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OPath II - Salivary Gland Lesions > Salivary Gland Tumors > Flashcards

Salivary Gland Tumors Flashcards

1
Q

What is the most common salivary gland tumor?

A

Pleomorphic Adenoma

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2
Q

Are sublingual gland tumors generally benign or malignant?

A

Very high rate of malignancy

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3
Q

What is the malignancy rate of minor salivary gland tumors?

A

50%

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4
Q

What fraction of salivary gland tumors occur in the parotid gland?

A

2/3 - 3/4

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5
Q

Of the tumors that occur in the parotid gland, what fraction are benign?

A

2/3 - 3/4

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6
Q

What are the two most common malignancies?

A

mucoepidoermoid carcinoma and adenoid cystic carcinoma

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7
Q

What type of cells/tissue elements compose a pleomorphic adenoma?

A

A mixture of ductal and myoepithelial elements

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8
Q

Is pleomorphic adenoma a mixed neoplasm?

A

Not a true mixed neoplasm (derived from more than one germ layer), but it is sometimes called a mixed neoplasm because of the prominent mesenchyme-appearing stromal component

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9
Q

Clinical features of pleomorphic adenoma

A

Painless, slowly growing, firm mass

In the parotid gland, most occur in the superficial lobe (overlying mandibular ramus in front of the ear)

Palate > upper lip > buccal mucosa

Palatal tumors almost always found on posterior lateral aspect and are immovable

If tumor is traumatized, secondary ulceration can occur

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10
Q

Histopathological features of pleomorphic adenoma

A

well-circumscribed, encapsulated tumor with variable microscopic pattern

Composed of mixture of glandular epithelium and myoepithelial cells within a mesenchyme-like background

Keratinizing squamous cells and mucous-producing cells are present

Myoepithelial cells make up a large percentage of tumor cells

Highly characteristic stromal cells are believed to be produced by myoepithelial cells

accumulation of extensive mucoid material may occur between tumor cells

Stroma exhibits areas of eosinophilic hyalinized change

Far or osteoid also seen

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11
Q

Treatment and prognosis of pleomorphic adenoma

A

Surgical excision is best

With adequate surgery, excellent prognosis

Malignant transformation extremely rare

Malignant degeneration is a potential complication (carcinoma ex pleomorphic adenoma)

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12
Q

What is oncocytosis?

A

Proliferation and accumulation of oncocytes within salivary gland tissue

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13
Q

Oncocytosis is uncommon in people under what age?

A

50

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14
Q

What is oncocytic metaplasia?

A

Transformation of ductal and acinar cells to oncocytes (excessive mito)

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15
Q

Is oncocytosis considered a metaplastic and/or neoplastic process?

A

Metaplastic, but not neoplastic, although it resembles a tumor both clinically and histologically

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16
Q

Histopathology of oncocytosis

A

Usually focal nodular collections of oncocytes within the salivary gland tissue

Englarged cells are polyhedral and demonstrate abundant granular eosinophiic cytoplasm as a result of the proliferation of mitochondria

Multifocal nature of proliferation may be confused with metastatic tumor

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17
Q

Oncocytosis treatment and prognosis

A

NO TREATMENT NECESSARY, excellent prognosis

Oncocytosis is a benign and incidental finding

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18
Q

What are Monomorphic adenomas

A

This term should not be used anymore

Originally used to describe a group of benign salivary gland tumors demonstrating a more uniform histopathologic pattern than the common “pleomorhpic adenoma”

E.g. warthin tumor, oncocytoma, basal cell adenoma, canalicular adenoma

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19
Q

What is an oncocytoma

A

Rare, benign salivary gland tumor composed of large epithelial cells called oncocytes

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20
Q

What are oncocytes and how do they appear?

A

Excessive accumulation of mito causing swollen granular cytoplasm

Large, polyhedral cells

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21
Q

How is focal oncocytic metaplasia related to a patient’s age?

