Ch11 Salivary Flashcards
What 3 syndromes can present with salivary gland APLASIA?
- mandibulofacial dysostosis (Treacher-Collins) 2.hemifacial microsomia 3. lacrimo-auriculo-dento-digital (LADD) syndrome
M:F ratio for salivary aplasia?
2M:1F
LADD (Lacrimo-auriculo-dento-digital) syndrome is what inheritance pattern? What gene mutation?
AD…FGF10
Superficial mucoceles are assoiciated with what type of disorders? What are three examples?
LICHENOID disorders…lichen planus, lichenoid drug eruptions, and GVHD
_______ is a term used for mucoceles that occur in the floor of the mouth, arising from the sublingual gland.
Ranula
Which gland forms a ranula again?
sublingual
What helps clinically distinguish a ranula from a dermoid cyst?
Ranulas are usually lateral to the midline (ducts of rivinus/bartholin) vs MIDLINE dermoid cysts are midline
Which muscle is dissected in a plunging ranula?
MYLOHYOID
What is the classic sign of a plunging ranula on CT or MRI?
“tail sign” (extension into the sublingual space)
What are the three top sites for salivary duct cysts in the mouth?
FOM, Buccal mucosa, lips
Salivary duct cysts on the FOM have what color?
amber
What is it called when a salivary duct cyst shows oncocytic metaplasia in the lining? What else can it resemble? If the features develop further, what can these be diagnosed as?
ductal ectasia secondary to salivary obstruction. it can resemble a warthin tumor (w/o the lymphoid stroma)..papillary cystadenoma
80% of cases of sialoliths form in which gland?
submandibular
If a sialolith forms in a minor salivary gland/duct, what two oral locations are most common?
upper lip, buccal mucosa
What age range is most common for salivary stones?
young and middle-aged adults
Multiple parotid stones radiographically can mimic calcified parotid lymph nodes, such as might occur in ________
TB
What is the characteristic micro appearance for sialoliths?
concentric laminations surrounding a nidus of amorphic debris
What is the most common virus to cause sialadenitis?
mumps
One of the more common causes of sialadenitis is recent surgery, especially WHAT TYPE?
abdominal surgery
After abdominal surgery, an acute parotitis (AKA ______) may arise because the patient has been kept without food or fluids (NPO) and has received ________ (WHAT DRUG?) during the surgical procedure.
surgical mumps…ATROPINE
What bacteria is responsible for most acute bacterial sialadenitis cases (both community and hospital acquired)?
Staph aureus
What are 4 causes of non-infectous sialadenitis?
Sjogrens, sarcoidosis, radiation therapy, allergens
What % of acute bacterial sialadenitis cases are bilateral?
10-25%
In chronic parotitis, Stensen duct may show a characteristic sialographic pattern known as “_______,” which reflects a combination of dilatation plus ductal strictures from scar formation.
sausaging
What are the two most common inflammatory salivary disorder in kids?
mumps and juvenile recurrent parotitis
juvenile recurrent parotitis: age range, treatment
3-6 years old, can irrigate during flare ups, but condition resolves around puberty
Subacute necrotizing sialadenitis: age range, location, tx
teenagers, young adults…minor salivary glands of the hard or soft palate…self-limiting
Clinical decision making: pts with sialadenitis should first have ______ to look for a possible _______….then more scans can be warrented. If a there is purulence at the duct orifice, then ________ should be done
a pano….sialolith…..bacterial culture
Name the condition: sausaging on sialography
chronic parotitis
Name the condition: 3-6 years old, can irrigate during flare ups, but condition resolves around puberty
juvenile recurrent parotitis
Name the condition: teenagers, young adults…minor salivary glands of the hard or soft palate…self-limiting
Subacute necrotizing sialadenitis
Name the condition: After abdominal surgery, an acute parotitis may arise because the patient has been kept without food or fluids
surgical mumps
Name the condition: inflammation of the minor salivary glands, lower lip vermillion swelling and eversion, caused by actinic damage, tobacco, etc
cheilitis glandularis
cheilitis glandularis: age, gender
middle aged or older men (some cases of women and children)
What can develop in albino patients 2/2 sun sensitivity?
cheilitis glandularis
What are the three types of cheilitis glandularis?
- simple 2.superficial supperative (Baelz disease) 3.Deep supperative (chelitis glandularis apostematosa)
What distiguishes Baelz disease and chelitis glandularis apostematosa from simple cheilitis glandularis?
they both involve bacterial infection whereas simple does not
What do rabies, heavy-metal poisoning, clozapine, Alzheimers / myasthenia gravis meds have in common?
assoc with sialorrhea
What is the term for excessive salivation lasting 2 to 5 min with prodrome of nausea or epigastric pain?
