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week 80 > Salivary Gland Pathology: > Flashcards

Salivary Gland Pathology: Flashcards

1
Q

Parotid Gland

A
  • Serous
  • most likely to get a tumor
    • ⅔ are benign
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2
Q

Submandibular Gland

A
  • Serous + Mucus
  • 26-45% are malignant
  • Adenoid Cystic Carcinoma: 11-17%
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3
Q

Sublingual Glands

A
  • Mucus
  • 1% of all Salivary Gland Tumors
    • 70-90% are malignant
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4
Q

Minor Glands

A
  • 40-50% are malignant
  • smaller the gland, more likely its malignant
  • Palate> Upper Lip> Buccal Mucosa
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5
Q

Salivary Gland Aplasia

A
  • 1+ major Salivary gland does not develop
  • can occur alone or associated with:
    • Mandibulofacial dysotosis
      • (Treacher Collins syndrome)
    • Hemifacial microsomia
    • Lacrimo-auriculo-dento-digital syndrome
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6
Q

Salivary Gland Aplasia: Oral Manifestations

A
  • Salivary Deficiency
  • caries due to “dry mouth”
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7
Q

Salivary Gland Aplasia: Treatment

A
  • Artificial saliva or stimulating salivary flow
    • Pilocarpine
    • Cevimeline
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8
Q

Salivary Gland Aplasia is associated with what other diseases?

A
  • Mandibulofacial dystosis
    • Treacher Collins Syndrome
  • Hemifacial microsomia
  • lacrimo-articulo-dento-digital syndrome
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9
Q

Mucocele

A
  • ruptured salivary duct
    • mucin into soft tissue
  • Lower Lip-most common
  • Superficial Mucoceles:
    • lichenoid reactions
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10
Q

Mucocele: Clinical Appearance

A
  • dome shaped swelling
    • bluish translucent hue
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11
Q

Mucocele: Treatment

A
  • Local excision and removal of feeding gland/duct
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12
Q

Ranula

A
  • mucocele on the floor of the mouth
    • associated with sublingual or submandibular gland
  • Location:
    • Duct of Rivinus or Bartholin Duct
  • Plunging or Cervical Ranula:
    • if it continues to grow=swelling in the neck
    • goes into mylohyoid facial planes
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13
Q

Ranula: Treatment

A
  • Surgical excision along with feed gland/duct
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14
Q

Salivary Duct Cyst

A
  • aka Mucous Retention Cyst
  • TRUE cyst w/epithelium lining
  • Develops secondary to duct blockage
    • major gland=parotide gland→Most common
    • Minor Glands→ floor of mouth, buccal mucosa, lips
  • Ductal ectasia
    • due to blockage and increased intraluminal pressure
    • not a true cyst
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15
Q

Salivary Duct Cyst: Clinical Appearance

A
  • soft, fluctuant swelling w/bluish hue
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16
Q

Salivary Ductal Cyst: Histo

A
  • Dx: Papillary cystadenoma
    • if extensive proliferation
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17
Q

Sialolithiasis

A
  • AKA Salivary gland stones
  • calcified structures in the salivary duct system
    • 80% in submandibular glands
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18
Q

Sialadenitis

A
  • infection of the salivary duct→ inflammation
    • Viral
      • Mumps (most common)
      • CMV (infants)
      • ECHO
      • HIV
    • Bacterial
      • normally due to Sialoliths or decreased flow
      • S. aureus and streptococci
        • most common
    • Non-infectious:
      • Radiation
      • Allergy
      • Sjogren Syndrome
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19
Q

Cheilitis Glandularis

A
  • Inflammation of minor salivary gland
    • swollen (lower) Lips
    • glands retain mucin
  • 3 types:
    • Simple
    • Superficial suppurative
      • Baelz disease
      • bacterial involved
    • Deep suppurative
      • Cheilitis glandular apostematosa
      • bacterial
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20
Q

Cheilitis Glandularis; Etiology

A
  • Actinic damage=UV radiation
  • Tobacco
  • hereditary
  • Hygiene
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21
Q

