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AU'18 Oral Path II > Salivary Gland Neoplasms > Flashcards

Salivary Gland Neoplasms Flashcards

1
Q

benign salivary gland neoplasms

A
  1. pleomorphic adenoma
  2. papillary cystadenoma lymphomatosum “Warthin tumor”
  3. canalicular adenoma
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2
Q

malignant salivary gland neoplasms

A
  1. mucoepidermoid carcinoma
  2. polymorphous adenocarcinoma
  3. adenoid cystic carcinoma
  4. acinic cell carcinoma
  5. carcinoma ex-pleomorphic adenoma
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3
Q

approximately what percent of all head and neck neoplasms are salivary gland neoplasms?

A

~6%

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4
Q

T/F: salivary gland neoplasms are common

A

false, they’re uncommon, but not rare

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5
Q

T/F: salivary gland neoplasms have a slight MALE predilection

A

false, female

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6
Q

when do vast majority of salivary gland neoplasms arise?

A

during adulthood

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7
Q

what is the etiology of salivary gland neoplasms?

A

unknown etiology

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8
Q

which salivary gland had the most neoplasms?

A

parotid

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9
Q

which sites are involved in salivary gland neoplasms?

A
  1. parotid
  2. submandibular
  3. sublingual
  4. minor
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10
Q

list the sites involved in salivary gland neoplasms from most to least

A

parotid > minor > submandibular > sublingual

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11
Q

where are the most common locations for minor salivary glands?

A
  1. palate
  2. lips
  3. buccal mucosa
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12
Q

which location has the most minor salivary glands?

A

palate

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13
Q

which major gland has the most malignancies?

A

sublingual

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14
Q

list the MAJOR glands from the most to least prevalent malignancies

A

sublingual > submandibular > parotid

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15
Q

prevalence of sites for MALIGNANT INTRAORAL MINOR glands

A
  1. retromolar region & tongue (90%)
  2. lower lip (60%)
  3. buccal mucosa (50%)
  4. palate (45%)
  5. upper lip (20%)
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16
Q

what is pleomorphic adenoma also known as?

A

benign mixed tumor

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17
Q

where is the name pleomorphic adenoma derived from?

A

from diverse microscopic appearance of different tumors

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18
Q

what is the most common salivary gland neoplasm (benign OR malignant)?

A

pleomorphic adenoma

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19
Q

where is the site predilection for pleomorphic adenoma?

A

parotid gland

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20
Q

what percent of pleomorphic adenoma occur in the parotid gland?

A

80%

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21
Q

list the site predilection for pleomorphic adenoma in order from most often to least

A 
parotid gland (80%) > submandibular gland 
 and intraoral minor salivary glands (10% each)
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22
Q

T/F: pleomorphic adenoma develops more often in children

A

false, adults

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23
Q

who are most often affected by pleomorphic adenoma?

A

4th -6th decade (mean age 45 y.o)

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24
Q

T/F: pleomorphic adenoma has a slight male predilection

A

false, FEMALE predilection

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25
Q

clinical features of pleomorphic adenoma

A
  1. slow-growing
  2. painless
  3. moveable
  4. rubbery-firm on palpation
  5. usually non-ulcerated, but ulceration may be present secondary to trauma
  6. usually round when small, bosselated as it grows
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26
Q

T/F: pleomorphic adenoma lesions on the hard palate are not moveable due to normal anatomy of the palate

A

true

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27
Q

T/F: pleomorphic adenoma palatal lesions are usually lateral to the midline

A

true

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28
Q

predilection of minor gland sites for pleomorphic adenoma

A

palate > upper lip > buccal mucosa

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29
Q

histopathologic features of pleomorphic adenoma

A
  1. encapsulated
  2. proliferation of ductal and myoepithelial cells
  3. myoepithelial cells may appear plasmacytoid or spindled
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30
Q

T/F: proportions of proliferation vary tremendously among different pleomorphic adenoma lesions

A

true

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31
Q

what can myoepithelial cells produce?

A
  1. myxoid stroma
  2. hyaline material
  3. cartilaginous material
  4. osteoid
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32
Q

treatment for pleomorphic adenoma depends on what?

