Pathology of Salivary Gland Tumours

Question 1

What are some causes of changes in salivary gland size?

Answer 1

• secretion retention
• chronic sialadenitis
• gland hyperplasia
• salivary neoplasms
• viral infection

Question 2

What types of pathology can cause salivary secretion retention?

Answer 2

• mucocele
• duct obstruction

Question 3

How do salivary gland neoplasms usually present?

Answer 3

• painless
• slow growing
• well defined
• may observe neurological change (eg facial nerve runs through parotid)

Question 4

What is the epidemiology of salivary gland tumours?

Answer 4

• 10 per 100,00 of general population
• 3% of head & neck neoplasms
• 75% benign

Question 5

What is an example of a viral infection that has an effect on the salivary glands?

Answer 5

Mumps

Question 6

What is the most common type of salivary gland to experience tumours?

Answer 6

Parotid gland (15% are malignant)

Question 7

What might be the first sign of a salivary gland neoplasm?

Answer 7

Localised swelling

Question 8

Which type of salivary gland is most likely to experience a malignant tumour formation?

Answer 8

Sublingual (low change of tumour development, but when tumours develop here they are high risk of being malignant)

Question 9

What are some clinical features seen in patients with tumours of the major salivary glands?

Answer 9

• asymmetry
• obstructions
• pain
• facial palsy (if in parotid)

Question 10

What are the classification types of salivary gland tumours?

Answer 10

Epithelial Neoplasms
- benign
- malignant

Non-epithelial Neoplasms
- lymphoma
- sarcoma

Question 11

Where is the most common area for development of minor/intraoral salivary gland neoplasms?

Answer 11

1. junction of hard/soft palate
2. Upper lip/cheek

Question 12

How can salivary gland tumours be diagnosed?

Answer 12

• ultrasound guided fine need aspirate (FNA)
• core biopsy (more invasive)
• incisional biopsy

Question 13

What problems can occur in diagnosing salivary gland tumours?

Answer 13

• high number of tumour types
• variation within tumour
• common features between types
• not all tumours fit the classification

Question 14

What does NOS stand for in tumour definitions.

Answer 14

Not otherwise specified

Question 15

What is the most common type of salivary gland tumour?

Answer 15

Pleomorphic adenoma (parotid most common)

Question 16

How can the histology of pleomorphic adenoma be described?

Answer 16

Very varied “mixed tumour”
- duct epithelium
- myoepithelial cells
- myxoid areas

Question 17

If a tumour is encapsulated, what might you assume?

Answer 17

It is benign

Question 18

How long should you follow up with a patient that has had a pleomorphic adenoma?

Answer 18

5 year follow-up
- pleomorphic adenoma very commonly reoccurs

Question 19

What percentage of pleomorphic adenomas become malignant?

Answer 19

5% (approx)

Question 20

How are pleomorphic adenomas treated?

Answer 20

Wide local excision

Question 21

What are malignant pleomorphic adenomas called?

Answer 21

carcinoma x pleomorphic adenoma

Question 22

What percentage of benign salivary gland tumours are known as Warthin’s tumours?

Answer 22

15%

Question 23

Where are you most likely to find a Warthin’s tumour?

Answer 23

Parotid gland

Question 24

What social history is relevent in patients with Warthin’s tumour?

Answer 24

Pts tend to be smokers

Question 25

How does the histology of Warthin’s tumours present?

Answer 25

• cystic
• distinctive epithelium
• lymphoid tissue

Question 26

How are Warthin’s tumours treated?

Answer 26

Excision

Question 27

What percentage of salivary tumours are salivary gland carcinomas?

Answer 27

15%

Question 28

What are the varied histological patterns of adenoid cystic carcinoma that are seen?

Answer 28

• cribriform (swiss cheese)
• tubular
• solid

Question 29

What is meant by perineural infiltration of an adenoid cystic carcinoma? What can this cause?

Answer 29

Tumour grows along the nerves in the area
- painful tumour

Question 30

What is seen here?

Answer 30

Adenoid cystic carcinoma

Question 31

What are mucoepidermoid carcinomas?

Answer 31

Malignancies that involve 2 cell types
- squamous
- glandular

Question 32

How can mucoepidermoid carcinomas be differentiated?

Answer 32

cystic or solid

Question 33

Why might a mucoepidermoid carcinoma be present intraosseously?

Answer 33

Jaw bones contain odontogenic epithelium, these are a source of mucous cells (multipotential type of epithelium)

Question 34

When would you use Alcian blue staining?

Answer 34

When investigating mucous producing cells

Question 35

Where is a polymorphous adenocarcinoma tumour located

Answer 35

Minor glands in palate