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M4: Saliva > Salivary Gland Disorders, Pathology And Presentation > Flashcards

Salivary Gland Disorders, Pathology And Presentation Flashcards

1
Q

Aplasia of salivary glands

A

Failure to develop normally.
Very rare, may occur as an isolated event of as part of a hereditary syndrome (e.g. Down syndrome)

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2
Q

Atresia of ducts

A

Failure to be tubular.
Very uncommon, submandibular duct most often affected when it does occur.

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3
Q

Salivary mucocoeles

A

A cystic cavity filled with mucus.
Two types:
Extravasation or retention

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4
Q

Extravasation mucocoele clinical features

A

Blueish/transparent swelling
Minor glands especially in lower lip
Occurs over a wide age range but most common in young people.
Asymptomatic
Discharges—> reforms
Trauma associated

Caused by ruptured duct with leakage of saliva into surrounding CT —> inflammatory reaction.

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5
Q

Why might a mucous extravasation cyst not be classes as a true cyst?

A

No epithelial linging

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6
Q

Treatment of extravasation mucocoele

A

Removal of all of the mucocoele together with the associated ruptured duct and gland where possible to prevent recurrrence.

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7
Q

Mucous retention cyst

A

Similar but less common than a extravasation cyst
Rare on lower lip
Major and minor glands effected
Represents cystic dilation of a duct typically due to obstruction.
Less inflammation
Cyst lining is epithelial lining of the duct.

Treatment: excision

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8
Q

Ranula

A

Painless soft bluish swelling in FOM
Unilateral
2-3cm
Arises from sublingual gland - uncommon

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9
Q

Plunging ranula

A
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10
Q

Ranula treatment

A

Drainage of the cystic cavity and removal of sublingual gland.

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11
Q

Sialadenitis

A

Inflammation of salivary glands (bacterial or viral infection)

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12
Q

Acute bacterial sialadenitis

A

Parotid most often affected.
Decreased salivary flow is major predisposing factor.
Pain, swelling, tenderness, exudation of pus, redness overlying the skin.
Staphy. Aureus infection

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13
Q

Acute bacterial sialadenitis treatment

A

Appropriate antibiotics after culture/sensitivity testing

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14
Q

Chronic bacterial sialadenitis

A

Secondary to duct obstruction (by stones etc)
Submandibular gland most affected
Typically unilateral
Asymptomatic (or random burst of pain associated with mealtimes)

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15
Q

Salivary calculi

A

Submandibular gland (most commonly affected)
Adults affected
Mineralisation of phosphates from supersaturated saliva being deposited around a central nidus of cell debris.
Forms within ducts in the gland or in the main excretory duct.
Yellowish
Bacteria grow on the stone surface eliciting an inflammatory response.

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16
Q

Salivary calculi

A

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.

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17
Q

What is this?

A

Chronic sialadenitis
Note the marked atrophy of salivary acini
Salivary duct appear dilated
Inflammation

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18
Q

Treatment for chronic bacterial sialadenitis

A
  • The gland may recover from mild sialadenitis if the associated obstruction can be removed.
  • If more extensive sialadenitis, the obstruction and gland requires to be excised.
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19
Q

Viral sialadenitis

A

Mumps
Acute, contagious by paramyxovirus
Spreads via saliva
Painful swelling of parotid glands
Fever, headache, malaise

20
Q

HIV-associated salivary gland disease

A
  • May be the first clinical sign of HIV infection
  • Swelling of major glands
  • Painful and soft to palpate
  • Multiple cysts are seen on imaging of the glands
  • Histopathology glands show multiple large cysts and dense lymphoid tissue.
    (The features are suggestive but not definitively diagnostic).
21
Q

Necrotising sialometaplasia features

A

More common in males
Older/smoker
Minor salivary glands (hard palate)
Painful
Slow to heal (weeks)

22
Q

Aetiology of necrotising sialometaplasia

A

Ischaemia or infarction secondary to trauma
Can be mistaken for cancer

23
Q

Treatment of necrotising sialometaplasia

A

None required, it slowly resolves itself. Biopsy is usually curative.

24
Q

Sjögren’s syndrome

A

Autoimmune disease of unknown cause characterised by lymphocytic infiltration and acinar destruction of lacrimal and salivary glands ( and other exocrine glands).

25
Q

Sjögren’s syndrome: two types

A

Primary Sjögren’s syndrome (dry eyes/mouth no associated CT disease)

Secondary Sjögren’s syndrome (dry eyes/mouth WITH AN associated CT disease

26
Q

Clinical features Sjogren syndrome

A

Females more affected
Middle Ages
Fatigue, joint pain, peripheral neuropathy
Complications of dry mouth
Swelling of salivary glands (i.e. parotids)
Eye problems (dryness)

27
Q

Patients with primary sjorgrens have an increased risk of developing _______

A

Lymphoma in affected glands

28
Q

Diagnostic testing for Sjögren’s syndrome

A

Lower lip biopsy (minor glands)
Focal periodical collections of 50 lymphocytes

29
Q

Management of Sjögren’s syndrome

A

Salivary stimualtion/replacement
I.e. systemic acetyl choline esterase inhibitor pilocarpine

Caries prevention

30
Q

Sialadenosis

A

Non-inflammatory, non-neoplastic, symmetrical swelling of salivary glands.

Predominately parotid glands affected.

Associated with malnutrition, anorexia, bulimia, alcoholism, diabetes etc

Hypertrophy of serous acini

31
Q

90% of major salivary gland tumours occur in the __________

A

Parotid gland

32
Q

55% of minor salivary gland tumours arise in the ___________, 20% arise in the _________.

A

55% —> palate
20% —> upper lip

33
Q

Salivary gland tumours of the ___________ are rare.

A

Lower lip

34
Q

Tumours are more commonly found in

A

major glands

( than minor glands)

35
Q

Salivary glands carcinomas are higher in __________

A

MINOR salivary glands

36
Q

FNA, Core biopsy, open biopsy and excision

A

FNA - fine needle aspiration

Core - needle in to remove the core for investigation

Open - incisional part of the tumour is removed for investigation.

Excision - tumour is removed and then investigated

37
Q

5 categories of salivary gland tumours

A
  1. Malignant tumours
  2. Benign tumours
  3. Non-neoplastic tumours
  4. Benign soft tissue lesions
  5. Haematolymphoid tumours
38
Q

Most common epithelial salivary gland malignant tumour?

A

Mucoepidermoid carcinoma

39
Q

Mucoepidermoid carcinoma features

A

Children and young adults
Females more common
Parotid gland typically
MAML2 gene fusions
Treatment: complete excision

40
Q

Three types of tumour cells:

A
  1. mucous-secreting cells
  2. Epidermoid (squamoid) cells
  3. Intermediate cells
41
Q

Tumour with high mucous cell numbers tend to be ….

A

Cystic

42
Q

Tumours with mainly epidermoid lesions tend to be more …

A

Solid and often more aggressive

43
Q

Most common type of salivary gland tumour?

A

Pleomorphic adenoma

44
Q

Pleomorphic adenoma features

A

Benign, painless, slow growing, “rubbery” lump
Slightly more common in females
Can occur at any age
Parotid gland

Gene arrangements PLAG1 or HMGA2

45
Q

Treatment of Pleomorphic adenoma

A

Complete excision

If incomplete incision —> recurrence!

Can become cancerous in long-standing lesions

M4: Saliva (4 decks)

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