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BDS4 Oral Medicine > Salivary Gland Tumours > Flashcards

Salivary Gland Tumours Flashcards

1
Q

What can changes in gland size be attributed to

A
  • secretion retention
  • chronic sialadenitis
  • gland hyerplasia
  • salivary neoplasm
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2
Q

What are different causes of secretion retention

A
  • mucocele
  • duct obstruction
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3
Q

What are the different causes of chronic sialadenitis

A
  • bacterial
  • viral
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4
Q

What are causes of gland hyperplasia

A
  • sialosis aka sialodenosis
  • sjogrens
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5
Q

How may salivary neoplasm present

A
  • localized swelling
  • neurological change?
  • painless, slow growing, well defined usually
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6
Q

Are SG tumours generally benign or malignant

A

benign
75%

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7
Q

What are the possible theories on the aetiology of SG tumours

A
  • nuclear radiation
  • EBV
  • racial susceptibility
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8
Q

Where are the majority of tumours

A
  • parotid
  • majority of parotid tumours = benign
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9
Q

Where is the least common place for salivary tumours

A
  • sublingual gland
  • majority of sublingual tumours = malignnat
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10
Q

How does the WHO 2017 classification categorize tumours

A

Epithelial neoplasm
* benign (adenoma)
* malignant (adenocarcinoma)
Non-epithelial neoplasm
* lymphoma
* sarcoma

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11
Q

What are the general clinical features of tumours in the major glands

A
  • lump in affected gland
  • asymmetry
  • obstruction (tumour compresses duct)
  • pain, facial palsy (parotid) - these are late signs
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12
Q

What are the general clinical features of tumours in the minor gland

A
  • commonest area is soft/hard palate junction
  • may also be seen in upper lip and cheek
  • ulcerate late (malignant)
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13
Q

What are the different biopsy techniques for salivary gland tumours

A
  • fine needle aspirate
  • core biopsy
  • incisional biopsy
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14
Q

What is a fine needle aspirate used for

A
  • swellings where access is difficult
  • however only small amount of tissue received
  • not always enough information
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15
Q

What is a core biopsy

A
  • small sample taken under LA
  • more tissue than FNA
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16
Q

What is incisional biopsy taken for

A
  • intra-oral
  • requires easy access
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17
Q

What are the problems with diagnosis of SG tumours

A
  • large no. of tumours
  • not all tumours fit classification
  • immunohistochemistry may be required to differentiate
  • molecular markers may be used
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18
Q

What are the most common benign tumours

A
  • pleomorphic adenoma
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19
Q

What is the most common gland effected in pleomorphic adenoma

A
  • parotid
  • when in minor glands, palate most common area
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20
Q

What is the presentation of pleomorphic adenoma

A
  • slow growing, painless, rubbery mass
  • overlying skin and mucosa intact
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21
Q

What is the histology of pleomorphic adenoma

A
  • mixed tumour
  • myxoid areas and chondroid tissue is a characteristic feature
  • predominantly fibrous
  • connective tissue capsule present but not always complete
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22
Q

How is pleomorphic adenoma a ‘mixed tumour’

A
  • cells can originate from epithelium (duct) or myoepithelial cells (surround ducts) and both can be present
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23
Q

What do myoepithelial cells resemble

pleomorphic adenoma

A
  • muscle cells
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24
Q

How does chondroid areas resemble

pleomorphic adenoma

A

hyaline cartilage

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25
Q

This is a slide of pleomorphic adenoma, what is b?

A

duct like structures

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26
Q

This is a pleomorphic adenoma, what does D represent

A

dense collagen

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27
Q

This is a pleomorphic adenoma, what does C represent

A

sheets of epithelial cells

28
Q

This is a pleomorphic adenoma, what does A represent

A

fibrous tissue capsule

29
Q

This is a pleomorphic adenoma, what does E represent

A

myxamatous area

30
Q

What is the treatment for pleomorphic adenoma

A
  • wide local excision
31
Q

What are the two main problems with pleomorphic adenoma

A
  • multifocal recurrence
  • progression to carcinoma
32
Q

Why may mutlifocal recurrence occur

A
  • tumours rich in mucoid material tend to rupture more easily during surgery
  • causes spillage and implantation of tumour into surrounding tissue
  • gives rise to multifocal recurrences (recurrance in >1 area)
33
Q

