Rank1 Sem2 Flashcards
- Central/reparative giant cell granuloma
a. Definition: non-neoplastic intraosseous swelling of jaw with unknown etiology, but some think it may be a reparative to trauma
b. Common clinical presentation: ANTERIOR MANDIBLE 70% swelling
c. Histologically IDENTICAL TO HYPERPARATHYROIDSIM BROWN TUMOR
i. highly vascular stroma rich with MNGC and spindle-shaped cells (i.e. fibroblasts, MNGC precursors and endothelium)
ii. hemosiderin staining
d. RADIO: Unilocular or multilocular radiolucency; ROOT RESORPTIOON IF NEAR ROOTS; quickly expanding
e. Tx: Curettage – high rate of recurrence, which will need subsequent curettage
f. SPECIAL DETAILS
i. DDX btw central giant cell granuloma and brown tumor: the histo will look identical, and the may look identical, so COMES DOWN TO BLOOD TEST TO CHECK FOR PTH AND BLOOD CALCIUM LEVELS (I.E. YOU’D EXPECT HIGH PTH AND HIGH BLOOD CA+2 LVLS)
- Sialolithiasis
= obstruction of salivary gland duct due to calcified mass
a. Etiology = decrease in salivary flow or increase in calcium phosphate in saliva are risk factors for precipitation of calcified mass, and if not cleared, the small calculi then act as seed for increased precipitation and crystal growth
i. So obviously metabolic conditions increasing calcium or phosphate concentration in saliva, or dehydration decreasing clearing flow + increasing calcium and phosphate concentrations
b. Clinical presentation = 1) pain when eating 2) reduced saliva 3) solid lump: 70% submandibular and remainder parotid (because gravity and anatomy of submandibular duct is better suited to promote statis of saliva) 4) can lead to bacterial sialadenitis if untreated, due to statis promoting ascending infection
c. Radio = well demarcated radiopaque lesion on floor of mouth
d. Histology: 1)round calcified mass with concentric layering 2)inflammation of involved gland
e. Tx:
i. 1) small sialolith massage out
ii. 2)large
1. Minor gland excise gland
2. Major glandsurgical removal of calculi
a. Shock wave therapy or endoscopic may be used to avoid surgical approach in major glands
- Sialadenitis
= inflammatory enlargement of salivary glands – 3 types (SIALADENOSIS IS NON-INFLAMMATORY ENLARGEMENT OF SALIVARY GLANDS)
a. Infectious – acinar cell damage from ascending infection through duct into acini
i. Bacterial (S. Aureus most common)
1. Acute – prognosis good (i.e. temporary reduction in saliva)
a. Clinical presentation: parotid + pus
b. Histo: neutrophils infiltration of gland + pus
c. Tx: antibiotics
2. Chronic – prognosis poor (i.e. damaged acini replaced by scar tissue – so reduction in saliva is permanent)
a. Clinical presentation: submandibular (usually with sialolith)
b. Histo: leukocytes infiltration of gland + fibrous scar tissue replacement of acinar cells
c. Tx: antibiotics, might even need surgical removal of gland if duct dilation is an issue, because it’ll just reoccur
ii. Viral (mumps – paramyxovirus) – acinar cell damage reversible
1. Clinical presentation = bilateral parotitis in children
2. Histo???
3. Tx: rest and fluids while wait for viral infection to pass
b. Radiation = salivary gland acini extremely sensitive to radiation; prognosis dependent on how many bouts… could be temporary or result in scar tissue of acini
i. Clinical: almost all patient’s that receive H&N radiation will develop radiation sialadenitis immediately after treatment received
ii. Histo???
iii. Tx: artificial saliva/sugarless gum/candy for duration of treatment?
c. Lymphocytic (i.e. Sjogren syndrome)
i. Clinical presentation: could be primary sjogrens (i.e. xerostomia + xerophthalmia) or secondary Sjogren (like primary but plus diagnosis of autoimmune like lupus or Rheumatoid arthritis as well) + tests positive for serum autoantibodies
ii. Histo: heavy lymphocytic infiltration of gland acinar atrophyscarring + duct epithelium and myoepithelial proliferation
iii. Tx: artificial tears + artificial saliva/sugarless gum/candy
- Mucocele
= mucus cyst
a. Etiology:
i. Extravasation mucocele aka mucus extravasation cyst
1. Trauma duct rupturemucin spillage
ii. Retention mucocele aka mucus retention cyst aka salivary duct cyst
1. Duct obstruction (e.g. sialolith)mucin buildup since can’t escape
iii. Ranula = extravasation mucocele at floor of mouth
1. Trauma to sublingual gland duct
b. Clinical presentation: all are blue colored and fluctuant
c. Histology
i. Extravasation/ranula = 1) ruptured duct/spilled mucin + 2)granulation tissue surrounding the spill + 3) mucin filled foamy macrophages 4) surrounding inflammation (NOTE: IT’S A PSEUDOCYST… NO EPITHELIAL LINING, JUST GRANULATION TISSUE)
ii. Retention = 1) true cyst – mucin encased by duct epithelium 2) no surrounding inflammation
d. Tx:
i. Extravasation = 1) may burst and self-resolve or 2) may not resolve and require surgical excision of lesion + FEEDING GLAND
ii. Ranula = always requires excision of lesion + feeding gland
iii. Retention = surgical excision gland
- Pleomorphic adenoma
= most common benign salivary gland neoplasm. A benign salivary gland neoplasm made of proliferation of both ductal epithelial cells and myoepithelial cells
a. Etiology – no cause, just benign growth
b. Clinical presentation = typically 85% of cases in parotid enlargement the remaining are minor salivary gland enlargements of hard palate
c. Histology
i. Mixture of epithelial and mesenchymal stroma
ii. Epithelial component from ductal epithelial cell proliferation
iii. Mesenchymal component from myoepithelial cell proliferation near basement membrane of duct
iv. Fibrous capsules in major glands only!