Cheilitis Glandular: histo

A
  • concomitant dysplastic changes
    • can transform into SCC
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22
Q

Cheilitis Glandularis: Tx

A
  • Vermillionectomy
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23
Q

Polymorphous Adenocarcinoma

A
  • only minor salivary glands
    • PRKD1 somatic point mutation (E710D)
  • Location:
    • hard or soft palate-Mainly
  • Bleeding or discomfort
  • infiltrate bone
  • “Polymorphous”
    • multiple growth patterns
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24
Q

Sialorrhea

A
  • Excessive Salivation
  • Types:
    • Minor
    • True Sialorrhea
    • Relative sialorrhea
    • idiopathic paroxysmal sialorrhea
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25
Q

Sialorrhea: Tx

A
  • Medication
  • Sever Chorda tympani-no parasympathetic stimulation
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26
Q

Minor Sialorrhea

A
  • Local Irritation
    • aphthous ulcers
    • ill-fitting dentures
  • Episodic hypersecretion due to GERD
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27
Q

True Sialorrhea

A
  • Rabies
  • Heavy-metal poisoning
  • Antipsychotic agents:
    • Clozapine
    • Cholinergic agonists to treat:
      • Dementia of the Alzheimer type
      • Myasthenia Gravis
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28
Q

Relative Sialorrhea

A
  • Lack of neuromuscular control
    • seen in patients w/cognitive impairments
    • Surgical resection of the mandible
    • Cerebral Palsy
    • Parkinson Disease
    • ALS
    • Stroke
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29
Q

Idiopathic Paroxysmal Sialorrhea

A
  • short episodes (2-5 mins) of excess salivation
  • Prodrome of nausea or epigastric pain
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30
Q

Xerostomia

A
  • Sensation of dry mouth
    • due to decreased salivary flow/secretions
  • Older population
  • Increased Candidal infection
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31
Q

Xerostomia: Etiology

A
  • Development
    • salivary Gland Aplasia
  • Water/Metabolite loss
  • Iatrogenic
    • medication
    • Radiation
    • Chemotherapy
  • Systemic Disease
    • Sjogren’s
  • Local factors
    • Smoking
    • mouth breathing
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32
Q

Xerostomia: Clinical Features

A
  • Saliva is thick and “ropey”
  • Mucosa appears dry
    • glove sticks to mucosal surfaces
  • Dorsal tongue-fissured w/atrophy of filiform papillae
33
Q

Xerostomia: Treatment

A
  • Salivary Stimulation
    • pilocarpine
      • 5-10mg
      • 3-4x/day
34
Q

Sjogren Syndrome

A
  • AKA Sicca Syndrome
  • immunological destruction of the salivary glands & lacrimal glands
    • autoimmune condition
  • Females 9x more than Male
  • High Associations with RA
  • Results in Xerostomia (Dry mouth) and Xerophthalmia (Dry eyes)
  • Types:
    • primary
      • only immunologic disorders in the patient
    • Secondary
      • due to another autoimmune disease
35
Q

Sjogren’s Syndrome: Relationship with genetics

A
  • HLA found in greater frequency
    • HLA-DRw52
      • both forms
    • HLA-B8 & HLA-DR3
      • primary SS
    • EBV is related somehow
36
Q

Sjogren’s Syndrome: Clinical Features

A
  • fi_ssured tongue w/atrophied papillae_
  • Xerostomia
  • Altered Taste
  • Red and tender oral mucosa
    • secondary candissais
  • ⅓ to ½→enlargement of major salivary glands
  • increased risk of Sialadenitis and Lymphomas
37
Q

Sjogrens Syndrome: Classification criteria

A
  • must have 2 of 3
      • RO-SSA and/or La-SSB antigen
        • or
          • RA and antinuclear antibody(ANA) titer ≥ 1:320
    • Labial Salivary gland biopsy:
      • focal lymphocytic sialenditis
      • focus score ≥ 1 focus/4mm
    • Keratoconjunctivitis siccca
      • ocular staining score ≥4
38
Q

