Ch11 Salivary Part 2 Flashcards
__________ is an unusual noninflammatory disorder characterized by salivary gland enlargement, particularly involving the parotid glands
Sialadenosis
What are the 4 main culprits for sialadenosis?
diabetes, malnutrition, alcoholism, bulimia
What are the 5 endocrine disorders assoiciated with sialadenosis?
diabetes melitus, diabetes insipidus, acromegaly, hypothyroidism, pregnancy
What 5 nutritional conditions are associated with Sialadenosis?
General malnutrition, alcoholism, cirrhosis, anorexia nervosa, bulimia
What 3 neurogenic medications are associated with sialadenosis?
antihypertensive drugs, psychotropic drugs, sypathomimetic drugs for asthma
In sialadenosis, which cell type is becoming enlarged due to dysregulation? Which cell is atrophying?
enlarged: acinar cells….atrophy: myoepithelial cells
“leafless tree” pattern on sialography
sialadenosis
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.
hypertrophy of acinar cells….zymogen
Micro for sialadenosis: In cases associated with long-standing diabetes or alcoholism, there may be acinar ATROPHY and ______ infiltration. Significant inflammation is NOT observed.
FATTY
Sialadenosis treatment: #1 overall? What drug has helped in bulimic patients?
1: treat the underlying cause…..pilocarpine
__________ is a rare ‘pseudotumor’ of the minor salivary glands characterized by localized swelling that mimics a neoplasm
Adenomatoid hyperplasia
Adenomatoid hyperplasia location? pathogenesis?
hard or soft palate….local trauma?
Necrotizing sialometaplasia age and gender
mean age 46 years….males 2x as often
Necrotizing sialometaplasia - histology can mimic SCC or MucoEp, what two stains can be helpful?
low reactivity to p53 and Ki67 for NS compared to SCC and MucoEp
What is the most common malignancy of the submandibular gland?
Adeniod cystic carcinoma
What are the 3 most common locations (in order) for minor salivary gland tumors?
Hard/soft palate > upper lip > buccal mucosa
What are the chances that a salivary tumor on the palate or buccal mucosa is malignant?
ALMOST HALF. (41-47% of palate; 30-50% of buccal mucosa salivary tumors are malignant)
Up to 95% of salivary gland tumors in WHAT AREA are malignant? (MucoEp)
Retromolar Pad
Cytogenetic studies of Pleomorphic Adenomas find TRANSLOCATIONS in ___% of them for WHICH GENE located on WHICH CHROMOSOME?
70% of PAs have translocations for PLAG1 (pleomorphic adenoma gene 1) located at chromosome region 8q12
Pleomorphic adenoma age range? Gender?
30-60 years old…slight FEMALE
What is the most common primary salivary gland tumor to develop in childhood?
Pleomorphic Adenoma
Are pleomorphic adenomas encapsulated?
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
The mesenchymal stroma in Pleomorphic Adenomas is thought to be a product of which cell?
myoepithelial
What is the name for pleomorphic adenomas composed of almost entirely myoepithelial cells and no ductal element?
myoepithelioma
Which pleomorphic adenomas are more likely to recur?
predominantly myxoid
Alternate name for oncocytoma
oxyphilic adenoma
What causes the swollen granular cytoplasm of an oncocytoma?
excessive accumulation of mitochondria
Oncocytoma age range, gender
60-80 years old, no gender predilection
Which gland has 85-90% of oncocytomas?
parotid
What two stains can highlight the neoplastic cells in an oncocytoma?
PTAH (phosphotungstic acid hematoxylin) and PAS
What histo feature can make an oncocytoma difficult to distinguish from malignancy?
variable number of clear cells (salivary clear cell adenocarcinoma vs met renal)
What location can oncocytomas have a more aggressive behavior?
Sinonasal glands
What is the name for a malignant oncocytoma?
oncocytic carcinoma
Alternate name for oncocytosis
multinodular oncocytic hyperplasia
What two cell types can transform into an oncocyte?
ductal and acinar cells
What is the term for complete gland replacement with oncocytes?
diffuse hyperplastic oncocytosis
What is the alternate name for a Warthin tumor?
Papillary Cystadenoma Lymphomatosum
What are the 2 pathogenic theories for Warthin tumor?
- heterotopic salivary gland tissue in a parotid lymph node 2. proliferation of salivary gland ductal epithelium with a secondary formation of lymphoid tissue
Smokers are at an ____ fold risk for developing a Warthin tumor
8 fold
If you see a warthin like histology in a gland other than the parotid, what are two more likely diagnoses?
papillary cystadenoma or a salivary duct cyst with oncocytic ductal metaplasia
Warthin tumor age range, race, sex
60-70 years, whites, male (10:1 estimated)
What is the recurrence rate for Warthin? What is the malignant counterpart?
2-6%…carcinoma ex papillary cystadenoma lymphomatosum
Canalicular adenoma age, sex
70s, female (1.8-1.2:1)
Does a canalicular adenoma have a capsule?
Yes, a thin, fibrous capsule often surrounds the tumor, satellite islands found in 22-24% of cases
What is the most common site for a basal cell adenoma?
Parotid (75%)
Basal cell adenoma age, sex
70’s, FEMALE (2:1)
What is the hereditary form of a basal cell adenoma?
membranous basal cell adenoma
Membranous basal cell adenomas can occur in combination with what 2 skin appendage tumors?
dermal cylindromas and trichoepitheliomas
Is a basal cell adenoma encapsulated?
usually encapsulated OR well-circumscribed
What has the histology of a membranous basal cell adenoma been likened to? What skin appendage tumor does this look like?
lobular islands of basal cells in a “jigsaw puzzle” fashion….dermal cylindroma
The recurrence for a membranous basal cell adenoma is much higher than a normal one. What is the % range?
25-37% recurrence
What is the malignant counterpart to a basal cell adenoma? What is the prognosis?
basal cell adenocarinoma…good prognosis - common local recurrence, but rare mets / death
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?
“Ductal” papilloma - can have scattered mucous cells within the exophytic growth
Sialadenoma papilliferum: location, age, sex? What do these look like clinically?
palate (minor salivary glands), older adults, MALE (1.5:1)…look like a surface papilloma
Intraductal papilloma: location (general), age (general)
minor salivary glands (submucosal swelling), adults
Inverted ductal papilloma: location, age, unique clinical finding?
minor salivary glands (lower lip, mand vestibule), adults, a PIT or INDENTATION in the overlying surface mucosa
What is the skin analogue to sialadenoma papilliferum?
syringocystadenoma papilliferum (SCAP)
What is the histologic difference between INTRAductal and INVERTED ductal papillomas?
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
Which ductal papilloma is associated with HPV infection? Which HPV type?
INVERTED ductal papilloma, HPV 6 and 11 (like a regular surface squamous papilloma)
Name the 2 expert groups that proposed evaluation schemes for MucoEp
- Auclair et al 1992 and 2. Brandwein et al 2001
What is “water brash”?
Episodic hypersalivation due to acid reflux
Personality analysis has suggested the complaint of drooling in otherwise healthy patients can be associated with _______ and ________
high levels of neuroticism and tendency to dissimulate
What % of older adults suffer xerostomia?
25%
Adenoid cystic carcinoma was originally called ________
cylindroma (should be avoided since it does not convey malignancy and it is different from the skin tumor)
T or F: The submandibular gland produces continuous flow of mucus even in the absence of neural stimulation
True
List 4 causes of Sialorrhea
- rabies 2.heavy metal poisoning 3.GERD 4. Meds (antipsychotic) 5. Intelllectually disabled 6. Neuro disorders (CP, PD, ALS, stroke)
