ORAL PATH salivary gland pathology

Question 1

what glands are carcinomas more common in?

Answer 1

minor glands

Question 2

list the methods used to confirm a definitive diagnosis of salivary gland tumours?

Answer 2

clinical + radiographic findings
AND
- FNA
- core biopsy
- open biopsy
- excision

Question 3

what is a core biopsy?

Answer 3

large hollow needle removes a core of tissue

Question 4

what is an open biopsy?

Answer 4

surgical incision is made then an incisional biopsy of the lesion is taken

Question 5

what is excision?

Answer 5

all the tumour removed for diagnosis and tx

Question 6

why does ALL of the tumour tend to be examined histologically for salivary gland tumours?

Answer 6

they tend to be heterogeneous

Question 7

what are the 4 categories in the WHO classification of salivary gland tumours?

Answer 7

1. non neoplastic epithelial lesions
2. benign epithelial tumours
3. malignant epithelial tumours
4. mesenchymal tumours specific to the salivary gland

Question 8

list 2 non-neoplastic epithelial lesions

Answer 8

nodular oncocytic hyperplasia
lymphoepithelial sialadenitis

Question 9

list 3 benign epithelial tumours?

Answer 9

pleomorphic adenoma
warthin tumour
canalicular adenoma

Question 10

list 3 malignant epithelial tumours?

Answer 10

mucoepidermoid carcinoma
adenoid cystic carcinoma
acinic cell carcinoma

Question 11

name a mesenchymal tumour specific to the salivary gland?

Answer 11

sialolipoma

Question 12

what is the most common type of all salivary gland tumours?

Answer 12

pleomorphic adenoma

*accounts for approx 60% of all parotid tumours

Question 13

epidemiology of pleomorphic adenoma?

Answer 13

F>M
any age, peak 50/60yrs
associated with gene rearrangements in PLAG1/ HMHA2

Question 14

describe pleomorphic adenoma?

Answer 14

benign
painless
slow growing
rubbery lump

usually solitary

Question 15

pleomorphic adenoma histopathology?

Answer 15

well-circumscribed tumour
incomplete fibrous capsule
may be cystic

Question 16

pleomorphic adenoma tx?

Answer 16

complete excision
if incompletely excised - high recurrence rate

Question 17

what is the name for a malignant transformed pleomorphic adenoma?

Answer 17

carcinoma ex pleomorphic adenoma (high grade, poor prognosis)

Question 18

where do you find warthin tumour?

Answer 18

parotid

Question 19

epidemiology of warthin tumour?

Answer 19

M>F
>50 yrs
strong link with smoking

Question 20

describe warthin tumour?

Answer 20

painless swelling
bilateral in 5-17% cases

Question 21

warthin tumour tx?

Answer 21

excision

Question 22

warthin tumour histopathology?

Answer 22

well-circumscribed within thin capsule
tumour tissue comprised of epithelial and lymphoid elements
cystic spaces

Question 23

where do you find canalicular adenoma?

Answer 23

upper lip

Question 24

canalicular adenoma epidemiology?

Answer 24

F>M
>50 years

Question 25

describe canalicular adenoma?

Answer 25

painless slow growing nodule

Question 26

canalicular adenoma histopathology?

Answer 26

well-circumscribed
rows of epithelial cells
minimal vascular stroma
may be cystic

Question 27

canalicular adenoma treatment?

Answer 27

local excision

Question 28

what is the most common malignant primary epithelial salivary gland tumour?

Answer 28

mucoepidermoid carcinoma

Question 29

where may you find mucoepidermoid carcinoma?

Answer 29

mainly in parotid but can occur in minor glands

Question 30

mucoepidermoid carcinoma epidemiology?

Answer 30

children and young adults
F.M

Question 31

describe mucoepidermoid carcinoma?

Answer 31

locally invasive
can recur
can metastasise

Question 32

mucoepidermoid carcinoma histopathology?

Answer 32

tumour is unencapsulated and displays an infiltrative pattern of growth
3 types of tumour cells:
- mucous secreting (cystic lesion)
- epidermoid (squamoid) (solid lesion = more aggressive)
- intermediate

Question 33

how is a mucoepidermoid carcinoma confirmed?

Answer 33

genetic analysis

Question 34

mucoepidermoid carcinoma tx?

Answer 34

complete excision of tumour

Question 35

where may you find adenoid cystic carcinoma?

Answer 35

parotid, submandibular and minor glands
30% minor gland tumours esp palate

Question 36

adenoid cystic carcinoma epidemiology?

Answer 36

middle aged or elderly patients

Question 37

describe adenoid cystic carcinoma?

Answer 37

slow growing
painful
tends to be ulcerated
predilection to infiltrate and spread along nerve sheaths
may also infiltrate along marrow spaces
metastases appear late
poor prognosis

Question 38

adenoid cystic carcinoma histopathology?

Answer 38

epithelial and myoepithelial cells
microscopic cyst-like spaces within epithelial islands - ‘swiss-cheese’/ lace like pattern

Question 39

adenoid cystic carcinoma treatment?

Answer 39

complete excision of the tumour

Question 40

where would you find acinic cell carcinoma?

Answer 40

most arise as swelling (sometimes cystic) in parotid

Question 41

acinic cell carcinoma epidemiology?

Answer 41

F>M
wide age range including children

Question 42

acinic cell carcinoma histopathology?

Answer 42

non-encapsulated
pushing/ infiltrative pattern of growth
uniform pattern of large tumour cells with granular cytoplasm often in acinar arrangment

Question 43

acinic cell carcinoma treatment?

Answer 43

complete excision of the tumour

Question 44

how are malignant tumours classified?

Answer 44

TNM staging
T - extent of primary tumour
N - absence/ presence and extent of regional lymph node involvement
M - absence/ presence of distant metastasis