Sjogren’s Syndrome: Lab Tests

A
  • Erythrocyte sédimentation rate=High
  • Elevated serum Ig levels
    • especially IgG
    • Rheumatoid Factor in 60% of cases
  • ANAs in 75-85% of patients:
    • Ro (SS-A) and La (SS-B)
39
Q

Sjogren’s Syndrome: Treatment

A
  • Pilocarpine or cevimeline
  • increased risk of lymphoma
    • 40x higher than normal
      • B-cell monoclonality (MALT Lymphoma)
40
Q

Sialadensosis

A
  • AKA Sialosis
  • dysregulation of autonomic innervation of salivary acini→uncontrolled secretion
    • Increased acini size
  • Bilateral
41
Q

Sialadenosis: Treatment

A
  • control the underlying cause
    • Endocrine disorders
      • diabetes
      • hypothyroidism
      • pregnancy
    • Nutritional conditions
      • Alcoholism
      • Eating disorders
    • Neurogenic medications
42
Q

Necrotizing Sialometaplasia

A
  • inflammatory condition of the salivary glands
    • local destruction
      • ischemia→ infarction (obstruction of blood supply)
  • Minor SG
    • palate (most common)
43
Q

Necrotizing Sialometaplasia: Causes

A
  • Trauma
  • poor fitting denture
  • Previous Surgeries
  • Eating disorders w/binge-purging
44
Q

Necrotizing Sialometaplasia: Clinical Appearance

A
  • Associated w/pain and paresthesia
  • Unilateral (normally)
  • Males 2x
  • starts as swelling→turns into ulceration
    • “a part of my palate fell out”
45
Q

Necrotizing Sialometaplasia: Treatment

A
  • None needed
    • disappears in 5-6 weeks
46
Q

Define Adenoma

A
  • Benign neoplasm
  • derived from glandular cells
47
Q

Define Carcinoma

A
  • Malignant neoplasm
    • derived from epithelial cells
48
Q

Define Sarcoma

A
  • Malignant neoplasm
    • derived from mesenchyme cells
      • ex: fat, muscle, bone, blood vessels
49
Q

Define Lymphoma

A
  • Malignant neoplasm
    • derived from lymphocytes
50
Q

Define Melanoma

A
  • Malignant neoplasm
    • derived from melanocytes
51
Q

Define: Germ Cell tumor

A
  • Malignant neoplasm
    • derived from germ cells
52
Q

Salivary Gland Tumors

A
  • 60-80% are parotid gland tumors
  • the smaller the gland is, the greater the likelihood of malignancy
    • except rare sublingual tumors
53
Q

Pleomorphic Adenoma

A
  • Aka Benign Mixed tumor
  • Adults & Children=MOST COMMON
    • can become carcinoma
  • PLAG1 gene mutation
54
Q

Pleomorphic Adenoma: Clinical Features

A
  • Painless, slow growing
    • Movable; Bigger=stiff
  • Major SG= superficial lobe of parotid gland
    • Minor SG= Palate
55
Q

Pleomorphic Adenoma: Histo

A
  • Major SG
    • encapsulated
  • Minor SG:
    • partially encapsulated
56
Q

Oncocytoma

A
  • rare→1% of all salivary tumors
  • Oncocytes:
    • composed of large epithelial cells
    • ⇡ Mitocondrial count= ⇡ eosinophilic granular cytoplasm
    • inflammatory disorders or other situations that cause cellular stress
57
Q

Oncocytoma: Clinical Features

A
  • slow growing, painless mass
    • Firm
  • Location:
    • Superficial Lobe of Parotid Gland
  • Females
58
Q

Papillary Cystadenoma Lymphomatosum

A
  • AKA warthin tumor
  • parotid gland ONLY
    • near angle of mandible
  • Etiology: uncertain
    • proliferation of gland duct epithelium associated w/secondary formation of lymph tissue
  • strong association w/ smoking
59
Q

Papillary Cystadenoma Lymphomatosum: Clinical Features

A
  • Exclusively parotid gland
  • Firm or fluctuant to palpation
  • older population (6-7th decade)
60
Q

