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Book - Molavi > Chapter 25 - Salivary Gland > Flashcards

Chapter 25 - Salivary Gland Flashcards

1
Q

What is the most common tumor of salivary gland?

For what non-neoplastic indications are biopsies done?

A

Pleomoprhic adenoma

Sjogren’s syndrome, inflammatory lesions (chronic sialadenitis or lymphoepithelial cyst)

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2
Q

What are the three major salivary glands?

What generalizations can be made about salivary glands?

A

Parotid, sublingual, submandibular

The smaller the gland, the more likely its neoplasm is malignant. Also, the more mucinous and less serous.

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3
Q

What are the normal three cellular components of salivary glands?

A

Secretory cells: Serous (wedge-shaped with purple granules) and mucinous (like goblet cells)

Duct cells: Terminal/intercalated, striated, and interlobular

Myoepithelial cells: Pale stellate with small nuclei (hard to find!)

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4
Q

Distinguish the three types of duct cells in salivary gland.

A

Intercalated ducts: Small profiles with low cuboidal epithelium.

Striated duct: Proximal, larger pink columnar cells.

Interlobular/excretory ducts: Pseudostratified columnar epithelium +/- goblet cells.

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5
Q

What are the four morphologies of myoepithelial cells?

A

Spindled

Plasmacytoid

Epithelioid

Clear

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6
Q

What is the best method to triage if a salivary neoplasm is malignant?

A

Evaluate the periphery or capsule for invasion. Benign lesions are encapsulated, whereas malignant tumors are infiltrative.

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7
Q

Recite and relate the cells of origin for the most common benign salivary gland adenomas.

A

Pleomorphic adenoma / myoepithelioma
Epithelial-myoepithelial

Basal cell adenoma
Epithelial-myoepithelial

Warthin’s tumor, oncocytoma
Striated duct cells

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8
Q

Recite and relate the cells of origin for the most common low-grade salivary malignancies

A 
_Mucoepidermoid carcinoma (low-grade)_
Interlobular duct cells

Polymorphous low-grade adenocarcinoma
Epithelial-myoepithelial

Acinic cell carcinoma
Serous acinar cells

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9
Q

Recite and relate the cells of origin for the most common high-grade salivary malignancies

A 
_Mucoepidermoid carcinoma (high-grade)_
Interlobular duct cells

Adenoid cystic carcinoma
Epithelial-myoepithelial

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10
Q

What is a pleomorphic adenoma?

Where do they most often occur?

A

A biphasic tumor with epithelial and myoepithelial components.

Most common in the parotid.

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11
Q

Describe the morphologic appearance of pleomorphic adenoma.

A

A circumscribed, usually encapsulated tumor with a mesenchymal-like component (usually myxoid, but can be chondroid or osseous). The epithelial component may be ductular or myoepithelial.

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12
Q

What is the diagnosis for a pleomorphic adenoma which seems to have a carcinoma component?

A

Carcinoma ex-pleomorphic adenoma

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13
Q

What is a myoepithelioma? How can it be distinguished?

What about a basal cell adenoma?

A

A pleomorphic adenoma with very little mesenchymal component and no ductular differentiation. Myoepithelium is positive for S100, cytokeratin, GFAP, and actin.

Basal cell adenoma has no mesenchymal component either, but has a population of basaloid cells.

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14
Q

Describe the morphologic appearance of a Warthin’s tumor.

How can it be distinguished from a lymphoepithelial cyst?

A

Papillary and cystic lesion lined by a double layer of oncocytic cells atop a prominent lymphoid infiltrate. Can be bilateral!

Lymphoepithelial cysts have a thin ragged epithelial lining instead of an oncocytic one.

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15
Q

What factors contribute to the grading of a mucoepidermoid carcinoma?

A

Percentage of cystic component

Tumor necrosis

Anaplasia

Mitoses

Neural invasion

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16
Q

Describe the morphologic appearance of a mucoepidermoid carcinoma.

A

A mixture of squamous, epithelioid, and clear cells of which any can dominate. Note intracellular mucin, usually with PAS or mucicarcmine stain. Infiltrative. Resembles an inflamed or metastatic duct.

17
Q

Describe the morphologic appearance of adenoid cystic carcinoma.

A

Very blue, cellular, with dense nuclei with high N:C ratio. Solid or tubular with profound cribriforming and luminal balls of hyaline material.

18
Q

Why is adenoid cystic carcinoma so aggressive?

What if a squamous area predominates?

What other lesions should be considered?

A

It is very invasive and loves nerves.

Favor basaloid squamous cell carcinoma instead.

Cylindroma (skin), polymorphous low-grade adenocarcinoma (lip/palate), basal cell adenoma (well-circumscribed)

19
Q

Describe the morphologic appearance of acinic cell carcinoma.

A

Resembles normal parotid, minus ducts. Pushing rather than infiltrative border. Can have nonserous cell types present. Follows four architectural patterns.

20
Q

What are the four architectural patterns of acinic cell carcinoma?

A

Solid

Microcystic (iregular holes, unlike adenoid cystic)

Papillary cystic

Follicular (like thyroid)

21
Q

What is a PLGA and where does it occur?

A

(polymorphous low-grade adenocarcinoma)

Resembles a pleomorphic adenoma with bland epithelium, but is infiltrative like lobular carcinoma. They occur almost exclusively in the intraoral minor salivary glands.

22
Q
A

Normal salivary gland

Arrow: Salivary duct

Arrowhead: Columnar mucinous cells

23
Q
A

Pleomorphic adenoma

Small and cytologically benign epithelial cells with a myxoid stroma

24
Q
A

Left: Parotid gland with mostly serous glands draining into intercalated ducts (arrowhead). Striated ducts are larger and more oncocytic (arrow)

Right: Interlobular ducts (arrow) with pseudostratified epithelium

25
Q
A

Warthin’s tumor

Note cyst with double-layer of oncocytic cells and dense lymphoid infiltrate

26
Q
A

Low grade mucoepidermoid carcinoma

Clear goblet-like mucinous cells (arrow) and squamous cells (arrowhead).

27
Q
A

Adenoid cystic carcinoma

Note small nuclei but high N:C ratio and classic cribriforming.

28
Q
A

Acinic cell carcinoma, solid pattern

Arrow: Tumor cells with serous acinar morphology

29
Q
A

Acinic cell carcinoma, microcystic pattern

Note irregular spaces. No serous blue granules

30
Q
A

Polymorphous low-grade adenocarcinoma

Arrow: Small tubules of bland cells

Arrowhead: Intervening benign mucinous glands

Book - Molavi (29 decks)

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