Salivary gland disorders, pathology Flashcards

1
Q

Aplasia

A
  • Failure to develop normally
  • Of salivary glands is very rare. It may occur as an isolated event or as part of a hereditary syndrome (e.g Down syndrome)
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2
Q

Atresia

A
  • Failure to be tubular
  • of ducts is also very uncommon. Submandibular duct most often affected when it does occur
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3
Q

Heterotopic salivary tissue

A

Can be found at various sites in head and neck

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4
Q

What is a mucocoele ?

A

Is a cystic cavity filled with mucus

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5
Q

What are the two mucocoele ?

A
  • Extravasation mucocoele (also called mucous extravascation cyst)
  • Retention mucocoele (also called mucous retention cyst)
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6
Q

Extravasation Mucocoele

A

Clinical Features/Aetiology

  • Presents as a bluish or transparent swelling
  • Most commonly affects minor glands especially in the lower lip
  • Occurs over a wide age range but most frequently seen in children and young adults
  • Asymptomatic
  • May discharge only to re-form
  • Typically history of trauma associated with the lesion
  • Due to ruptured duct with leakage of saliva into surrounding connective tissue
  • Leaked saliva elicits an inflammatory reaction
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7
Q

Mucous Extravasation cyst

A

Histopathology
- Lesion appears as a cystic cavity filled with mucin in connective
- Mucin is surrounded by inflamed granulation tissue, typically with lots of macrophages
- Not classed as a true cyst as no epithelial lining

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8
Q

Mucous retention cyst (clinical features/aetiology)

A
  • Similar appearance to but less common than extravasation cyst
  • Rare on lower lip
  • Can affect the major and minor glands
  • Represents cystic dilatation of a duct typically due to obstruction
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9
Q

Mucous retention cyst (Histopathology)

A
  • Mucin retained within a dilated duct
  • Cyst lining is epithelial lining of the duct
  • As saliva is retained within the duct and doesn’t escape, there is much less inflammation

Treatment
- Excision

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10
Q

Ranula

A
  • Painless soft bluish swelling in floor of mouth
    Clinical features
  • Presents as painless soft bluish swelling in floor of mouth
  • Unilateral
  • 2-3 cm in size
  • It is an uncommon form of mucous extravasation cyst arising from sublingual gland
  • A ‘plunging ranula’ arises when the mucin passes through and develops below mylohyoid as swelling in neck
    Treatment
  • Drainage of the cystic cavity and removal of sublingual gland
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11
Q

Acute Bacteria Sialadenitis

A
  • The most common causes are bacterial or viral infection
    Clinical features
  • Parotid most often affected
  • Decreased salivary flow is major predisposing factor
  • Patients present with pain, swelling, tenderness, exudation of pus. There may be redness of overlying skin
  • Associated bacteria frequent Staphylococcus aureus, streptococci and oral anaerobes
    Treatment
  • Appropriate antibiotics after culture/sensitivity testing
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12
Q

Chronic Bacterial sialadenitis

A

Clinical features
- Usually secondary to duct obstruction
- Obstruction most frequently caused by stones/salivary calculi/mucous plugs (parotid)
- Submandibular gland most often affected
- Typically unilateral
- May be asymptomatic or may be intermittent painful swelling which is usually mealtime related
Treatment
- The gland may recover from mild sialadenitis if the associated obstruction can be removed
- If more extensive sialadenitis, the obstruction can be removed
- If more extensive sialenitis, the obstruction and gland requires to be excised

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13
Q

Salivary calculi (Sialoliths/stones)

A
  • Submandibular gland most commonly affected
  • Calculi mainly occur in adults
  • Caused by mineralisation of phosphates from supersaturated saliva being deposited around a central nidus of cell debris
  • Calculi may form within ducts in the gland or in the main excretory duct
  • Calculi vary in size, may be more than one, may be round or avoid, rough or smooth and usually yellowish in colour
  • Bacteria often grow on the stone surface and elicit an inflammatory response
  • No symptoms until stone cause obstruction
  • Typically unilateral swelling/pain, often at mealtimes
  • Calculi do not cause dry mouth however factors which icnrease saliva saturation e.g. dry mouth, dehydration predisposes to stones
  • Treatment varies depending on size and location of stones
  • May be possible to remove or breakdown some stones. Alternatively it may be necessary to remove the gland, especially if it has become very damaged by longstanding infection
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14
Q

Mumps (Viral Sialadenitis)

A
  • Acute, contagious infection caused by paramyxovirus
  • Spreads via saliva
  • Mumps causes painful swelling of parotids and other exocrine glands
  • Patients also present with fever headache, malaise
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15
Q

Necrotising Sialometaplasia (Clinical features)

