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Oral and Maxillofacial Pathology > Chapter 11: Salivary Gland Diseases > Flashcards

Chapter 11: Salivary Gland Diseases Flashcards

1
Q

what is another name for a salivary duct cyst?

A

mucus retention cyst

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2
Q

ranulas are typically associated with rupture of ___

A

the sublingual gland duct

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3
Q

are polymorphous low-grade adenocarcinomas more common in males or females? older or younger?

A

F>M

older adults

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4
Q

what are two places you will never see a salivary gland tumor?

A

gingiva, dorsal tongue

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5
Q

what is another name for a mucocele?

A

mucus extravasation phenomenon

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6
Q

what are malignant mixed tumors?

A

tumors that transfer to malignancy

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7
Q

do adenoid cystic carcinomas have early or late recurrence and metastasis?

A

late

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8
Q

carcinoma ex pleomorphic adenomas are most common in which gland?

A

major glands (>80% cases)

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9
Q

what percent of cheek minor salivary gland neoplasms are benign? what percent are malignant?

A
  • benign - 50%
  • malignant - 50%
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10
Q

what percent of minor salivary gland neoplasms are benign? what percent are malignant?

A
  • benign - 50%
  • malignant - 50%
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11
Q

what percent of retromolar pad minor salivary gland neoplasms are benign? what percent are malignant?

A
  • benign - 10%
  • malignant - 90%
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12
Q

are pleomorphic adenoma tumors encapsulated?

A

yes

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13
Q

what are the common locations of polymorphous low-grade adenocarcinomas?

A

hard and soft palate (65% cases) > upper lip, buccal mucosa

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14
Q

what percent of upper lip minor salivary gland neoplasms are benign? what percent are malignant?

A
  • benign - 80%
  • malignant - 20%
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15
Q

what is the clinical presentation of cheilitis glandularis?

A
  • swelling and pain, typically of the lower lip
  • eversion of the lip
  • red dots indicate duct orifices
  • “weeping” mucopurulent secretions often are seen
  • middle aged to older males
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16
Q

70-90% of neoplasms in what location are malignant?

A

sublingual

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17
Q

what are the most common sites of mucoceles?

A
  • lower lip 81%
  • floor of mouth (ranula)
  • anterior ventral tongue
  • buccal mucosa
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18
Q

what is a salivary duct cyst?

A

epithelial-lined cavity that arises from salivary gland tissue

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19
Q

sialoliths are usually associated with ___ or ___, especially at meal time

A

pain or swelling

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20
Q

adenomatoid hyperplasia of the minor salivary glands often affect ___

A

minor glands, often on hard or soft palate

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21
Q

what is the treatment for a ranula?

A

removal of the feeding sublingual gland and/or marsupialization

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22
Q
A

salivary duct cyst

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23
Q

patients who are <50 years old with a salivary gland neoplasm on the upper lip most likely have ___

A

pleomorphic adenoma

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24
Q

___ is a slow growing, painless mass, blue or normal in color, and may be multifocal

A

canalicular adenoma

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25
Q

what are the infectious causes of sialadenitis?

A
  • viral: mumps
  • bacterial
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26
Q
A

ranula

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27
Q

___ is the most common malignant salivary neoplasm

A

mucoepidermoid carcinoma

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28
Q
A

sialolith aka sialolithiasis aka salivary stone

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29
Q
A

intraosseious mucoepidermoid carcinoma

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30
Q

what percent of acinic cell adenocarcinoma undergo metastasis?

A

10-15%

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31
Q

what glands are most affected by adenoid cystic carcinomas?

A

minor gland (50% of cases), palate > parotid, submandibular gland

*most common malignant salivary gland tumor of the submandibular gland

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32
Q

what are some underlying systemic conditions that can cause sialadenosis?

A
  • endocrine disorders: diabetes mellitus, hypothyroidism, pregnancy
  • malnutrition: general malnutrition, alcoholism, anorexia nervosa, bulimia
  • drugs: anti-hypertensive drugs, psychotropic drugs
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33
Q

what age patient are adenoid cystic carcinomas more common in?

