19. Non-neoplastic salivary gland disorders Flashcards
Describe salivary glands?
Structurally a series of branched ducts terminating in spherical or tubular secretory pieces or acini.
What is the predominant duct in salivary glands?
Striated duct where the saliva is modified
What are ducts between acini called and what do they empty into?
Intercalated ducts- striated ducts- excretory ducts
What cells are associated with acini and intercalated ducts?
Myoepithelial cells
What does H and E stained section of salivary gland look like?
Pale mucous staining
Nuclei condensed at base of cell
Serous cells- blue
Mucous cells- bubbly
Where are myoepithelial cells found?
They are found between the plasma membrane of the secretory cell and basement membrane
What do myoepithelial cells contain, and how do they stain?
They contain contractile proteins which allows squeezing of the acini.
Microfilament characteristic of muscle cells but not epithelium
What can be used to stain myoepithelial cells?
SMA actin- they stain the myoepithelial cells brown and it is found around the acini.
What does parotid gland cells contain?
Mostly serous fluid
Serous contains zymogen granules- darkly stained and contain proteins
What does submandibular gland cells contain?
Mixture of serous and mucous secretory units.
Either mixed, or pure, eg. with serous demilunes.
What do sublingual gland contain?
Mostly mucous cells.
Poor staining with H and E.
Excretory duct lined by cuboidal epithelium.
What is the general architecture of salivary glands?
Many secretory units are grouped together in lobules
Connective tissue septa radiates between the lobules from the outer capsule and conveys blood vessels, nerves and large excretory ducts
What is aplasia of salivary gland?
Failure to develop salivary glands-rare
What is salivary gland ductal atresia?
Absence of normal opening of duct or failure of a structure to be tubular
Where are 3 places heterotopic salivary tissue can be found?
- Peri-parotid lymph nodes or other parts of head and neck
- Accessory parotid tissue common in masseter and cheek
- Stafne’s idiopathic bone cavity
What is acute bacterial sialadenitis mostly due to- ie. infectious origin?
Streptococcus Pyogenes
Staphlococcus Aureus
Which gland does acute bacterial sialadenitis affect most?
Parotid gland
What are the large reasons for acute bacterial sialadenitis?
- Used to be post-op complication in dehydrated/debilitated patients
- Reduced salivary flow- eg, sjogren, drugs, immunocompromised
- Could be acute exacerbation with chronic bacterial sialadenitis
What are the clinical symptoms of acute bacterial sialadenititis?
Rapid onset
Pain
Swelling
Fever
Redness
Pus from affected ducts
What is chronic bacterial sialadenitis usually due to?
Usually non-specific
Associated with duct obstruction
What gland does chronic bacterial sialadenitis affect most?
Submandibular over parotid
What are the symptoms of chronic bacterial sialadenitis?
Unilateral
Purulent discharge
Replacement of parenchyma by fibrous tissue- salivary gland becomes firm, harder, like a neoplasm- chronic sclerosing sialadenitis
What is the histology of chronic bacterial sialadenitis?
- Chronic- lymphocytic/plasma cell infiltration
- Atrophy of acinar cells
- Periductal fibrosis
- Fibrous replacement
- Ductal hyperplasia
When the parotid is massaged, what do you see in chronic sialadenitis?
Purulent exudate from Stenson’s duct
What is viral sialadenitis/mumps caused by?
Acute contagious infection by paramyxovirus
What does mumps affect, and how is it spread?
Commonest cause of parotid enlargement- 70%
Childhood
Direct contact/droplet spread
What should you always consider mumps in?
Acute salivary gland swelling
What are the symptoms of mumps?
2-3 weeks prodromal symptoms- fever, malaise then painful swelling of salivary glands, trismus, oedema, erythema of duct orifice.
Subsides in 7 days
What other organs can be involved in mumps?
Testes
Ovaries
CNS
Pancreas
What is cytomegalic inclusion disease caused by?
Cytomegalovirus
HHV5
What are the symptoms of cytomegalic inclusion disease?
Primary infection-asymptomatic
Can cause severe disease in neonates, immunocompromised and HIV positive
Where can cytomegalic inclusion disease spread to?
Kidneys
Liver
Brain
Lungs
Lethal multi-organ involvement
What is the histology of cytomegalic inclusion disease?
Owl eye inclusion bodes in nucleus or cytoplasm of duct cells
What is cytomegalic inclusion disease associated with?
Xerostomia in HIV
What is post-irradiation sialadenitis?
Occurs after radiotherapy
Fibrous replacement of acini
Direct correlation between dose and damage
Persistent xerostomia
What cells does post-irradiation sialadenitis affect most?
Serous acini more than mucous acini
What is sarcoidosis?
