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Neville and Damm > Ch11 Salivary Part 2 > Flashcards

Ch11 Salivary Part 2 Flashcards

1
Q

__________ is an unusual noninflammatory disorder characterized by salivary gland enlargement, particularly involving the parotid glands

A

Sialadenosis

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2
Q

What are the 4 main culprits for sialadenosis?

A

diabetes, malnutrition, alcoholism, bulimia

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3
Q

What are the 5 endocrine disorders assoiciated with sialadenosis?

A

diabetes melitus, diabetes insipidus, acromegaly, hypothyroidism, pregnancy

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4
Q

What 5 nutritional conditions are associated with Sialadenosis?

A

General malnutrition, alcoholism, cirrhosis, anorexia nervosa, bulimia

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5
Q

What 3 neurogenic medications are associated with sialadenosis?

A

antihypertensive drugs, psychotropic drugs, sypathomimetic drugs for asthma

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6
Q

In sialadenosis, which cell type is becoming enlarged due to dysregulation? Which cell is atrophying?

A

enlarged: acinar cells….atrophy: myoepithelial cells

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7
Q

“leafless tree” pattern on sialography

A

sialadenosis

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8
Q

Micro for sialadenosis: hypertrophy of the _____ cells, sometimes two to three times greater than normal size. The nuclei are displaced to the cell base, and the cytoplasm is engorged with ______ granules.

A

hypertrophy of acinar cells….zymogen

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9
Q

Micro for sialadenosis: In cases associated with long-standing diabetes or alcoholism, there may be acinar ATROPHY and ______ infiltration. Significant inflammation is NOT observed.

A

FATTY

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10
Q

Sialadenosis treatment: #1 overall? What drug has helped in bulimic patients?

A

1: treat the underlying cause…..pilocarpine

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11
Q

__________ is a rare ‘pseudotumor’ of the minor salivary glands characterized by localized swelling that mimics a neoplasm

A

Adenomatoid hyperplasia

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12
Q

Adenomatoid hyperplasia location? pathogenesis?

A

hard or soft palate….local trauma?

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13
Q

Necrotizing sialometaplasia age and gender

A

mean age 46 years….males 2x as often

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14
Q

Necrotizing sialometaplasia - histology can mimic SCC or MucoEp, what two stains can be helpful?

A

low reactivity to p53 and Ki67 for NS compared to SCC and MucoEp

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15
Q

What is the most common malignancy of the submandibular gland?

A

Adeniod cystic carcinoma

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16
Q

What are the 3 most common locations (in order) for minor salivary gland tumors?

A

Hard/soft palate > upper lip > buccal mucosa

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17
Q

What are the chances that a salivary tumor on the palate or buccal mucosa is malignant?

A

ALMOST HALF. (41-47% of palate; 30-50% of buccal mucosa salivary tumors are malignant)

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18
Q

Up to 95% of salivary gland tumors in WHAT AREA are malignant? (MucoEp)

A

Retromolar Pad

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19
Q

Cytogenetic studies of Pleomorphic Adenomas find TRANSLOCATIONS in ___% of them for WHICH GENE located on WHICH CHROMOSOME?

A

70% of PAs have translocations for PLAG1 (pleomorphic adenoma gene 1) located at chromosome region 8q12

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20
Q

Pleomorphic adenoma age range? Gender?

A

30-60 years old…slight FEMALE

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21
Q

What is the most common primary salivary gland tumor to develop in childhood?

A

Pleomorphic Adenoma

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22
Q

Are pleomorphic adenomas encapsulated?

A

The pleomorphic adenoma is typically a well-circumscribed, encapsulated tumor. HOWEVER, the capsule may be incomplete or show infiltration by tumor cells. This lack of complete encapsulation is more common for minor gland tumors, especially along the superficial aspect of palatal tumors beneath the epithelial surface

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23
Q

The mesenchymal stroma in Pleomorphic Adenomas is thought to be a product of which cell?

A

myoepithelial

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24
Q

What is the name for pleomorphic adenomas composed of almost entirely myoepithelial cells and no ductal element?

A

myoepithelioma

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25
Q

Which pleomorphic adenomas are more likely to recur?

A

predominantly myxoid

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26
Q

Alternate name for oncocytoma

A

oxyphilic adenoma

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27
Q

What causes the swollen granular cytoplasm of an oncocytoma?

A

excessive accumulation of mitochondria

28
Q

Oncocytoma age range, gender

A

60-80 years old, no gender predilection

29
Q

Which gland has 85-90% of oncocytomas?

A

parotid

30
Q

What two stains can highlight the neoplastic cells in an oncocytoma?

A

PTAH (phosphotungstic acid hematoxylin) and PAS

31
Q

What histo feature can make an oncocytoma difficult to distinguish from malignancy?

A

variable number of clear cells (salivary clear cell adenocarcinoma vs met renal)

32
Q

What location can oncocytomas have a more aggressive behavior?

