor of sublingual
mucoep
most common benign tumor of minor salivary glands overall
pleomorphic adenoma
most common malignant tumorS (list multiple) of minor salivary glands overall
PLGA/mucoep/ACC
most common salivary gland tumor
pleeomorphic adenoma
most common salivary gland tumor in children
pleomorphic adnoma
pleomorphic adenoma old aka and why; IHC?
myoepithelioma
composed of myoepithelial cells
calponin, p63+
which pleomorphic adenomas higher recurrence
myxoid
string of pearls on skin
recurrent pleomorphic adenoma
special histo finding in a small subset of pleomorphic adenomas and how common
tyrosinde crystals in 6%