What % of pleomorphic adenoma progress to carcinoma

A

5%
usually tumours which have been present for years

34
Q

What is the carcinoma that pleomorphic adenoma progresses to called

A
  • carcinoma ex-pleomorphic adenoma
35
Q

Where is warthins tumour mostly seen

A
36
Q

Where is warthins tumour mostly seen

A
  • parotid
37
Q

How does warthins tumour present

A
  • swellings
  • may arise multifocally
  • can present bilaterally sometimes
38
Q

What is the histology of warthins tumour

A
  • consists of epithelial and lymphoid tissue
  • papillary cystic structure
  • distinictive epithelium
39
Q

Describe the papillary cystic structure of warthins tumour

A
  • irregular cyst spaces
  • contain mucoid material
40
Q

Describe the distinictive epithelium seen in warthins tumour

A
  • cover the papillary processes
  • double layered
  • basal cells = cuboidal
  • layered with columnar cells
41
Q

What is the theory surrounding the aetiology of warthins tumour

A

residue from salivary gland epithelium entrapped within lymph nodes during development

42
Q

What is the treatment of warthins tumour

A

excision

43
Q

Here are some slides of warthins tumour

A
44
Q

Here are some slides of warthin’s tumour

A
45
Q

What are some of the most common malignant salivary gland tumours

A
  • adenoid cystic carcinoma
  • mucoepidermoid carcinoma
  • acinic cell carcinoma
  • polymorphous adenocarcinoma
46
Q

Describe the epidemiology of adenoid cystic carcinoma

A

5% of salivary gland tumours
more common for minor gland tumours

47
Q

What is the presentation of adenoid cystic carcinoma

A
  • similar to pleomorphic adenoma
  • slow growing tumour
  • may also experience pain and ulceration of overlying skin and mucosa
  • facial palsy (parotid tumour)
48
Q

What are the varied histological patterns for adenoid cystic carcinoma

A
  • cribiform (swiss cheese) - characteristic
  • tubular
  • solid
49
Q

How does adenoid cystic carcinoma spread initially

A
  • along nerves
  • marrow spaces in bone
50
Q

Why is adenoid cystic carcinoma difficult to treat

A
  • high recurrance
  • poor prognosis
51
Q

What makes the late spread of adenoid cystic carcinoma distinictive

A
  • carcinomas usually spread by lymph first
  • ACC usually metastesise to lungs via blood
52
Q

This is a slide from an adenoid cystic carcinoma, what does B show

A

perineural spread

53
Q

This is a slide from an adenoid cystic carcinoma, what does F show

A

cribiform pattern

54
Q

This is a slide from an adenoid cystic carcinoma, what does E show

A

tubular pattern

55
Q

This is a slide from an adenoid cystic carcinoma, what does A show

A

muscle infiltration

56
Q

What is the incidence of mucoepidermoid carcinoma

A

3-5% - higher in the USA

57
Q

What site is mucoepidermoid carcinoma must common

A

parotid
palate in minor glands

58
Q

What is the presentation of mucoepidermid carcinoma

A
  • similar to pleomorphic adenoma
  • grossly cystic tumours may fluctate
  • more aggressive ones may present with pain and ulceration
59
Q

What 2 cell types can be seen in the histology of mucoepidermoid carcinoma

A

squamous (epidermoid)
glandular (mucous)

60
Q

What is the behaviour of mucoepidermoid carcinoma

A

unpredictable
may spread via intraosseous with various sources e.g odontogenic cysts

61
Q

Here are some slides of mucoepidermoid carcinoma

A
62
Q

Where does polymorphous adenocarcinoma mostly occur

A

minor glands in the palate

63
Q

What are the features of polymorphous adenocarcinoma

A
  • locally infiltrative (nerves)
  • often requires immunohistochemistry to differentiate
  • more common, slower growing
  • metastases rare
  • straight forward tx
64
Q

What is the most common site for acinic cell carcinoma

A
  • rare
  • mostly in parotid
  • histology and behaviour varied
65
Q

Note down the most common salivary gland tumours from most common to least common

A

pleomorphic adenoma (75%)
warthin’s tumour (15%)
adenoid cystic carcinoma (5%)
mucoepidermoid carcinoma (3%)
acinic cell carcinoma (<1%)

BDS4 Oral Medicine (17 decks)

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