Pathology of Salivary Glands Flashcards
Give some reasons why salivary glands may change in size
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
What virus can cause inflammation in Salivary glands?
- Mumps
What clinical signs are present with pts with Salivary neoplasia (tumours)?
- Localised swelling to major gland
- Neurolof=gical change due to facial nerve in parotid
- Painless
- Slow growing
- Well defined
What is the epidemiology of salivary gland tumours?
- Uncommon with about 10 per 100, 000 but increasing
- Mostly adults
- 3% of head and neck neoplasms
- 75% benign
What is the aetiology of salivary gland tumours?
Unclear but may be due to
- Radiation
- Viruses
- Racial susceptibility
Give the distribution of salivary tumours and the %malignancy of each
- Parotid 80% with 15% malignant
- Submandibular 10% with 30% malignant
- Sublingual 0.5% with 80% malignant
- Minor 10% but 45% malignant
According to WHO classification 2017 how are salivary neoplasms classified?
Epithelial neoplasms
- Benign (adenoma) 11 types
- Maligant (adenocarcinoma) 20 types
Non-epithelial neoplasms
- Lymphoma
- Sarcoma
What are the clinical features of major gland neoplasm?
- Lump in affected gland
- Assymetry
- Obstruction - dry mouth
- Pain , facial palsy (late signs)
Give some clinical features of minor or intraoral salivary neoplasm
- occur at junction of hard and soft palate
- Upper lip/ cheek
- Ulcerate late (maligant)
What are the techniques used for diagnosis of neoplasm?
- Ultrasound guided fine needle aspirate
- Core biopsy
- Incisional biopsy
Diagnosing a particular tumour can be difficult. Give some reasons why
- Variation within a tumour +***
What is the most common salivary tumour? What gland does it affect?
- Pleomorphic adenoma
- 75% of all salivary tumours
Affects Parotid most common
Give some histological features of pleomorphic adenoma
-Varied histology giving mixed tumour appearance
- Duct epithelium
- Myoepithelial cells
- Myxoid and Chondroid area
- Has incomplete fibrous tissue capsule
How long should you follow up with a pt who has had pleomorphic adenoma?
- 5 year follow up
- Very commonly reoccurs
What is a malignant pleomorphic adenoma called? What is the % that it progress’ to carcinoma
Carcinoma ex pleomorphic adenoma
- 5% progression
Txt of Pleomorphic adenoma
- Wide local excision
- has recurrence
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?
- Adenolymphoma
- 15% of tumours
- Mostly Parotid
- Smokers
- 10% multiple/bilateral
- Excision
Give the histological features of Warthin’s Tumour
Cystic spaces
Distinctive epithelium
Lymphoid tissue
What are the two main types of Salivary gland carcinomas?
- Adenoid cystic carcinoma (5%, more in minor)
- Mucoepidermoid carcinoma
What are the patterns that adenoid cystic carcinoma can exist in? What type of spread does it have?
- Cribiform (swiss cheese)
- Tubular or solid (less common)
Local spread to nerves and bone
Are adenoid cystic carcinoma easy to txt?
- No diff to treat as has high recurrence
- Long term prognosis poor (20yrs)
- If late diagnosis can spread to metastasis by blood to lung
This shows an adenoid cystic carcinoma. Give the key histological features of them.
- Cribiform architecture
- Cystic spaces
- Malignant cells
What is the prevalence of Mucoepidermoid carcinoma esp USA? What are the 2 cell types found histologically?
- 3-5%
- Squamous (epidermoid)
- Glandular (mucous)
What is the grading/differentiation of mucoepidermoid carcinoma? What is it’s behaviour?
- Cystic or solid
- Has unpredictable behaviour and very rarely has lymphatic spread
What histological features are present Mucoepidermoid carcinoma?
- Squamous epithelium
- Mucous secreting cells
- Cystic spaces
Give two other rarer carcinomas
Acinic cell carcinoma
- Rare , found mostly in parotid
Polymorphous adenocarcinoma
- Minor glands in palate
- Locally infiltrative (nerves)