Canalicular Adenoma

A
  • rare
  • Upper Lip
    • very/most common (75%)
    • most common tumor here
  • can be mistaken for mucocele
    • normal or bluish color
61
Q

Canalicular Adenoma: Histo

A
  • Single layered cords of columnar or cuboidal epithelial cells
62
Q

Basal Cell Adenoma

A
  • Basaloid appearance of tumor cells
63
Q

Basal Cell Adenoma: Clinical Features

A
  • Slow growing, freely movable mass
  • Primary→Parotid Gland
  • Secondary→minor salivary glands in upper lip and buccal mucosa
64
Q

Basal Cell Adenoma: Histo

A
  • mostly encapsulated
  • jigsaw puzzle
65
Q

Ductal Papillomas

A
  • Sialadenoma papilliferum
    • minor salivary glands on palate
  • Intraductal Papilloma
    • Minor Salivary glands
    • ill-defined borders
    • submucosal swelling
  • Inverted Ductal papilloma
    • Lower lip and mandible vestibule
    • asymptomatic nodules
66
Q

Mucoepidermoid Carcinoma (MEC)

A
  • most common malignant salivary gland tumor
  • Location:
    • Parotid gland=Most common
    • If a minor salivary gland→palate
      • may be mistaken as a mucocele
  • Intraosseous tumors can develop in jaw
67
Q

Mucoepidermoid Carcinoma: Histo

A
  • 3 grades
    • Low→ <20% intracystic component
    • intermediate→ Neural involvement
    • high→ necrosis
68
Q

Mucoepidermoid Carcinoma: Treatment

A
  • Early stage:
    • remove parotid
    • preserve CN 7 (facial nerve)
  • Late Stage:
    • remove parotid & CN7
  • Minor glands
    • excision
  • Post operative radiotherapy
69
Q

Mucoepidermoid Carcinoma: Prognosis

A
  • Submandibular is worse than parotid
  • Early stage-good
70
Q

Mucoepidermoid Carcinoma: Intraosseous manifestation

A
  • Most common intrabony salivary tumor
  • looks like odontogenic cyst/tumor
  • Females
71
Q

Acinic Cell Carcinoma

A
  • Serous Acinar differentiation
  • Parotid Gland
  • slow growing mass for months or years
    • asymptomatic
  • Mitotic activity=rare
72
Q

Secretory Carcinoma

A
  • similar to secretory carcinoma of breast
  • Parotid gland
    • most common
  • Genetic:
    • Translocation= ETV6-NTRK3 fusion gene
  • Low grade malignancy
    • good prognosis
73
Q

Adenoid Cystic Carcinoma

A
  • Minor salivary glands=most common
    • Palate
  • Females
74
Q

Adenoid Cystic Carcinoma: Clinical Features

A
  • Pain as the tumor grows
    • dull ache that gets worse
  • can cause facial paralysis
  • ulceration of mucosa over tumor
  • Tumor in palate or maxillary sinus→ radiographic bone destruction
75
Q

Adenoid Cystic Carcinoma: Histo

A
  • Swiss cheese appearance
  • Perineural invastion
76
Q

Adenocarcinoma No Otherwise Specified (NOS)

A

Types

  • Microsecretory Adenocarcinoma
  • Carcinoma Ex Pleomorphic Adenoma
  • Salivary Duct Carcinoma
77
Q

Microsecretory Adenocarcionma

A
  • Type of Salivary Adenocarcinoma NOS
  • Low grade
  • use RNA sequencing for diagnosis
78
Q

Carcinoma Ex Pleomorphic Adenoma

A
  • Type of Salivary Adenocarcinoma NOS
  • Malignant transformation of Pleomorphic adenoma
  • Mass present for long time
  • Most common in parotid
79
Q

Salivary Duct Carcinoma

A
  • Type of Salivary Adenocarcinoma NOS
  • Resembles High-grade breast ductal cancer
  • 90% are HIGH GRADE

week 80 (9 decks)

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