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Oral Pathology Exam 2 > 3. Salivary Gland Tumors > Flashcards

3. Salivary Gland Tumors Flashcards

1
Q

Malignant Rules of Salivary Gland Tumors

A
  • Slow growing
  • Moveable
  • Painless
  • Demarcated
  • Seemingly encapsulated
  • Extermely well differentiated
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2
Q

Benign Rules of Salivary Gland Tumors

A
  • Infiltrative
  • Pleomorphism
  • Hyperchromatism
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3
Q

If it is a Parotid Gland tumor where will it be seen?

A

In front of ear

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4
Q

If it is a tumor of the palate where will it be seen?

A
  • Off the midline
  • at the junction of hard and soft palate
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5
Q

What is the tx for a Parotid Tumor?

A

Removal of ENTIRE Superficial Lobe along with Tumor

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6
Q

What is the Tx of a Submandibular Tumor?

A

Removal of gland with tumor

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7
Q

Are reserve cells from which all tumors and new salivary tissues are derived

A

Myoepithlial

Intercalated Duct Cells

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8
Q

What may Myoepithelial Cells appear as or produce?

A
  • Clear Cells
  • Angular Cells
  • Basaloid Cells
  • Spindle Cells
  • Plasmacytoid Cells
  • Myxoid
  • Chondroid
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9
Q

What are the Benign Salivary Gland Tumors? (4)

A
  1. Benign Mixed Tumor (Pleomorphic Adenoma)
  2. Warthin Tumor (Papillary Cystadenoma Lymphomatosum)
  3. Canalicular Adenoma
  4. Oncocytoma (Oxyphil Adenoma)
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10
Q

Where is Benign Mixed Tumor most common? (3)

A
  • Parotid
  • Palate
  • Upper Lip
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11
Q

What is the classic histology of Benign Mixed Tumor (Pleomorphic Adenoma)?

A
  • Myoepithelial cells that start to produce goopy, mucinous substance and peel away from duct
  • Myoepithelial variation within the same tumor
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12
Q

What is a common misdiagnosis of Pleomorphic Adenoma?

A

Invasive SCC

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13
Q

Where are Warthin Tumors located?

A

Only in Parotid Area

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14
Q

What is the incidence of Warthin Tumor’s?

A
  • 80% male
  • increased incidence in cigarette smokers
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15
Q

What is the clinical and gross presentation of Warthin Tumor?

A
  • Soft brown encapsulated tumor
    • BMT is firm
  • Small freely moveable mass
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16
Q

What Salivary Gland Tumor never recurs and never becomes malignant?

A

Warthin Tumor (Papillary Cystadenoma Lymphomatosum)

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17
Q

What is the ONLY salivary gland tumor that can be bilateral?

A

Warthin Tumor

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18
Q

Where do Papillary Cystadenoma Lymphomatosum (Warthin’s Tumor) arise from?

A

Ectopic gland ducts embedded in periparotid lymph nodes

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19
Q

What has the pathognomonic Histology: papillary cyst lined by double row of eosinophilic duct cells covering lymphoid stroma?

A

Warthin Tumor

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20
Q

Where are Canalicular Adenoma’s located?

A
  • Upper Lip (75%)
  • Minor intraoral glands
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21
Q

Slow growth, encapsulated, freely moveable, with a bluish cast from vascularity

A

Canalicular Adenoma

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22
Q

What is the histological pattern of Canalicular Adenoma?

A

Swiss cheese or cribiform

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23
Q

What is the histological differential diagnosis of Canalicular Adenoma?

A

Adenoid Cystic Carcinoma

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24
Q
  • Almost exclusively in parotid
  • Elderly (8th decade)
  • Usually remain small
  • Histo made up of large pink cells (oncocytes) with central nuclei
A

Oncocytoma (oxyphil adenoma)

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25
Q

What are the 3 Malignant Salivary Gland Tumors?

A
  1. Mucoepidermoid Carcinoma
  2. Adenoid Cystic Carcinoma (Clindroma)
  3. Acinic Cell Carcinoma
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26
Q

What 3 cell types must Mucoepidermoid Carcinoma have?

A
  • Mucous Cells
  • Squamous Cells
  • Intermediate Cells
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27
Q

Mucoepidermoid Carcinoma represents almost all Salivary Neoplasms of what location?

