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Oral Pathology > Salivary Gland Diseases (2nd Test Material) > Flashcards

Salivary Gland Diseases (2nd Test Material) Flashcards

1
Q

Tell me about Salivary Gland Neoplasia

A
  • It’s 3% of all head and neck neoplasms
  • uncommon but not rare
  • slight female predilection
  • majority arise during adulthood, unknown etiology
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2
Q

In glandular terms, where do you find Salivary Gland Neoplasia?

A
  • Parotid - 64 - 80%
  • Submandibular - 6 - 11%
  • Sublingual - less than 1%
  • Minor - 9 - 23%
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3
Q

In intraoral terms, where do you find salivary neoplasia?

A
  • Palate - 50%
  • Lips - 20%
  • Buccal Mucosa - 15%
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4
Q

What is the prevalence of malignancy for the different glandular sites of Salivary Gland Neoplasia?

A
  • Parotid - 15 - 32%
  • Submandibular - 37 - 45%
  • Sublingual - 70 - 90%
  • Minor - 45 - 50%
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5
Q

In intraoral terms, what is the prevalence of malignancy for the different sites of Salivary Gland Neoplasia?

A
  • Palate - 45%
  • Upper Lip - 20%
  • Lower Lip - 60%
  • Buccal Mucosa - 50%
  • Retromolar - 90%
  • Tongue - 90%
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6
Q

Tell me about Pleomorphic Adenoma.

A
  • It’s a “benign mixed tumor”
  • It’s the most common salivary gland neoplasm
  • named because of a combination of neoplastic ductal
    epithelial and myoepithelial cells
  • Usually develops in an adult patient
  •  Typically in the fourth to sixth decade (mean age - 45 years)
    - Slight female predilection
  • In the major glands, a slow-growing, painless, freely moveable mass will be detected
  • Rubbery firm on palpation
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7
Q

What is the site predilection of pleomorphic adenoma?

A
  • Parotid - 80% (63% of all parotid tumors)
  • Submandibular - 10% (60% of all submand. tumors)
  • Minor - 10% (43% of all intraoral salivary gland tumors)
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8
Q

Tell me about Palatal Pleomorphic Adenoma lesions.

A
  • usually lateral to the midline
  • non-ulcerated, but ulceration may be present secondary to trauma
  • anatomic configuration of posterior hard palate does not allow for mobility of the lesion
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9
Q

When the Pleomorphic Adenoma lesion is small, it’s usually round, but it typically becomes what as it grows larger?

A

bosselated - Marked by numerous bosses or rounded protuberances. (The bulge on the middle of a knight’s shield is called a boss).

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10
Q

What are the top 3 intraoral sites for pleomorphic adenoma?

A
  • palate (54%)
  • upper lip (18%)
  • buccal mucosa (11%)
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11
Q

What is the histopathology of pleomorphic adenoma?

A
  • An encapsulated proliferation of ductal
    epithelial cells and myoepithelial cells
  • proportions of cells may vary tremendously from lesion to lesion.
  • myoepithelial cells may appear spindled or plasmacytoid, and they have the ability to produce a myxoid stroma, hyaline material, cartilaginous material or even osteoid.
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12
Q

What is the tx for Pleomorphic Adenoma?

A

Depends on location:

  • Parotid - remove the lesion with the involved lobe
  • Submandibular - remove the lesion and the involved gland
  • Hard palate - remove the lesion, including overlying oral mucosa, down to periosteum
  • Soft palate, labial and buccal mucosa - enucleation
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13
Q

What is the prognosis for Pleomorphic Adenoma?

A
  • If inadequately treated, this lesion will recur. Seems to be more of a problem with parotid lesions rather than oral lesions.
  • If not removed, may undergo malignant transformation in 5% of cases
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14
Q

Tell me about Papillary Cystadenoma Lymphomatous.

A
  • Also known as “Warthin tumor”
  • Histogenesis: Probably arises from salivary duct epithelium entrapped in parotid lymph nodes during
    development
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15
Q

What is the prevalence of Papillary Cystadenoma Lymphomatous?

A
  • Comprises 5% of all salivary gland neoplasms
  • 5-14% of parotid gland neoplasms.
  • Found almost exclusively in parotid gland.
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16
Q

Who gets Papillary Cystadenoma Lymphomatous?

