Salivary Gland Lesions Flashcards
1
Q
What causes a mucocele?
A
Rupture of salivary gland duct due to local trauma
2
Q
Is mucocele a true cyst? Why/why not?
A
No. Lacks epithelial lining
3
Q
What is the appearance of a mucocele?
A
Dome-shaped mucosal swellings ranging from 1 mm to several cm in size
4
Q
Where is mucocele never found?
A
Upper lip
5
Q
Histopathologic features of mucocele
A
- spilled mucin surrounded by granulation tissue
- cyst-like cavity filled with mucin, beneath the mucosal surface
- mucin-associated with granulation tissue containing foamy histiocytes
- minor salivary glands present below and lateral to spilled mucin
6
Q
Treatment and Prognosis of mucocele
A
- Excellent prognosis
- Usually short-lived, self-resolving lesions
- Rupture on their own
- Many are chronic & need surgical excision
- Need to remove all adjacent minor salivary glands to minimize recurrence
- Occasional recurrence
7
Q
What is a mucocele called that occurs on the floor of the mouth?
A
Ranula
8
Q
Which gland is most commonly the source of spilled mucin for a ranula?
A
Sublingual gland. (Could also be submandibular duct or minor salivary glands on floor of mouth)
9
Q
How does ranula appear clinically, and in what population does it tend to appear?
A
Blue, dome-shaped, fluctuant swelling on floor of mouth.
Found in children and young adults.
10
Q
What is a plunging or cervical ranula?
A
Usually a clinical variant– spilled mucin dissects through mylohyoid muscle and produces swelling in the neck
11
Q
What are the histopathologic features of ranula?
A
Similar to mucoceles (except for location): mucin-filled cyst-like cavity beneath the mucosal surface.
Spilled mucin elicits a graulation tissue response containing foamy histiocytes.
12
Q
Ranula treatment and prognosis
A
Removal of feeding sublingual gland and/or marsupialization (remove roof of intraoral lesion)
Usually successful for small, superficial ranulas associated with ducts or rivini
Usually unsuccessful for larger ranulas–may need to remove entire feeding gland
13
Q
What is a salivary duct cyst, and what type of tissue does it arise from?
A
- True epithelial-lined developmental cyst that is separate from the adjacent normal salivary ducts
- Arises from salivary gland tissue
- “Mucous Retention Cyst” -cyst-like dilation of salivary ducts also may develop secondary to ductal obstructions (mucus plug)
14
Q
Salivary Duct Cyst tends to occur more often in children or adults?
A
Adults
15
Q
Does salivary duct cyst arise within major or minor salivary glands?
A
Either one
16
Q
Histopathological features of salivary duct cyst?
A
- Cyst is lined by thin cuboidal epithelium
- Excretory salivary gland duct lined by columnar epithelium adjacent to cyst
- Dilated duct lined by columnar eosinophilic oncocytes that exhibit papillary folds into the ductal lumen
17
Q
Salivary duct cyst usually develops secondary to what?
A
Ductal obstruction
18
Q
Isolated salivary duct cysts are treated how?
A
Conservative surgical excision
19
Q
What is sialolithiasis?
A
Calcified structures within the salivary ductal system
20
Q
How does sialolithiasis arise?
A
From deposition of Ca salts around a nidus of debris within the duct lumen
Formation is NOT related to any systemic derangement in Ca or P metabolism
21
Q
Sialolithiasis most commonly develops in ductal system of which gland?
A
Submandibular gland
22
Q
For minor salivary gland sialolithiasis, usually found in mucosa of what region in the mouth?
A
upper lip or buccal mucosa
23
Q
How might sialolithiasis present on a radiograph?
A
Radiopaque mass visible sometimes
24
Q
Symptoms of major gland sialolithiasis?
A
Pain or swelling of affected gland
25
Histopathology of sialolithiasis
Intraductal calcified mass with concentric laminations
Surround nidus of amorphous debris
Duct exhibits squamous metaplasia
26
Treatment of sialoliths
If small: gentle massage of gland to "milk" stone out of duct orifice
sialogogues: drugs that increase salviary flow, moist heat, increased fluid intake--promote passage of stone
Larger sialoliths may need surgical excision
Feeding gland may have to be removed
27
Define sialadenitis
Inflammation of the salivary gland (usually due to infection)
28
Which viral disease most commonly causes sialadenitis
Mumps
29
If sialadenitis is bacterial in nature, what conditions usually facilitate bacterial infection in the salivary gland?
