Salivary Gland Disorders Flashcards
Salivary gland developmental abnormalities are rare. name two salivary gland developmental abnormalities
aplasia
atresia
what is aplasia?
salivary gland fails to develop normally
what is atresia?
ducts fail to be tubular
what duct does atresia mainly affect?
submandibular
what is a mucocoele?
a cystic cavity filled with mucus
what are the two types of salivary mucocoele?
extravasion mucocoele/cyst
retention mucocoele/cyst
what is an extravasion mucocoele caused by?
ruptured duct which leaks saliva into surrounding connective tissue which elicits an inflammatory reaction - associated with trauma
what are the clinical features of an extravasion mucocoele?
Blue-ish or transparent swelling that’s asymptomatic
what gland does extravasion mucocoele mainly affect?
minor glands especially lips
extravasion mucocoele is common in ?
children and young adults
what is the histopathology of an extravasion mucocoele?
Cystic cavity filled with mucin surrounded by inflamed granulation tissue (macrophages) in connective tissue
why is an extravasion mucocoele not a true cyst?
no epithelial lining
what is the treatment for an extravasion mucocoele?
Remove mucocoele, ruptured duct and gland if possible to prevent recurrence
what is a ranula?
uncommon form of extravasion mucocoele from sublingual gland
clinical features of a ranula
Painless, bluish 2-3cm swelling in the floor of the mouth
treatment of a ranula?
Drainage and removal of sublingual gland
what is a plunging ranula?
Swelling in the neck as mucin passes through and develops below the mylohyoid
what is this Blue-ish or transparent swelling that’s asymptomatic?
extravasion mucocoele
what is this Painless, bluish 2-3cm swelling in the floor of the mouth?
ranula
what is this Swelling in the neck as mucin passes through and develops below the mylohyoid?
plunging ranula
what is a retention mucocoele?
Cystic dilatation of a duct due to obstruction
what are the clinical features of a retention mucocoele?
Blue-ish or transparent swelling that asymptomatic
what gland do retention mucocoeles affect?
major and minor salivary glands
can you get a retention mucocoele on the lower lip?
yes but rare
what is the histopathology of a retention mucocoele?
Mucin retained in dilated duct
is a retention mucocoele a true cyst?
yes as lining is epithelial lining of the duct
which type mucocoele has less inflammation, extravasion or retention? why?
retention mucocoele as saliva is retained within the duct and not in connective tissue
what is the treatment for a retention mucocoele?
excision
what is sialadenitis?
Inflammation of the salivary glands
sialadenitis can be caused by what two things?
bacteria and viruses
what bacteria are associates with sialadenitis?
Staph. Aureus, Streptococci and oral anaerobes
what are the two types of bacterial sianadenitis?
acute bacterial sialadenitis
chronic bacterial sialadenitis
what gland is most often affected in acute bacterial sialadenitis?
parotid gland
what are the clinical features of acute bacterial sialadenitis?
Pain, swelling, tenderness, puss, redness
Decreased salivary flow
what is the treatment for acute bacterial sialadenitis?
Antibiotics after culture/sensitivity testing
what is this painfull, tender, red swelling of the parotid?
acute bacterial sialadenitis
what is this infection of the parotid with puss from the duct?
acute bacterial sialadenitis
what gland is most often affected in chronic bacterial sialadenitis?
submandibular gland
what causes chronic bacterial sialadenitis?
Obstruction of duct by stone, salivary calculi or mucous plugs
what are the clinical features of chronic bacterial sialadenitis?
Asymptomatic or intermittent pain at meal times
Firm mass that may be mistaken for neoplasm (cancer)
histopathology for chronic bacterial sialadenitis
Salivary ? become ? (waisted away) and are replaced by ???
Salivary ? become ? with ? of the ?
Chronic inflammatory infiltrate (?? and ?) within the gland
acini
atrophic
fibrous scar tissue
duct
dilated
hyperplasia
epithelium
plasma cells
lymphocytes
treatment for chronic bacterial sialadenitis if mild
remove obstruction and it will heal
treatment for chronic bacterial sialadenitis if extensive
remove obstruction and gland
look at this VM presentation of chronic bacterial sialadenitis
what viruses are associated with viral sialadenitis?
mumps and HIV
what is mumps?
Acute contagious infection caused by paramyxovirus
clinical features of mumps
Painful swelling of glands (parotid), fever, headache and malaise
mumps is typically seen in ?
children and young adults
prevention for mumps
MMR vaccine
name three significant implications of mumps
orchitis - inflammation of testicles
oophoritis - inflammation of ovaries
nephritis - inflammation of kidneys
what is this Painful swelling of glands (parotid), fever, headache and malaise?
mumps
clinical presentation of HIV
Swelling and occasional pain of major glands (parotid)
Cysts
what is another name for salivary calculi?
salivary sialoliths or stones
what gland is most often affected by salivary calculi?
submandibular gland
salivary calculi are seen mainly in?
adults
what is the cause of salivary calculi?
