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Oral Pathology > Salivary Glands: Inflammatory Disorders & Neoplasms > Flashcards

Salivary Glands: Inflammatory Disorders & Neoplasms Flashcards

1
Q

What are the three types of salivary glands?

A

Parotid, submandibular and sublingual

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2
Q

What kind of saliva is secreted out of parotid glands?

A

Mainly serous saliva

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3
Q

Parotid Gland Duct

A

Stensen’s Duct/Parotid Papilla

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4
Q

Submandibular Gland Saliva Type

A

Mixture of serous and mucinous saliva

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5
Q

Submandibular Gland Duct

A

Wharton’s Duct; sublingual caruncles on either side of the lingual frenum

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6
Q

Sublingual Gland Saliva Type

A

Mainly mucinous saliva

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7
Q

Sublingual Gland Ducts

A

8-20 excretory ducts

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8
Q

Smaller Sublingual Gland Ducts; where do they exit?

A

Ducts of Rivinus; exit into the floor of the mouth

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9
Q

Major Sublingual Glands; where do they exit?

A

Duct of Bartholin; exits through the submandibular duct (wharton’s duct)

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10
Q

How many minor salivary glands are there?

A

600+ of them

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11
Q

Are minor salivary glands encapsulated?

A

No

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12
Q

Where are minor salivary glands located?

A

Labial mucosa, buccal mucosa, palate, tongue

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13
Q

Describe Minor salivary glands located on tongue

A

Anterior and posterior

Von Ebner’s Glands produce serous saliva surrounding circumvallate papillae

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14
Q

Where are minor salivary glands not located?

A

Anterior hard palate and gingiva except retromolar pad

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15
Q

Salivary Glands are composed of what three structures?

A

Secretory component+ ducts+ myoepithelial cells

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16
Q

Salivary Gland Structure: Describe what makes up secretory component

A

Serous, mucous or both serous and mucous saliva

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17
Q

Salivary Gland Structure: Describe serous cells

A

Protein secreting, from acinar structures, think less saliva

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18
Q

Salivary Gland Structure: Describe mucous cells

A

Secrete mucin, usually tubular strcuture rather than acini, think more viscous saliva

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19
Q

Salivary Gland Structure: Describe serious demilunes

A

Mixed serous and mucous acinus, serous cells surrounding mucous acinus

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20
Q

Salivary Gland Structure: Describe duct system

A

Intercalated duct -> striated duct -> excretory duct

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21
Q

Salivary Gland Structure: Describe myoepithelial cells

A

Surround acini and intercalated ducts, contract to help move secretory products

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22
Q

List Salivary Gland DIsorders

A 
Mucocele
Ranula
Salivary Duct Cyst 
Necrotizing Sialometaplasia 
Sialolithiasis 
Sialadenosis
Sialadenitis
Sjogren's Syndrome
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23
Q

Mucocele Clinical Presentation

A

Dome-shaped swelling, compressible, non-painful (frequently) blush

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24
Q

Mucocele Etiology

A

Trauma to a salivary gland duct causing extravasation of mucin into adjacent tissue

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25
Q

Mucocele Location

A

Lower labial mucosa&raquo_space; floor of mouth (ranula) > anterior ventral tongue, buccal mucosa, palate, retromolar pad

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26
Q

In what oral site will a mucocele never occur?

A

Gingiva

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27
Q

Mucocele Population

A

Any age, but usually younger patients as a results of increased prevalence of trauma

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28
Q

Mucocele Histology

A

Mucous surrounded by granulation tissue wall

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29
Q

Mucocele Treatment

A

Conservative excision of lesion+ surrounding minor salivary gland lobules

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30
Q

Mucocele Excision Techniques

A

Elipse, Enucleation, laser ablation

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31
Q

Muocele Recurrence

A

Remove adjacent minor salivary gland lobules to prevent recurrence

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32
Q

Mucocele: Clinical Variant

A

Superficial Mucocele

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33
Q

Superficial Mucocele Common Sites

A

Soft palate, retromolar pad, posterior buccal mucosa

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34
Q

Superficial Mucocele Treatment

A

Ruptures and leave shallow painful ulcers -> do not require excision

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35
Q

Superficial Mucocele may develop in associate with what other conditions?

A

Lichen Planus, lichenoid drug eruption, or GVHD

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36
Q

Describe a Ranula

A

Mucocele of the floor of the mouth

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37
Q

Where do Ranulas occur?