Chronic condition of unknown aetiology
What are the symptoms of sarcoidosis?
Bilateral hilar lymphadenopathy
Skin and eye lesions
Pulmonary infiltration
Malaise
Cough
Shortness of breath
Athralgia
What is the histology of sarcoidosis?
Non-caseating granulomas
No acid fast organisms
Multinucleated giant cells
Increased ESR
What is Heerefordt syndrome?
Sarcoidosis
Fever
Parotitis
Facial paralysis
Uveitis
Where does salivary calculi/sialoliths affect most?
Submandibular
Then parotid, sublingual, minor
What is the symptoms for salivary calculi?
Usually unilateral
Sudden enlargement at meals
What do salivary calculi look like?
Yellow/brown
Round/ovoid
Homogenous or lamellated structure
How are salivary calculi formed?
Calcium phosphate deposition on an organic nidus (mucin, microorganisms, desquamated cells)
What does the duct epithelium in salivary canculi contain?
Squamous or mucous cell metaplasia
What does the duct epithelium in salivary canculi contain?
Squamous or mucous cell metaplasia
What do the radiograph of salivary calculi show?
Axial CT scan
Radiopacity
How large are mucous extravasation cysts?
1mm-3cm
Dome shaped mucosal recurrent swelling
What do mucous extravasation cysts mostly look like and where are they mostly found?
Lower lip
Superficial- blue-ish
Deep- normal colour
What is the histology of mucous extravasation cyst?
No epithelium lining
MN giant cells
Foamy macrophages
Granulation tissues
Area of spilled mucin
What is the treatment for mucous extravasation cyst?
Some rupture and self heal
If chronic may require surgical removal with associated glands
Biopsy to rule out salivary gland tumour
What is mucus retention cyst?
Epithelium lined cavity from salivary gland tissue
Due to obstruction or increased intraluminal pressure
Almost never on lip
What is the treatment for mucous retention cyst?
Excision
Remove calculus
May remove gland
What is the histology of salivary retention cyst?
Lined by epithelium
Contains double layer of low cuboidal to columnar cells
Lack of inflammatory response
What is the cause for necrotising sialometaplasia?
Unknown, may be trauma, local anaesthetic, previous surgery, ischaemia
Where does necrotising sialometaplasia occur?
Mostly in hard palate
What does necrotising sialometaplasia commonly look like?
Deep, crater-like ulcer, takes 10-12 weeks to heal
Sometimes preceded by an indurated swelling
What is the histology of necrotising sialometaplasia?
Necrosis of dead acini with just pale outlines of cells
Pseudoepitheliomatous hyperplasia- mimics invading tumour
What is Sjogren disease?
Chronic autoimmune disease
50% have another AI disorder
What is primary sjogren syndrome?
Sicca
Xerostomia
Xeropthalmia
What is secondary Sjogren syndrome?
Xerostomia
Xeropthalmia
Another autoimmune disease- commonly rheumatoid arthiritis
What are the symptoms of Sjogren?
Xerostomia
Candida
Caries
Taste dysfunction
Swallowing problems
Denture retention
Speaking
Bacterial sialadenitits
Red atrophic tongue
fissuring
Salivary gland enlargement
What is the pathology reason for Sjogren causing its symptoms?
Lymphocytic infiltration
Acinar destruction in lacrimal and salivary gland and other exocrine glands
What may Sjogren progress to?
B cell malignant lymphoma
How do you diagnose Sjogren syndrome?
Need 4 out of 6 of European diagnostic criteria
Oral symptoms
Ocular symptoms
Ocular signs
Salivary gland involvement
Minor salivary gland histopathology
Autoantibodies
What is the histology of Sjogrens syndrome?
Focal collections of B and T lymphocytes- not crossing connective septa but may do in lymhomatous change
Loss of acini
Ductal hyperplasia
Periductal fibrosis
What is Myoepithelial sialadenitis?
Formation of epimyoepithelial islands
Chronic lymphocytic infiltration of glandular parenchyma
Glandular atrophy
What is myoepithelial sialadenitis seen in?
Sjogren
Hep C
HIV associated salivary gland disease
What is sialadenosis?
Non-inflammatory
Non-neoplastic
Recurrent bilateral swelling of salivary glands
Not associated with meal times
Maybe due to abnormal neurosecretory control
What is the histology of sialadenosis?
Hypertrophy of serous acinar cells
No inflammation
What is HIV associated salivary gland disease?
Get xerostomia
Gland affected is always almost parotid
What is the histology of HIV salivary gland disease?
Diffuse lymphocytic infiltration
Changes similar to myoepithelial sialadenitis but without antibody profile of Sjogren
Cytomegalovirus infections- inclusion bodies
