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osomop 4th > salivary gland neoplasia > Flashcards

salivary gland neoplasia Flashcards

1
Q

what could cause a source of swelling in the region of major salivery glands?

A
  • Skin/subcutaneous

– Blood vessels

– Nerves

– Muscles

– Lymph nodes (most common)

– Salivary tissue

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2
Q

what could cause a source of swelling in the region of minor salivery glands?

A

> Mucosa/submucosa – Blood vessels

> Nerves

> Muscles

> Bone

> (Nose/sinuses)

> (Skin, etc)

> Salivary tissue

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3
Q

what are swelling of the salivary gland classified as?

A

> Reactive

> Neoplastic

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4
Q

what are Reactive salivary gland swellings classified into?

A

> Developmental
- Hamartoma, heterotopia

> Traumatic
- Mucous extravasation cyst

> Infective
- Viral, bacterial,…

> Obstructive
- Calculus, duct stricture

> Autoimmune
- Sjögren’s syndrome

> Metabolic
- Sialosis

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5
Q

what are neoplastic salivary gland swellings classified into?

A

> Primary =
- Benign = Epithelial or Mesenchymal
- Malignant = Epithelial or Mesenchymal or Lymphoid

> Secondary =
- Nodal metastasis
- Haematogenous metastasis
- Nodal lymphoma

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6
Q

what are the more general 3 categories of salivary gland neoplasms?

A

> Completely benign = Warthin’s, Oncocytoma

> Potentialforlocalrecurrence±nodalmets. = PA, Mucoepidermoid Ca, PLGA, Acinic

> High grade malignant = Ca ex-PA, Salivary Duct Ca

(adenoid cystic carcinoma in a category of its own due to its severity)

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7
Q

what is the incidence of neoplasm in major glands compared to minor?

A

> 10 times more common in major glands

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8
Q

what is the site and behaviour (B:M) of salivary gland neoplasms?

A

> 60-70% occur in the parotid gland (4:1)

> 10-15% occur in the sub mandibular gland (1:1)

> 20-25% occur in the minor salivary glands (1:1)
- upper lip (3:1)
- cheek/ palate (1:1)
- lower lip (1:2)
- tongue/ FOM/ RMP (1:6-8)

> <1% occur in the sub lingual gland (1:5)

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9
Q

what is the most common salviery gland tumour?

A

> pleomorphic adenoma

> 60%+

> in both major and minor glands

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10
Q

what age does pleomorphic adenoma usually affect?

A

> occurs at all ages

> peak 20 - 40 years

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11
Q

what does pleomorphic describe?

A

> describes the architectural diversity NOT the cytology

> forms ducts, sheets and strands of my-epithelium

> forms a Myxoid matrix – may resemble cartilage

> Thin incomplete capsule formed

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12
Q

what type of tumour is a pleomorphic adenoma?

A

> Benign tumour but local recurrence common
– Especially if ruptures

> Malignancy can occur in longstanding and/or recurrent lesions
– Carcinoma ex-PA

> Very rarely benign PAs may metastasise – Usually post-op, major glands

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13
Q

is warthins tumour common?

A

yes, 2nd most common?

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14
Q

where is a warthins tumour found?

A

> only In the parotid near the tail

> can present as a neck swelling

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15
Q

what is the typical age range of a warthins tumour

A

> wide age range

> usually older patients (50-60)

> never in children

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16
Q

what is the frequency in males and females?

A

> 3M: 2F

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17
Q

what is a common risk factor for warthins tumour?

A

> smokers

> 8 times more likely

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18
Q

how does a warthins tumour present as ?

A

> completely benign…

> May be multiple and/or bilateral…

> Probably hyperplastic/neoplastic salivary elements in a lymph node…
- May be affected by other malignancies, e.g., metastatic CAs, NHL

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19
Q

what is warthins tumour also known as ?

A

> Also known as adenoid lymphoma

> histo = Cysts with papillary projections of bland epithelium and lymphoid background++

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20
Q

where is a muceopidermoid carcinoma common?

A

> common in minor salivary glands and the parotid gland

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20
Q

where is a muceopidermoid carcinoma common?

A

> common in minor salivary glands and the parotid gland

> if removed to margin of normal tissue they do not recur if low grade, however high grade behaves badly

21
Q

what is the typical age range for mucoepidermoid carcinoma?

A

> occurs at all age ranges

> peak at 40-50 years

> most common salivary tumour in childhood and adolescents

22
Q

how does a mucoepidermoid carcinoma usually present?

A

> Malignant tumour but usually low-grade – Less than - 10% metastasise (cured with surgery)

> May be solid, cystic or both

> Circumscribed but unencapsulated

> histo = Mucous cells, epidermoid cells and intermediate cells

> Generally cytologically bland but it is malignant

23
Q

how do high grade mucoepidermoid carcinomas usually present?