A
  • Usually Males
  • average age 55-60 years
  • smokers (8x more likely)
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17
Q

How does Papillary Cystadenoma Lymphomatous look?

A
  • non-tender, slowly growing freely moveable mass of the parotid region
  • In 10% of cases, synchronous or
    (mostly) metachronous lesions are observed
  • may be bilateral or unilateral
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18
Q

What is the histopathology of Papillary Cystadenoma Lymphomatous?

A
  • Encapsulated collection of lymphoid
    tissue that usually exhibits typical germinal center formation
  • Cystic spaces containing serous, milky or chocolate-syrup-like fluid
  • Papillary infoldings that are lined by a double row of columnar to cuboidal oncocytes (altered ductal epithelial cells) project into the cystic spaces
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19
Q

What is the tx of Papillary Cystadenoma Lymphomatous?

A
  • Surgical excision
  • Prognosis: Very low recurrence rate - 5% range
  • Recurrences actually may represent
    development of metachronous lesion
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20
Q

Tell me about Monomorphic Adenoma.

A
  • Much less common than pleomorphic adenoma, it is characterized by a proliferation of one cell type
  • the term was originally was used to describe tumors demonstrating a more uniform histopathologic pattern
  • The term probably should be discontinued in favor of the specific tumor
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21
Q

Tell me about Canalicular (tubular) adenoma.

A
  • Seen in both the major salivary glands and intraorally
    - Relatively more common intramurally, especially in the upper labial mucosa
    - Presents as a well-encapsulated, non-tender mass in an older adult (mean age - 65 years)
  • Encapsulated proliferation of cuboidal to columnar cells that form tubules and narrow trabecular cords, with the
    appearance of channels or “canals”
22
Q

What is the tx for Canalicular (tubular) adenoma?

A
  • Tx: Simple enucleation

- Prognosis: Excellent, Virtually no tendency to recur

23
Q

Tell me about Mucoepidermoid Carcinoma.

A
  • Most common intraoral salivary gland malignancy
  • Wide age range - mucoepidermoid Ca is the most common salivary gland malignancy in children, with 15%
    occurring in patient
24
Q

What does Mucoepidermoid Carcinoma look like?

A
  • Well-demarcated or infiltrative mass
  • Non-tender and non-ulcerated initially
  • Ulceration and pain may develop as lesion progresses
  • Fluctuant to hard on palpation
  • May have bluish tinge due to entrapped mucin
25
Q

A Mucocele-appearing lesion of retromolar area should be considered to be what until proven otherwise?

A

Mucoepidermoid Carcinoma

26
Q

Can Mucoepidermoid Carcinoma be found centrally within mandible or maxilla?

A

Yes

27
Q

What is the histopathology of Mucoepidermoid Carcinoma?

A 
comprised of at least two distinct cellular elements -
both must be seen to make the diagnosis:     
1.  mucous cells     
2. epidermoid cells
- Lesional cells usually do not show
significant pleomorphism or increased
mitotic activity, but a spectrum of
differentiation is recognized
28
Q

What is the tx of Mucoepidermoid Carcinoma?

A

– Low-grade - wide surgical excision

– High-grade - wide surgical excision, plus radiation

29
Q

What is the prognosis of Mucoepidermoid Carcinoma?

A

Depends on tumor size and histologic grade

30
Q

Tell me about Polymorphous Low-Grade Adenocarcinoma (PLGA).

A
  • Second most common intraoral salivary gland malignancy
  • Female predilection by a 2:1 ratio
  • Adult population, mean age of 56 years, with a range of 23-94 years
31
Q

What does PLGA look like?

A
  • Usually presents as a firm, painless swelling that may or may not be ulcerated
  • Typically well-demarcated initially, later becomes infiltrative
32
Q

Where is PLGA?

A 
Almost exclusively in minor salivary
glands:
–  posterior hard palate/soft palate (62%)
 – buccal mucosa (15%) 
– upper lip (10%)

Usually a very slowly-growing lesion

33
Q

Why is PLGA called “polymorphous”?

A
  • because one often sees a variety of growth patterns from lesion to lesion or within the same lesion
    - These include solid, trabecular, cribriform-like, ductal and spindle-cell areas
34
Q

Low-power PLGA usually shows what?

A

a lobular growth pattern that infiltrates the surrounding normal tissue, although a pseudocapsule may be present in some areas

35
Q

What is the histopathology of PLGA?

