Salivary Gland Pathology Flashcards
Common lesion resulting from damage of the salivary duct, with extravasation (spillage) of mucin into the surrounding tissue, frequently due to local trauma
Mucocele (Mucus Extravasation Phenomenon)
Most on the LOWER LIP of children or young adults, fluctuant, dome shaped swelling with a translucent blue color, may wax and wane
Mucocele
variant of mucocele secondary to superficial location of the mucin, palate, retromolar pad, posterior buccal mucosa
superficial mucocele
variant of mucocele occuring in the floor of the mouth, usually from the sublingual gland, although some arise from the submandibular duct
ranula
translucent blue or normal colored, fluctuant swelling in the floor of the mouth, may cause elevation of the tongue
ranula
Variant of ranula- mucin penetrating the mylohyoid muscle, showing submandibular swelling or swelling of the neck
plugging ranula
epithelial-lined cavity filled with mucin, most probably arise secondary to ductal obstruction, which increases intraluminal pressure, probably represent ductal ectasia (dilation) rather than a true cyst
salivary duct cyst (mucus retention cyst; mucus duct cyst)
typically adults; major (parotid) or minor glands (floor of mouth, buccal mucosa, lips; fluctuant asymptomatic swelling
salivary duct cyst
cystic space lined by cuboidal or columnar epithelium; may acquire papillary infoldings
salivary duct cyst
salivary duct calcifications of unknown etiology; arise secondary to deposition of calcium salts around a nidus of debris; unrelated to calcium-phosphorus metabolism
sialolithiasis
usually within the submandibular duct; episodic pain and/or swelling; may have palpable mass; minor gland involvement will often be asymptomatic; radiographic appearance- opaque mass
sialolithiasis
concentric laminations around an amorphous central nidus; inflammation of duct and adjacent glands; may see squamous, oncocytic, or mucous cell metaplasia
sialolithiasis
inflammation of salivary glands; infectious (viral, bacterial) or noninfectious (sjogren, sarcoidosis, radiation) etiology, “surgical mumps”- post abdominal surgery
sialadenitis
_ _ sialadenitis- typically involves the parotid, swollen, painful gland, purulent discharge
acute bacterial
_ sialadenitis- usually secondary to recurrent or persistent ductal obstruction (sialolith), episodic pain and swelling, usually at mealtime, submandibular involvement may include persistent enlargement (Kuttner tumor)
chronic
excessive salivation; associated with local irritation (dentures), medications, heavy metal poisoning, GI reflux disease; may also be seen in patients with poor neuromuscular control
sialorrhea
drooling, choking; may cause irritation or open sores of the surrounding skin
sialorrhea
subjective sensation of dry mouth; secondary to a number of systemic conditions; aging, smoking, or medications and treatments
xerostomia
systemic diseases associated w/ xerostomia
sjogren, diabetes, sarcoidosis, HIV
The following medications are associated with _: antihistamines (diphenhydramine), decongestants (pseudoephedrine), antidepressants (amitriptyline), antipsychotics, antihypertensives, anticholinergics (atropine, scopolamine)
xerostomia
F>M, elderly; thick, foamy saliva; dry mucosa, with atrophy and fissuring; increased incidence of candidiasis infection
xerostomia
_-related caries: caries of the root surface or cervical area secondary to lack of salivary protection
xerostomia
intense lymphocytic infiltration of the salivary glands; most are associated with Sjogren
Benign lymphoepithelial lesion
benign lymphoepithelial lesion by itself
Mikulicz’s disease
benign lymphoepithelial lesion in combination with another disease such as sjogren’s syndrome
Mikulicz’s syndrome
typically bilateral; F>M, average age 50; usually an asymptomatic, diffuse swelling of the parotid gland; epimyoepithelial islands
benign lymphoepithelial lesion
surgical removal of the involved gland; good prognosis, although an increased risk of developing lymphoma; MALT lymphoma
benign lymphoepithelial lesion
autoimmune disorder affecting the salivary and lacrimal glands
sjogren syndrome
_ sjogren syndrome- sjogren along
primary
_ sjogren syndrome- sjogren along with another autoimmune disorder (SLE, rheumatoid arthritis)
secondary
unknown etiology, although an association with certain histocompatibility antigens (HLA-DRw52, HLA-B8, HLA-DR3) has been found
Sjogren
F»M, Sicca syndrome
sjogren
xerostomia and xeropthalmia
sicca syndrome
sialographic appearance- “Fruit-laden, branchless tree”
Sjogren
Anti-SS-A (anti-Ro), Anti-SS-B (anti-La)
Sjogren
Major glands show benign lymphoepithelial lesion; labial salivary gland biopsy shows focal aggregates or lymphocytes
Sjogren
40-fold increase in development of lymphoma (non-Hodgkin’s B-cell)
Sjogren
Noninflammatory salivary gland enlargement, usually associated with an underlying systemic disorder; conditions associated include diabetes, alcoholism, anorexia nervosa, bulimia, malnutrition; these conditions result in dysregulation of the autonomic innervation of the salivary acini
sialodenosis
typically bilateral involvement of the parotid glands; slowly progressing painless or painful swelling of the involved gland
sialadenosis
may see a decrease in salivation; sialographic presentation- Leafless tree
sialadenosis
Prominent zymogen granules
sialadenosis
_ associated with alcoholism or diabetes may show atrophy and fatty infiltrate
sialadenosis
localized swelling (hyperplasia) of minor salivary glands; unknown pathogenesis; significance lies in the resemblance to neoplasia
adenomatoid hyperplasia
soft or firm swelling of the soft or hard palate; 4th-6th decade; asymptomatic
adenomatoid hyperplasia
Hyperplastic aggregates of normal salivary gland tissue
adenomatoid hyperplasia
Locally destructive inflammatory process of unknown etiology; possibly due to local ischemia; may be associated with previous surgery, adjacent tumors, dental infections, trauma
necrotizing sialometaplasia
M>F, average age 46, most involve the palatal salivary glands; Unilateral>bilateral
necrotizing sialometaplasia
initial painful swelling; 2-3 weeks, necrotic tissue sloughs, leaving a crater-like ulcer; may resemble a malignant process
necrotizing sialometaplasia
Squamous metaplasia of the salivary ducts (often misdiagnosed); pseudoepitheliomatous hyperplasia of the overlying epithelium; process may mimic malignancy
necrotizing sialometaplasia
Resolves within 5-6 weeks
necrotizing sialometaplasia
Most salivary gland tumors (up to 2/3) involve the _ gland
parotid
Most salivary gland tumors (up to 3/4) are benign or malignant?
