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oral path 2, exam 2 > salivary neoplasm 1 > Flashcards

salivary neoplasm 1 Flashcards

1
Q

Salivary gland neoplasms comprise approximately __% of all head and neck neoplasms

A

3%

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2
Q

how many cases of salivary gland neoplasms are diagnosed each year? who is at the greatest risk?

A

A) Uncommon, but not rare, with 4,000 new cases diagnosed each year in U.S.

B) May be a slight female sex predilection

C) Vast majority of these lesions arise during adulthood

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3
Q

which salivary glands are most likely to be effected with neoplasms?

A

Parotid- 61-80%
Submandibular- 8-11%
Sublingual- less than 1%
Minor glands- 9-28%

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4
Q

what is the most common INTRAORAL site of involvement for salivary neoplasms?

A

Palate (50%)

  • 20% are found on lips, 15% on buccal mucosa
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5
Q

Minor salivary gland neoplasms typically effect what intraoral site?

A

palate

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6
Q

what salivary gland has the highest risk for malignant transformation of salivary neoplasms?

A

Sublingual gland

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7
Q

what is the prevalence of MALIGNANCY in salivary gland neoplasms in the parotid/sublingual/submandibular/minor glands?

A

A) parotid = 15-32%

B) submandibular = 26-45%

C) sublingual = 70-95%

D) minor = 45-50%

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8
Q

which intraoral sites are most likely to present with malignancies?

A 
A) Retromolar- 90%
B) Tongue - 80%
C) Lower lip - 60%
D) Palate & Buccal mucosa - 45%
E) Upper lip - 15%
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9
Q

______________ are also known as “benign mixed tumor”

A

Pleomorphic Adenomas

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10
Q

T/F: Pleomorphic Adenomas are a relatively rare form of salivary neoplasms

A

FALSE

  • PA’s are the most common salivary gland neoplasm
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11
Q

what does the naming of “pleomorphic adenomas” refer to?

A

the combination of neoplastic ductal epithelial and myoepithelial cells that often show a variety of histologic patterns

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12
Q

___% of all Pleomorphic Adenomas are found in the parotid gland

PA’s account for ___% of all parotid tumors

A

80% of all PA’s are in the parotid

PA’s make up 63% of all parotid tumors

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13
Q

___% of Pleomorphic Adenomas are found in the submandibular gland

PA’s account for ___% of all submandibular tumors

A

10% - submandibular (60% of all submandibular tumors)

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14
Q

___% of Pleomorphic Adenomas are found intraorally

PA’s account for ___% of all intraoral salivary gland tumors

A

10% - intraoral (40% of all intraoral salivary gland tumors)

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15
Q

what is the clinical presentation of a salivary gland Pleomorphic adenoma?

A

In the major glands, a slow-growing, painless, freely moveable mass will be detected

Rubbery firm on palpation

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16
Q

in what location of the mouth would you NOT expect a pleomorphic adenoma to be mobile?

A

Posterior Hard Palate

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17
Q

T/F: PA’s are typically non-ulcerated, and are NOT bilateral in presentation

A

True

A) Palatal lesions are usually to one side of the midline
B) Usually non-ulcerated, but ulceration may be present secondary to trauma

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18
Q

When a Pleomorphic Adenoma lesion is small, it’s usually round, but it typically becomes ___________ as it grows larger

A

bosselated

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19
Q

intraorally, where are pleomorphic adenomas most likely to be found?

A

palate is most frequent (54%), followed by upper lip (22%) and buccal mucosa (15%)

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20
Q

T/F: For Pleomorphic Adenomas, the encapsulated proliferation of ductal epithelial cells and myoepithelial cells vary in proportions from lesion to lesion

A

true

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21
Q

what are the histological features of Pleomorphic Adenomas?

A

1) The myoepithelial cells may appear spindled or plasmacytoid
2) myoepithelial cells have the ability to produce a myxoid stroma, hyaline material, cartilaginous material or even osteoid

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22
Q

what is the treatment protocol for Pleomorphic Adenomas?

A

Tx: Depends on location:

1) Parotid - remove the lesion with the involved lobe
2) Submandibular - remove the lesion and the involved gland
3) Hard palate - remove the lesion, including overlying oral mucosa, down to periosteum
4) Soft palate, labial and buccal mucosa - enucleation

23
Q

a pleomorphic adenoma in what location has the highest rate of reoccurance?

what is the risk for malignancy in PA’s?

A

A) reoccurance = parotid gland

B) 5% of PA’s will undergo malignant transformation

24
Q

Papillary Cystadenoma Lymphomatosums are also known as “_____________”

A

Warthins tumors

25
Q

what is the histogenesis of Warthins tumors (PCL)?

A

Probably arises from salivary duct epithelium entrapped in parotid lymph nodes during development

26
Q

Prevalence of Warthins tumors (PCL):

A

Comprises 5% of all salivary gland neoplasms and 5-22% of parotid gland neoplasms

27
Q

Papillary Cystadenoma Lymphomatosums are almost always found in what location?

