salivary gland disorders Flashcards
What is aplasia an example of? what is it
example of developmental anomaly. VERY RARE, FAILURE TO DEVELOP NORMALLY. can be isolated or combined with down syndrome
what is atresia?
developmental anomaly, FAILURE TO BE TUBULAR. VERY RARE, SUBMANDIBULAR DUCT MOST AFFECTED
What is a mucocele? Types?
A mucocele is a cystic cavity filled with mucous. There is EXTRAVASATION and RETENTION cyst.
What area does a extravasation mucocele most commonly affect?
minor salivary glands of lower lip
What causes extravasation mucosele?
Trauma, usually in children, causes ruptured duct and saliva leaks out
what is a ranula
rare type of extravasation cyst, unilateral, sublingual, asymptomatic,
what is a plunging ranula
mucin goes under mylohyoid and presents as facial swelling
what is histology of mucous extravasation cyst
granulation tissue, macrophages, NO EPITHELIAL LINING
what is histology of mucous retention cyst
less inflamation as retained in duct
What causes retention mucocele
duct obstruction leading to cystic swelling of duct
what structures does retention mucocele commonly affect
both minor and major salivary glands
what are 5 symptoms of acute bacterial sialadenitis
pain, swelling, redness of overlying skin, pus exudation, tenderness
which gland does acute bacterial sialadenitis most commonly affect. what organisms usually cause it.
parotid. staphyloccocus aureus, streptococci, oral anaerobes
what is a predisposing factor to acute bacterial sialadenitis
decreased saliva flow
which gland does chronic bacterial sialadenitis most commonly affect. what causes it.
submandibular. due to duct obstruction via salivary calculi.
What are some features of chronic bacterial siladentitis
either asymptomatic or intermittently painful during mealtimes. Usually unilateral.
what is treatment of chronic bacterial sialadenitis
if mild may recover if obstruction is removed.
if severe must remove obstruction and gland due to SCAR TISSUE.
what causes salivary gland calculi
mineralization of phsophates in supersaturated saliva.
when do calculi cause pain?
Only cause pain when they have caused an obstruction, usually at mealtime.
what predisposes to calculi and thus chronic bacterial sialadenitis?
dehydration, dry mouth
what are the two types of viral sialadenitis
Mumps and HIV associated salivary gland disease
What causes mumps? which gland is most commonly affected? What are complications?
Paramyxovirus, spreads via saliva. PAINFUL swelling of the parotids and other exocrine glands. Complications include orchitis, oophoritis and nephritis.
HIV associated salivary gland disease. what strucutures does it usually affect, what are the symtpms and common histological presentation
may be the first clinical sign of HIV infection, sometimes causes painful, soft, bilateral swelling of the parotids. MULTIPLE CYSTS and lymphoid tissue seen histologically.
Who is most at risk for necrotizing sialometaplasia. Which site does it commonly affect and what is its presentation. what causes it
Males, older and who smoke. Affects minor salivary glands of hard palate. large, deep ulcer which may be painful and takes long to heal. unclear cause, likely ischaemi or infarction due to trauma.
what may you see histologically in necrotizing sialometaplasia and what is the treatment
histologically see necrosis of acini and hyperplasia/ metaplasia of salivary ducts which may be mistaken for cancer.
No treatment, biopsy often curative
what may you see histologicall in chronic bacterial sialadenitis
atrophy os acini, replaced by FIBROUS SCAR TISSUE (may be mistaken for NEOPLASM).
What is sjogren’s syndrome, what are the two types
autoimmune disease which causes lymphocyte infiltration and acinar destruction of SALIVARY AND LACRIMAL glands.
Primary type just dry mouth and or eyes WITHOUT connective tissue disease. has increased risk of developing lymphoma.
secondary type dry mouth and or eyes WITH connective tissue disease like rheumatoid arthritis.
when does sjogrens syndrome onset, who is most affected and what are some symptoms.
Women much more likely than men, onset is middle age.
symptoms include fatigue, joint pain, peripheral neuropathy. dry mouth and dry eyes.
SWELLING OF GLANDS, ESPECIALLY PAROTID.
What test is used to diagnose sjogrens
many tests, one is labial gland biopsy. score of 1 or more is suggetive of having it.
what can be prescribed to sjogrens patients to promote saliva production
acetyl choline esterase inhibitor pilocarpine
what is the clinical presentaiton of sialadenosis
non neoplastic, non inflammatory BILATERAL PAINLESS SYMMETRICAL SWELLING OF SALIVARY GLANDS, usually PAROTID.
what is sialadenosis associated with (7)
poor nutriotion, anorexia, bulimia, diabetes, alcoholism, certain drugs and hormonal imbalances.
what does sialadenosis cause (what changes in the salivary gland) and why is this disease caused
sialadenosis causes hypertrophy of serous acini. likely due to changes in salivary gland innervation.
Are major or minor salivary gland tumors more common
MAJOR, minor only account for 15-20%
which main salivary gland haas most tumors
90% of major salivary gland tumors in PAROTID.
which minor salivary gland haas most tumors
55% on palate, 20% on upper lip. lower lip salivary gland tumor rare.
do major or minor salivary glands have more carcinomas
Proportion of carcinomas (malignant epithelial tumors) is HIGHER IN MINOR SALIVARY GLANDS.
how do you diagnose slaivary gland tumors
through both radiological and clinical findings
what are the 4 methods for obtaining tissue
- fine needle aspiration
- core biopsy
- open biopsy
- excision
why do we often need to excise entire salivary gland tumors to reach diagnosis.
Salivary gland tumors often HETEROGENOUS and all the tumour needs to be examined histologically to reach definitive diagnosis
what is the most common epithelialsalivary gland malignant tumor?
mucoepidermoid carcinoma.
in which gland does mucoepidermoid carcinoma occur most frequently
parotid gland (but can affect others including the minor salivary glands)
what gene is often affected in mucoepidermoid carcinoma
up to 80% have MALM2 gene fusions.
what are the characteristics (aka how does it behave) of mucoepidermoid carcinoma
locally invasive/ infiltrative growth, unencapsulated, can recur and metastasize.
what are the three types of tumor cells in mucoepidermoid carcinoma
mucous secreting, epidermoid (squamoid), inetrmediate.
high level of mucous means cystic.
high epidermoid means solid and agressive
what is the most common salivary gland tumor
pleomorphic adenoma
what percent of parotid gland tumors does pleomorphic adenoma accoutn for
60%
what age and sex is more at risk of pleomoprhic adenoma
slightly F, peak 50-60
what genes are associated with pleomorphic adenoma?
gene rearrangments in PLAG1 and HMGA2
describe the histopathology of pleomorphic adenoma
benign, painless, slow growing, rubbery, well circumscribed, incomplete fibrous capsule, may be cystic.