benign
_ gland- 8-11% of tumors, with up to 45% malignant
submandibular
_ gland- rare site for tumors but most (up to 90%) are malignant
sublingual
Second most common site for tumors is the _ _ glands, with almost 50% malignant
minor salivary
the most common of all salivary gland tumors; tumor arises from a mixture of ductal epithelium and myoepithelial elements; the term pleomorphic refers to the variety of patterns that may be seen
pleomorphic adenoma (benign mixed tumor)
F>M, mostly in young adults; slowly growing, rubbery firm mass; parotid tumors usually located within the superficial lobe; palate is the most common site for minor salivary tumors, followed by upper lip
pleomorphic adenoma
myoepithelial component and stroma is highly variable; tumors may be composed almost entirely of myoepithelial cells
pleomorphic adenoma
as many as _% of pleomorphic adenomas may undergo malignant transformation (carcinoma ex pleomorphic adenoma)
5%
second most common benign tumor of the parotid; uncertain pathogenesis; strongly associated with history of smoking
Warthin’s tumor (papillary cystadenoma lymphomatosum)
M>F, older adults, slow growing mass (firm or fluctuant) involving the tail of the parotid; 5-14% bilateral
warthin’s tumor
cystic spaces surrounded by a double row of oncocytes; prominent lymphoid stroma
warthin’s
original terminology for benign salivary tumors of one cell type; archaic term
monomorphic adenoma
tumor of minor salivary glands, primarily those of the upper lip; older adults; F>M; slow growing, firm to fluctuant mass
canalicular adenoma
often encapsulated; columnar or cuboidal cells arranged in cords or parallel rows
canalicular adenoma
common malignant salivary tumor of mucous and squamous differentiation; highly variable biologic bahavior
mucoepidermoid carcinoma
the most common malignant salivary gland tumor (children as well); F>M; parotid and minor glands of the palate most common sites
mucoepidermoid carcinoma
typically an asymptomatic swelling; intraosseous tumors sometimes occur; mixture of mucous and squamous cells in variable ratios
mucoepidermoid carcinoma
central tumor, possibly arising from entrapped ectopic salivary gland tissue or odontogenic epithelium; the most common intraosseous salivary gland tumor; histologically identical to soft tissue tumor
intraosseous (central) mucoepidermoid carcinoma
F>M, middle-aged adults; mandible>maxilla; swelling, pain, paresthesia; unilocular or multilocular radiolucency
intraosseous mucoepidermoid carcinoma
salivary gland malignancy of serous acinar differentiation; typically considered a low-grade malignancy
acinic cell adenocarcinoma
F>M, average age 45; most commonly involves the parotid gland or minor glands of the buccal mucosa; typically asymptomatic
acinic cell adenocarcinoma
malignant counterpart to pleomorphic adenoma
malignant mixed tumor
pleomorphic adenoma that undergoes malignant transformation; F>M, older adults; most involve the major glands, primarily the parotid; present for years with recent increase in size and/or symptoms
carcinoma ex pleomorphic adenoma
rare tumor, featuring malignant epithelial and stromal components
carcinosarcoma
histologically benign pleomorphic adenoma that has metastasized to distant location
metastasizing mixed tumor
tumor showing residual benign tumor and areas featuring malignant characteristics of the epithelial component
carcinoma ex PA
carcinomatous and sarcomatous areas
carcinosarcoma
common and well recognized salivary gland malignancy; relentless tumor requiring long-term follow-up; F>M, middle aged adults; majority involve the minor salivary glands of the palate; typically painful
adenoid cystic carcinoma
may cause ulceration of the overlying mucosa; may erode adjacent bone
adenoid cystic carcinoma
recently recognized tumor (1983); currently seen as one of the more common salivary gland tumors
Polymorphous low-grade adenocarcinom
F>M, older adults; most involve the minor salivary glands of the palate; usually painless mass of long duration
polymorphous low-grade adenocarcinoma
deceptively uniform cells with round or ovoid nuclei and abundant cytoplasm; “Indian filling”
polymorphous low-grade adenocarcinoma