A

middle aged adults, 30-60yo

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34
Q

whay should you biopsy an adenomatoid hyperplasia of the minor salivary glands?

A

rule out neoplasm

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35
Q

what is the treatment/management of sjogren’s syndrome?

A
  • manage xerostomia
    • sugarless candies and gum, OTC dry mouth products, sialogogues (pilocarpine and cevimeline)
  • emphasize oral hygiene, regular dental care
  • monitor for lymphoma
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36
Q

what percent of submandibular major salivary gland neoplasms are benign? what percent are malignant?

A
  • benign - 60%
  • malignant - 40%
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37
Q

___ is an autoimmune disease mainly affecting salivary and lacrimal glands, and is characterized by dry mouth and dry eyes

A

sjogren’s syndrome (sicca syndrome)

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38
Q

necrotizing sialometaplasia is frequently found ___, and is __unilatera/bilateral__

A
  • on the palate
  • unilateral
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39
Q

what is sialorrhea?

A

excessive salivation

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40
Q

mucoepidermoid carcinomas affect what gland most commonly? second most?

A
  1. parotid gland
  2. minor glands, most commonly on the palate
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41
Q

what is the etiology of sialoliths?

A

calcification of salivary secretions within the duct system

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42
Q

treatment of mucoepidermoid carcinoma treatment depends on what?

A

location, histopathologic grade, and clinical stage

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43
Q

what is the management for xerostomia?

A
  • elimination of alcohol, smoking, caffeine consumption
  • drug modification, if possible
  • sugarless candies, gum
  • oral lubricants (mouthwash, gels, spray)
  • prescription: pilocarpine (salagen), cevimeline (evoxac)
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44
Q

___ is the subjective sensation of a dry mouth

A

xerostomia

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45
Q

oncocytoma:

the prefix onco- is derived from which greek word, and what does it mean?

A

onkoustai, which means to swell

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46
Q

what are 4 other intraosseous salivary tumors other than intraosseous mucoepidermoid carcinoma?

A
  • adenoid cystic carcinoma
  • benign and malignant mixed tumors
  • acinic cell adenocarcinoma
  • monomorphic adenoma
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47
Q

what population are oncocytomas common in?

A

older adults (peak 70yo)

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48
Q

what are 3 examples of malignant mixed tumors?

A
  • carcinoma ex pleomorphic adenoma
  • carcinosarcoma
  • metastasizing mixed tumor
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49
Q

what locations do salivary duct cysts most often occur?

A

parotid gland, FOM, buccal mucosa, and lips

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50
Q

salivary gland neoplasms in the retromolar area are mostly ___

A

malignant (90%)

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51
Q

are oncocytomas common?

A

no they are rare, and represent approx 1% of all salivary tumors

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52
Q

what population is cheilitis glandularis common in?

A

middle aged to older males

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53
Q
A

sialolith aka sialolithiasis aka salivary stone

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54
Q

what is the most common malignant salivary gland tumor in children?

A

mucoepidermoid carcinoma

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55
Q

what is the most common site of acinic cell adenocarcinoma? second and third most common sites?

A

parotid is the most common site (85% of the cases) > minor glands > submandibular gland

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56
Q

what is the treatment for salivary duct cysts?

A

surgical excision

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57
Q

what are examples of things that slow or inhibit salivary glow through the duct system that can predispose to the development of calculi?

A
  • mucous plug
  • bacterial colonies
  • chronic duct blockage phenomena
  • normal ductal anatomy (wharton’s duct)
  • xerostomia - typically not associated with elevated serum calcium levels
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58
Q
A

necrotizing sialometaplasia

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59
Q

what is the definiton of sialadenitis?

A

salivary gland inflammation

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60
Q

what is the treatment of sialorrhea?

A
  • treat the underlying cause
  • anticholinergic medications, scopolamine transdermal patch (not for children)
  • surgery: relocation of the salivary ducts to tonsillar fossa, tympanic neurectomy
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61
Q

___ is another name for an oncocytoma

A

oxyphilic adenoma

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62
Q

___ is another term for pleomorphic adenoma

A

benign mixed tumor

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63
Q

what percent of parotid major salivary gland neoplasms are benign? what percent are malignant?