A
  • The lesional cells are usually rather bland cytologically
  • May be confused with adenoid cystic Ca or pleomorphic adenoma if the pathologist is unfamiliar with features of this lesion
36
Q

What is the tx of PLGA?

A

Wide surgical excision:

  •  Prognosis: Excellent
  •  Recurrence - 20%
  •  Lymph node metastasis - 7%
  •  Dead of disease - 2%
37
Q

Tell me about Adenoid Cystic Carcinoma.

A
  • Prevalence: This lesion comprises approximately 5% of all salivary gland neoplasms
    - Intraorally, the palate is the most commonly affected site, with approximately half of the intraoral cases involving that location
  • Parotid and submandibular gland are affected about equally
    - Slight female predilection
    - Age range has been reported from 15-88 years, with a mean of 55 years, and most tumors present in the fifth decade
38
Q

Tell me more about Adenoid Cystic Carcinoma.

A
  • Parotid and submandibular gland are affected about equally
    - Slight female predilection
    - Age range has been reported from 15-88 years, with a mean of 55 years, and most tumors present in the fifth decade
39
Q

How does Adenoid Cystic Carcinoma present?

A
  • Lesion initially presents as a slow-growing, non-ulcerated, infiltrative mass
    - Frequently associated with pain or tenderness may be an early finding
    - Ulceration may develop later in its
    course
40
Q

What is the histopathology of Adenoid Cystic Carcinoma?

A
  • Hyperchromatic basaloid cells with minimal cytoplasm
  •  Little pleomorphism or mitotic activity
  •  Marked propensity for this lesion to exhibit perineural and intraoral invasion
41
Q

What forms does Adenoid Cystic Carcinoma take?

A

Unencapsulated lesion which may exhibit one or more of three growth patterns:

  • tubular - well-differentiated
  • cribriform - classic “Swiss cheese”
  • pattern - intermediate
  • solid - poorly-differentiated
42
Q

What is the tx for Adenoid Cystic Carcinoma?

A
  • Tx: Wide surgical excision, with radiation therapy afterwards
  • Prognosis: Depends on location of lesion, grade, anatomic structures involved, presence of tumor at surgical margins
43
Q

What is the prognosis for Adenoid Cystic Carcinoma?

A
  • Generally, poor prognosis - slow-growing and relentless
    - Patients may die of tumor 20 years
    after Dx:
    10-year survival – 50%
     20-year survival – 25%
44
Q

Tell me about metastases of Adenoid Cystic Carcinoma.

A
  • Lymph node involvement typically accounts for only 5% of metastatic deposits of adenoid cystic Ca
  •  Metastases go to the lung, followed by brain, bone and liver via hematogenous spread
45
Q

Tell me about Acinic Cell Adenocarcinoma.

A
  • Incidence: This neoplasm comprises only 2% of all salivary gland tumors, with the vast majority occurring in the parotid (90%)
  • The remaining 10% are usually seen intraorally
46
Q

Tell me more about Acinic Cell Adenocarcinoma.

A
  • Age range is reported from 5-84 years, with a mean age of about 45 years

- Fairly circumscribed, slow-growing mass in the parotid region; intraorally–buccal mucosa or palate

- Pain or tenderness may eventually become evident in nearly half the cases

47
Q

What is the histopathology of Acinic Cell Adenocarcinoma?

A

– Often they appear to be pseudo-encapsulated, may appear infiltrative
– Basophilic granular cells; bland cells that are histologically very similar to acinar cells

48
Q

What is the treatment for Acinic Cell Adenocarcinoma?

A
  • Surgical excision
    - Prognosis: Guarded
    - In AFIP series, 35% recurred, 16% metastasized (usually to lymph node) and 16% died of their disease
49
Q

Tell me about Carcinoma-ex-Mixed Tumor.

A
  • Peak incidence in the sixth to eighth decades of life
  •  Patient usually is aware of long-standing asymptomatic mass that suddenly becomes tender or is associated with paresthesia
50
Q

The majority of carcinomas ex-mixed tumor show areas of what from which carcinomatous elements appear to arise?

A

typical pleomorphic adenoma

51
Q

What is the tx for Ca-ex-Mixed Tumor?

A
  • Tx: Wide surgical excision

- Prognosis: Varies with degree of invasion and type of adenoCa Invasion: 8 mm - bad prognosis - all patients died

Oral Pathology (7 decks)

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