A
  • Found almost exclusively in parotid gland
28
Q

Risk factors for Papillary Cystadenoma Lymphomatosum (Warthins tumor):

A
  • More common in MALES
  • May be caused by cigarette smoking
  • Average age is 55-60 years
29
Q

Clinical presentation of Warthins tumors (PCL):

Papillary Cystadenoma Lymphomatosum

A

A) Presents as a non-tender, slowly growing freely moveable mass of the parotid region

B) In 10% of cases, synchronous or (mostly) metachronous lesions are observed, may be bilateral or unilateral

C) Grossly, encapsulated with cystic spaces containing serous, milky or chocolate-syrup-like fluid

30
Q

Histology of PCL’s (warthins tumors)

Papillary Cystadenoma Lymphomatosum

A
  • Encapsulated collection of lymphoid tissue that usually exhibits typical germinal center formation
  • Contained within this tissue are dilated cystic spaces into which project papillary infoldings that are lined by a double row of columnar to cuboidal oncocytes (altered ductal epithelial cells)
31
Q

what is the treatment/prognosis/reoccurance for Papillary Cystadenoma Lymphomatosum?

A

Tx: Surgical excision

Prognosis: Very low recurrence rate - 5% range

Recurrences actually may represent development of metachronous lesion

32
Q

T/F: Monomorphic adenomas are far more common than Pleomorphic adenomas

A

False

Pleomorphic adenomas are more common

33
Q

what are the 2 major sub-types of Monomorphic adenomas?

A

canalicular adenoma and basal cell adenoma

34
Q

where would Canalicular (tubular) adenomas usually be found?

A
  • Seen in both the major salivary glands and intraorally

- Relatively more common intraorally, especially in the upper labial mucosa

35
Q

what population is at greatest risk for Canalicular adenomas?

A

Presents as a well-encapsulated, non-tender mass in an older adult (mean age - 65 years)

Female predominance

36
Q

histological characteristics of Canalicular Adenomas:

A

Encapsulated proliferation of cuboidal to columnar cells that form tubules and narrow trabecular cords, with the appearance of channels or “canals”

37
Q

Treatment/reoccurance/prognosis for Canalicular Adenomas:

A

Tx: Simple enucleation
Prognosis: Excellent
Virtually no tendency to recur

38
Q

_____________ are the most common intraoral salivary gland MALIGNANCIES

A

Mucoepidermoid Carcinoma

39
Q

T/F: Mucoepidermoid carcinomas are typically found in older (45-60 years old) adults

A

FALSE

mucoepidermoid Ca is the most common salivary gland malignancy in children, with 15% occurring in patients less than 15 yrs old

40
Q

In what intraoral locations are Mucoepidermoid carcinomas typically found?

A

A) Intraorally, palate is most common site (28%), followed by retromolar area (23%)

B) May also be found centrally within mandible or maxilla

41
Q

Clinical presentation of Mucoepidermoid cysts:

A

1) Well-demarcated or infiltrative mass
2) Non-tender and non-ulcerated initially
3) May have bluish tinge due to entrapped mucin
4) Ulceration and pain may develop as lesion progresses

42
Q

T/F: A Mucocele-appearing lesion of retromolar area should be considered to be mucoepidermoid Ca until proven otherwise

A

True

43
Q

what are the 2 distinct cellular elements of Mucoepidermoid carcinoma?

A
  1. mucous cells

2. epidermoid cells

44
Q

T/F: both cellular elements must be seen histologically to diagnose a lesion as Mucoepidermoid carcinoma

A

true

45
Q

what is the treatment protocol for Mucoepidermoid carcinoma

A

Low-grade - wide surgical excision

High-grade - wide surgical excision, plus radiation

46
Q

what is the prognosis for Mucoepidermoid carcinoma?

A

A) prognosis depends on tumor size and histologic grade

B) lesions less than 2.5 cm have excellent prognosis

C) 10 yr survival: low grade = 95%, high grade = 40%

47
Q

____________ is the SECOND most common intraoral salivary gland MALIGNANCY

A

Polymorphous Low-Grade Adenocarcinoma (PLGA)

48
Q

what population groups are at risk for developing PLGA?

A

Female predilection by a 2:1 ratio

Adult population, mean age of 56 years, with a range of 23-94 years

49
Q

Clinical presentation of PLGA’s:

A

A) Usually presents as a firm, painless swelling that may or may not be ulcerated

B) Typically well-demarcated initially, later becomes more infiltrative and diffuse

C) Usually a very slow-growing lesion

50
Q

where are most PLGA’s found?

A

Most commonly found in the posterior hard palate/soft palate (65%), followed by upper lip and buccal mucosa

51
Q

histological features of PLGA’s

A

lobular growth pattern that infiltrates the surrounding normal tissue, although a pseudocapsule may be present in some areas

52
Q

what are some possible growth patterns of PLGA?

A

solid, trabecular, cribriform-like, ductal and spindle-cell areas

Lesional cells are usually cytologically bland

53
Q

PLGA can be confused with what other condition?

A

May be confused with adenoid cystic Ca or pleomorphic adenoma

54
Q

what is the treatment/prognosis/reoccurrence of PLGA’s?

A 
Tx:  Wide surgical excision
Prognosis:  Excellent
Recurrence				-  9-29%
Lymph node metastasis 	-  9-17%
Dead of disease			-  rare

oral path 2, exam 2 (6 decks)

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