A
  • benign - 70%
  • malignant - 30%
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64
Q

___ is the second most common benign parotid tumor

A

warthin’s tumor

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65
Q

what are the two typical presentations of salivary gland neoplasms?

A
  • smooth surfaced dome shaped nodule
  • an ulcerated mass lesion
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66
Q
A

chronic sialadenitis

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67
Q

what percent of lower lip minor salivary gland neoplasms are benign? what percent are malignant?

A
  • benign - 40%
  • malignant - 60%
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68
Q

what is the general prognosis for people with acinic cell adenocarcinoma?

A

relatively good prognosis

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69
Q
A

plunging (cervical) ranula

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70
Q
A

sialolith aka sialolithiasis aka salivary stones

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71
Q

mucoepidermoid carcinoma tumors in what location are associated with a poorer prognosis than in the parotid gland?

A

submandibular gland tumors

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72
Q

pleomorphic ademonas make up ___% of parotid tumors (superficial lobe) and ___% of submandibular tumors

A
  • 53-77% of parotid tumors
  • 44-68% of submandibular tumors
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73
Q

___ is the most common malignant salivary gland tumor of the submandibular gland?

A

adenoid cystic carcinoma

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74
Q
A

mucoele

75
Q

what percent of palate minor salivary gland neoplasms are benign? what percent are malignant?

A
  • benign - 50%
  • malignant - 50%
76
Q

what is a common location for a sialadenosis?

A
  • mainly in parotid
    • hypertrophy of acini
77
Q

what are some things you would see in a patient with xerostomia?

A

fissured tongue, increased dental caries, halitosis, “sticky” palate and tongue, fungal infections like candidiasis and angular cheilitis

78
Q

what is the pathogenesis of intraosseous (central) mucoepidermoid carcinoma?

A
  • ectopic salivary gland tissue that was developmentally entrapped within the jaw
  • odontogenic epithelium, mucous metaplasia
79
Q

is primary sjogrens syndrome associated with other autoimmune diseases? what about secondary sjogren’s syndrome?

A
  • primary SS: no other autoimmune disease
    • it’s just dry mouth and dry eyes (aka sicca syndrome)
  • secondary SS: associated with other autoimmune diseases
    • technically this would be sjogren’s syndrome
80
Q

what is another name for warthin’s tumor?

A

papillary cystadenoma lymphomatosum

81
Q

salivary duct cysts are ___, ___ swellings

A

bluish (or normal color), soft fluctuant swelling

82
Q

what is the incidence of salivary neoplasms?

A

1-6.5 cases per 100,000 people

83
Q

patients who are >60 years old with a salivary gland neoplasm on the upper lip most likely have ___

A

canalicular adenoma

84
Q

an oncocytoma is a ___ tumor composed of large epithelial cells known as ___

A
  • benign salivary gland tumor
  • oncocytes
85
Q

___ is the most common site for minor salivary gland neoplasm (50%), especially in what location?

A
  • palate
  • especially posterior lateral hard or soft palate
86
Q

what are the non-infectious causes of sialadenitis?

A
  • sjogren syndrome
  • sarcoidosis, granulomatous inflammation
  • radiation induced
  • recent surgery
  • allergic reaction
  • obstruction of the salivary duct
87
Q

what is the prognosis for patients with intraosseious mucoepidermoid carcinoma?

A

90% survival

88
Q

mucoceles of the ___ region are distinctly unusual, and most will prove to be ___

A
  • retromolar region
  • mucoepidermoid carcinoma
89
Q

what other autoimmune diseases are associated with secondary sjogren’s syndrome?

A

rheumatoid arthritis, SLE

90
Q
A

mucocele

91
Q

80-90% of sjogren’s syndrome cases affect males or females?

A

females

92
Q

what are anesthesia mumps?

A
  • rare complication after general anesthesia
  • swelling of parotid or submandibular glands after surgery
  • spontaneously resolving in hours or in a few days
93
Q

does sialadenitis have an infectious or non-infectious etiology?

A

can be either

94
Q

what is the definition of a sialolith?

