Salivary Gland Pathology Flashcards
Mixed Tumor (Pleomorphic adenoma) Presentation
- parotid > palate and lips
- small, painless, slowly enlarging nodule
- movable (except palatal tumor)
- females 30-50 yo, children
Basal Cell Adenoma
Presentation
- parotid (rare in oral cavity)
- painless, slow-growing nodule
- older males
Canalicular Adenoma
Presentation
- 75% upper lip (and other minor salivary glands)
- well-circumscribed, movable, slow-growing, painless nodule
- older females
Central Mucoepidermoid Carcinoma
Presentation
jawbone (posterior mandible > maxilla)
all ages
females > males
Carcinoma Ex Mixed Tumor
Presentation
- occurs in pre-existing mixed tumors with history of sudden enlargement
- occurs in patients 10-15 years older than mixed tumor patients (30-50s)
- pain and discomfort
Warthin’s Tumor (Papillary Cystadenoma Lymphomatosum)
Presentation
- parotid, 14% bilateral
- males in 60s (10:1 male:female)
- firm asymptomatic swelling
Oncocytoma (oxyphilic adenoma)
Presentation
- parotid
- oncocytic cystadenoma in buccal mucosa, upper lip (rare)
- females in 70-80s
- small, asymptomatic, encapsulated nodule
Mucoepidermoid Carcinoma
Presentation
- parotid > palate, tongue, buccal mucosa, retromolar pad
- low grade: posterior-lateral palate, slowly enlarging, painless lesions, not encapsulated, sometimes resembling mucocele in retromolar pad area
- high grade: major glands (rare in mouth), rapidly growing, painful lesions, facial nerve paralysis, regional lymph node metastasis
Polymorphous Low Grade Adenocarcinoma
Presentation
- minor glands: palate > upper lip, buccal mucosa
- slow growing, rarely metastasizing, painless mass
- females in 60s (6th-8th decade)
- attracted to nerve
Adenoid Cystic Carcinoma (Cylindroma)
Presentation
- minor and major glands including lacrimal gland, pharynx, larynx
- palate, submandibular gland, tongue
- middle aged (40-50s) and younger
- local pain, facial nerve paralysis, fixation to deeper structures, local invasion
- palatal tumor may be covered with normal-looking epithelium or be ulcerated
- perineural invasion (pain and paresis)
Actinic Cell Carcinoma
Presentation
- buccal mucosa and lips (otherwise rare in mouth)
- young and Middle Ages (40-50s) but reported in older
- females > males
- bilateral parotid
Necrotizing Sialometaplasia
Presentation
- benign inflammatory reaction
- caused by local ischemia (sometimes by injection)
- 2:1 male:female in 4th-5th decade
- palate (75%) > buccal mucosa, lip
- 2/3 bilateral palate
- ulcerated, deep, well-circumscribed painless swelling
- can mimic salivary gland malignancy
Mucocele
Presentation
- Mucous extravasation type
- Caused by trauma to duct (saliva seeps into extra cellular tissue, macrophages/lymphocytes/plasma cells create granulation tissue to wall off
- lip or cheek biting
- lower lip (very rare on upper lip) > buccal mucosa, FOM, (ventral tongue, soft palate)
- light blue (superficial) to pink swelling that increases and decreases in size
- 17% superficial 83% deep
Salivary Duct Cyst/Mucus Retention Cyst
Presentation
- true development cyst of duct all origin
- major and minor glands
- unknown etiology
- FOM, buccal mucosa, lips
- similar clinical morphology as extravasation mucocele
Ranula (Frog’s Belly)
Presentation
- unilateral or bilateral FOM
- deep-seated normal color swelling
- caused by localized dilatation of sublingual gland ducts with mucous pooling or severed salivary gland duct
- ‘plunging ranula’ if penetrates mylohyoid
Mixed Tumor (Pleomorphic adenoma) Treatment and Prognosis
complete surgical removal with clean margins
-parotid: removal of involved lobe with preservation of facial nerve
-submandibular: removal of whole gland with tumor
-minor: removal with clean margins
-palate: excise in one piece with periosteum and overlying mucosa
tendency for recurrence (44% in parotid) if not treated thoroughly
5% risk of malignant transformation
Mixed Tumor (Pleomorphic adenoma) Histopathology
- well-demarced to encapsulated
- cords, strands, and islands of cuboidal and spindle cells
- stroma is loose and mucoid to dense
- cartilage, bone, and keratin perals
Basal Cell Adenoma
Histopathology
- encapsulated
- basaloid, uniform, monotonous cells in cords and duct-like structures
- mitosis is rare
- mistaken for adenoid cystic carcinoma
Canalicular Adenoma
Histopathology
- encapsulated
- cords, duct-like structures of monotonous, cuboidal or low columnar basaloid cells
- large cystic dilation of duct-like spaces
Warthin’s Tumor (Papillary Cystadenoma Lymphomatosum)
Histopathology
- encapsulated
- papillary projections with double-layered lining of oncocytes and prominent lymphoid elements forming follicles
Oncocytoma (oxyphilic adenoma)
Histopathology
- encapsulated
- sheets of oncocytes filled with nonfunctional mitochondria
Mucoepidermoid Carcinoma
Histopathology
- invasion of surrounding tissue
- low grade: mucous secreting cells and duct-like structures > epidermoid cells
- high grade: epidermoid cells > mucous producing
Polymorphous Low Grade Adenocarcinoma
Histopathology
- cribiform, tubular, cystic
- mitosis is rare
- neural invasion is common
Adenoid Cystic Carcinoma (Cylindroma)
Histopathology
- Infiltrative growth pattern
- small, dark, uniform cells in islands with typical cribiform, “Swiss cheese” pattern
- perineural invasion