Mineralisation of phosphates from supersaturated saliva deposited around a central nidus of cell debris
Bacteria often grow on the stone surface eliciting an inflammatory response
clinical presentation of salivary calculi
Asymptomatic until obstruction then pain at meal times
treatment of salivary calculi
Remove or breakdown stones
Remove gland
this shows a salivary calculi
cause of necrotising sialometaplasia
Trauma causing ischaemia (reduced blood flow) or infarction (death of tissue from lack of blood supply)
clinical presentation of necrotising sialometaplasia
Large, deep, painful ulcer that’s slow to heal
necrotising sialometaplasia is most common in
males
older patient
smokers
histopathology of necrotising sialometaplasia
Necrosis of salivary acini
Inflammation and hyperplasia/metaplasia of salivary ducts (often mistaken for cancer
treatment of necrotising sialometaplasia
Not required as heals itself but biopsy taken if mistaken for cancer
what is this Large, deep, painful ulcer that’s slow to heal?
necrotising sialometaplasia
what is Sjogren’s syndrome?
Autoimmune disease with lymphocytic infiltration and acinar destruction of lacrimal and salivary glands
sjogren’s syndrome affects mainly
females and middle aged
what is primary Sjogren’s syndrome?
Dry eyes and mouth with no connective tissue disease
patients with primary Sjogren’s syndrome are at increased risk of developing what?
lymphoma (cancer in lymph system) in affected glands
what is secondary Sjogren’s syndrome?
Dry eyes and mouth and a connective tissue disease e.g. rheumatoid arthritis
clinical features of Sjogren’s syndrome
Fatigue, joint pain, peripheral neuropathy
Complications of dry mouth and eyes
Swelling of salivary glands
Connective tissue disease in secondary Sjögren’s syndrome
how is Sjogren’s syndrome diagnosed?
Lower lip biopsy, examined for collections of lymphocytes
how is Sjogren’s syndrome treated/managed?
Rheumatology to treat systemic symptoms
Ophthalmology for eyes
Stimulate saliva production
Caries prevention
what is the cause of sialadenosis?
Salivary gland innervation problem secondary to peripheral autonomic neuropathy
sialadenosis clinical features
Bilateral non-inflammatory swelling of the salivary glands
Painless
what gland does sialadenosis commonly affect?
parotid
histopathology of sialadenosis
Hypertrophy of serous acini
sialadenosis is associated with?
malnutrition, anorexia, bulimia, alcoholism, diabetes mellitus, drugs and hormonal disturbances
what is this painless bilateral non-inflammatory swelling of the salivary glands (parotid)
sialadenosis
what gland do salivary gland tumours mainly affect?
major salivary glands -> parotid
how are salivary gland tumours diagnosed?
clinical and radiological findings
tissue sample
what is Fine needle aspiration FNA tissue sampling method?
uses needle to aspirate cells
what is core biopsy tissue sampling method?
hollow needle used to remove a core of tissue
what is open biopsy tissue sampling method?
surgical incision then an initial biopsy
what is excision tissue sampling?
all of the tumour is removed for diagnosis and treatment
what are the 5 who classifications of salivary gland tumours?
malignant tumours
benign tumours
non-neoplastic epithelial tumours
benign soft tissue lesions
haematolymphoid tumours
what does non-neoplastic epithelial lesion mean?
uncontrolled cell proliferation in the epithelium resulting in a lesion (damaged tissue) not associated with abnormal tissue growth
what does haematolymphoid tumour mean?
haematopoietic (associated with fromation of red blood cells) and lymphoid neoplasms
what is the most common malignant salivary gland tumour?
Mucoepidermoid carcinoma
what is an mucoepidermoid carcinoma?
Epithelial salivary gland malignant tumour
what is the cause of mucoepidermoid carcinoma?
MAML2 gene fusions
mucoepidermoid carcinoma contains what 3 types of tumour cell?
mucous-secreting cells, epidermoid (squamoid) cells, intermediate cells
treatment for mucoepidermoid carcinoma
complete excision
what is the most common benign tumour?
pleomorphic adenoma
clinical presentation of pleomorphic adenoma
Painless, slow growing, rubbery lump
cause of pleomorphic adenoma
Gene rearrangements: PLAG1 or HMGA2
histopathology of pleomorphic adenoma
Incomplete fibrous capsule, may be ?
Intermingling of ? and ? cells.
Epithelial cells can ? to ?? type
Can undergo ??
cystic
epithelial
myoepithelial
differentiate
connective tissue
malignant transformation
treatment for pleomorphic adenoma
Complete excision
what is this Painless, slow growing, rubbery lump
pleomorphic adenoma
what is this?
mucoepidermoid carcinoma