A

calcifications developed in a salivary duct

95
Q

what is the definition of a neoplasm?

A

new growth with unlimited growth potential

neoplasm can also be called a tumor

96
Q

mucoceles are the result of spillage of ___ into the soft tissues due to rupture of ___, usually caused by ___

A
  • mucin
  • salivary gland duct
  • trauma
97
Q

polymorphous low-grade adenocarcinomas and pleomorphic adenomas exhibit different ___

A

growth patterns histologically

98
Q

what are 4 common benign salivary gland neoplasms?

A
  • canalicular adenoma
  • pleomorphic adenoma
  • warthin tumor (papillar cystadenoma lymphomatosum)
  • oncocytoma
99
Q

carcinosarcoma has what two components?

A

carcinomatous and sarcomatous components

100
Q

what is the treatment for sialoliths?

A

gentle massage, increase fluid intake, moist heat, sialogogue, surgery

101
Q

canalicular adenoma is a type of ___ adenoma

A

monomorphic

102
Q

what are predisposing factors for necrotizing sialometaplasia?

A

traumatic injuries, dental injections, ill-fitting dentures, upper respiratory infections, adjacent tumors, previous surgery

103
Q

polymorphous low-grade adenocarcinomas occur almost exclusively in which glands?

A

minor glands

104
Q

what age group is canalicular adenoma more common in? male or female prevalence?

A

older age group, 70s, slight female predominance

105
Q

pleomorphic adenomas show a mixture of ___ and ___ cells

A
  • ductal and myoepithelial cells
    • remarkable microscopic diversity accounts for the name
106
Q

prognosis of mucoepidermoid carcinoma depends on what?

A

grade and stage

107
Q

what percent of sublingual major salivary gland neoplasms are benign? what percent are malignant?

A
  • benign - 30%
  • malignant - 70%
108
Q

how are sialoliths diagnosed?

A

radiograph, sialography, ultrasound, CT

109
Q

what are the most common sites of salivary neoplasms?

A
  1. parotid gland (64-80% of all cases)
  2. minor glands (9-23%)
  3. submandibular
  4. sublingual <1%
110
Q

what is the most common neoplasm?

A

pleomorphic adenoma (benign)

111
Q

what is marsupialization?

A

(exteriorization) entails removal of the roof of the intraoral lesion

112
Q

what are other names for a sialolith?

A

sialolithiasis (multiple) and salivary stones

113
Q

what is the presentation of necrotizing sialometaplasia?

A

non-ulcerated swelling, pain, and parasthesia → necrotic tissue sloughs out, ulcer → heals in 5-6 weeks

114
Q

what type of carcinoma is slow-growing, widely infiltrative, and has a tendency for perineural spread?

A

adenoid cystic carcinoma

115
Q

___ is a locally destructive inflammatory condition of the salivary glands, believed to be due to ischemia

A

necrotizing sialometaplasia

116
Q
A

sialolith aka sialolithiasis aka salivary stone

117
Q

the incidence of mumps decreases due to ___

A

MMR vaccine

118
Q

___ infection primarily affect the salivary glands, causing mumps

A

paramyxovirus

119
Q

what is the ocular staining score using as a diagnostic criteria for sjogrens syndrome?

A

sum of fluorescein staining of cornea (0-6) and lissamine green staining of both nasal and temporal bulbar conjuntiva (0-3)

120
Q

___ is a mucocele in the floor of the mouth, usually located ___

A
  • ranula
  • lateral to the midline
121
Q

what is the swollen granular cytoplasm of oncocytes due to?

A

excessive accumulation of mitochondria

122
Q

is a mucocele a neoplastic or non-neoplastic salivary gland condition?

A

non-neoplastic

123
Q

___ is the most common salivary neoplasm (benign OR malignant)

A

pleomorphic adenoma

124
Q

*there are often “weeping” mucopurulent secretions

A

cheilitis glandularis

125
Q

clinical mucoceles of the upper lip are more likely to be a ___ tumor

A

salivary gland

126
Q

what locations do canalicular adenomas commonly occur?

