3. Salivary Gland Tumors Flashcards
1
Q
Malignant Rules of Salivary Gland Tumors
A
- Slow growing
- Moveable
- Painless
- Demarcated
- Seemingly encapsulated
- Extermely well differentiated
2
Q
Benign Rules of Salivary Gland Tumors
A
- Infiltrative
- Pleomorphism
- Hyperchromatism
3
Q
If it is a Parotid Gland tumor where will it be seen?
A
In front of ear
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
5
Q
What is the tx for a Parotid Tumor?
A
Removal of ENTIRE Superficial Lobe along with Tumor
6
Q
What is the Tx of a Submandibular Tumor?
A
Removal of gland with tumor
7
Q
Are reserve cells from which all tumors and new salivary tissues are derived
A
Myoepithlial
Intercalated Duct Cells
8
Q
What may Myoepithelial Cells appear as or produce?
A
- Clear Cells
- Angular Cells
- Basaloid Cells
- Spindle Cells
- Plasmacytoid Cells
- Myxoid
- Chondroid
9
Q
What are the Benign Salivary Gland Tumors? (4)
A
- Benign Mixed Tumor (Pleomorphic Adenoma)
- Warthin Tumor (Papillary Cystadenoma Lymphomatosum)
- Canalicular Adenoma
- Oncocytoma (Oxyphil Adenoma)
10
Q
Where is Benign Mixed Tumor most common? (3)
A
- Parotid
- Palate
- Upper Lip
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
12
Q
What is a common misdiagnosis of Pleomorphic Adenoma?
A
Invasive SCC
13
Q
Where are Warthin Tumors located?
A
Only in Parotid Area
14
Q
What is the incidence of Warthin Tumor’s?
A
- 80% male
- increased incidence in cigarette smokers
15
Q
What is the clinical and gross presentation of Warthin Tumor?
A
-
Soft brown encapsulated tumor
- BMT is firm
- Small freely moveable mass
16
Q
What Salivary Gland Tumor never recurs and never becomes malignant?
A
Warthin Tumor (Papillary Cystadenoma Lymphomatosum)
17
Q
What is the ONLY salivary gland tumor that can be bilateral?
A
Warthin Tumor
18
Q
Where do Papillary Cystadenoma Lymphomatosum (Warthin’s Tumor) arise from?
A
Ectopic gland ducts embedded in periparotid lymph nodes
19
Q
What has the pathognomonic Histology: papillary cyst lined by double row of eosinophilic duct cells covering lymphoid stroma?
A
Warthin Tumor
20
Q
Where are Canalicular Adenoma’s located?
A
- Upper Lip (75%)
- Minor intraoral glands
21
Q
Slow growth, encapsulated, freely moveable, with a bluish cast from vascularity
A
Canalicular Adenoma
22
Q
What is the histological pattern of Canalicular Adenoma?
A
Swiss cheese or cribiform
23
Q
What is the histological differential diagnosis of Canalicular Adenoma?
A
Adenoid Cystic Carcinoma
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)
25
What are the 3 Malignant Salivary Gland Tumors?
1. Mucoepidermoid Carcinoma
2. Adenoid Cystic Carcinoma (Clindroma)
3. Acinic Cell Carcinoma
26
What 3 cell types must Mucoepidermoid Carcinoma have?
* Mucous Cells
* Squamous Cells
* Intermediate Cells
27
Mucoepidermoid Carcinoma represents almost all Salivary Neoplasms of what location?
Retromolar Pad
28
What are the most common sites for Mucoepidermoid Carcinoma?
* Parotid
* Palate
29
Mucoepidermoid Carcinoma occurs as a primary tumor in jaws arising from...
dentigerous cysts
30
Most common salivary malignancy of Children?
Mucoepidermoid Carcinoma
31
What histology differentiates Mucoepidermoid Carcinoma from SCCA?
single mucous cell with mucicarmine stain
32
Are most Mucoepidermoid Carcinomas High or Low Grade?
Low Grade
33
Which Salivary Gland Tumor is known as the Wolf in Sheeps Clothing (clinically and histologically benign, and spares lymph nodes)?
Adenoid Cystic Carcinoma (Clindroma)
34
Where do Adenoid Cystic Carcinomas have recurrences via blood-borne mets to?
* Bone
* Lung
* Liver
35
What location are Adenoid Cystic Carcinomas most common?
* Palate
* Submandibular Gland
36
* Tends to cause early pain/facial paralysis due to **perineural and intraneural invasion**
* Tends to spontaneously ulcerate and invade adjacent bone
Adenoid Cystic Carcinoma
37
What is the hallmark of Adenoid Cystic Carcinoma?
* **Neurotropism** responsible for *pain and local recurrences* as invisable nests of _tumor cells extend along nerves_
38
What is the location of Acinic Cell Carcinoma?
85% in Parotid
39
What malignant Salivary Gland Tumor is mistaken often for a Benign Neoplasia?
Acinic Cell Carcinoma
40
* Called the **Blue Dot Tumor** Histologically
* Sheets of acinar cells without ducts
* Well differentiated acini with **zymogen granules**
Acinic Cell Carcinoma
41
What are the 3 types of Malignant Mixed Tumors?