A

Sinonasal glands

33
Q

What is the name for a malignant oncocytoma?

A

oncocytic carcinoma

34
Q

Alternate name for oncocytosis

A

multinodular oncocytic hyperplasia

35
Q

What two cell types can transform into an oncocyte?

A

ductal and acinar cells

36
Q

What is the term for complete gland replacement with oncocytes?

A

diffuse hyperplastic oncocytosis

37
Q

What is the alternate name for a Warthin tumor?

A

Papillary Cystadenoma Lymphomatosum

38
Q

What are the 2 pathogenic theories for Warthin tumor?

A
  1. heterotopic salivary gland tissue in a parotid lymph node 2. proliferation of salivary gland ductal epithelium with a secondary formation of lymphoid tissue
39
Q

Smokers are at an ____ fold risk for developing a Warthin tumor

A

8 fold

40
Q

If you see a warthin like histology in a gland other than the parotid, what are two more likely diagnoses?

A

papillary cystadenoma or a salivary duct cyst with oncocytic ductal metaplasia

41
Q

Warthin tumor age range, race, sex

A

60-70 years, whites, male (10:1 estimated)

42
Q

What is the recurrence rate for Warthin? What is the malignant counterpart?

A

2-6%…carcinoma ex papillary cystadenoma lymphomatosum

43
Q

Canalicular adenoma age, sex

A

70s, female (1.8-1.2:1)

44
Q

Does a canalicular adenoma have a capsule?

A

Yes, a thin, fibrous capsule often surrounds the tumor, satellite islands found in 22-24% of cases

45
Q

What is the most common site for a basal cell adenoma?

A

Parotid (75%)

46
Q

Basal cell adenoma age, sex

A

70’s, FEMALE (2:1)

47
Q

What is the hereditary form of a basal cell adenoma?

A

membranous basal cell adenoma

48
Q

Membranous basal cell adenomas can occur in combination with what 2 skin appendage tumors?

A

dermal cylindromas and trichoepitheliomas

49
Q

Is a basal cell adenoma encapsulated?

A

usually encapsulated OR well-circumscribed

50
Q

What has the histology of a membranous basal cell adenoma been likened to? What skin appendage tumor does this look like?

A

lobular islands of basal cells in a “jigsaw puzzle” fashion….dermal cylindroma

51
Q

The recurrence for a membranous basal cell adenoma is much higher than a normal one. What is the % range?

A

25-37% recurrence

52
Q

What is the malignant counterpart to a basal cell adenoma? What is the prognosis?

A

basal cell adenocarinoma…good prognosis - common local recurrence, but rare mets / death

53
Q

What is the term for a surface squamous papilloma that arises at the site where a minor salivary gland duct merges with the surface epithelium?

A

“Ductal” papilloma - can have scattered mucous cells within the exophytic growth

54
Q

Sialadenoma papilliferum: location, age, sex? What do these look like clinically?

A

palate (minor salivary glands), older adults, MALE (1.5:1)…look like a surface papilloma

55
Q

Intraductal papilloma: location (general), age (general)

A

minor salivary glands (submucosal swelling), adults

56
Q

Inverted ductal papilloma: location, age, unique clinical finding?

A

minor salivary glands (lower lip, mand vestibule), adults, a PIT or INDENTATION in the overlying surface mucosa

57
Q

What is the skin analogue to sialadenoma papilliferum?

A

syringocystadenoma papilliferum (SCAP)

58
Q

What is the histologic difference between INTRAductal and INVERTED ductal papillomas?

A

intraductal papilloma: unicystic, lined by a single or double row of cuboidal or columnar epithelium, which has multiple arborizing papillary projections into the cystic lumen. In contrast, the inverted ductal papilloma: squamoid epithelium with multiple thick, bulbous papillary projections that fill the ductal lumen

59
Q

Which ductal papilloma is associated with HPV infection? Which HPV type?

A

INVERTED ductal papilloma, HPV 6 and 11 (like a regular surface squamous papilloma)

60
Q

Name the 2 expert groups that proposed evaluation schemes for MucoEp

A
  1. Auclair et al 1992 and 2. Brandwein et al 2001
61
Q

What is “water brash”?

A

Episodic hypersalivation due to acid reflux

62
Q

Personality analysis has suggested the complaint of drooling in otherwise healthy patients can be associated with _______ and ________

A

high levels of neuroticism and tendency to dissimulate

63
Q

What % of older adults suffer xerostomia?

A

25%

64
Q

Adenoid cystic carcinoma was originally called ________

A

cylindroma (should be avoided since it does not convey malignancy and it is different from the skin tumor)

65
Q

T or F: The submandibular gland produces continuous flow of mucus even in the absence of neural stimulation

A

True

66
Q

List 4 causes of Sialorrhea

A
  1. rabies 2.heavy metal poisoning 3.GERD 4. Meds (antipsychotic) 5. Intelllectually disabled 6. Neuro disorders (CP, PD, ALS, stroke)

Neville and Damm (72 decks)

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