A
  1. upper lip - 75% (only pleomorphic adenoma is found more commonly in the upper lip; canalicular adenoma is second most common)
  2. buccal mucosa
  3. exclusively in minor glands
127
Q

where are warthin’s tumors commonly found?

A

almost exclusively in the parotid gland, may occur bilaterally

128
Q

what is the clinical presentation of sialadenosis?

A
  • parotid swelling
  • usually slowly evolving
  • usually bilateral
  • +/- pain
129
Q

___ is a localized, sessile painless swelling that mimics a neoplasm, defined as hyperplasia and/or hypertrophy of the normal gland

A

adenomatoid hyperplasia of the minor salivary glands

130
Q

where are sialoliths most common?

A
  • submandibular gland, upper lip, buccal mucosa
    • long and tortuous (curvy) duct with thick secretions
131
Q

what is the diagnostic criteria for primary sjogren’s syndrome?

A

must have 2/3 of these be positive to be sjogren’s syndrome

  • positive serum anti-SSA and/or anti-SSB (or positive RF and ANA titer >/= 1:320)
  • ocular staining score >/= 3
  • presence of focal lymphocytic sialadenitis with a focus score >/= 1 focus/4mm2 in labial salivary gland biopsy samples
132
Q

is xerostomia common? what % of older adults is it seen in?

A

yes, and it is seen in 25% of older adults

133
Q

what are 8 common causes of xerostomia?

A
  • medications
  • caffeine/alcohol
  • smoking
  • radiation therapy to head and neck
  • sjogren’s syndrome
  • diabetes mellitus
  • sarcoidosis
  • surgery of salivary glands
134
Q

___ is a non-inflammatory asymptomatic salivary gland enlargement

A

sialadenosis (sialosis)

135
Q

salivary gland neoplasms in the upper lip are mostly ___, while salivary gland neoplasms in the lower lip are mostly ___

A
  • benign
  • malignant
136
Q

what age patient is instraosseious mucoepidermoid carcinoma most common in? more common in the maxilla or mandible? what specific location is most common?

A
  • middle aged adults
  • mandible > maxilla
  • molar-ramus region
137
Q

what is criteria used to exclude sjogren’s syndrome?

A
  • past head and neck radiation treatment
  • hepatitis C infection
  • acquired immunodeficiency syndrome (AIDS)
  • preexisting lymphoma
  • sarcoidosis
  • graft-versus-host-disease (GVHD)
  • use of anticholinergic drugs
138
Q

what is the histology of cheilitis glandularis?

A

chronic sialadenitis and ductal dilation

139
Q

what percent of tongue minor salivary gland neoplasms are benign? what percent are malignant?

A
  • benign - 15%
  • malignant - 85%
140
Q

salivary duct cysts occur mostly in what population?

A

adults

141
Q

necrotizing sialometaplasia mimics ___ clinically and histologically

A

malignancy (except for too acute onset)

142
Q

what is another name for mumps?

A

epidemic parotitis

143
Q

what are 11 salivary gland non-neoplastic conditions?

A
  • mucocele, ranula
  • salivary duct cyst
  • sialolith
  • sialadenitis
  • sialadenosis
  • adenomatoid hyperplasia of the minor glands
  • necrotizing sialometaplasia
  • cheilitis glandularis
  • sialorrhea
  • xerostomia
  • sjogren’s syndrome
144
Q

what are 5 malignant salivary neoplasms?

A
  • mucoepidermoid carcinoma
  • acinic cell adenocarcinoma
  • adenoid cystic carcinoma
  • polymorphous low-grade adenocarcinoma (terminal duct adenocarcinoma)
  • malignant mixed tumor
145
Q

what can happen if a pleomorphic adenoma is untreated?

A

it can grow to grotesque proportions if untreated

146
Q

___ is a low-grade malignant neoplasm showing serous acinar differentiation

A

acinic cell adenocarcinoma

147
Q
A

canalicular adenoma

148
Q

what is the survival rate for a person with acinic cell adenocarcinoma?

A

80-94%

149
Q

what is the female to male ratio of the prevalence of acinic cell adenocarcinoma?