A

location

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33
Q

treatment of pleomorphic adenoma lesion on parotid

A

remove lesion with the involved lobe

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34
Q

treatment of pleomorphic adenoma lesion on submandibular

A

remove lesion and the involved gland

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35
Q

treatment of pleomorphic adenoma lesion on hard palate

A

remove lesion, including overlying mucosa down to periosteum

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36
Q

treatment of pleomorphic adenoma lesion on soft palate, labial and buccal mucosa

A

enucleation

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37
Q

T/F: pleomorphic adenoma lesions will recur if inadequately treated

A

true

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38
Q

T/F: pleomorphic adenoma lesions in the minor gland have more recurrences than the parotid

A

false, parotid lesions have more recurrences than minor glands

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39
Q

what percent of pleomorphic adenoma lesions will undergo malignant transformation if not removed?

A

5%

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40
Q

how does papillary cystadenoma lymphomatosum “Warthin tumor” arise?

A

from salivary duct epithelium entrapped in parotid lymph nodes during development

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41
Q

Warthin tumor is exclusively seen where?

A

parotid gland

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42
Q

who is most affected by Warthin tumor?

A

6th-7th decade (mean age 55-60 y.o)

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43
Q

what is the 2nd most common BENIGN tumor of salivary glands?

A

Warthin tumor

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44
Q

Warthin tumor has a strong association with what?

A

cig smoking; 8-fold greater risk in people who smoke

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45
Q

T/F: Warthin tumor occur more often in males

A

false, more often in males but recent studies suggest more equal gender ratio

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46
Q

clinical features of Warthin tumor

A
  1. non-tender
  2. slow-growing
  3. freely moveable
  4. parotid region, especially tail
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47
Q

what percent of Warthin tumor lesions are synchronous or metachronous?

A

10%

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48
Q

T/F: Warthin tumor lesions only occur bilaterally

A

false, unilateral or bilateral

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49
Q

histopathologic features of Warthin tumor

A
  1. encapsulated
  2. collection of lymphoid tissue, often shows germinal centers
  3. cystic spaces containing serous fluid
  4. papillary infoldings lined by a double row of cuboidal and columnar oncocytes (altered ductal epithelial cells) which project into the cystic spaces
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50
Q

tx for Warthin tumor

A

surgical excision

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51
Q

prognosis of Warthin tumor

A

good

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52
Q

T/F: Warthin tumor have a high recurrence rate

A

false, low (5%)

53
Q

what does recurrence of a Warthin tumor represent?

A

metachronous lesion

54
Q

T/F: monomorphic adenoma is more common than pleomorphic adenoma

A

false, LESS common

55
Q

what was originally used to describe tumors demonstrating a more uniform histopathologic pattern?

A

monomorphic adenoma

56
Q

T/F: canalicular adenoma is more common in major salivary glands

A

false, more common in MINOR glands especially upper labial mucosa

57
Q

sites for canalicular adenoma

A

major and minor salivary glands

58
Q

who is affected by canalicular adenoma?

A

7th decade (mean age 65 y.o.)

59
Q

clinical features of canalicular adenoma

A
  1. well-encapsulated
  2. non-tender
  3. vascularity can impart bluish color
60
Q

histopathologic features of canalicular adenoma

A
  1. encapsulated
  2. cuboidal to columnar cells
  3. tubules and narrow trabecular cords with appearance of channels or “canals”
61
Q

tx for canalicular adenoma

A

enucleation

62
Q

prognosis for canalicular adenoma

63
Q

T/F: canalicular adenoma has a tendency to recur

A

false, no tendency to recur

64
Q

what is the most common salivary gland malignancy (major AND minor glands)?

A

mucoepidermoid carcinoma

65
Q

what is the most common salivary gland malignancy in children?

A

mucoepidermoid carcinoma

66
Q

who is affected by mucoepidermoid carcinoma?

A

wide age rang, 2nd to 7th decade

67
Q

T/F: mucoepidermoid carcinoma may also be found centrally within maxilla or mandible

68
Q

which major salivary gland does mucoepidermoid carcinoma usually affect?

