Salivary glands tumours/ Salivary gland swelling and enlargement Flashcards
Why might a salivary gland encounter change is size (4)?
- Secretion retention
- Chronic sialadentitis
- Gland hyperplasia
- Salivary neoplasma
How would you describe a salivary gland neoplasm? (3)
- Painless
- Slow growing
- Well defined
What nerve can be affected in a neoplasm in the parotid gland?
Facial nerve
List the distribution of tumours in the salivary gland
- Parotid - 80% - 15% malignant
- Submandibular - 10% - 30% malignant
- Minor - 10% - 45% malignant
- Sublingual - 0.5% - 80% malignant
Two examples of epithelial salivary neoplasms?
Adenoma - 11 types
Adenocarcinoma - 20 types
Two examples of non epithelial salivary neoplasms?
Lymphoma
Sarcoma
3 clinical featured of major gland neoplasm?
Asymmetry
Obstruction
Pain and facial palsy in late stages
What feature is considered a malignancy in minor salivary glands?
Ulceration
Where do minor salivary gland tumours usually appear?
- Junction of hard and soft palate
- Upper lip and cheek
What are 3 diagnosis techniques for salivary gland tumours?
- Ultrasound guided fine needle aspiration
- Core biopsy
- Incisional biopsy
3 problems in diagnosing salivary gland tumours?
- Variation within tumour due to complex pathology
- Common featured between different types
- Not all tumours fit the classification
Most common site of pleomorphic adenoma?
Parotid gland
What type of tumour is pleomorphic adenoma?
Mixed tumour
3 histological features of pleomorphic adenoma?
Duct epithelium
Myoepithelial cells
Myxoid and chondroid areas
Variable capsule
What % for pleomorphic adenoma progress to cancer?
5%
What problem might be associated with pleomorphic adenoma other than malignancy?
Recurrence
What is the most common gland to be affected by warthin’s tumour (15%)?
Parotid
3 histological sites of adenolymphoma? (Warthin’s tumour)
Cystic spaces
Distinctive pink epithelium
lymphoid tissue
How does adenoid cystic carcinoma (5%) spread?
through nerves and bones
Why is adenoid cystic carcinoma difficult to treat?
Due its high rate of recurrence
Where do adenoid cystic carcinoma metastasise to in late stages ?
to the lungs by blood
What are the 3 patterns of adenoid cystic carcinoma?
- Cribriform
- Tubular
- Solid
Which glands do adenoid cystic carcinoma mostly affect?
Minor glands
What is the 2 types of mucoepidermoid carcinoma (3-5%) when it comes to grading?
Cystic and solid
How does mucoepidermoid carcinoma spread?
Lymphatic
2 cell types found histologically in mucoepidermoid carcinoma?
Squamous and glandular
By order list salivary gland tumours from the commonest to the rarest?
- Pleomorphic adenoma (75%)
- Salivary gland carcinoma and warthins tumour(15%)
- Adenoid cystic carcinoma (5%)
- Mucoepidermoid carcinoma (3-5%)
- acinic cell carcinoma
Two viruses that cause changes in salivary gland size?
paramyxovirus (mumps)
HIV
Two reasons why there is secretion retention in a salivary gland?
- Mucocele
- Duct obstruction
Two conditions that cause salivary gland hyperplasia?
- Sialosis
- Sjogren’s syndrome
Which vaccine prevents mumps?
MMR
Give 4 symptoms of mumps infection?
- xerostomia
- headache
- loss of appetite
- Fatigue and pyrexia
How does paramyxovirus spread?
Droplet
What is a mucocele?
A recurrent swelling due to secretion retention in the duct of a salivary gland
What the most common sites of a mucocele?
- Junction of the hard and soft palate
- Lower lip
What is a subacute obstruction of the salivary gland?
Swelling associated with meals due to obstruction of salivary gland ducts most common in the submandibular gland due to sialoliths or duct damage due to chronic infection
How is subacute obstruction different between parotid and submandibular?
- Duct blockage in submandibular
- Duct stricture in parotid
What investigations would you carry out if suspected a sailolith?
- Radiography - lower true occlusal , OPT
- Sialography
- isotope scan if gland function uncertain
- Ultrasound
How to manage subacute obstruction?
- Surgical sialolith removal
- Sialography for no stone cases
- If fixed swelling remove gland
What is sialosis?
Inflammation of salivary gland leading to enlargement
What 4 factors may contribute to sialolis?
- alcohol
- Cirrhosis
- Diabetes
- Drugs
4 investigations you would carry out for Sialosis?
- Blood tests - general ones , bilirubin
- Autoantibody screening (ANA, anti-ro and anti-la)
- MRI of major salivary glands