A

Sublingual gland

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38
Q

Ranula Treatment

A

Marsupialization

Removal of lesion along with the sublingual gland

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39
Q

Why may marsupialization not be successful with ranulas?

A

Larger lesions

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40
Q

Ranula Clinical Variant & Significance

A

Plunging Ranula (cervical ranula)

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41
Q

What occurs with a plunging ranula (cervical ranula)?

A

Spilled mucin dissects through the mylohyoid muscle

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42
Q

What may plunging ranula be present as?

A

Only a neck swelling

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43
Q

What is used to diagnose plunging ranula?

A

MRI/CT

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44
Q

Plunging Ranula Radiographic Hallmark

A

Tail Sign

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45
Q

Define Tail Sign

A

Extension of the lesion into the sublingual space on imaging

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46
Q

Salivary Duct Cyst: Clinical Presentation

A

Typically soft, mucosal swelling

Color: Ranges from bluish to amber

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47
Q

Salivary Duct Cyst: Etiology

A

Ductal obstruction from sialolith or mucous plug

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48
Q

Salivary Duct Cyst: Location

A
  • Any major or minor salivary glands
  • Major: Parotid most common
  • Minor: FOM>Buccal mucosa> lip
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49
Q

Salivary Duct Cyst: Population

A

Adults

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50
Q

Components of a Salivary Duct Cyst

A
  • Lumen
  • Fibrous Connective Wall
  • Epithelium
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51
Q

Salivary Duct Cyst Treatment

A
  • Conservative Excision

- Should not recur

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52
Q

Necrotizing Sialometaplasia Clinical Presentation

A

Swelling (1 week) -> ulceration (2 weeks) -> healing (5-6 weeks)

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53
Q

Necrotizing Sialometaplasia: Etiology

A

Ischemia, local infarction from trauma and dental injections

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54
Q

Necrotizing Sialometaplasia:Location

A

Almost always on the palate (75%)

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55
Q

Necrotizing Sialometaplasia: Population

A

Adults, male (2:1)

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56
Q

Necrotizing Sialometaplasia: Histology

A
  • Acinar necrosis

- Squamous metaplasia

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57
Q

Describe squamous metaplasia

A

Cuboidal epithelium of ducts changes to squamous epithelium

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58
Q

Necrotizing Sialometaplasia: Treatment

A
  • Self limiting
  • Follw up and ensure complete resoultion
  • If the lesion does not resolve in typical 5-6 week span you must biopsy
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59
Q

Sialolithiasis aka

A

Salivary Stones

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60
Q

Sialolithiasis Clinical Presentation

A

Episodic pain and/or swelling

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61
Q

Sialolithiasis Etiology

A

Deposition of calcium salts around a nidus of debris within the lumen of a salivary gland duct

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62
Q

SIalolithiasis Location

A

Any salivary gland (duct or within the gland itself)

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63
Q

Sialolithiasis: Most common major gland site; why?

A

Submandibular gland; long tortuous upward path

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64
Q

Sialolithiasis: most common minor gland site

A

Upper lip, buccal mucosa

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65
Q

Sialolithiasis Population

A

Most common in young and middle-aged adults

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66
Q

Sialolithiasis: Treatment for Minor gland stone

A

Excision of stone and associated minor gland

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67
Q

Sialolithiasis: Treatment for Major Salivary Gland Stone

A
  • Promote passage of stone by massage of gland, moist heat+ increased salivary flow (increased fluid intake, sour candy)
  • Surgical Excision: May require partial or complete excision of the gland in some cases
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68
Q

Define “Sial”

A

Denoting saliva or salivary glands

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69
Q

Define “-adenitis”

A

Inflammation of a gland

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70
Q

Define “-adenosis”

A

Non-inflammatory enlargement of glands

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71
Q

Sialadenosis: Define

A

Non-inflammatory salivary gland enlargement

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72
Q

Sialadenosis: Clinical Presentation

A

Slowly evolving enlargement of the salivary glands

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73
Q

Sialdenosis: Etiology

A

Underlying systemic condition

  • Diabetes Mellitus
  • Bulimia
  • Alcoholism
  • Malnutrition
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74
Q

Sialadenosis: Location

A

parotid gland> submandibular > minor salivary glands

Usually bilateral

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75
Q

Sialadenosis: Population

A

Any age/demographic

76
Q

Sialadenosis: Diagnosis

A

Sialography finding: leafless tree

77
Q

Sialadenosis: Treatment

A
  • Control of underlying cause

- Partial parotidectomy for esthetic purposes

78
Q

Define Sialadenitis

A

Inflammation of the salivary glands

79
Q

Sialadenitis Clinical Presentation

A

Variable: Asymptomatic to pain/swelling/purulence

80
Q

Sialadenitis: Etiology

A

Infectious causes, non-infectious causes, idiopathic

81
Q

Sialadenitis: What are some infectious etiologies?

