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pathology > head and neck -- oral and salivary gland pathology > Flashcards

head and neck -- oral and salivary gland pathology Flashcards

1
Q

What structures fall under the realm of head and neck?

A

Everything that touches air or food:

  • oral cavity
  • upper resp. tract
  • ears
  • nose
  • salivary glands
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2
Q

True/False….All mucosa within ENT domain behaves the same toward degenerative, inflammatory, and neoplastic incluences.

A

True. And they all have a thicker squamous mucosa to deal with contact with any non-air/food

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3
Q

Which cells make the enamel for teeth?

A

amelioblasts

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4
Q

How does tooth decay (or caries) occur?

A
  • sugar is present in the oral cavity
  • bacteria (strep mutans or lactobacilli) convert the sugar to acid
  • acid degrades the teeth
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5
Q

What results from buildup of bacteria/cells/proteins around the teeth?

A

plaque/calculus/tartar

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6
Q

What is the difference between an irritation fibroma and pyogenic granulation?

A

fibroma is not well vascularized, will not blanch.

granuloma will blanch.

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7
Q

How is a Tzanck test performed and what constitutes a positive?

A

blood smear to identify a herpetic lesion. gently scrape a vesicle, smear it, stain with about anything, examine.

looking for squamous cells with much larger than usual nuclei and inclusions. probably surrounded by PMNs.

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8
Q

What type of mucosa does candida love?

A

moist, non-keratinized stratified squamous cell mucosa (mouth, vagina, genital skin)

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9
Q

What treats candida very well?

A

gentian violet

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10
Q

What is the Periodic acid–Schiff (PAS) staining method useful for?

A

good for polysaccharides, glycoproteins, and glycolipids in tissues.

also, stains yeasts and pseudo-hyphae (non-septate hyphae) a bright red.

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11
Q

What could basic leukoplakia mean? What about hairy leukoplakia?

A

Basic could mean anything from nothing to sever.

Hairy almost always means HIV.

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12
Q

What is the progression from normal tissue to SCC?

A

NORMAL | DYSPLASIA | CARCINOMA-IN-SITU (severe dysplasia) | INFILTRATING MALIGNANCY (into basement membrane)

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13
Q

What is the classic presentation of infiltrative SCC of the mouth?

A

a plaque w/ ulceration and induration under the ulcer bed

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14
Q

Where would you take the biopsy from an oral SCC (center or edge)?

A

From the edge…center is necrotic.

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15
Q

What are three forms of SCC differentiation and what are the histologic findings with each?

A
  • well: pearls
  • moderate: intercellular bridges
  • poor: can’t even tell it’s squamous (mayhem)
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16
Q

What are the three major salivary glands?

A

parotid
submandibular
sublingual

17
Q

True/false: salivary glands are sensitive to inflammatory processes and the development of neoplasms

A

true

18
Q

What are some conditions which may produce salivary enlargement?

A
  • Bacterial infection
  • Viral infection (such as Mono or Mumps)
  • Tuberculosis
  • Sjogren’s syndrome
  • Sarcoidosis
  • Alcoholism
  • Tumors (although salivary gland enlargement is usually nonneoplastic)
19
Q

What are the risk factors for salivary gland stones (sialolithiasis)?

A

obstruction (food/edema/cellular debris)
prior trauma
duct dehydration

20
Q

What is sialadenitis? What causes it? What is the distribution pattern?

A

inflammation of a salivary gland (with or without supra-infection). can be acute, chronic, or recurrent

frequently due to obstruction (such as a stone), bacteria/viral infx, trauma, autoimmune.

usually unilateral involving a single gland

21
Q

What is a common finding with chronic sialadenitis

A

squamous metaplasia of an interlobular duct

22
Q

What is the most common form of viral

sialadenitis?

A

Secondary to mumps

23
Q

What is the most common form of salivary duct calculi?

A

calcium phosphate stones

24
Q

In which gland are stones most commonly found?

A

submandiblar

25
Q

What is the classic place for ANY visible parotid swelling or tumor to present?

A

between the tip of the ear and the tip (angle) of the mandible.

26
Q

What is Mikulicz syndrome and what potentially causes it?

A

Combination of salivary and lacrimal gland enlargement (usually painless) plus xerostomia (dry mouth).

Potential etiologies include but are not limited to leukemia, lymphoma, Sjogren, sarcoidosis, and other granulomatous diseases.

27
Q

Which autoimmune condition has a major feature of xerostomia?

A

Sjogren’s (usually with dry eyes)

28
Q

What type of duct is involved in the formation of a mucocele and where do they typically occur?

A

Salivary gland duct.

Usually on the lower lip.

29
Q

What are mucoceles filled with? Lined with?

A

Filled with mucin, lined with inflammatory granulation or fibrous connective tissue

30
Q

How to get rid of mucocele?

A

Most resolve spontaneously. If not, cut it out. If excision is incomplete, it will likely grow back.

31
Q

W/r/t salivary neoplasms and Warthin tumors: Do they tend toward males/females? During which decades of life do benign and malignant tumors tend to present?

A

Salivary neoplasms: slight female dominance
Warthin tumors: much more often males
Benign tumors: 50s-70
Malignant tumors: 70+

32
Q

What is the ONLY clearly associated risk factor for salivary gland malignancy?

A

Head/neck radiation (like in cancer tx)

33
Q

Know the percentage of tumors that are malignant for parotid, submandibular, minor salivary, and sublingual glands

A

parotid: 15-30% (least likely to be malignant)
submandibular: 40%
minor salivary: 50%
sublingual glands: 70-90% (almost all are)

34
Q

What form of cancer are all salivary gland malignancies?

A

Adenocarcinoma…they’re all glands.

35
Q

What are the most common benign salivary tumors?

A

Mixed (pleomorphic adenoma) and Warthin’s

36
Q

Which specific gland gets most salivary gland tumors?

A

Parotid

37
Q

With pleomorphic adenomas, how does the risk of malignancy change over time?

A

2% risk if less than 5 years, if it lasts 15 years there’s a 10% risk.

38
Q

What is the 5-yr survival rate for salivary gland adenocarcinomas?

A

30-50%

pathology (5 decks)

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