69
Q

which minor salivary gland does mucoepidermoid carcinoma affect?

A

palate and retromolar region

70
Q

T/F: lips, floor of mouth, tongue are uncommon sites for mucoepidermoid carcinoma but mucoepidermoid carcinoma is the most common salivary gland carcinoma in those areas

71
Q

clinical features of mucoepidermoid carcinoma

A
  1. well-demarcated or infiltrative
  2. non-tender
  3. usually non-ulcerated, but can be
  4. ulceration and pain may develop as lesion progresses
  5. fluctuant to hard on palpation
  6. may have bluish tinge due to entrapped mucin
72
Q

T/F: mucocele-appearing lesion of retromolar area should be considered mucoepidermoid carcinoma unless proven otherwise

73
Q

histopathologic features of mucoepidermoid carcinoma

A
  1. lesional cells usually do not show significant pleomorphism or increased mitotic activity
  2. must show intracellular mucin
  3. 2 distinct cellular elements: mucous cells and epidermoid cells (squamoid features, polygonal, intercellular bridges)
74
Q

tx for mucoepidermoid carcinoma depends on what?

75
Q

tx for low-grade mucoepidermoid carcinoma

A

wide surgical excision

76
Q

tx for high-grade mucoepidermoid carcinoma

A

wide surgical excision plus radiaton

77
Q

what does the prognosis of mucoepidermoid carcinoma depend on?

A

tumor size and histologic grade (low, intermediate, high)

78
Q

mucoepidermoid carcinoma lesion smaller than what size has an excellent prognosis?

79
Q

what is the 2nd most common minor salivary gland malignancy?

A

polymorphous adenocarcinoma (PAC) - formally polymorphous low-grade adenocarcinoma (PLGA)

80
Q

T/F: PAC has a male predilection

A

false, 2:1 female predilection

81
Q

who is affected by PAC?

A

6th-8th decade (mean 56 y.o.) but wide age range 23-94 y.o.

82
Q

clinical features of PAC

A
  1. slow-growing
  2. firm, painless swelling
  3. ± ulceration
  4. well-demarcated initially, later becomes infiltrative
83
Q

T/F: PAC is almost exclusively in minor salivary glands

84
Q

which sites are affected by PAC?

A

posterior hard/soft palate > buccal mucosa > upper lip

85
Q

histopathologic features of PAC

A
  1. low-power - lobular growth pattern infiltrating surrounding tissue
  2. may have pseudocapsule in some areas
  3. can see a variety of growth patterns from lesion to lesion or within the same lesion
  4. lesional cells usually bland
86
Q

what can PAC be confused with if pathologist is not familiar with features of PAC?

A

adenoid cystic carcinoma or carcinoma ex-pleomorphic adenoma

87
Q

tx for PAC

A

wide surgical excision

88
Q

prognosis of PAC

89
Q

does PAC recur?

A

yes, 20% recurrence rate

90
Q

T/F: pts with PAC can have lymph node metastasis

91
Q

T/F: although prognosis of PAC is good, pts with PAC can die from the disease

92
Q

adenoid cystic carcinoma makes up what percent of all salivary gland neoplasms?

93
Q

T/F: adenoid cystic carcinoma has a slight female predilection

94
Q

who is affected by adenoid cystic carcinoma?

A

most 5th decade, but wide age range (mean 55 y.o.)

95
Q

T/F: adenoid cystic carcinoma can occur in any salivary gland but 40-45% are in minor glands

96
Q

50% of all minor salivary gland adenoid cystic carcinomas are where?

A

in the palate

97
Q

which major glands are mainly affected by adenoid cystic carcinoma?

A

parotid and submandibular

98
Q

what is the most common malignancy in the submandibular gland?

