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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
What is a warthin tumor?
Benign neoplasm that amost exclusively occurs in the parotid gland
26
What do analyses of epithelial and lymphoid components suggest about the Warthin Tumor?
Anyalyses show both to be polyclonal, so may not be a true neoplasm
27
What kind of tissue do warthin tumors arise form?
Heterotropic salivary gland tissue found within parotid lymph nodes _Strong association between development of this tumor and smoking (8x higher risk!)_
28
Clinical features of warthin tumor
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
Where does the warthin tumor appear in relation to the mandible?
Near the angle of the mandible
30
Histopathologic features of papillary cystadenoma lymphomatosum (warthin)
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
What are the two layers of cells seen in a papillary cystadenoma lymphomatosum?
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
Papillary cystadenoma lymphomatosum treatment?
Surgica excision
33
Canalicular adenoma is found almost exclusively in what gland?
Minor salivary glands
34
Which area of the mouth is usually affected by canalicular adenoma?
Upper lip
35
What age/gender is affected most by canalicular adenoma?
Older adults Females \> Males
36
Clinical appearance of canalicular adenoma
Slowly growing Painless Several mm - 2 cm
37
Histopathology of canalicular adenoma
Uniform columnar cells forming canal-like ductal structures Monomorphic appearance _Single layered cords of columnar or cuboidal epithelial cells with deeply basophilic nuclei_
38
Treatment and prognosis of canalicular adenoma
Surgical excision is best Recurrence uncommon
39
Describe Basal cell adenoma
Benign salivary tumor Name comes from basaloid appearance of tumor cells
40
Basal cell adenoma primarily occurs in which gland?
Paroti gland
41
Histopathological features of basal cell adenoma
Usually encapsulated or well-circumscribed Cords of basaloid cells arranged in a trabecular pattern
42
Treatment of basal cell adenoma
Complete surgical removal Recurrance is rare
43
Mucoepidermoid carcinoma-- benign or malignant?
MOST COMMON _malignant_ salivary gland neoplasm Has a low-grade benign form, which can become malignant
44
Age range in which you see mucoepidermoid carcinoma
Wide range, 20-70 yrs Most common salivary gland malignancy in children
45
Mucoepidermoid carcinoma most common in which gland?
Parotid (Minor salivary glands second most common, esp on palate)
46
Clinical appearance of mucoepidermoid carcinoma
Usually appears as an asymptomatic swelling Blue pigmented mass
47
Histopathologic features of mucoepidermoid carcinoma
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
Describe the difference between low-grade, high-grade, and intermediate mucoepidermoid carcinoma tumors
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
Mucoepidermoid carcinoma treatment and prognosis
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
What is Intraosseous mucoepidermoid carcinoma?
Salivary gland tumor that arises centrally within the jaw Most common and best-recognized intrabony salivary tumor
51
Most likely source of intraosseous mucoepidermoid carcinoma
Odontogenic epithelium Many intraosseous mucoepidermoid carcinomas develop **in associtaion with impacted teeth or odontogenic cysts** (esp dentigerous cysts!)
52
What is acinic cell adenocarcinoma?
Salivary gland malignancy w/ **cells that show serous acinar differentiation** Formerly called acinic cell tumor
53
Prognosis of acinic cell adenocarcinoma
Non-aggressive tumor, associated w/ good prognosis
54
What are malignant mixed tumors?
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
Histopathology of malignant mixed tumors
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
Adenoid cystic carcinoma appearance?
Usually appears as slow-growing mass
57
Adenoid cystic carcinoma symptoms
Low-grade, dull ache, gradually increases in intensity
58
Histopathology of adenoid cystic carcinoma
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
Treatment and prognosis of adenoid cystic carcinoma
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
What is polymorphous low-grade adenocarcinoma
One of the more common minor salivary gland malignancies Posess distinct clinicopathologic features
61
Polymorphous low-grade adenocarcinoma is almost exclusively a tumor of what glands?
Minor salivary glands
62
Histopathologic features of polymorphous low-grade adenocarcinoma
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
Polymorphous low-grade adenocarcinoma treatment and prognosis
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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