A

Viral: Mumps, HIV, CMV
Bacterial: Decreased salivary flow and/or ductal obstruction allows for retrograde spread of bacteria

82
Q

Sialadenitis: What are some non-infectous etiologies?

A

Sjogren syndrome, sarcoidosis, radiation therapy, surgical mumps

83
Q

Sialadenitis: What are some idiopathic causes?

A
  • Juvenile recurrent parotitis

- Subacute nectrotizing sialadenitis

84
Q

Sialadenitis: Location

A

Any salivary gland

85
Q

Sialadenitis: Population

A

Any

86
Q

Sialadenitis: Three Clinical Highlights

A
  • Acute bacterial sialadenitis
  • Mumps
  • Surgical mumps
87
Q

Describe Acute bacterial sialadenitis site & characteristics

A
  • Most commonly affects parotid gland

- Characteristic Finding: purulent discharge from parotid papilla

88
Q

What is mumps

A

-Paramyxovirus

89
Q

What is the most common viral cause of sialadenitis

A

Mumps

90
Q

Mumps Site

A

Parotid glands (may be unilateral) but can affect other major salivary glands

91
Q

Why is mumps infrequent in the US?

A

Vaccination

92
Q

Describe what causes surgical mumps

A

Acute parotitis following a recent surgery

93
Q

Surgical Mumps Etiology

A

patient without food or fluids leading up to surgery and given atropine to decrease saliva production during surgery

94
Q

Sialadenitis: Treatment

A

Treatment is based on the underlying cause

95
Q

Sialadenitis: Treatment with presence of purulence

A

Culture and appropriate antibiotic therapy

96
Q

Sialadenitis: Treatment for self limiting viral infection

A

Monitor for resolution

97
Q

Sjogren Syndrome: Clinical Features

A
  • Xerostomia
  • Xerophthalmia
  • 1/3 to 1/2 of patients exhibit enlargement of the major salivary glands
98
Q

Describe features of xerostomia

A

Altered taste, dysphagia, atrophy of tongue papillae, increased caries risk

99
Q

Describe features of xerophtalmia

A

Scratchy, gritty sensation

100
Q

Describe sicca syndrome

A

Xerostomia+ xerophthalmia

101
Q

Sjogren Syndrome: Etiology

A

Autoimmune disorder

102
Q

Sjogren Syndrome: Population

A

Middle aged adults; Female; 9-1

103
Q

Sjogren Syndrome: Diagnosis

A

Criteria (2 out 3 necessary for diagnosis)

104
Q

Sjogren Syndrome: First criteria

A

Positive antibodies to Ro(SS-A) and/or La(SS-B) antigens; OR positive RF and ANA (antinuclear antibody)

105
Q

Sjogren Syndrome: Second criteria

A

Labial salivary gland biopsy with focus score equal to or greater than 1 focus/4 mm^2

106
Q

Sjogren Syndrome: Third cteria

A

Keratoconjuctivitis Sicca with ocular staining score equal to or greater than 3

107
Q

Sjogren Syndrome: Describe Keratoconjunctivitis Sicca

A

Terminology for xerophthalmia+ pathologic changes to the ocular surface

108
Q

Describe Primary Sjogren Syndrome

A

Sicca Syndrome only

109
Q

Describe secondary sjogren syndrome

A

Sicca syndrome+ another associated autoimmune disorder like SLE, RA, systemic sclerosis

110
Q

Describe Diagnostic tools for Sjogren Syndrome

A
  • Labial salivary gland biopsy by harvesting 5-7 lobules

- Sialography

111
Q

Sjogren Syndrome Histology

A
  • Chronic sialadenitis

- benign lympoepithelial lesions

112
Q

Sjogren Syndrome: What is seen on sialography

A

Fruit-laden, branchless tree

113
Q

Sjogren Syndrome: Treatment

A
  • Mostly palliative
  • Regular opthalmologist visits
  • Hydration/Coating products
  • Sialogogue medications
  • Increased preventative dental care for xerostomia-related caries
  • Increased prevalence of oral candidiasis
  • Significantly increased lifetime risk for lymphoma
114
Q

What are two medications used to treat Sjogren Syndrome

A

Cevimeline or Pilocarpine

115
Q

Who should we avoid use of cevimeline or pilocarpine with?