1. Carcinoma ex Mixed Tumor
2. Metastasizing Mixed Tumor
3. Carcinosarcoma
42
* 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
Carcinoma ex Mixed Tumor
43
* Histologically BMT that mets to Bone, Lung, or Nodes
* 75% fatal
Metastasizing Mixed Tumor
44
* De novo biphasic malignancy showing Carcinomatous and Sarcomatous elements
* Extremely rare
Carcinosarcoma
45
* Slow growing, benign appearing mass almost exclusively in minor glands
* 65% on **palate**
* Comon palatal malignancy
Polymorphous Low Grade Adenocarcinoma (PLGA)
46
What are the 3 Malignant Palatal Salivary Gland Tumors?
Mucoepidermoid, Adenoid Cystic, PLGA
47
What is the origin of PLGA?
Intercalated ducts
48
* **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
PLGA
49
What is the Differential Diagnosis of PLGA?
* Benigned Mixed Tumor
* Malignant Mixed Tumor
Adenoid Cystic Carcinoma
* Canalicular Adenoma
* Unspecified Adenocarcinoma
50
What is the most common salivary gland tumor of infants?
Hemangioendothelioma - Parotid
51
What is the Non-Neoplastic Salivary Gland Tumor - **Mumps** etiology?
Paramyxovirus
52
What is the clinical presentation of Mumps in Children?
* Acute **swelling of salivary glands**
* With **pain** and **xerostomia**
53
What is the clinical presentation of Mumps in Adults?
* Swelling of **pancreas** (pancreatitis/diabetes) and **testes** (infertility)
54
**Acute Suppurative Parotitis** most often occurs after abdominal surgery where dehydration and debilitation cause acute xerostomia which allows an ...
Ascending ***S. aureus*** infection up **Stenson's Duct**
55
What causes a life-threatening situation in **Acute Suppurative Parotitis**?
* Rapid expansion of **parapharyngeal space**
* Get the pus out of the duct
* Tx with antibiotics
56
* Autoimmune involvement of **salivary and lacrimal glands** causing **Xerostomia and Xerophthalmia** respectively
Sjogren Syndrome
57
What major autoimmune ds is Secondary Sjogren Syndrome associated with?
* Rheumatoid Ds
* SLE
58
What is the diagnostic Histo finding of Sjogren Sx?
Benign Lymphoepithelial Lesions
59
What are the lab values associated with Sjogren Sx?
* increase Rheumatoid Factor
* ANA
* Anti-SS-A (Ro) or Anti-SS-B (La) Antibody
60
What complication is associated with Sjogren Syndrome?
6% develop Lymphoma
61
* A systemic condition in which the salivary and lacrimal gland components **mimics Sjogren Sx clinically** BUT **dry mouth rare**
IgG4-Related Disease
62
What does IgG4-Related Disease cause?
Sclerosing Chronic Inflammation of pancreas, thyroid, liver, retroperitoneum (aorta, uterus)
63
What is the pathogenesis of IgG4-Related Disease thought to be related to?
Allergy
64
What are the lab findings of IgG4-Related Disease?
* Elevated serum IgG4 and IgG4-producing plasma cells
* Tx with steroid and immunosuppressives
65
Bilateral non-inflammatory enlargement of salivary glands
Sialadenosis
66
What are the (non ds) causes of Sialadenosis? (4)
* Iodine
* Nutrition
* Diabetes
* Alcoholism and Drugs
67
What are the Specific Disease causes of Bilateral Salivary Gland Swelling? (4)
* **T**B
* **L**ymphoma/Leukemia
* **C**ystic Fibrosis (younger)
* Sarcoidosis (uveoparotid fever)
68
What is most vulnerable to Sialolithiasis?
Submandibular GLand
69
What is the clinical presentation of Sialolithiasis?
* 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
What are the 4 etiologies of Xerostomia?
1. Duct Obstruction
2. Nerve Dysfunction
3. Parenchymal Loss
4. Dehydration
71
What can lead to Duct Obstruction causing Xerostomia?
* Vitamin A Def
* Mumps
72
What can lead to Nerve Dysfunction causing Xerostomia?
* Psychogenic
* Drugs
* Neurologic Diseases
73
What can lead to Parenchymal Loss causing Xerostomia? (6)
* Senile Atrophy
* Sjogren Sx
* Sarcoidosis
* GvHD
* Ectodermal Dysplasia
* Radiation
74
What mediates dry mouth?
palatal glands
75
What stimulates saliva and improves taste?
ZnSO4
76
What is the etiology of Sialorrhea? (5)
* Stomatitis (ANUG, Primary Herpes, Teething, RAU)
* Drugs
* Specific Ds (Rabies)
* Heavy Metal Poisoning
* Esophageal and Gastric Ds (GERD, ulcers)
77
* A benign process representing a **salivary infarct that mimics cancer** and has been misdiagnosed as
Necrotizing Sialometaplasia
78
What is the clinical presentation of Necrotizing Sialometaplasia?
* Starts as slight palatal swelling -\> spontaneously ulcerates and sloughs -\> heals in 6 wks
* Chunk of your palate falls out
79
Necrotizing Sialometaplasia's histology shows
* coagulative necrosis of _mucus acini_
* **PEH**