**Ductal obstruction or decreased salivary flow**
- Allows retrograde spread of bacteria throughout the ductal system
- Decreased flow can result from dehydration, debilitation, or medications that inhibit secretions
30
What is a relatively common iatrogenic cause of sialadenitis?
Recent surgery, especially abdominal
31
Which medications can cause sialadenitis without infection?
Medications that cause xerostomia, Sjogren syndrome, sarcoidosis, radiation therapy and various allergens cause this without infection
32
Clinical features of sialadenitis?
- Tender swelling of the submandibular or other affected gland
- Purulent exudates may be seen arising from stenson's duct when the parotid is massaged
33
Histopathologic features of chronic sclerosing sialadenitis
chronic inflammatory infiltrate w/ associated acinar atrophy, ductal dilation, and fibrosis
34
Sialadenitis treatment and prognosis
Acute sialadenitis:
- AB therapy and rehydration of pt to stimulate salivary flow
- Surgical drainage if abcess is present
Chronic sialadenitis:
- management depends on condition and ranges from conservative therapy to surgical intervention
- AB, analgesics, sialagogues and glandular massage usually included
35
Which gland is most commonly affected by Sialadenosis?
Parotid
36
What systemic problems is Sialadenosis usually associated with?
DM, DI, acromegaly, hypothyroidism, pregnancy, malnutrition, alcoholism, eating disorders, anti-HTN drugs, asthma drugs
Result in dysregulation of autonomic innervations of the salivary acini causing an aberrant intracellular secretory cycle
37
Clinical features of sialadenosis
Enlargement of the parotid and submandibular glands
**Sometimes secondary to alcoholism**
Non-inflammatory disorder
38
What is the name of the unusual non-inflammatory disorder characterized by salivary gland enlargement that may be secondary to alcoholism?
Sialodenosis
39
Histopathologic features of sialodenosis
Excessive accumulation of secretory granules with marked enlargement of acinar cells
**Hypertorphy of acinar cells** sometimes 2-3x larger than normal size
40
Treatment and prognosis of sialadenosis
- Closely related to control of underlying disease
- Clinical management is **_often unsatisfactory_**
41
What is Sialorrhea?
Excessive salivation
(sialorrhea:saliva::diarrhea:poop)
42
What can cause sialorrhea?
local irritations such as apthous ulcers or ill-fitting dentures
43
What is "water brash" and what condition is it associated with?
Water brash = episodic hypersecretion of saliva
- neutralize stomach acid in pts with reflux
- associated with Sialorrhea
44
Clinical features, histo, treatment/prognosis of sialorrhea
None
45
Are symptoms of xerostomia subjective or objective?
Subjective
46
Most common causes of xerostomia
Salivary gland aplasia, impaired fluid intake, meds, radiation, chemo, systemic diseases (Sjogren's, DM, DI, Sarcoidosis, HIV, Hep C, GVDH, Psychogenic disorders), smoking, mouth breathing
All are causative
63% of the 200 most prescribed meds cause xerostomia
47
Clinical features of xerostomia?
Reduction in salivary secretions and residual saliva appears foamy or thick and ropey
Dorsal tongue fissured with atrophy of filiform papillae
Degree of actual salivary flow can be measured using both resting and stimulated salivary flow
Difficulty swallowing or chewing
Increased prevalence of **candidiasis**
Prone to dental **decay**
48
Treatment and prognosis of xerostomia
- Artificial salivas available
- suck on sugarless candies to increase salivary flow
- **Lactoperoxidase, lysozyme and lactoferrin** in oral hygiene products such as Biotene and Oralbalance
- Change doses or switch medications
- Sialagogues: systemic pilocarpine and cevimeline hydrochloride (both contraindicated for pts with glaucoma)
Frequent dental visits to reduce caries risk
49
What is Sjogren syndrome?