A

adenoid cystic carcinoma

99
Q

clinical features of adenoid cystic carcinoma

A
  1. slow-growing
  2. frequently associated with pain or tenderness, which may be an early finding
  3. pain can be lancing and constant
  4. variably firm
  5. usually poorly demarcated on palpation
  6. ± ulceration, more often seen later in the course of lesion
100
Q

T/F: NSAIDS and acetaminophen will help ease the pain of adenoid cystic carcinoma

A

false, does not

101
Q

histopathologic features of adenoid cystic carcinoma

A
  1. unencapsulated
  2. propensity for perineural and intraneural invasion
  3. one or more of 3 growth patterns
  4. hyperchromatic basaloid cells
  5. minimal cytoplasm
  6. little pleomorphism
  7. little mitotic activity
102
Q

what are the 3 different growth patterns for adenoid cystic carcinoma histopathologically?

A
  1. tubular
  2. cribriform
  3. solid
103
Q

tubular growth pattern seen histopathogically in adenoid cystic carcinoma

A

well-differentiated

104
Q

cribriform growth pattern seen histopathogically in adenoid cystic carcinoma

A

classic “Swiss cheese” pattern - intermediate

105
Q

solid growth pattern seen histopathogically in adenoid cystic carcinoma

A

poorly-differentiated

106
Q

tx for adenoid cystic carcinoma

A

wide surgical excision followed by radiation

107
Q

prognosis of adenoid cystic carcinoma

A

generally poor, tumor is slow-growing and relentless

108
Q

prognosis of adenoid cystic carcinoma depends on what?

A
  1. lesion location
  2. grade
  3. anatomic structures involved
  4. presence of tumor at surgical margins
109
Q

routes of metastasis for adenoid cystic carcinoma

A
  1. lymphatics

2. blood

110
Q

most adenoid cystic carcinoma metastasize by what route?

111
Q

metastasis of adenoid cystic carcinoma via blood to which organs?

A
  1. lung
  2. brain
  3. bone
  4. liver
112
Q

T/F: pts with adenoid cystic carcinoma may die from the tumor 20 years after diagnosis

113
Q

which salivary gland neoplasm makes up 2% of all salivary gland tumors?

A

acinic cell carcinoma

114
Q

where does acinic cell carcinoma mostly occur?

A

90% in parotid

115
Q

which site with minor salivary glands does acinic cell carcinoma affect?

A
  1. buccal mucosa
  2. lips
  3. palate
116
Q

who is affected by acinic cell carcinoma?

A

2nd-7th decade (mean age ranges mid 40’s to early 50’s)

117
Q

clinical features of acinic cell carcinoma

A
  1. fairly circumscribed
  2. slow-growing
  3. pain, tenderness may develop in half the cases
118
Q

histopathologic features of acinic cell carcinoma

A
  1. often appear pseudoencapsulated
  2. bland cells similar to normal acinar cells
  3. basophilic granular cells (zymogen granules)
  4. dark, eccentrically place nucleus
119
Q

tx for acinic cell carcinoma

A

surgical excision

120
Q

T/F: pts with acinic cell carcinoma can have the lesions recur, metastasize via lymphatics (usually local), or die of the disease

121
Q

pts with carcinoma ex-pleomorphic adenoma are usually aware of long-standing, asymptomatic mass which suddenly becomes tender or is associated with paresthesia

122
Q

who is affected by carcinoma ex-pleomorphic adenoma?

A

6th-7th decade

123
Q

histopathologic features of carcinoma ex-pleomorphic adenoma

A
  1. carcinomatous elements which arise in areas of benign pleomorphic adenoma
  2. usually adenocarcinoma NOS (not otherwise specified), adenoid cystic carcinoma, PAC but can see other types of salivary adenocarcinoma
124
Q

tx for carcinoma ex-pleomorphic adenoma

A
  1. usually wide excision
  2. ± lymph node dissection
  3. ± radiation
125
Q

prognosis of carcinoma ex-pleomorphic adenoma is related to what?

A

related to histologic subtype of malignant component

126
Q

prognosis of carcinoma ex-pleomorphic adenoma

127
Q

which salivary gland neoplasm is associated with one of the better prognoses of the salivary gland malignancies?

A

acinic cell carcinoma

128
Q

T/F: the outcome of acinic cell carcinoma for major gland tumors is worse than for minor gland tumors

AU'18 Oral Path II (31 decks)

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