A

Older = more metaplasia

Focal oncocytic metaplasia of salivary ductal and acinar cells is a common finding

Also identified in thyroid, PTH and kidney

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22
Q

Histopathologic features of oncocytoma

A

Well-circumscribed tumor tat is composed of sheets of large polyhedral cells

Abundant granular, eosinophilic (acidophilic) cytoplasm

Nuclei centrally located and vary in size

V. little stroma

Associated lymphocitic infiltrate may be noted

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23
Q

Treatment and Prognosis of oncocytoma

A

Best treated by surgical excision

Prognosis is good after removal with low rate of recurrence

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24
Q

What is another name for a warthin tumor?

A

Papillary cystadenoma lymphomatosum

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25
Q

What is a warthin tumor?

A

Benign neoplasm that amost exclusively occurs in the parotid gland

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26
Q

What do analyses of epithelial and lymphoid components suggest about the Warthin Tumor?

A

Anyalyses show both to be polyclonal, so may not be a true neoplasm

27
Q

What kind of tissue do warthin tumors arise form?

A

Heterotropic salivary gland tissue found within parotid lymph nodes

Strong association between development of this tumor and smoking (8x higher risk!)

28
Q

Clinical features of warthin tumor

A

Slowly growing, painless, nodular mass of the parotid gland

Frequently bilateral but not at the same time (bilaterality may be explained by association with smoking)

29
Q

Where does the warthin tumor appear in relation to the mandible?

A

Near the angle of the mandible

30
Q

Histopathologic features of papillary cystadenoma lymphomatosum (warthin)

A

One of the most distinctive histopathologic patterns of any tumor in the body

Mixture of ductal epithelium and lyphoid stroma

Epithelium is oncocytic w/ uniform rows of cells surrounding cystic spaces

Lining epithelium demonstrates multiple papillary infoldings that protrude into the cystic spaces

Focal areas of squamous metaplasia or mucous proplasia may be seen

Epithelium is supported by a lymphoid stroma (frequently shows germinal center formation)

31
Q

What are the two layers of cells seen in a papillary cystadenoma lymphomatosum?

A
  1. inner luminal layer w/ talll columnar cells w/ centrally placed, palisaded and slightly hyperchromatic nuclei
  2. outer layer of cuboidal or polygonal cells with more vesicular nuclei
32
Q

Papillary cystadenoma lymphomatosum treatment?

A

Surgica excision

33
Q

Canalicular adenoma is found almost exclusively in what gland?

A

Minor salivary glands

34
Q

Which area of the mouth is usually affected by canalicular adenoma?

A

Upper lip

35
Q

What age/gender is affected most by canalicular adenoma?

A

Older adults

Females > Males

36
Q

Clinical appearance of canalicular adenoma

A

Slowly growing

Painless

Several mm - 2 cm

37
Q

Histopathology of canalicular adenoma

A

Uniform columnar cells forming canal-like ductal structures

Monomorphic appearance

Single layered cords of columnar or cuboidal epithelial cells with deeply basophilic nuclei

38
Q

Treatment and prognosis of canalicular adenoma

A

Surgical excision is best

Recurrence uncommon

39
Q

Describe Basal cell adenoma

A

Benign salivary tumor

Name comes from basaloid appearance of tumor cells

40
Q

Basal cell adenoma primarily occurs in which gland?

A

Paroti gland

41
Q

Histopathological features of basal cell adenoma

A

Usually encapsulated or well-circumscribed

Cords of basaloid cells arranged in a trabecular pattern

42
Q

Treatment of basal cell adenoma

A

Complete surgical removal

Recurrance is rare

43
Q

Mucoepidermoid carcinoma– benign or malignant?

A

MOST COMMON malignant salivary gland neoplasm

Has a low-grade benign form, which can become malignant

44
Q

Age range in which you see mucoepidermoid carcinoma

A

Wide range, 20-70 yrs

Most common salivary gland malignancy in children

45
Q

Mucoepidermoid carcinoma most common in which gland?