d. Tx: 6% CHANCE IT’LL DEVELOP INTO CARCINOMA EX PLEOMORPHIC ADENOMA IF LEFT
i. If in parotid = excise growth, conserve gland. Lots of important structures to be careful of… particularly CN7
ii. If in submandibular = excise the growth + gland
iii. Palatal (minor glands) = excise to periosteum
e. Special fact:
i. WHEN EXCISING FROM PAROTID I.E. THERE’S A FIBROUS CAPSULE… MUST NOT BE TOO CONSERVATIVE. OUTGROWTHS BEYOND CAPSULE ARE COMMON, THEREFORE CONSERVATIVE EXCSION TOO CLOSE TO CAPSULE MAY LEAVE OUTGROWTH BEHIND AND RESULT IN RECURRENT NEOPLASM.
- Mucoepidermoid carcinoma
= most common malignant salivary gland tumor. Characterized by squamous epithelial cells and mucus-secreting cells and cystic spaces filled with mucus
a. Clinical presentation = same area as pleomorphic – i.e. major-parotid and minor-hard palate. LOW-GRADE SAME AS PLEOMORPHIC = SOLITARY, RUBBERY, SLOW GROWING; HIGH-GRADE = ULCERATED AND PAINFUL
b. Histology
i. Squamous epidermoid cells + mucus-secreting cells + intermediate cells (that can differentiate into either of the 2 types)
ii. Cystic spaces fill with mucus
iii. No capsule
iv. Invasive
c. Tx: surgical excision with wide margin
d. Special notes:
i. Low-grade has more mucus-secreting cells & mucus filled cysts
ii. High-grade is more solid because it has more squamous epithelial cells
- Adenoid cystic carcinoma
= malignant salivary gland neoplasm characterized by numerous microscopic “CRIBRIFORM PATTERN” cystic spaces
a. Clinical presentation: 50% minor glands- hard palate often; other 50% equally parotid and submandibular; FACIAL PARALYSIS COMMON-TARGETS NERVES FOR INVASION; OFTEN METASIZES TO LUNGS VIA BLOOD; CAN SPREAD INTO SINUS OR NASAL CAVITY SO DOESN’T EXPAND FACE LIKE MUCOEPIDEROID CARCINOMA AND PLEOMORPHIC ADENOMA DO.
b. Histology
i. Ductal cells and myoepithelial cells forming “ovoid epithelial islands”
ii. “cribriform pattern” numerous microscopic cystic space inside said islands
iii. Invasion of surrounding nerves
c. Tx: Surgical excision
d. Special notes: 1) slow growing + late metastasis 2) favorable 5y but poor long term prognosis 3) prognosis worsened if recurrent or more solid variant
- Polymorphous low-grade adenocarcinoma
= malignant MINOR SALIVARY GLAND TUMOR, characterized by CYTOLOGICAL UNIFORMITY (all cells look same) and DIVERSE ARCHITECTURE
a. Clinical presentation: 65% on hard palate, slow growing + painless
b. Histology
i. Cytological uniformity = all cells look pale + oval nuclei + open chromatin
ii. Diverse architecture = solid + cribriform + ductal …
iii. Invasive growth into adjacent nerves (same as adenoid cystics)
c. Tx: surgical excision with wide margin (24% recur, 6% metastasize)
- Nasopalatine duct cyst
= most common non-odontogenic cyst; a developmental non-neoplastic cyst in incisive canal, derived from epithelial remnants of nasopalatine duct.
a. Clinical presentation: intraoral swelling on anterior midline of hard palate- at incise canal + SALTY TASTING DISCHARGE
b. Histology:
i. Epithelium can vary: SSE if closer to oral, pseudostratified columnar if closer to nasal cavity end of incisive canal
ii. Connective tissue capsule around epithelium contains BV and nasopalatine nerve from incisive canal
c. Radio
i. Large well-defined oval/heart-shaped radiolucency (must be >6mm, if less then its normal incisive canal)
d. Tx: Enucleation via palatal flap
- Antral pseudocyst (neville p.298)
= focal subepithelial edema (under periosteum) of inflammatory exudate, in maxillary sinus mucosa; can occur anywhere technically but normally seen at mucosa of maxillary sinus floor. CAN BE PRIMARY – I.E. SINUS IRRIATION/INFECTION OR SECONDARY TO ADJACENT MAXIALLY ODONTOGENIC INFECTION
a. Clinical presentation: asymptomatic, not visible and often missed or opg, easily rupturable
b. Histology:
i. No epithelial lining (hence the pseudocyst)
ii. Inflammatory infiltrate cause of edema
c. Radio:
i. Solitary dome shaped radiopaque lesion typically on floor of maxillary sinus (not usually on lateral walls)
d. Tx: if secondary to odontogenic infection, will self-resolve once the infection is dealt with. If primary sinus infection, then that needs to be resolved. Sometimes idiopathic, and you can just leave, as GROWTH IS LIMITED.
- Polyp of the sino-nasal tract
= multiple focal subepithelial edema (in lamina propria) of inflammatory exudate, in sinonasal tract, DUE TO SINUS INFECTON OR ALLERGIC SINUSITIS
a. Clinical presentation: sinusitis or nasal obstruction
b. Histology:
i. Inflammatory infiltrate cause of edema
c. Radio:
i. Multiple pendulous shaped radiopacities
d. Tx: 1) nasal corticosteroids 2) surgically remove
