Salivary Gland Diseases (2nd Test Material) Flashcards
Tell me about Salivary Gland Neoplasia
- It’s 3% of all head and neck neoplasms
- uncommon but not rare
- slight female predilection
- majority arise during adulthood, unknown etiology
In glandular terms, where do you find Salivary Gland Neoplasia?
- Parotid - 64 - 80%
- Submandibular - 6 - 11%
- Sublingual - less than 1%
- Minor - 9 - 23%
In intraoral terms, where do you find salivary neoplasia?
- Palate - 50%
- Lips - 20%
- Buccal Mucosa - 15%
What is the prevalence of malignancy for the different glandular sites of Salivary Gland Neoplasia?
- Parotid - 15 - 32%
- Submandibular - 37 - 45%
- Sublingual - 70 - 90%
- Minor - 45 - 50%
In intraoral terms, what is the prevalence of malignancy for the different sites of Salivary Gland Neoplasia?
- Palate - 45%
- Upper Lip - 20%
- Lower Lip - 60%
- Buccal Mucosa - 50%
- Retromolar - 90%
- Tongue - 90%
Tell me about Pleomorphic Adenoma.
- 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
What is the site predilection of pleomorphic adenoma?
- Parotid - 80% (63% of all parotid tumors)
- Submandibular - 10% (60% of all submand. tumors)
- Minor - 10% (43% of all intraoral salivary gland tumors)
Tell me about Palatal Pleomorphic Adenoma lesions.
- 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
When the Pleomorphic Adenoma lesion is small, it’s usually round, but it typically becomes what as it grows larger?
bosselated - Marked by numerous bosses or rounded protuberances. (The bulge on the middle of a knight’s shield is called a boss).
What are the top 3 intraoral sites for pleomorphic adenoma?
- palate (54%)
- upper lip (18%)
- buccal mucosa (11%)
What is the histopathology of pleomorphic adenoma?
- 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.
What is the tx for Pleomorphic Adenoma?
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
What is the prognosis for Pleomorphic Adenoma?
- 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
Tell me about Papillary Cystadenoma Lymphomatous.
- Also known as “Warthin tumor”
- Histogenesis: Probably arises from salivary duct epithelium entrapped in parotid lymph nodes during
development
What is the prevalence of Papillary Cystadenoma Lymphomatous?
- Comprises 5% of all salivary gland neoplasms
- 5-14% of parotid gland neoplasms.
- Found almost exclusively in parotid gland.
Who gets Papillary Cystadenoma Lymphomatous?
- Usually Males
- average age 55-60 years
- smokers (8x more likely)
How does Papillary Cystadenoma Lymphomatous look?
- 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
What is the histopathology of Papillary Cystadenoma Lymphomatous?
- 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
What is the tx of Papillary Cystadenoma Lymphomatous?
- Surgical excision
- Prognosis: Very low recurrence rate - 5% range
- Recurrences actually may represent
development of metachronous lesion
Tell me about Monomorphic Adenoma.
- 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
Tell me about Canalicular (tubular) adenoma.
- 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”
What is the tx for Canalicular (tubular) adenoma?
- Tx: Simple enucleation
- Prognosis: Excellent, Virtually no tendency to recur
Tell me about Mucoepidermoid Carcinoma.
- 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
What does Mucoepidermoid Carcinoma look like?
- 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
A Mucocele-appearing lesion of retromolar area should be considered to be what until proven otherwise?
Mucoepidermoid Carcinoma
Can Mucoepidermoid Carcinoma be found centrally within mandible or maxilla?
Yes
What is the histopathology of Mucoepidermoid Carcinoma?
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
What is the tx of Mucoepidermoid Carcinoma?
– Low-grade - wide surgical excision
– High-grade - wide surgical excision, plus radiation
What is the prognosis of Mucoepidermoid Carcinoma?
Depends on tumor size and histologic grade
Tell me about Polymorphous Low-Grade Adenocarcinoma (PLGA).
- 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
What does PLGA look like?
- Usually presents as a firm, painless swelling that may or may not be ulcerated
- Typically well-demarcated initially, later becomes infiltrative
Where is PLGA?
Almost exclusively in minor salivary glands: – posterior hard palate/soft palate (62%) – buccal mucosa (15%) – upper lip (10%)
Usually a very slowly-growing lesion
Why is PLGA called “polymorphous”?
- 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
Low-power PLGA usually shows what?
a lobular growth pattern that infiltrates the surrounding normal tissue, although a pseudocapsule may be present in some areas
What is the histopathology of PLGA?
- 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
What is the tx of PLGA?
Wide surgical excision:
- Prognosis: Excellent
- Recurrence - 20%
- Lymph node metastasis - 7%
- Dead of disease - 2%
Tell me about Adenoid Cystic Carcinoma.
- 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
Tell me more about Adenoid Cystic Carcinoma.
- 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
How does Adenoid Cystic Carcinoma present?
- 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
What is the histopathology of Adenoid Cystic Carcinoma?
- Hyperchromatic basaloid cells with minimal cytoplasm
- Little pleomorphism or mitotic activity
- Marked propensity for this lesion to exhibit perineural and intraoral invasion
What forms does Adenoid Cystic Carcinoma take?
Unencapsulated lesion which may exhibit one or more of three growth patterns:
- tubular - well-differentiated
- cribriform - classic “Swiss cheese”
- pattern - intermediate
- solid - poorly-differentiated
What is the tx for Adenoid Cystic Carcinoma?
- Tx: Wide surgical excision, with radiation therapy afterwards
- Prognosis: Depends on location of lesion, grade, anatomic structures involved, presence of tumor at surgical margins
What is the prognosis for Adenoid Cystic Carcinoma?
- Generally, poor prognosis - slow-growing and relentless
- Patients may die of tumor 20 years
after Dx:
10-year survival – 50%
20-year survival – 25%
Tell me about metastases of Adenoid Cystic Carcinoma.
- 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
Tell me about Acinic Cell Adenocarcinoma.
- 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
Tell me more about Acinic Cell Adenocarcinoma.
- 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
What is the histopathology of Acinic Cell Adenocarcinoma?
– Often they appear to be pseudo-encapsulated, may appear infiltrative
– Basophilic granular cells; bland cells that are histologically very similar to acinar cells
What is the treatment for Acinic Cell Adenocarcinoma?
- Surgical excision
- Prognosis: Guarded
- In AFIP series, 35% recurred, 16% metastasized (usually to lymph node) and 16% died of their disease
Tell me about Carcinoma-ex-Mixed Tumor.
- 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
The majority of carcinomas ex-mixed tumor show areas of what from which carcinomatous elements appear to arise?
typical pleomorphic adenoma
What is the tx for Ca-ex-Mixed Tumor?
- Tx: Wide surgical excision
- Prognosis: Varies with degree of invasion and type of adenoCa Invasion: 8 mm - bad prognosis - all patients died
