Salivary Gland Tumours Flashcards
1
Q
What can changes in gland size be attributed to
A
- secretion retention
- chronic sialadenitis
- gland hyerplasia
- salivary neoplasm
2
Q
What are different causes of secretion retention
A
- mucocele
- duct obstruction
3
Q
What are the different causes of chronic sialadenitis
A
- bacterial
- viral
4
Q
What are causes of gland hyperplasia
A
- sialosis aka sialodenosis
- sjogrens
5
Q
How may salivary neoplasm present
A
- localized swelling
- neurological change?
- painless, slow growing, well defined usually
6
Q
Are SG tumours generally benign or malignant
A
benign
75%
7
Q
What are the possible theories on the aetiology of SG tumours
A
- nuclear radiation
- EBV
- racial susceptibility
8
Q
Where are the majority of tumours
A
- parotid
- majority of parotid tumours = benign
9
Q
Where is the least common place for salivary tumours
A
- sublingual gland
- majority of sublingual tumours = malignnat
10
Q
How does the WHO 2017 classification categorize tumours
A
Epithelial neoplasm
* benign (adenoma)
* malignant (adenocarcinoma)
Non-epithelial neoplasm
* lymphoma
* sarcoma
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
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)
13
Q
What are the different biopsy techniques for salivary gland tumours
A
- fine needle aspirate
- core biopsy
- incisional biopsy
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
15
Q
What is a core biopsy
A
- small sample taken under LA
- more tissue than FNA
16
Q
What is incisional biopsy taken for
A
- intra-oral
- requires easy access
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
18
Q
What are the most common benign tumours
A
- pleomorphic adenoma
19
Q
What is the most common gland effected in pleomorphic adenoma
A
- parotid
- when in minor glands, palate most common area
20
Q
What is the presentation of pleomorphic adenoma
A
- slow growing, painless, rubbery mass
- overlying skin and mucosa intact
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
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
23
Q
What do myoepithelial cells resemble
pleomorphic adenoma
A
- muscle cells
24
Q
How does chondroid areas resemble
pleomorphic adenoma
A
hyaline cartilage
25
This is a slide of pleomorphic adenoma, what is b?
duct like structures
26
This is a pleomorphic adenoma, what does D represent
dense collagen
27
This is a pleomorphic adenoma, what does C represent
sheets of epithelial cells
28
This is a pleomorphic adenoma, what does A represent
fibrous tissue capsule
29
This is a pleomorphic adenoma, what does E represent
myxamatous area
30
What is the treatment for pleomorphic adenoma
* wide local excision
31
What are the two main problems with pleomorphic adenoma
* multifocal recurrence
* progression to carcinoma
32
Why may mutlifocal recurrence occur
* 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
What % of pleomorphic adenoma progress to carcinoma
5%
usually tumours which have been present for years
34
What is the carcinoma that pleomorphic adenoma progresses to called
* carcinoma ex-pleomorphic adenoma
35
Where is warthins tumour mostly seen
36
Where is warthins tumour mostly seen
* parotid
37
How does warthins tumour present
* swellings
* may arise multifocally
* can present bilaterally sometimes
38
What is the histology of warthins tumour
* consists of epithelial and lymphoid tissue
* papillary cystic structure
* distinictive epithelium
39
Describe the papillary cystic structure of warthins tumour
* irregular cyst spaces
* contain mucoid material
40
Describe the distinictive epithelium seen in warthins tumour
* cover the papillary processes
* double layered
* basal cells = cuboidal
* layered with columnar cells
41
What is the theory surrounding the aetiology of warthins tumour
residue from salivary gland epithelium entrapped within lymph nodes during development
42
What is the treatment of warthins tumour
excision
43
Here are some slides of warthins tumour
44
Here are some slides of warthin's tumour
45
What are some of the most common malignant salivary gland tumours
* adenoid cystic carcinoma
* mucoepidermoid carcinoma
* acinic cell carcinoma
* polymorphous adenocarcinoma
46
Describe the epidemiology of adenoid cystic carcinoma
5% of salivary gland tumours
more common for minor gland tumours
47
What is the presentation of adenoid cystic carcinoma
* similar to pleomorphic adenoma
* slow growing tumour
* may also experience pain and ulceration of overlying skin and mucosa
* facial palsy (parotid tumour)
48
What are the varied histological patterns for adenoid cystic carcinoma
* cribiform (swiss cheese) - characteristic
* tubular
* solid
49
How does adenoid cystic carcinoma spread initially
* along nerves
* marrow spaces in bone
50
Why is adenoid cystic carcinoma difficult to treat
* high recurrance
* poor prognosis
51
What makes the late spread of adenoid cystic carcinoma distinictive
* carcinomas usually spread by lymph first
* ACC usually metastesise to lungs via blood
52
This is a slide from an adenoid cystic carcinoma, what does B show
perineural spread
53
This is a slide from an adenoid cystic carcinoma, what does F show
cribiform pattern
54
This is a slide from an adenoid cystic carcinoma, what does E show
tubular pattern
55
This is a slide from an adenoid cystic carcinoma, what does A show
muscle infiltration
56
What is the incidence of mucoepidermoid carcinoma
3-5% - higher in the USA
57
What site is mucoepidermoid carcinoma must common
parotid
palate in minor glands
58
What is the presentation of mucoepidermid carcinoma
* similar to pleomorphic adenoma
* grossly cystic tumours may fluctate
* more aggressive ones may present with pain and ulceration
59
What 2 cell types can be seen in the histology of mucoepidermoid carcinoma
squamous (epidermoid)
glandular (mucous)
60
What is the behaviour of mucoepidermoid carcinoma
unpredictable
may spread via intraosseous with various sources e.g odontogenic cysts
61
Here are some slides of mucoepidermoid carcinoma
62
Where does polymorphous adenocarcinoma mostly occur
minor glands in the palate
63
What are the features of polymorphous adenocarcinoma
* locally infiltrative (nerves)
* often requires immunohistochemistry to differentiate
* more common, slower growing
* metastases rare
* straight forward tx
64
What is the most common site for acinic cell carcinoma
* rare
* mostly in parotid
* histology and behaviour varied
65
Note down the most common salivary gland tumours from most common to least common
pleomorphic adenoma (75%)
warthin's tumour (15%)
adenoid cystic carcinoma (5%)
mucoepidermoid carcinoma (3%)
acinic cell carcinoma (<1%)
