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Oral Disease for FINALS > Salivary gland tumours (and some tumour like lesions) > Flashcards

Salivary gland tumours (and some tumour like lesions) Flashcards

1
Q

Classification of salivary gland tumours (7)

A 
Epithelial
1) adenomas
2) carcinomas
Non-epithelial
3) connective tissue tumours
4) malignant lymphomas
5) secondary tumours
6) unclassified tumours
7) tumour-like lesions
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2
Q

Salivary gland tumours - epidemiology (6)

A

About 1000 malignant tumours per year
70% are in the parotid gland, 9% submandibular, 1% sublingual
70% are pleomorphic adenomas
90% are benign
Only 20% are in minor glands
Minor gland (intra-oral) tumours are more commonly malignant (50%)

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3
Q

Age and gender distribution of salivary gland tumours (2)

A

F > M

F 61-70 most affected

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4
Q

Site distribution of salivary tumours in minor glands (5)

A 
Palate 55%
Lips 15% (95% in upper lip)
Cheek 10%
Tongue 10%
Other 10%
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5
Q

Types of tumour by site (5)

A 
Major glands
-70% pleomorphic adenoma
-5% mucoepidermoid carcinoma
-5% ad cystic carcinoma
-15% other
Minor glands
-45% pleomorphic adenoma
-20% mucoepidermoid carcinoma
-10% PLGA
-15% ad cystic carcinoma
-10% others
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6
Q

How many tumours in major salivary glands are benign? (1)

A

80%

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7
Q

Types of benign salivary epithelial neoplasms (6)

A 
Pleomorphic adenoma
Warthins tumour
Basal cell adenoma
Ductal papillomas
Cystadenoma
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8
Q

What is a pleomorphic adenoma? (7)

A 
Most common salivary gland tumour
Parotid most common site
Palate next most common
Age 30-60 
M=F
Benign
May recur
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9
Q

Histopathology of pleomorphic adenoma (7)

A 
Mixed (pleomorphic) pattern
Islands and strands of epithelial cells
Ductal structures common
Myxoid, mucoid or chondroid stroma
Encapsulated
-infiltration of tumour into capsule may be seen
Often lobular pattern
Occasional tumours are solid
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10
Q

What is a Warthin tumour? (5)

A 
About 10% of benign salivary tumours
Always parotid gland
More common in males (60:40)
Sometimes bilateral or multifocal
Completely benign
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11
Q

Histopathology of Warthin tumour

A

Irregular cysts
Lined by onocytic duct epithelium
Stroma composed of lymphoid tissue

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12
Q

Salivary adenomas (4)

A

Basal cell adenoma
Canalicular adenoma
Cystadenoma
Inverted ductal papilloma

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13
Q

Malignant epithelial neoplasms (carcinomas) (5)

A 
Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Polymorphous adenocarcinoma
Acinic cell carcinoma
Carcinoma in pleomorphic adenoma
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14
Q

Mucoepidermoid carcinoma (6)

A
  • Most common malignant salivary tumour
  • 20% of minor and 5% of major gland lesions
  • Parotid most common site
  • Palate, cheek, retromolar
  • Seen occasionally in children
  • Malignant – about 10% metastasise
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15
Q

Mucoepidermoid carcinoma histopathology (4)

A

A mixture of mucous cells and epidermoid (squamous cells)
Lesions are usually multicystic
High grade lesions may be solid with few mucous cells
Occasional lesions have many clear cells

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16
Q

Adenoid cystic carcinoma (7)

A
  • Second most common malignant tumour
  • 15% of minor and 5% of major gland lesions
  • Parotid most common site
  • Palate, cheek, sinuses
  • Highly malignant
  • 75% of patients die within 20 years
  • Metastasis via blood stream
17
Q

Adenoid cystic carcinoma histopathology (2)

A

Infiltrative tumour - no capsule
-infiltrates through bone, in blood vessels, along nerves
Has a characteristic multicystic or cribiform pattern: ‘Swiss cheese’

18
Q

Polymorphous adenocarcinoma (5)

A

• Only found intra-orally
• Usually palate - 70%
• Lips, Cheek 30%
• Third most common intra-oral malignancy
• Usually over 50 years
-often misdiagnosed on incisional biopsies as pleomorphic adenoma or adenoid cystic carcinoma
-need great care with small palatal biopsies
-previously termed ‘low-grade’
-often survival > 90% at 5 years
-metastases in 10-15%
-similar to umcoepidermoid
-can be unpredictable: papillary cystic lesions and cytological atypia may have worse prognosis

19
Q

Polymorphous adenomacarcinoma histolopathology (8)

A
  • Lobules
  • Ductal structures
  • Cribriform areas and ‘washed-out’ nuclei
  • Papillary cystic pattern
  • Single cell filing
  • Perineural infiltration typical
  • Infiltrative growth
  • Bland, monotonous cytology
20
Q

Acinic cell carcinoma (3)

A
  • About 5% of salivary gland malignancies
  • 80% in parotid; 15% in minor glands
  • 30% recurrence rate & 15% metastasise
21
Q

Histological appearance of acinic cell carcinoma (5)

A 
– Solid
– Microcystic
– papillary cystic
– follicular
• Lymphoid tissue + germinal centres common
22
Q

Carcinoma in pleomorphic adenoma (3)

A

• About 10% of pleomorphic adenomas may
become malignant
• Usually long standing and/or recurrent lesions
• Elderly: 60+

23
Q

Carcinoma in pleomorphic adenoma - histopathology (3)

A

May appear to be a typical pleomorphic adenoma
BUT - shows areas of cytological atypia
Some lesions contain other types of carcinoma: adenoid cystic, adenocarcinoma etc.

24
Q

Tumour-like lesions (7)

A 
• sialadenosis
• oncocytosis
• necrotising sialometaplasia
• salivary gland cysts
• chronic sialadenitis of submandibular
gland
• lymphoepithelial lesions
• cystic lymphoid hyperplasia in HIV
25
Q

What is Sjogren’s syndrome? (1)

A

An autoimmune disorder characterised by
lymphocyte mediated destruction of exocrine
glands resulting in dry eyes and dry mouth.

26
Q

Primary and secondary SS (3)

A 
Primary SS
• dry eyes and dry mouth
Secondary SS
• dry eyes and/ or dry mouth
• connective tissue disease (RA, SLE)
27
Q

Clinical features of Sjogren’s syndrome (5)

A 
90% in females
Middle age
Oral symptoms:
• Dry mouth – dry mucosa, lobulated tongue
• Infections – candidosis
• Caries
Dry eyes - keratoconjuctivitis
Parotid swelling in about 20%
28
Q

Pathology of Sjogren’s syndrome (3)

A 
Lymphocytic infiltrates in salivary glands
In minor glands:
• Focal sialadenitis
In major glands
• Lymphoepithelial lesion
29
Q

Histopathology of Sjogren’s syndrome (5)

A 
Shows typical lymphoepithelial lesions 
Gland is replaced by
lymphocytes
Acini disappear, but ducts
proliferate to form epithelial
islands
Epithelial islands infiltrated
by lymphocytes:
‘lymphoepithelial lesion’
In about 5% of cases
these lesions may
progress to lymphoma
30
Q

HIV salivary gland disease (5)

A 
5-10% develop parotid enlargement:
• Chronic parotitis
• Cystic lymphoepithelial lesions
• Sjogren’s – like symptoms
• Parotid lymphomas

Oral Disease for FINALS (34 decks)

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