Pathology - Nichols I Flashcards
Sialadenitis
- infectious or noninfectious (Sjogren syndrome, sarcoidosis, radiation)
- Staph Aureus is often the pathogen
Acute Bacterial Sialadenitis
- typically involves parotid gland
- parotid becomes slow and painful
- purulent discharge drains from the duct
Chronic Sialadenitis
- usually secondary to recurrent or persistent ductal obstruction due to a stone (sialolith)
- episodic pain and swelling, usually at mealtime
- submandibular involvement may include persistent enlargement (Kuttner tumor)
Sialadenitis - Treatment
Acute-abx, rehydration
Chronic-sialolith removal if appropriate
-surgical removal of gland may be indicated for chronic sialadenitis
Salivary Gland Tumors
- uncommon (7% of head/neck tumors)
- 80% involve parotid gland
- 70% are benign
- the smaller the salivary gland, the more likely the tumor in it is malignant
Submandibular Gland
11% of salivary gland tumors
45% are malignant
Sublingual Gland
- rare site for tumors
- 90% malignant
Pleomorphic Adenoma (Benign Mixed Tumor)
- most common type of salivary gland tumor (50% of total)
- tumor arises from mixture of ductal epithelium and mesenchymal elements (2 germ layers, hence it is a mixed tumor)
- 60% in females, middle age (50)
Pleomorphic
variety of patterns that may be seen
Presentation of Pleomorphic Adenoma
- slowly growing, painless, movable, firm mass
- carcinomas can arise in pleomorphic adenomas (rarely, typically a tumor slowly growing for may years that begins rapidly growing)
Appearance of Pleomorphic Adenoma
- typically rounded in shape
- well circumscribed
- not tender
- movable
- commonly with a rubbery texture
Pathology of Pleomorphic Adenoma
- encapsulated
- epithelial component usually in ductal or cystic formations
- mesenchymal component usually myoepithelial cells in a myxoid or chondroid (cartilaginous) matrix
Treatment of Pleomorphic Adenoma
- surgical excision
- injury to facial nerve (CN VII) is main complication of parotidectomy
- good prognosis with removal
Warthin’s Tumor (Papillary Cystadenoma Lymphomatosum)
- second most common benign tumor of parotid
- more common in males (60%)
- more common in late middle age (around 60)
- smoking
Warthin’s Tumor Gross Pathology
- slowly growing mass, painless, firm or fluctuant, in tail of parotid
- 17% bilateral
Warthin’s Tumor Histology
- Cystic spaces lined by a double layer of oncocytes (epithelial cells with abundant granular eosinophilic cytoplasm)
- Prominent lymphoid stroma (commonly with germinal centers)
Warthin’s Tumor Pathogenesis
- uncertain, most polyclonal (not neoplastic)
- most ma be metaplastic lesions with lymphoid reaction
Treatment of Warthin’s Tumor
- surgical removal
- very low recurrence
- with good surgical excision, good prognosis
Mucoepidermoid Carcinoma
- uncommon (15% of all salivary gland tumors)
- most common malignant tumor of salivary gland
- highly variable biologic behavior
- middle age, women
- most common site = parotid & minor glands of palate
Mucoepidermoid Carcinoma Symptoms
- typically an asymptomatic swelling
- intraosseous tumors sometimes occur
Mucoepidermoid Carcinoma Histology
mixture of mucous and squamous cells in variable rations
-red (mucus) with mucicarmine stain
Tumor Grade
how bad it looks under microscope
Tumor Stage
anatomic extent of tumor
What determines Prognosis of Mucoepidermoid Carcinoma?
GRADE
- low 90% 5 year
- high 50% 5 year
Mucoepidermoid Carcinoma Treatment
- based on histologic grade, location, clinical stage
- surgical removal (some/all of gland)
- post-op radiation
Mucoepidermoid Carcinoma Prognosis
- variable: grade, location, stage
- younger patients fare better
