Chaper 11: Salivary gland pathology Flashcards
- Von Ebner glands
- Blandin-‐Nuhn
-‐ Von Ebner glands: located in tongue beneath circumvalate and foliate papillae. Primarly serous.
-‐ Blandin-‐Nuhn glands: located in ventral tongue, serous
Salivary gland aplasia
-‐ Isolated or associated with Treacher Collins, hemifacial microsomia and lacrimo-‐auriculo-‐dental-‐ digital syndrome (LADD)
-‐ LADD: FGF10 mutation. SG/LG aplasia, cup-‐shaped ears, and dental/digital anomalies
Mucocele
-‐ Superficial mucoceles: in soft palate and retromolar pad
-‐ Seen in lichen planus, lichenoid drug reactions, GVHD, and tartar control toothpaste
-‐ Mucous extravasation often causes granulation tissue
Ranula
-‐ Arises from sublingual gland (body or ducts of Rivini).
-‐ Shows tail sign on CT/MRI (only if from Sub-‐MD gland)
-‐ Plunging ranula: spilled mucin dissects through mylohyoid muscle
Salivary duct cyst (mucous retention cyst, sialocyst)
-‐True epithelium-‐lined cyst, frequent on upper lip
– Major glands: Parotid glands = most common
– Minor glands: Floor of the mouth, buccal mucosa, lips; appear bluish depending on depth of cyst below surface
If in floor of mouth, often arise adjacent to submandibular ducts, sometimes have amber color
-‐Ductal ectasia: cyst-‐like dilatation of salivary duct due to ductal obstruction and increased intraluminal pressure (probably not a true cyst). Possibly multifocal=presents as painful nodules with dilated ductal orifices, with pus. Tx with erythromycin and chlorhexidine
-‐ Cuboidal, columnar or squamous epithelium + ductal ectasia with oncocytic metaplasia (may contain papillary folds: if so, named papillary cystadenoma)
Sialolithiasis
-‐ Most in SubMD (tortuous duct and mucoid secretion)
– Most common in young and middle-aged adults
* Major gland sialoliths most frequently cause episodic pain or swelling of affected gland, esp at mealtime
Sialadenitis
-‐ Infectious (viral-‐mumps; or bacterial-‐S.aureus) or non-‐infectious (Sjogrens, RT, sarcoidosis).
-‐ Bacterial retrograde spread from reduced flow (dehydration, medication) or block (sialolith, tumor). Fever and pus present, usually parotid
-‐ Kuttner tumor: chronic sclerosing sialadenitis in subMD leading to gland enlargement. Pts should be evaluated for sclerosing pancreatitis.
-‐ Surgical mumps: after abdominal sx, when pt is kept w/o food/fluids and received atropine
-‐ Sialography: sausaging of Stensen’s duct (dilation + strictures from scar tissue alternating)
-‐ Subacute necrotizing sialoadenitis: no squamous metaplasia, mixed acute and chronic inflamm, younger patients, does not ulcerate-
– Juvenile recurrent parotitis = Most common inflammatory salivary disorder of children in US, recurring episodes of unilateral or bilateral, non-suppurative parotid swelling, Unknown cause,
Multiple recurrences but usually resolves around time of puberty
Cheilitis glandularis
-‐ Swelling and eversion of** lower lip **due to hypertrophy and inflammation of glands.
-‐ Possible etiologies: UV damage, tobacco, syphilis, poor hygiene and hereditary
-‐ Forms: simple, superficial suppurative (Baelz’s disease) or deep suppurative (CG apostematosa)
-‐ Small beads of fluid may be extruded with pressure. String of mucus may form
-‐ 18-‐35% of CG transform into SCC
Sialorhhea
-‐ True sialorrhea: caused by apthae, new dentures, GERD (“water brash”), rabies, heavy metal poisoning (acrodynia) and medications (Alzheimer’s)
-‐ Relative sialorrhea (can’t keep saliva in mouth): Down’s, cerebral palsy, Parkinson’s, prior Sx
-‐ Idiopathic paroxysmal sialorrhea: short episodes 2-‐5min each, prodrome of nausea and epigastric pain
Xerostomia
-‐ Complaint of 25% of the adult population
-‐ Causes: developmental (SG aplasia), water/metabolite (reduced intake, vomit, hemorrhage), iatrogenic (drugs, RT, CT), systemic disorders (SS, sarcoidosis, diabetes, HIV, HCV, GVHD) and local (reduced mastication, smoking, mouth breathing)
Benign lymphoepithelial lesion (lymphoepithelial sialadenitis)
-‐ Mikulicz disease = BLEL = Benign lymphoepithelial lesion = symmetric bilateral swelling of the lacrimal and salivary glands
-‐ Mikulicz syndrome = SG enlargement from other causes (eg sarcoidosis)
-‐ BLEL: painless enlargement SG (usually unilateral). Pts may or may not have clinical Sjogren
-‐ Histo: lymphocytic sialadenitis + epimyoepithelial islands (ductal preservation with epith prolif)
-‐ Malignant LEL (aka lymphoepithelial carcinoma): poorly differentiated salivary ca with prominent lymphoid stroma. EBV-‐related. Arises de novo or from BLEL
-‐ Increased risk MALT lymphoma
Sjogrens syndrome
– Female predilection, middle-aged
-‐ 1ary (sicca syndrome=dry eyes+mouth) or 2ary (sicca syndrome+ RA, SLE, billiary cirrhosis)
-‐ Dry eyes=keratoconjunctivitis sicca
-‐ HLA-‐DRw52 (both forms), DR3 and B8 (primary form only)
-‐ Fruit-‐laden, branchless tree on sialography
-‐ Rose Bengal dye: shows defects on ocular surface epithelium
-‐ Schirmer test: to confirm dry eyes (< 5mm +)
-‐ Elevated ANAs, anti-‐SSA (Ro), anti-‐SSB (La), ESR, IgG, RF
-‐ Histo: multifocal lymphocytic sialadenitis (T cells) leading to acini destruction.
-‐ MSG biopsy: 2+ foci 50+ lymphocytes within a 4-‐mm2 is supportive of SS. Smokers have less foci
-‐ Increased risk of MALT lymphoma (40x)
HIV-‐related parotid cysts
-‐ Usually bilateral
-‐ Histo: cystic spaces lined with squamous epithelium, with abundant reactive lymphoid stroma
-‐ Epimyoepithelial islands and Warthin-‐Finkeldey giant cells may be seen
Sialadenosis
– noninflammatory disorder
○ Salivary gland enlargement, particularly parotid glands
– Associated with underlying systemic problem - endocrine, nutritional, neurogenic in origin
-‐ Risk factors: diabetes, malnutrition, alcoholism, and bulimia
-‐ Aka sialosis: increased accumulation of secretory zymogen granules due to innervation disruption
-‐ Sialography: leafless tree (compression of finer ducts by hypetrophic acinar cells)
Adenomatoid hyperplasia of the minor salivary glands
-‐ Mostly on palate (“pseudotumor”). Possibly due to chronic trauma.
-‐ Coalescing lobules of normal appearing mucinous acini in lamina propria and submucosa
Polycystic (dysgenetic) parotid disease
-‐ Developmental abnormality histologically ~ to polycystic disease of the kidney
-‐ Amost always in parotid, usually bilateral, usually childhood
-‐ Histo: Parenchyma diffusely replaced by varying degrees of honeycombed cystic change, lined with a thin layer of flattened epithelium.
-‐ DDx: cystadenoma/carcinoma (but these are localized masses)