Chronic **systemic** autoimmune disorder that principally involves the salivary and lacrimal glands, resulting in xerostomia and xerophthalmia
50
What is "Sicca syndrome?"
Combined effects of Sjogren Syndrome on mouth and eyes
51
Name and describe the 2 forms of Sjogren's Syndrome
Primary: sicca syndrome only
Secondary: Sicca syndrome plus another associated autoimmune disease
52
Sjogren's cause
Unknown
53
What lab values are seen in Sjogren's Syndrome?
Elevated erythrocyte sedimentation rate
Elevated serum immunoglobulin levels
54
What antibodies are found in Sjogren's syndrome
- Rheumatoid Factor (RF) is found in a significant number of patients with SS, even if they don’t have RA.
- Antinuclear antibodies (ANAs) are present in majority of cases
- Anti-SS-A (anti-Ro) and anti-SS-B (anti-La) found in patients with primary SS
- Salivary duct autoantibodies can also be found
55
Sjogren's more prevalent in females or males, and by what ratio?
F\>M
9:1
56
What two conditions is secondary SS most commonly associated with?
RA and SLE
57
Sjogren's syndrome causes an increased risk for what other salivary gland problem?
Sialadenitis
58
Clinical presentation of Sjogren's?
Oral mucosa red and tender, usually a result of secondary candidiasis
59
What is the Schirmer test?
Confirms reduced tear production (Sjogren's)
60
Because Sjogren's is a systemic disease, how can it affect other parts of the body?
o Fatigue and depression are fairly common
o Lymphadenopathy, primary biliary cirrhosis, Raynaud’s phenomenom, interstitial nephritis, intierstitial lung fibrosis, vasculitis, and peripheral neuropathies can also occur
61
Hisopathologic features of Sjogren's
- Lymphocytic infiltration of the salivary glands and destruction of the acinar units
- Biopsy of the minor salivary glands of the lower lip is a useful test in the diagnosis of SS
- Examined for presence of focal chronic inflammatory aggregates
- Greater the number of foci, the greater the correlation with the diagnosis of SS
- Focal nature of the chronic inflammation among otherwise normal acini is a highly suggestive pattern
- Finding of scattered inflammation with ductal dilation and fibrosis (Chronic sclerosis Sialadentitis) does NOT support the diagnosis of SS
62
Sjogren's treatment and prognosis
Mostly supportive
- Dry Eye: artificial tears
- Dry Mouth: artificial salivas, Sialagogues (pilocarpine and cevimeline)
- Dental Decay: mouth rinses and daily fluoride applications
- **Increased risk for lymphoma (up to 40x higher than normal)**
- Tumors may arise initially within the salivary glands or within the lymph nodes
- Predominantly low-grade non-Hodgkin’s B cell lymphomas of the mucosa-associated lymphoid tissue
- Detection of immunoglobulin gene rearrangements in labial salivary gland biopsies may prove to be a useful marker for predicting the development of lymphoma
63
Benign lymphoepithelial lesion is assocated with what disease?
Mikulicz disease
-many Mikulicz diseases are examples of Sjogren Syndrome
Not all BLLs are associated with Sjogren's
64
Histopathological features of benign lymphoepithelial lesion
Lymphocytic infiltrate of the parotid gland with an associated epimyoepithelial island
65
Describe necrotizing sialometaplasia
Locally destructive inflammatory condition of the salivary glands
Mimics a malignant process, both clinically and histologically
Uncommon disease, cause uncertain (but maybe due to ischemia of salivary tissue)
66
Clinical features of necrotizing sialometaplasia
Most frequently develops in palatal salivary glands, hard palate \> soft palate
Unilateral \> bilateral or midline
Reported in minor salivary glands and occasionally parotid gland
**Submand and subling glands rarely affected**
Most common in adults
Later stage will see crater-like defects on palage
67
Histopathology of necrotizing sialometaplasia
Necrotic mucous acini and adjacent ductal squamous metaplasia
Ulceration visible in later stages
68
Necrotizing metaplasia treatment and prognosis
**Biopsy necessary to confirm diagnosis and rule out malignant disease**
If confirmed, NO TREATMENT NECESSARY
Will resolve on its own in ~5-6 wks on avg.
69
