Pathology Of Salivary Glands Flashcards
Congenetal (salicary glands)
Heterotopia
Heterotopia
Salivary gland tissue present in areas it’s not supposed to be)
Intranodal or extranodal (mandible, ear, tonsil, pituitary, thyroid)
Acquired (salivary glands)
Sialadenosis
Obstructive disorders
Inflammatory Disorders
Sialadenosis
Bilateral, painless enlargement of salivary glands
Causes of Sialadenosis
▪ Nutritional (Alcoholism, Cirrhosis, Kwashiorkor and Pellagra
▪ Endocrine (Diabetes, Thyroid disease, Gonadal dysfunction)
▪ Neurochemical (Vegetative state, Lead, Mercury, Iodine, Thiouracil)
Obstructive disorders
1-mucocele
2-ranula
3-sialolithiasis
Mucocele
Cyst filled with mucus and lined by granulation tissue
Mucocele usually in
Small glands in lower lip
Mucocele characterstics
Small
Bluish
Transparent
Rupture and reform
Mucocele microscpy
Granulation tissue surrounding extravasated mucus
Ranula
Type of mucocele in the floor of the mouth
blue dome shaped swelling in the floor of mouth (FOM)
Rabula in ——— mucocele
Larger
Conse of ranula
Elevate tongue
Ranula ( distinguish it from a midline dermoid cyst)
Located lateral to the midline
Sialolithiasis
Stones in the salivary glands that result in a mechanical obstruction of the salivary duct
Sialolithiasis is a major cause of
unilateral diffuse parotid or submandibular gland swelling
most common site of sialolithiasis
submandibular gland
Sialolithiasis Usually post-inflammatory (due to
increased viscosity of the secretions)
Sialolithiasis on x-ray
Radiopaque
Sialolithiasis
swelling, pain at meal time (Due to increased salivation when eating
Sialolithiasis cause
correlation with smoking and gout
Predisposing factors to salivary gland infection:
▪ Duct obstruction by stones (sialolithiasis)
▪ impacted food debris
▪ edema consequent to injury
▪ Dehydration and decreased secretory function (predispose to bacterial invasion)
▪ Extremes of age
▪ Poor oral hygiene
Acute Sialadenitis:
Most causaitve agent
mostly bacterial (e.g. s. aureus)
ascending infection from the mouth
Acute Sialadenitis often affects
Major glands
More common in parotid
Why Acute Sialadenitis is more common in oatitid
because they’re serous
(Mucoid saliva contains elements
that protect against bacterial infection)
Acute Sialadenitis:
Gross
gland is red and tender, pus coming out of the duct
Chronic Sialadenitis:
Causes
MTB/ recurrent sialadenitis
recurrent sialadenitis → patients who have:
- duct obstruction
- hyposecretion of saliva (xerostomia)
- ascending infection:
Chronic Sialadenitis:
Microscopy
prominent inflammatory cell infiltrates, increased replacement of
parenchyma with adipose cells, periductal fibrosis and ductal dilation
Viral sialadenitis:
Causes
EBV, CMV, Mumps (paramyxovirus)
Mumps
Upper respiratory infection (droplet) —> incubation period (2-3 wks) —> viremia
(during which patient presents with fever) —> localize in certain tissues (salivary
glands, testes, CNS)
Mumps gross
uni/bilateral painful swelling of parotid gland
Mumps microsco
interstitial lymphoplasmacytic infiltrate
Mumps rare complicatins
orchitis, menigoencephalitis, pancreatitis, arthritis, May be
serious in adults –> sterility & deafness
Lst common immunilogic disorder associated with salivary
gland dissase
Sjogren’s syndrome:
Sjogren’s syndrome:
autoimmune disorder characterized by keratoconjunctivitis sicca (dry eyes) and xerostomia (dry mouth)
Primary Sjogren’s syndrome:
without other connective tissue disease (but frequently associated with involvement of other organs, including the thyroid, lung and kidney)
Secondary Sjogren’s syndrome:
associated with other connective tissue disorders (SLE, rheumatoid arthritis, scleroderma, polymyositis)
Sjogren’s syndrome
Pathogenesis
lymphocyte-mediated destruction of the exocrine glands → dry eyes and dry mouth
Sjogren’s syndrome: 90% cases in ?
Average age of onset?
women
50 yrs
Sjogren’s syndrome may progress to
B cell lymphoma
Mikulicz syndrome:
combination of salivary and
lacrimal gland inflammatory enlargement
(usually painless) and
xerostomia
Mikulicz syndrome
Causes
sarcoidosis,
leukemia,
lymphoma, and
idiopathic lymphoepithelial hyperplasia
Xerostomia
dry mouth - from decrease production of saliva
Xerostomia increased incidence with increased
age
Xerostomia
Causes
autoimmune disorders (Sjögren syndrome), radiation therapy, side effect of medications
Xerostomia gross
Oral cavity shows dry mucosa and/or atrophy of tongue papillae with fissuring and
ulcerations
Xerostomia Complications
increased dental caries and candidiasis, as well as difficulty in swallowing
and speaking
Salivary gland tumors:
- Uncommon, usually in ——— predominance
- Mostly (75%) in——- gland
adults, slight female
parotid
Proportion of malignant and benign varies with the gland of origin:
Parotid: Most common site but tumors here are mostly benign
Submandibular and sublingual: Less common sites but higher percentage of malignancy
Pleomorphic adenomas originate from
Intercalated duct cells and
Myoepithelial cells
Oncocytic tumors originate from
Striated duct cells
Acinous cell tumors originate from
Acinad cells
Mucoepidermoid tumors and SCC develop in the
Excretory duct
