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Oral candidiasis > 19. Non-neoplastic salivary gland disorders > Flashcards

19. Non-neoplastic salivary gland disorders Flashcards

1
Q

Describe salivary glands?

A

Structurally a series of branched ducts terminating in spherical or tubular secretory pieces or acini.

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2
Q

What is the predominant duct in salivary glands?

A

Striated duct where the saliva is modified

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3
Q

What are ducts between acini called and what do they empty into?

A

Intercalated ducts- striated ducts- excretory ducts

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4
Q

What cells are associated with acini and intercalated ducts?

A

Myoepithelial cells

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5
Q

What does H and E stained section of salivary gland look like?

A

Pale mucous staining
Nuclei condensed at base of cell
Serous cells- blue
Mucous cells- bubbly

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6
Q

Where are myoepithelial cells found?

A

They are found between the plasma membrane of the secretory cell and basement membrane

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7
Q

What do myoepithelial cells contain, and how do they stain?

A

They contain contractile proteins which allows squeezing of the acini.
Microfilament characteristic of muscle cells but not epithelium

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8
Q

What can be used to stain myoepithelial cells?

A

SMA actin- they stain the myoepithelial cells brown and it is found around the acini.

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9
Q

What does parotid gland cells contain?

A

Mostly serous fluid
Serous contains zymogen granules- darkly stained and contain proteins

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10
Q

What does submandibular gland cells contain?

A

Mixture of serous and mucous secretory units.
Either mixed, or pure, eg. with serous demilunes.

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11
Q

What do sublingual gland contain?

A

Mostly mucous cells.
Poor staining with H and E.
Excretory duct lined by cuboidal epithelium.

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12
Q

What is the general architecture of salivary glands?

A

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

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13
Q

What is aplasia of salivary gland?

A

Failure to develop salivary glands-rare

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14
Q

What is salivary gland ductal atresia?

A

Absence of normal opening of duct or failure of a structure to be tubular

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15
Q

Where are 3 places heterotopic salivary tissue can be found?

A
  1. Peri-parotid lymph nodes or other parts of head and neck
  2. Accessory parotid tissue common in masseter and cheek
  3. Stafne’s idiopathic bone cavity
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16
Q

What is acute bacterial sialadenitis mostly due to- ie. infectious origin?

A

Streptococcus Pyogenes
Staphlococcus Aureus

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17
Q

Which gland does acute bacterial sialadenitis affect most?

A

Parotid gland

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18
Q

What are the large reasons for acute bacterial sialadenitis?

A
  1. Used to be post-op complication in dehydrated/debilitated patients
  2. Reduced salivary flow- eg, sjogren, drugs, immunocompromised
  3. Could be acute exacerbation with chronic bacterial sialadenitis
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19
Q

What are the clinical symptoms of acute bacterial sialadenititis?

A

Rapid onset
Pain
Swelling
Fever
Redness
Pus from affected ducts

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20
Q

What is chronic bacterial sialadenitis usually due to?

A

Usually non-specific
Associated with duct obstruction

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21
Q

What gland does chronic bacterial sialadenitis affect most?

A

Submandibular over parotid

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22
Q

What are the symptoms of chronic bacterial sialadenitis?

A

Unilateral
Purulent discharge
Replacement of parenchyma by fibrous tissue- salivary gland becomes firm, harder, like a neoplasm- chronic sclerosing sialadenitis

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23
Q

What is the histology of chronic bacterial sialadenitis?

A
  1. Chronic- lymphocytic/plasma cell infiltration
  2. Atrophy of acinar cells
  3. Periductal fibrosis
  4. Fibrous replacement
  5. Ductal hyperplasia
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24
Q

When the parotid is massaged, what do you see in chronic sialadenitis?

A

Purulent exudate from Stenson’s duct

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25
Q

What is viral sialadenitis/mumps caused by?

A

Acute contagious infection by paramyxovirus

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26
Q

What does mumps affect, and how is it spread?

A

Commonest cause of parotid enlargement- 70%
Childhood
Direct contact/droplet spread

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27
Q

What should you always consider mumps in?

A

Acute salivary gland swelling

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28
Q

What are the symptoms of mumps?

A

2-3 weeks prodromal symptoms- fever, malaise then painful swelling of salivary glands, trismus, oedema, erythema of duct orifice.
Subsides in 7 days

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29
Q

What other organs can be involved in mumps?

A

Testes
Ovaries
CNS
Pancreas

30
Q

What is cytomegalic inclusion disease caused by?

A

Cytomegalovirus
HHV5

31
Q

What are the symptoms of cytomegalic inclusion disease?

A

Primary infection-asymptomatic
Can cause severe disease in neonates, immunocompromised and HIV positive

32
Q

Where can cytomegalic inclusion disease spread to?

A

Kidneys
Liver
Brain
Lungs
Lethal multi-organ involvement

33
Q

What is the histology of cytomegalic inclusion disease?

A

Owl eye inclusion bodes in nucleus or cytoplasm of duct cells

34
Q

What is cytomegalic inclusion disease associated with?

A

Xerostomia in HIV

35
Q

What is post-irradiation sialadenitis?

A

Occurs after radiotherapy
Fibrous replacement of acini
Direct correlation between dose and damage
Persistent xerostomia

36
Q

What cells does post-irradiation sialadenitis affect most?

A

Serous acini more than mucous acini

37
Q

What is sarcoidosis?

