key points to learn SGs Flashcards
SG tumours by incidence
pleomorphic adenoma Warthin's tumour adenoid cystic carcinoma mucoepidermoid carcinoma acinic cell carcinoma
pleomorphic adenoma location
PAROTID
(SM)
(minor - palate)
pleomorphic adenoma clinical
unilateral
painless
slow-growing
not fixed to underlying tissues
pleomorphic adenoma histology
epithelial: ducts/cystic
myoepithelial cells
stroma: myxomatous - CT
fibrous tissue capsule - often incomplete
pleomorphic adenoma tx and recurrence
surgery
recurrence - incomplete capsule
risk of malignant transformation 3-13%
Warthin’s tumour location
PAROTID
(SM)
Warthin’s tumour clinical
smoking
can be bilateral and multifocal
painless
slow-growing
Warthin’s tumour histology
well-defined CT capsule
epithelial tissue, cystic formations
dense lymphoid tissue stroma
- germinal centres
Warthin’s tumour - where is it thought to arise from?
remnants of salivary duct epithelium trapped in LNs during embryogenesis
Warthin’s tumour tx and recurrence
surgery (/monitor)
low recurrence rate
1% malignant transformation of epithelial component
Adenoid cystic carcinoma location
most common minor malignancy - palate
can get major
Adenoid cystic carcinoma clinical
asymptomatic can get ulcer perineural invasion - neuropathies - parotid facial n palsy slow growing invasive
Adenoid cystic carcinoma histology
cribiform tubular solid swiss cheese no capsule perineural invasion
Adenoid cystic carcinoma tx and recurrence
surgery and radio
poor prognosis - local recurrence - hard to determine clinically how far tumour has spread
haematogenous spread to lungs most common
mucoepidermoid carcinoma location
50% parotid
minor - palate
mucoepidermoid carcinoma clinical
swelling pain ulcer infiltration discolouration facial paralysis
mucoepidermoid carcinoma histology
mucin secreting cells
intermediate cells
epidermoid cells
perineural spread
mucoepidermoid carcinoma tx
surgery and radio
high grade poorer survival
acinic cell carcinoma location
parotid >80%
can be bilateral
acinic cell carcinoma clinical
slowly enlarging
few symptoms
occ involves nerves / regional nodes
invasive
acinic cell carcinoma histology
serous acinar cell differentiation
clear/vacuolated cells
intercalated duct like cells
non-specific glandular cells
acinic cell carcinoma tx
slow growth, good prognosis
surgery
sialectasis
cystic dilatation of duct
extrasalivary manifestations of mumps
oophoritis
orchitis
pancreatitis
mumps clinical
bilateral enlargement parotid
pain
skin over unaffected
malaise, fever, headache
mumps histology
accumulation of neutrophils and fluid in lumen of ductal structures
acute bacterial sialadenitis clinical
one gland pus discharge redness of overlying skin trismus pyrexia
acute bacterial sialadenitis histology
acinar destruction with neutrophil infiltrates and bacterial presence
acute bacterial sialadenitis underlying cause
ALWAYS dehydration and flow reduction flow obstruction DM immune suppression abnormal anatomy hospital pts SS elderly HandN radio
mucocele recurrence
esp if traumatic habit persists
RFs = younger pt, ventral tongue
mucocele histology
vascular GT surrounding a mucus pool foam cells macrophage lined cavity cystic cavity severed duct if trauma
sialolithiasis clinical
unilateral SG swelling worst pain periprandial painful intermittent affected gland can get infected - suppurative sialadenitis
sialolithiasis histology
calcified structure
dilated ducts with calculi
chronic inflammatory cells
metaplasia of lining from columnar to SSE - irritation from stone
sialolithiasis diagnosis
hx attempt to palpate calculus radiograph - not always sialography CT - check for other causes of obstruction
sialolithiasis tx
conservative - moist heat and gentle massage - hydration - sialogogues e.g. lemon drops - try to remove it if in proximity of exit - NSAIDs - AB if infection surgery lithotripsy sialendoscopy surgical removal of gland - recurrent stones/irreversible damage to gland
sialosis
non-inflammatory, non-neoplastic, chronic, diffuse enlargement of major SGs
painless
bilateral
can be reactive mechanism e.g. EDs/alcoholism
clinical diagnosis
no tx
sialosis histology
hypertrophy of serous acini
oedema of interstitial CT
causes of xerostomia
dehydration psychological mouth breathing neurological dysfct disease e.g. SS, sarcoidosis meds - tricyclics, antihistamines, diuretics SG tumour SG trauma nutritional deficiencies and/or EDs
pilocarpine dose
5mg up to 30mg
pilocarpine contraindications
iritis and narrow angle glaucoma CV disease chronic pulmonary disease inc uncontrolled asthma pts taking B adrenergic blockers active gastric ulcers
pilocarpine SEs
vision changes hiccups bradycardia hypotension bronchoconstriction hyperhidrosis nausea, vomiting, diarrhoea cutaneous vasodilation increased urinary freq
frey’s syndrome
gustatory sweating
excision from parotid gland and damaged nerve fibres
indication of malignant change
rapid growth
pain
fixation to deep tissues
facial palsy
acute necrotising sialometaplasia process
vascular damage of palatine vessels
ischaemic necrosis and infarction of minor SGs
acute necrotising sialometaplasia histology
hyperplasia
metaplasia of ducts
necrosis of salivary acini
sarcoidosis
collections of granulomas
can occur in any organ but often affect SGs causing large masses and facial palsy
duct atresia
failure of a duct to canalise
can result in salivary retention cysts
HIV
parotid enlargement in 10% pts
CF
causes plugging of acinar ducts with precipitated secretions
essentially microscopic sialoliths
gland infiltration - amyloidosis
build up of amyloid protein fibrils
lymphoepithelial cysts
aplasia
congenital absence of 1 or more SGs
ectodermal dysplasia
why are SG tissues sensitive to radio?
because of their highly differentiated and specialised state
- not because of high mitotic figures
SG and chemo
reduced secretion
early apoptosis of SG cells
radioiodine
reduction of gland fct
increased lymphocytic infiltrate
SS investigations
1 - dry eyes subjective 2 - dry eyes objective 3 - dry mouth subjective 4 - dry mouth objective 5 - autoAB findings 6 - HP American european consensus group revised international criteria 4 or more positive criteria (must inc 5 and/or 6)
SS minor gland histology
focal lymphocytic sialadenitis - focal collections of 50+ lymphocytes - ≥1 collection/4mm2 acinar loss fibrosis
SS major gland histology
lymphocytic infiltration
atrophy of acini
ductal epithelium shows hyperplasia which eventually occludes ducts - myoepithelial islands