A
  • It is more common in males than females
  • More frequently seen in older patients and in smokers
  • It mainly affects minor salivary glands, especially those in the hard palate
  • Presents as a large, deep ulcer
  • May be painful
  • Slow to heal, often takes several weeks
    Treatment
    None required, it slowly resolves itself. Biopsy is usually curative
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16
Q

Sjogren’s syndrome

A
  • Is an autoimmune disease of unknown cause
  • characterised by lymphocytic infiltration and acinar destruction of lacrimal and salivary glands (and other exocrine glands)
    Clinical features
  • Onset middle age
  • Females are much more commonly affected than males
  • Systemic symptoms including fatigue, joint pain, peripheral neuropathy
  • Complications of dry mouth - caries, periodontal disease, difficulty with swallowing, speech, taste, predisposition to infections
  • There may be swelling of salivary glands, esp parotids
  • Eye problems due to dry eyes
  • Connective tissue disease in 2 sjogren’s syndrome
17
Q

What are the two forms of sjogren’s syndrome that exist?

A
  • Primary sjogren’s syndrome
  • Secondary Sjogren’s syndrome
18
Q

Primary sjogren’s syndrome

A

Patients have dry eyes and/or a dry mouth with no associated connective tissue disease

  • Increased risk of developing lymphoma in affected glands
19
Q

Secondary sjogren’s syndrome

A

Patients have dry eyes and/or, a dry mouth and a connective tissue disease, e.g. rheumatoid arthritis

20
Q

What are the diagnostic tests for sjogren’s syndrome?

A
  • One test is a labial gland biopsy taken from the lower lip. The biopsy aims to sample 5-8 minor glands
  • The biopsy is examined, in particular noting focal periductal collections of 50 or more lymphocytes
  • The number of foci of one or more focus of 50 > lymphocytes in 4mm^2 of salivary tissue is counted
  • A score of more or more is suggestive of sjogren’s syndrome
    Management
  • Multidisciplinary
  • Systemic symptoms e.g. joint pain, fatigue normally assessed and managed by rheumatology
  • Opthalmology for eye symptoms
  • Dry mouth - as for other causes of dry mouth - stimulation and/or replacement
  • Some saliva replacement products specifically licensed for use in sjorgren’s
  • The systemic acetyl choline esterase inhibitor pilocarpine may be prescribed by specialists to stimulate saliva production in patients with sjogren’s
  • caries prevention
21
Q

Sialadenosis

A
  • This is a non-inflammatory, non-neoplastic, bilateral, symmetrical swelling of salivary glands
  • Predominantly parotid glands affected
  • Painless
  • Associated with malnutrition, anorexia, bulimia, alcoholism, diabetes mellitus, certain drugs and hormonal disturbances
  • Results in hypertrophy of serous acini
  • Not entirely understood but changes likely due to salivary gland innervation problem secondary to peripheral autonomic neuropathy
22
Q

Diagnosis of salivary gland tumours

A

The clinical and radiological findings are very important in the diagnosis of salivary gland tumours
Tissue may be obtained to attempt to confirm a definitive diagnosis by various methods

  • Fine needle aspiration (FNA) - a needle is used to aspirate cells from the lesion and the cell features examined
  • Core biopsy - a larger hollow needle is used to remove a core of tissue
  • Open biopsy - a surgical incision is made then an incisional biopsy of the lesion taken
  • ## Excision - all of the tumour is removed for diagnosis and treatment
23
Q

What are the current WHO classification of salivary gland tumours

A

1) Malignant tumours
2) Benign tumours
3) Non-neoplastic epithelial lesions
4) Benign soft tissue lesions
5) Haematolymphoid tumours

24
Q

Mucoepidermoid carcinoma

A
  • Most frequently affects the parotids but can occur in others including minor glands
  • Can be seen in children and young adults
  • More common in females than males
  • It is locally invasive, it can recur and can metastasise
    Treatment
  • Complete excision of the tumour
25
Q

Pleomorphic adenoma

A
  • Most common type of all salivary gland tumours
  • Most frequently occurring of 12 primary benign epithelial tumours
  • Slightly more common in females than males
  • Occur at any age, peak incidence 5th and 6th decades
  • Benign, painless, slow growing, ‘rubbery’ lump
  • Usually solitary although recurrences may be multifocal
  • Most are associated with gene rearrangements in PLAG1 or HMGA2
    Treatment
  • Complete excision. If incompletely excised pleomorphic adenoma has a high recurrence rate
    Malignant transformation can occur in pleomorphic adenoma, usually in long standing lesions. Transformed tumours, called carcinoma ex pleomorphic adenoma, are typically high grade malignancies with poor prognosis