A

Patients with uncontrolled respiratory disease, significant cardiac disease, narrow-angle glaucoma

116
Q

How are effects limited with cevimeline or pilocarpine?

A

Effect is limited by amount of remaining functional salivary gland tissue

117
Q

Side Effect of cevimeline or pilocarpine

A

Significant sweating

118
Q

What are the three most common benign salivary gland tumors?

A
  • Pleomorphic adenoma
  • Warthin Tumor
  • Monomorphic adenoma
119
Q

Another name for Pleomorphic adenoma

A

Benign mixed tumor

120
Q

Another name for Warthin tumor

A

Papillary cystadenoma lymphomatosum

121
Q

Two other names for monomorphic adenoma

A

Canalicular adenoma, basal cell adenoma

122
Q

Four most common malignant salivary gland tumors

A
  • Mucoepidermoid carcinoma
  • Acinic cell carcinoma
  • Adenoid cystic carcinoma
  • Carcinoma ex pleomorphic adenoma
123
Q

Define Adenoma

A

A benign tumor formed from glandular structures in epithelial tissue

124
Q

Define Carcinoma

A

A malignant tumor of epithelial origin

125
Q

Where is epithelium present in the body?

A

Covering of body surfaces (skin, mucosa), lining of body cavities, major tissue in glands

126
Q

Define adenocarcinoma

A

Generic term for a cancer of glandular origin

127
Q

Most common salivary gland tumor

A

Pleomorphic adenoma

128
Q

Most common benign salivary gland tumor

A

Pleomorphic Adenoma

129
Q

Most common malignant salivary gland tumor

A

Mucoepidermoid carcinoma

130
Q

Most common benign salivary gland tumor in children

A

Pleomorphic adenoma

131
Q

Most common malignant salivary gland tumor in children

A

Mucoepidermoid carcinoma

132
Q

Describe Pleomorphic Adenoma

A

Benign, most common salivary gland tumor

133
Q

Pleomorphic adenoma Clinical Features

A
  • Painless, slow-growing firm mass

- Can be present for months or years before pt seeks a diagnosis

134
Q

Pleomorphic adenoma site

A

Parotid> submandibular > minor (palate> upper lip> buccal mucosa)

135
Q

Pleomorphic adenoma population

A

Age: 30-60 years old
Sex: Slight female predilection

136
Q

Pleomorphic adenoma Treatment

A

Complete surgical excision; may be difficult due to facial nerve placement

137
Q

Pleomorphic adenoma: Prognosis

A
  • Excellent, cure rate more than 95%

- Can undergo malignant transformation if left untreated for a prolonged amount of time

138
Q

Malignant amount of pleomorphic adenoma

A

Carcinoma

139
Q

Describe Warthin Tumor

A

Benign, second most common tumor of the parotid gland behind the pleomorphic adenoma

140
Q

Warthin Tumor Etiology

A
  • Possible heterotopic salivary tissue within the parotid lymph nodes
  • Smokers have a 8x greater chance of developing this tumor
141
Q

Warthin Tumor Clinical Features

A
  • Slow growing, painless mass

- 5-7% bilateral

142
Q

Warthin Tumor Site

A

Almost exclusive to the parotid

143
Q

Warthin Tumor Age

A

60-70 years old

144
Q

Warthin Tumor Sex

A

Equal or slight male predilection

145
Q

Warthin Tumor Treatment

A

Surgical excision (though in some cases clinicans can observe/monitor)

146
Q

Warthin Tumor Prognosis

A

2-6% recurrence rate

Malignant transformation is exceedingly rare

147
Q

Two types of monomorphic adenoma

A

Canicular adenoma and basal cell adenoma

148
Q

Describe canalicular adenoma

A

Benign

149
Q

Canalicular Adenoma Site

A 
Almost exclusive to minor salivary glands.
Upper lip (75%)> buccal mucosa
150
Q

