Pathology of Salivary Glands

Question 1

Give some reasons why salivary glands may change in size

Answer 1

Secretion retention
- Can be due to Mucocele or Duct obstruction (calculus)

Chronic Sialadenitis

Gland Hyperplasia
- Sialosis
- Sjogrens syndrome
- Seen in alcoholics, diabetic pts

Salivary neoplasms

Question 2

What virus can cause inflammation in Salivary glands?

Answer 2

• Mumps

Question 3

What clinical signs are present with pts with Salivary neoplasia (tumours)?

Answer 3

• Localised swelling to major gland
• Neurolof=gical change due to facial nerve in parotid
• Painless
• Slow growing
• Well defined

Question 4

What is the epidemiology of salivary gland tumours?

Answer 4

• Uncommon with about 10 per 100, 000 but increasing
• Mostly adults
• 3% of head and neck neoplasms
• 75% benign

Question 5

What is the aetiology of salivary gland tumours?

Answer 5

Unclear but may be due to
- Radiation
- Viruses
- Racial susceptibility

Question 6

Give the distribution of salivary tumours and the %malignancy of each

Answer 6

• Parotid 80% with 15% malignant
• Submandibular 10% with 30% malignant
• Sublingual 0.5% with 80% malignant
• Minor 10% but 45% malignant

Question 7

According to WHO classification 2017 how are salivary neoplasms classified?

Answer 7

Epithelial neoplasms
- Benign (adenoma) 11 types
- Maligant (adenocarcinoma) 20 types

Non-epithelial neoplasms
- Lymphoma
- Sarcoma

Question 8

What are the clinical features of major gland neoplasm?

Answer 8

• Lump in affected gland
• Assymetry
• Obstruction - dry mouth
• Pain , facial palsy (late signs)

Question 9

Give some clinical features of minor or intraoral salivary neoplasm

Answer 9

• occur at junction of hard and soft palate
• Upper lip/ cheek
• Ulcerate late (maligant)

Question 10

What are the techniques used for diagnosis of neoplasm?

Answer 10

• Ultrasound guided fine needle aspirate
• Core biopsy
• Incisional biopsy

Question 11

Diagnosing a particular tumour can be difficult. Give some reasons why

Answer 11

• Variation within a tumour +***

Question 12

What is the most common salivary tumour? What gland does it affect?

Answer 12

• Pleomorphic adenoma
• 75% of all salivary tumours
  Affects Parotid most common

Question 13

Give some histological features of pleomorphic adenoma

Answer 13

-Varied histology giving mixed tumour appearance
- Duct epithelium
- Myoepithelial cells
- Myxoid and Chondroid area
- Has incomplete fibrous tissue capsule

Question 14

How long should you follow up with a pt who has had pleomorphic adenoma?

Answer 14

• 5 year follow up
• Very commonly reoccurs

Question 15

What is a malignant pleomorphic adenoma called? What is the % that it progress’ to carcinoma

Answer 15

Carcinoma ex pleomorphic adenoma
- 5% progression

Question 16

Txt of Pleomorphic adenoma

Answer 16

• Wide local excision
• has recurrence

Question 17

What is a Warthin’s Tumour aka? Where is it most affected and who does it mostly affect? Does it occur by itself or in multiples? How is it treated?

Answer 17

• Adenolymphoma
• 15% of tumours
• Mostly Parotid
• Smokers
• 10% multiple/bilateral
• Excision

Question 18

Give the histological features of Warthin’s Tumour

Answer 18

Cystic spaces
Distinctive epithelium
Lymphoid tissue

Question 19

What are the two main types of Salivary gland carcinomas?

Answer 19

• Adenoid cystic carcinoma (5%, more in minor)
• Mucoepidermoid carcinoma

Question 20

What are the patterns that adenoid cystic carcinoma can exist in? What type of spread does it have?

Answer 20

• Cribiform (swiss cheese)
• Tubular or solid (less common)

Local spread to nerves and bone

Question 21

Are adenoid cystic carcinoma easy to txt?

Answer 21

• No diff to treat as has high recurrence
• Long term prognosis poor (20yrs)
• If late diagnosis can spread to metastasis by blood to lung

Question 22

This shows an adenoid cystic carcinoma. Give the key histological features of them.

Answer 22

• Cribiform architecture
• Cystic spaces
• Malignant cells

Question 23

What is the prevalence of Mucoepidermoid carcinoma esp USA? What are the 2 cell types found histologically?

Answer 23

• 3-5%
• Squamous (epidermoid)
• Glandular (mucous)

Question 24

What is the grading/differentiation of mucoepidermoid carcinoma? What is it’s behaviour?

Answer 24

• Cystic or solid
• Has unpredictable behaviour and very rarely has lymphatic spread

Question 25

What histological features are present Mucoepidermoid carcinoma?

Answer 25

• Squamous epithelium
• Mucous secreting cells
• Cystic spaces

Question 26

Give two other rarer carcinomas

Answer 26

Acinic cell carcinoma
- Rare , found mostly in parotid

Polymorphous adenocarcinoma
- Minor glands in palate
- Locally infiltrative (nerves)