A

> High-grade lesions look like adenocarcinoma NOS or even SCC

> Solid rather than cystic

> Cytologically malignant-looking cells

> infiltrative edge

24
Q

where are adenoid cystic carcinoma common?

A

> common in minor glands and the parotid gland

> most feared

> top 4 most common

25
Q

what is the common age ranges of adenoid cystic carcinoma?

A

> occurs at all ages, not defined

> peak at 40- 50 years

26
Q

how does an adenoid cystic carcinoma usually present?

A

> usually very subtle, often missed

> Soft, unencapsulated, discoloured mucosa

> May have nerve-related symptoms

> histo Classical “Swiss cheese” pattern (cribuform), Deceptively bland cytology

27
Q

is an adenoid cystic carcinoma benign or malignant?

A

> Malignant tumour but usually low-grade

28
Q

does the adenoid cystic carcinoma invade?

A

> yes, there is widespread local invasion seen beyond the borders of the mass

> rarely excised completely

> the tumour cells don’t cause a virus reaction to the host cells so they just keep invading

29
Q

what is the adenoid cystic carcinoma famed for?

A

> perineurial invasion

> seen in around 50%

30
Q

why is it hard to diagnose the adenoid cystic carcinoma?

A

> the absence of an advert desnoplastic reaction, it does not feel hard or like a malignant tumour by palpation

> accounts for the difficulty of finding the true extents of the tumour

31
Q

how long do patients tend to live for with adenoid cystic carcinoma?

A

> patients live for 10 years but rarely cured

> doesn’t respond well to radiotherapy

32
Q

what type of matastisis common in adenoid cystic carcinoma?

A

> haematogenous metastasis common to brain, liver and lungs

> not regional lymphnoids

33
Q

what does a carcinoma ex PA usually affect?

A

> usually effects major glands

34
Q

when is the peak incidence of a carcinoma ex PA?

A

> Peak incidence about 10 years after PA

35
Q

how does a carcinoma ex PA usually present?

A

> classically rapid enlargement of lump

36
Q

what does the prognosis of a caricinoma ex PA usually depend on?

A

> Degree of invasion beyond capsule of the PA

> precise subtype(s)

37
Q

what is the management of salivary gland tumours?

A

> Establish the diagnosis

> Determine the treatment need – Usually to get rid of the tumour

> Rationalise treatment options
– Surgery
– Radiotherapy
– Both
– Neither

38
Q

what investigation can you carry out to aid treatment and diagnosis of salivary gland tumours?

A

> Ultrasound (USS)

> Computerised Tomography (CT)

> Magnetic Resonance Imaging (MRI)

> Fine Needle Aspiration (FNA)

> Open biopsy
– Incisional
– Excisional

39
Q

what does imaging investigations show you?

A

USS/ CT/ MRI

> Location

> Size and shape

> Consistency
– Solid or cystic

> Interface with adjacent tissues… – …up to a point

40
Q

what are the advantages of FNA cytology?

A

> Cellular populations to be visualised

> highly Accurate = Exclude metastasis

> Quick and easy… Painless (if pain when withdrawn = ACC)

41
Q

what are the disadvantages of FNA cytology?

A

> Sampling error common

> Guidance often required

> Not always correct = Benign-malignant inversions common

> Usually doesn’t change the treatment

42
Q

what are the advantage of an incisional biopsy?

A

> more accurate than other biopsy

> allows more precise treatment planning

43
Q

what are th disadvantages of an incisional biopsy?

A

> risks in PG, SMG = salivary fistula, causing injury, seeding tumour along the tract

> Not always correct = minor element missed

> usually doesn’t change the treatment

44
Q

what are the advantages excisional biopsys?

A

> very accurate

> may be the treatment

> usually the preferred option

45
Q

what are the disadvantages of excisional biopsys?

A

> May need a major op

> Risk to vital structures VII, Gr Aur. N

> Facial asymmetry PG, SMG

> Mucosal defect

> Further Rx may be required…radiotherapy

46
Q

is radiotherapy efffective?

A

> no

> CAs mostly recapitulate ductal differentiation and the ducts are mostly radiation-resistant

> it is used when you have to make sure a tumour doesn’t continue to grow E.g., high-grade tumours with positive/close margins +/- LN mets…

47
Q

what chemotherapy drug is used to target salivary Gland tumour?

A

> Formalin

48
Q

what is the go to treatment for slavery gland tumours?

A

> surgery (eg excisional biopsy)

49
Q

a salivary gland tumour is likely to be malignant if…

A

> It’s low in the mouth

> There’s a history of pain/tenderness

> There’s VIIth nerve dysfunction

> There’s involvement of skin, fixation or ulceration

osomop 4th (18 decks)

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