Canalicular adenoma age

A

Older, patients in 70’s

151
Q

Canalicular Adenoma Sex

A

Female predilection

152
Q

Canalicular Adenoma Treatment

A

Excision

153
Q

Canalicular Adenoma Prognosis

A

Recurrence is rare

154
Q

Describe Basel Cell Adenoma

A

Benign

155
Q

Basal cell adenoma site

A

75% occur in the parotid

156
Q

Basal cell adenoma Age

A

Middle aged-older adults

157
Q

Basal cell adenoma Sex

A

Female predilection

158
Q

Basal cell adenoma treatment

A

Excision

159
Q

Basal cell adenoma prognosis

A
  • Recurrence is rare

- Malignant transformation to bassal cell adenocarcinoma is rare

160
Q

Describe mucoepidermoid carcinoma

A

Most common salivary gland malignancy

161
Q

Mucoepidermoid carcinoma Clinical Features

A
  • Most commonly an asymptomatic swelling present for a year or less
  • High grade variants can cause pain or parasthesia and/or grow more rapidly
162
Q

Mucoepidermoid carcinoma site

A

Parotid gland> minor salivary glands of the palate

163
Q

Mucoepidermoid carcinoma age

A

Wide Range 10-60 years old

164
Q

Mucoepidermoid Carcinoma Treatment

A

Depends on location, grade, stage

  • Early stage tumors of the parotid can be treated with subtotal parotidectomy
  • Late stage in parotid my mean total parotidectomy with facial nerve
  • Possible neck dissection
  • Post op radiation
165
Q

Mucoepidermoid carcinoma Low grade prognosis

A

-Good prognosis

90-98% cure rate

166
Q

Mucoepidermoid carcinoma high grade prognosis

A

Guarded

30-54% survival

167
Q

Mucoepidermoid carcinoma:

Prognosis if in Submandibular gland

A

Poorer prognosis compared to parotid

168
Q

Mucoepidermoid carcinoma: prognosis if in oral minor salivary glands

A

Good prognosis

169
Q

Mucoepidermoid carcinoma: prognosis if present in tongue and floor of the mouth

A

Less predictable, more aggressive

170
Q

Describe Acinic cell carcinoma

A

Low grade malignant salivary gland neoplasm

171
Q

Acinic cell carcinoma clinical features

A

Slow growing, painless mass

172
Q

Acinic cell carcinoma site

A

Parotid (85-90%)

173
Q

Acinic Cell Carcinoma: Age

A

Mean age mid 40’s to early 50’s

174
Q

Acinic Cell Carcinoma Treatment

A
  • Partial parotid lobectomy (total parotidectomy if indicated)
  • Lymph node dissection only if evidence of spread, radiation indicated for uncontrolled disease
175
Q

Acinic Cell Carcinoma Prognosis

A

Considered non-aggressive, good prognosis

176
Q

Acinic Cell Carcinoma Local recurrence rate

A

10-20%

177
Q

Acinic Cell Carcinoma Metastasis Rate

A

8-11%

178
Q

Acinic Cell Carcinoma Death Rate

A

10%

179
Q

Describe Adenoid Cystic Carcinoma

A

Malignant salivary gland neoplasm

180
Q

Adenoid cystic carcinoma Clinical features

A

Slow growing, painful immediately, parasthesia, dull aching

181
Q

Adenoid Cystic Carcinoma Site

A

50% occur in minor salivary glands with the palate being most common site

182
Q

What is the most common malignancy of the submandibular gland?

A

Adenoid cystic carcinoma

183
Q

Adenoid Cystic Carcinoma Age

A

Middle aged adults, rare under 20

184
Q

Adenoid Cystic Carcinoma: Sex

A

Slight Female Predilection

185
Q

Adenoid Cystic Carcinoma: Treatment

A

Resection

+/- radiation

186
Q

Adenoid cystic carcinoma prognosis

A
  • “Relentless tumor”: local recurrence and metastasis (typically distant metastasis, meaning regional lymph node less likely site of met)
  • Good five year prognosis, but 35-53% 20 year survival rate
  • Metastasizes in 35% of patients -> common met sites include lungs, brain, and bone
187
Q

Biopsy techniques for suspected salivary gland tumors

A

-Refer: hospital based ENT/head and surgeon
Typical procedure: fine-needle aspiration
-In office punch biopsy

Oral Pathology (7 decks)

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