A

Retromolar Pad

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28
Q

What are the most common sites for Mucoepidermoid Carcinoma?

A
  • Parotid
  • Palate
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29
Q

Mucoepidermoid Carcinoma occurs as a primary tumor in jaws arising from…

A

dentigerous cysts

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30
Q

Most common salivary malignancy of Children?

A

Mucoepidermoid Carcinoma

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31
Q

What histology differentiates Mucoepidermoid Carcinoma from SCCA?

A

single mucous cell with mucicarmine stain

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32
Q

Are most Mucoepidermoid Carcinomas High or Low Grade?

A

Low Grade

33
Q

Which Salivary Gland Tumor is known as the Wolf in Sheeps Clothing (clinically and histologically benign, and spares lymph nodes)?

A

Adenoid Cystic Carcinoma (Clindroma)

34
Q

Where do Adenoid Cystic Carcinomas have recurrences via blood-borne mets to?

A
  • Bone
  • Lung
  • Liver
35
Q

What location are Adenoid Cystic Carcinomas most common?

A
  • Palate
  • Submandibular Gland
36
Q
  • Tends to cause early pain/facial paralysis due to perineural and intraneural invasion
  • Tends to spontaneously ulcerate and invade adjacent bone
A

Adenoid Cystic Carcinoma

37
Q

What is the hallmark of Adenoid Cystic Carcinoma?

A
  • Neurotropism responsible for pain and local recurrences as invisable nests of tumor cells extend along nerves
38
Q

What is the location of Acinic Cell Carcinoma?

A

85% in Parotid

39
Q

What malignant Salivary Gland Tumor is mistaken often for a Benign Neoplasia?

A

Acinic Cell Carcinoma

40
Q
  • Called the Blue Dot Tumor Histologically
    • Sheets of acinar cells without ducts
    • Well differentiated acini with zymogen granules
A

Acinic Cell Carcinoma

41
Q

What are the 3 types of Malignant Mixed Tumors?

A
  1. Carcinoma ex Mixed Tumor
  2. Metastasizing Mixed Tumor
  3. Carcinosarcoma
42
Q
  • Malignant degeneration of a previously BMT
  • Shows Adenocarcinoma adjacent to a BMT
  • Most common type of Malignant Mixed Tumor
  • Occurs in a longstanding, large tumor, or one that has been surgically manipulated or radiated
  • 75% fatal
A

Carcinoma ex Mixed Tumor

43
Q
  • Histologically BMT that mets to Bone, Lung, or Nodes
  • 75% fatal
A

Metastasizing Mixed Tumor

44
Q
  • De novo biphasic malignancy showing Carcinomatous and Sarcomatous elements
  • Extremely rare
A

Carcinosarcoma

45
Q
  • Slow growing, benign appearing mass almost exclusively in minor glands
  • 65% on palate
    • Comon palatal malignancy
A

Polymorphous Low Grade Adenocarcinoma (PLGA)

46
Q

What are the 3 Malignant Palatal Salivary Gland Tumors?

A

Mucoepidermoid, Adenoid Cystic, PLGA

47
Q

What is the origin of PLGA?

A

Intercalated ducts

48
Q
  • Isomorphic, pale ductal cell nests
  • Polymorphous cell organization
  • Neurotropism (perineural invasion)
    • in spite it acts as a low grade cancer
  • Tumor periphery shows characteristic infiltration of tumor cells in a single file through CT called Indian Filing
  • Combo of benign appearing cells, polymorphous growth patterns, and perineural invasion
A

PLGA

49
Q

What is the Differential Diagnosis of PLGA?

A
  • Benigned Mixed Tumor
  • Malignant Mixed Tumor
    Adenoid Cystic Carcinoma
  • Canalicular Adenoma
  • Unspecified Adenocarcinoma
50
Q

What is the most common salivary gland tumor of infants?

A

Hemangioendothelioma - Parotid

51
Q

What is the Non-Neoplastic Salivary Gland Tumor - Mumps etiology?

A

Paramyxovirus

52
Q

What is the clinical presentation of Mumps in Children?

A
  • Acute swelling of salivary glands
  • With pain and xerostomia
53
Q

What is the clinical presentation of Mumps in Adults?