A

Parotid

(Minor salivary glands second most common, esp on palate)

46
Q

Clinical appearance of mucoepidermoid carcinoma

A

Usually appears as an asymptomatic swelling

Blue pigmented mass

47
Q

Histopathologic features of mucoepidermoid carcinoma

A

composed of a mix of mucus-producing and epidermoid (squamous) cells

-mucus cells vary in shape, contain foamy cytoplasm that stains pos. with mucin stains

intermediate cells: thought to be the progentor of both mucus and epidermoid cells

48
Q

Describe the difference between low-grade, high-grade, and intermediate mucoepidermoid carcinoma tumors

A

Low-grade: prominent cyst formation, minimal cellular atypia and relatively high proportion of mucous cells

High-grade: solid islands of squamous and intermediate cells, can demonstrate considerable pleomorphism and mitotic activity

Intermediate: features thta fall between low and high grade

49
Q

Mucoepidermoid carcinoma treatment and prognosis

A

Prognosis depends on grade and stage of the tumor:

Low->good, local recurrences or regional metastases are uncommon

Intermediate->slightly worse prognosis than low

High->survival rate of 30-54%

Minor salivary gland tumors have a good prognosis due to low grade

50
Q

What is Intraosseous mucoepidermoid carcinoma?

A

Salivary gland tumor that arises centrally within the jaw

Most common and best-recognized intrabony salivary tumor

51
Q

Most likely source of intraosseous mucoepidermoid carcinoma

A

Odontogenic epithelium

Many intraosseous mucoepidermoid carcinomas develop in associtaion with impacted teeth or odontogenic cysts (esp dentigerous cysts!)

52
Q

What is acinic cell adenocarcinoma?

A

Salivary gland malignancy w/ cells that show serous acinar differentiation

Formerly called acinic cell tumor

53
Q

Prognosis of acinic cell adenocarcinoma

A

Non-aggressive tumor, associated w/ good prognosis

54
Q

What are malignant mixed tumors?

A

Malignant counterparts to the benign mixed tumor (pleomorphic adenoma)

Most common: carcinoma ex pleomorphic adenoma

-malignant transformation of the epithelial component of a previously benign pleomorphic adenoma

55
Q

Histopathology of malignant mixed tumors

A

Within the tumor are areas of malignant degeneration of the epithelial component

Characterized by cellular pleomorphism and abnormal mitotic activity

Malignant portion of the tumor shows epithelial cells with pleomorphic nuclei

56
Q

Adenoid cystic carcinoma appearance?

A

Usually appears as slow-growing mass

57
Q

Adenoid cystic carcinoma symptoms

A

Low-grade, dull ache, gradually increases in intensity

58
Q

Histopathology of adenoid cystic carcinoma

A

Mixture of myoepithelial and ductal cells

Three patterns:

Cribriform (most common)

Tubular

Solid

Usually see a combination of the three

Highly characteristic feature is tendency to show perineural invasion–corresponds to clinical finding of pain, cells swirl around bundle

59
Q

Treatment and prognosis of adenoid cystic carcinoma

A

Prone to late recurrence and metastases

Survival rate is high after 5 years but declines rapidly over time

Death– local recurrence or distant metastases

60
Q

What is polymorphous low-grade adenocarcinoma

A

One of the more common minor salivary gland malignancies

Posess distinct clinicopathologic features

61
Q

Polymorphous low-grade adenocarcinoma is almost exclusively a tumor of what glands?

A

Minor salivary glands

62
Q

Histopathologic features of polymorphous low-grade adenocarcinoma

A

Cribriform pattern can be produced that mimics adenoid cystic carcinoma

Perineural invasion is common (another reason it may be mistaken for adenoid cystic carcinoma)

Distinction between the two is important bc of vastly different prognosis

63
Q

Polymorphous low-grade adenocarcinoma treatment and prognosis

A

Wide surgical excision, sometimes resection of underlying bone

Metastasis to regional lymph nodes is relatively uncommon

Overall prognosis is good

Death is rare, but may occur secondary to direct extension into vital structures

ID of perineural invasion doesn’t change prognosis

OPath II - Salivary Gland Lesions (2 decks)

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