IPS - idiopathic paroxysmal sialorrhea
Lots of tx for sialorrhea, including surgery, but what class of meds can sometimes be used?
anticholinergic meds
What % of the 200 most rx’d meds in the US have a side effect of xerostomia?
63%
What are the 3 active ingredients in biotene and oralbalence products?
lactoperoxidase, lysozyme, lactoferrin
Systemic _______ is a parasympathomimetic agonist that can be used as a sialagogue. At doses of ___-___ mg, ____x daily
pilocarpine…5 to 10 mg…3-4x daily
Pilocarpine: three side effects
excessive sweating, increased HR, increased BP
_________ hydrochloride, a cholinergic agonist with affinity for muscarinic M3 receptors
Cevimeline
BOTH pilocarpine and cevimeline are CONTRAINDICATED in patients with __________.
narrow-angle glaucoma
What is the old term for IgG4 disease?
MI-KUL-ICZ disease
What organ was first associated with IgG4 disease? You see IgG4 protein in the serum up to ___x the normal level as well as what type of immune cell?
Pancreas..25x (60-80% of the time)..plasma cells
IgG4 mean age, gender
60 y/o..men slightly more than women (Japan women more than men)
What is the most commonly involved salivary gland in IgG4 disease?
submandibular
Pancreatitis, cholangitis, abdominal aortitis/aneurysm, inflammatory pesudotumors of the kidney, thyroid inflammation (Ridel thyroiditis) and lymphadenopathy are possible effects of what?
IgG4
What are the 2 main histo findings for IgG4? What is the overall pattern sometimes referred to as?
Chronic sclerosing sialadenitis, obliteraitve phelbitis…Kuttner tumor
What is the other term for sicca syndrome?
kerato-conjunctivitis sicca
What is the difference between primary and secondary sjogrens? (may be obsolete)
primary = sicca only, secondary = sicca + autoimmune disorder
What histocompatability antigen (HLA) is associated with both primary and secondary sjogrens?
HLA-DRw52
What 2 histocompatability antigens (HLAs) are associated with primary sjogrens?
HLA-B8 and HLA-DR3
What is the F:M ratio for sjogrens?
9:1 F:M
What % of patients with RA have SS?
15%
Secondary Sjogren may develop in 30% of patients with ________
SLE
Whats the buzz phrase for the sialographic presentation of sjogrens?
“fruit-laden, branchless tree”
What are the 3 diagnostic qualifiers of sjogrens for the amer col of rheum?
- positive autoantibodies to Ro(SS-A) and/or La(SS-B) OR positive RF AND ANA >1:320 2.Labial salivary gland bx with focus score of >or equal to 1 3. Keratoconjunctivitis sicca with ocular staining score >3
What serum markers are elevated in sjogrens?
- increased ESR 2.increased Ig 3. increased IgG 4. RF 5. ANA 6. anti-SS-A (anti-Ro) 7. anti-SS-B (anti-La)
Terms (2) for a more advanced lesion in Sjogren’s (2 names)
benign lymphoepithelial lesion (myoepithelial sialadenitis)
Sjogrens histo: In a benign lymphoepithelial lesion (myoepithelial sialadenitis), what structure is destroyed, what tissue persists?
acini are destroyed, ductal epithelium persists
Sjogren Histo: In a benign lymphoepithelial lesion (myoepithelial sialadenitis) of Sjogrens, the remaining ductal and myoepithelial cells become hyperplastic forming ________
epimyoepithelial islands (throughout a lymphoid proliferation) (these are rare in the minor salivary glands)
Sjogren Histo: Ideal # of minor glands during bx? What is the # of lymphocytes or plasma cells in an aggregate to qualify for an SS Dx?
5…..>50 (adjacent to normal acini and conistently in most glands of the specimen
What is the formula for focus score in Sjogrens?
Focus score = (# of inflammatory aggregates x 4) / (# of mm^2 of salivary gland parynchema)
Interesting - what habit can lower the amount of inflammation in a Sjogrens biopsy?
smoking
What are the three ‘L’s of supportive medications for Sjogrens?
Lactoperoxidase, Lysozyme, Lactoferrin
Patients with Sjögren syndrome have a lifetime risk for LYMPHOMA of __ to __%, which is estimated to be about ___ times greater than the general population.
5-15%….20x greater
If a patient with Sjogrens develops lymphoma, what are the two locations it will likely arise first?
salivary glands or lymph nodes
What is the most common category of Lymphoma to arise in Sjogren? What 2 types specifically?
low-grade non-Hodgkin B-cell lymphomas….MALT or extranodal marginal zone