A
  • Swelling of pancreas (pancreatitis/diabetes) and testes (infertility)
54
Q

Acute Suppurative Parotitis most often occurs after abdominal surgery where dehydration and debilitation cause acute xerostomia which allows an …

A

Ascending S. aureus infection up Stenson’s Duct

55
Q

What causes a life-threatening situation in Acute Suppurative Parotitis?

A
  • Rapid expansion of parapharyngeal space
  • Get the pus out of the duct
  • Tx with antibiotics
56
Q
  • Autoimmune involvement of salivary and lacrimal glands causing Xerostomia and Xerophthalmia respectively
A

Sjogren Syndrome

57
Q

What major autoimmune ds is Secondary Sjogren Syndrome associated with?

A
  • Rheumatoid Ds
  • SLE
58
Q

What is the diagnostic Histo finding of Sjogren Sx?

A

Benign Lymphoepithelial Lesions

59
Q

What are the lab values associated with Sjogren Sx?

A
  • increase Rheumatoid Factor
  • ANA
  • Anti-SS-A (Ro) or Anti-SS-B (La) Antibody
60
Q

What complication is associated with Sjogren Syndrome?

A

6% develop Lymphoma

61
Q
  • A systemic condition in which the salivary and lacrimal gland components mimics Sjogren Sx clinically BUT dry mouth rare
A

IgG4-Related Disease

62
Q

What does IgG4-Related Disease cause?

A

Sclerosing Chronic Inflammation of pancreas, thyroid, liver, retroperitoneum (aorta, uterus)

63
Q

What is the pathogenesis of IgG4-Related Disease thought to be related to?

A

Allergy

64
Q

What are the lab findings of IgG4-Related Disease?

A
  • Elevated serum IgG4 and IgG4-producing plasma cells
  • Tx with steroid and immunosuppressives
65
Q

Bilateral non-inflammatory enlargement of salivary glands

A

Sialadenosis

66
Q

What are the (non ds) causes of Sialadenosis? (4)

A
  • Iodine
  • Nutrition
  • Diabetes
  • Alcoholism and Drugs
67
Q

What are the Specific Disease causes of Bilateral Salivary Gland Swelling? (4)

A
  • TB
  • Lymphoma/Leukemia
  • Cystic Fibrosis (younger)
  • Sarcoidosis (uveoparotid fever)
68
Q

What is most vulnerable to Sialolithiasis?

A

Submandibular GLand

69
Q

What is the clinical presentation of Sialolithiasis?

A
  • Pain and Swelling at mealtime when saliva is excreted and duct is blocked
    • Causes chronic inflammation of gland and eventual fibrosis
  • Occasionally seen at orfice
  • Occasionally palpable in FOM
70
Q

What are the 4 etiologies of Xerostomia?

A
  1. Duct Obstruction
  2. Nerve Dysfunction
  3. Parenchymal Loss
  4. Dehydration
71
Q

What can lead to Duct Obstruction causing Xerostomia?

A
  • Vitamin A Def
  • Mumps
72
Q

What can lead to Nerve Dysfunction causing Xerostomia?

A
  • Psychogenic
  • Drugs
  • Neurologic Diseases
73
Q

What can lead to Parenchymal Loss causing Xerostomia? (6)

A
  • Senile Atrophy
  • Sjogren Sx
  • Sarcoidosis
  • GvHD
  • Ectodermal Dysplasia
  • Radiation
74
Q

What mediates dry mouth?

A

palatal glands

75
Q

What stimulates saliva and improves taste?

A

ZnSO4

76
Q

What is the etiology of Sialorrhea? (5)

A
  • Stomatitis (ANUG, Primary Herpes, Teething, RAU)
  • Drugs
  • Specific Ds (Rabies)
  • Heavy Metal Poisoning
  • Esophageal and Gastric Ds (GERD, ulcers)
77
Q
  • A benign process representing a salivary infarct that mimics cancer and has been misdiagnosed as
A

Necrotizing Sialometaplasia

78
Q

What is the clinical presentation of Necrotizing Sialometaplasia?

A
  • Starts as slight palatal swelling -> spontaneously ulcerates and sloughs -> heals in 6 wks
  • Chunk of your palate falls out
79
Q

Necrotizing Sialometaplasia’s histology shows

A
  • coagulative necrosis of mucus acini
  • PEH

Oral Pathology Exam 2 (7 decks)

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