A

F:M

2:1

150
Q

what is another name for sjogren’s syndrome?

A

sicca syndrome

151
Q

what is another name for polymorphous low-grade adenocarcinoma?

A

terminal duct carcinoma

152
Q

what is the cause of cheilitis glandularis?

A

unknown, but possibly due to sun damage, tobacco, syphilis, poor hygiene, heredity

153
Q

what is the pathogenesis of adenomatoid hyperplasia of the minor salivary glands?

A

unknown, possibly trauma

154
Q

salivary gland neoplasms are more common in the upper or lower lip?

A

upper lip

155
Q

what is the survival rate for high-grade mucoepidermoid carcinoma?

A

30-54% survival rate

156
Q

what are the common locations of oncocytomas?

A

occur mainly in major glands, mostly parotid (85-90%)

157
Q

why should you biopsy necrotizing sialometaplasia

A

to rule out possible malignancy

158
Q

in addition to salivary glands, oncocytes have been identified in a number of other organs, including what?

A

thyroid, parathyroid, and kidney

159
Q

carcinoma ex pleomorphic adenoma includes malignant transformation of which cells?

A

epithelial cells

160
Q
A

mucocele

161
Q

what are some things that sialorrhea is caused by?

A
  • local irritations: ex. aphthous ulcers, ill-fitting dentures
  • GERD
  • rabies, heavy metal poisoning
  • medications: lithium, cholinergic agonists
  • idiopathic paroxysmal sialorrhea
  • drooling: down syndrome, neurological disorder, ex. cerebral palsy
162
Q

___ is a mass present for many years but a recent rapid growth with pain or ulceration, is most common in major glands, and involves malignant transformation of epithelial cells

A

carcinoma ex pleomorphic adenoma

163
Q

what is the most common malignant neoplasm?

A

mucoepidermoid carcinoma

164
Q

what is the survival rate for low-grade mucoepidermoid carcinoma?

A

90-95% survival

165
Q

salivary duct cysts occur in ___ and ___ glands, and there can be ___

A

major and minor glands, and there can be multiple cysts

166
Q

___ is swelling and eversion of the lower lip as a result of hypertrophy and inflammation of the minor salivary glands

A

cheilitis glandularis

167
Q

top photo is from the submandibular gland, lower photo is from the parotid gland (stenson’s duct)

A

sialadenitis

168
Q

what are sjogren’s syndrome patients at increased risk for?

A
  • lymphoma (40x)
  • marginal zone lymphoma (MALT lymphoma)
169
Q

what is the treatment of mucoceles?

A
  • surgical excision, remove with the adjacent minor salivary gland
    • submit to pathology
170
Q

what is the local recurrence of acinic cell adenocarcinoma?

A

1/3

171
Q

what is the 5 year survival rate for adenoid cystic carcinoma? 20 year survival rate?

A
  • 5-year: 70%
  • 20-year: 20%
172
Q

mumps is diagnosed based on what?

A
  • clinical findings
  • viral culture
  • serological tests
173
Q

what are 3 complications associated with xerostomia?

A
  • candidiasis
  • prone to cervical and root caries
  • alteration of taste
174
Q

adenoid cystic carcinoma is associated with pain and paralysis of which nerve?

A

facial nerve

175
Q

anything that slows or inhibits salivary flow through the duct system may predispose to the development of ___

A

calculi

176
Q

is acinic cell adenocarcinoma associated with pain? is it fast or slow growing?

A
    • or - pain
  • slow growing mass
177
Q
A

necrotizing sialometaplasia

178
Q

what is another name for sialadenosis?

A

sialosis

179
Q
A

sialadenosis

180
Q

what are complications that arise from mumps?

A
  • epididymorchitis in males
  • oophoritis
  • mastitis in females
181
Q

what population is warthin’s tumor most common in?

A

60-70 yo, male predominance (10:1), increasing incidence in females in recent studies (possibly due to smoking)

smokers have 8x increased risk

182
Q

mucocele’s are common in what populations?

A

children and young adults

183
Q
A

sialolith aka sialolithiasis aka salivary stone

Oral and Maxillofacial Pathology (45 decks)

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