A

Chronic condition of unknown aetiology

38
Q

What are the symptoms of sarcoidosis?

A

Bilateral hilar lymphadenopathy
Skin and eye lesions
Pulmonary infiltration
Malaise
Cough
Shortness of breath
Athralgia

39
Q

What is the histology of sarcoidosis?

A

Non-caseating granulomas
No acid fast organisms
Multinucleated giant cells
Increased ESR

40
Q

What is Heerefordt syndrome?

A

Sarcoidosis
Fever
Parotitis
Facial paralysis
Uveitis

41
Q

Where does salivary calculi/sialoliths affect most?

A

Submandibular
Then parotid, sublingual, minor

42
Q

What is the symptoms for salivary calculi?

A

Usually unilateral
Sudden enlargement at meals

43
Q

What do salivary calculi look like?

A

Yellow/brown
Round/ovoid
Homogenous or lamellated structure

44
Q

How are salivary calculi formed?

A

Calcium phosphate deposition on an organic nidus (mucin, microorganisms, desquamated cells)

45
Q

What does the duct epithelium in salivary canculi contain?

A

Squamous or mucous cell metaplasia

46
Q

What does the duct epithelium in salivary canculi contain?

A

Squamous or mucous cell metaplasia

47
Q

What do the radiograph of salivary calculi show?

A

Axial CT scan
Radiopacity

48
Q

How large are mucous extravasation cysts?

A

1mm-3cm
Dome shaped mucosal recurrent swelling

49
Q

What do mucous extravasation cysts mostly look like and where are they mostly found?

A

Lower lip
Superficial- blue-ish
Deep- normal colour

50
Q

What is the histology of mucous extravasation cyst?

A

No epithelium lining
MN giant cells
Foamy macrophages
Granulation tissues
Area of spilled mucin

51
Q

What is the treatment for mucous extravasation cyst?

A

Some rupture and self heal
If chronic may require surgical removal with associated glands
Biopsy to rule out salivary gland tumour

52
Q

What is mucus retention cyst?

A

Epithelium lined cavity from salivary gland tissue
Due to obstruction or increased intraluminal pressure
Almost never on lip

53
Q

What is the treatment for mucous retention cyst?

A

Excision
Remove calculus
May remove gland

54
Q

What is the histology of salivary retention cyst?

A

Lined by epithelium
Contains double layer of low cuboidal to columnar cells
Lack of inflammatory response

55
Q

What is the cause for necrotising sialometaplasia?

A

Unknown, may be trauma, local anaesthetic, previous surgery, ischaemia

56
Q

Where does necrotising sialometaplasia occur?

A

Mostly in hard palate

57
Q

What does necrotising sialometaplasia commonly look like?

A

Deep, crater-like ulcer, takes 10-12 weeks to heal
Sometimes preceded by an indurated swelling

58
Q

What is the histology of necrotising sialometaplasia?

A

Necrosis of dead acini with just pale outlines of cells
Pseudoepitheliomatous hyperplasia- mimics invading tumour

59
Q

What is Sjogren disease?

A

Chronic autoimmune disease
50% have another AI disorder

60
Q

What is primary sjogren syndrome?

A

Sicca
Xerostomia
Xeropthalmia

61
Q

What is secondary Sjogren syndrome?

A

Xerostomia
Xeropthalmia
Another autoimmune disease- commonly rheumatoid arthiritis

62
Q

What are the symptoms of Sjogren?

A

Xerostomia
Candida
Caries
Taste dysfunction
Swallowing problems
Denture retention
Speaking
Bacterial sialadenitits
Red atrophic tongue
fissuring
Salivary gland enlargement

63
Q

What is the pathology reason for Sjogren causing its symptoms?

A

Lymphocytic infiltration
Acinar destruction in lacrimal and salivary gland and other exocrine glands

64
Q

What may Sjogren progress to?

A

B cell malignant lymphoma

65
Q

How do you diagnose Sjogren syndrome?

A

Need 4 out of 6 of European diagnostic criteria
Oral symptoms
Ocular symptoms
Ocular signs
Salivary gland involvement
Minor salivary gland histopathology
Autoantibodies

66
Q

What is the histology of Sjogrens syndrome?

A

Focal collections of B and T lymphocytes- not crossing connective septa but may do in lymhomatous change
Loss of acini
Ductal hyperplasia
Periductal fibrosis

67
Q

What is Myoepithelial sialadenitis?

A

Formation of epimyoepithelial islands
Chronic lymphocytic infiltration of glandular parenchyma
Glandular atrophy

68
Q

What is myoepithelial sialadenitis seen in?

A

Sjogren
Hep C
HIV associated salivary gland disease

69
Q

What is sialadenosis?

A

Non-inflammatory
Non-neoplastic
Recurrent bilateral swelling of salivary glands
Not associated with meal times
Maybe due to abnormal neurosecretory control

70
Q

What is the histology of sialadenosis?

A

Hypertrophy of serous acinar cells
No inflammation

71
Q

What is HIV associated salivary gland disease?

A

Get xerostomia
Gland affected is always almost parotid

72
Q

What is the histology of HIV salivary gland disease?

A

Diffuse lymphocytic infiltration
Changes similar to myoepithelial sialadenitis but without antibody profile of Sjogren
Cytomegalovirus infections- inclusion bodies

Oral candidiasis (18 decks)

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