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BDS5 oral disease > salivary neoplasms > Flashcards

salivary neoplasms Flashcards

1
Q

what is the mechanism of oncogenesis for most salivary neoplasms?

A

chromosomal translocations

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2
Q

how can chromosomal translocations be visualised?

A

fluorescence in situ hybridisation (fluorescent probes will be separated)

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3
Q

describe the site prevalence of salivary neoplasms (3)

A
  • most in parotid, least in sublingual
  • parotid most likely to be benign
  • sublingual most likely to be malignant
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4
Q

where are most benign salivary neoplasms found?

A

parotid gland

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5
Q

which salivary gland has the highest proportion of malignant salivary neoplasms?

A

sublingual

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6
Q

give some features of benign salivary gland neoplasms (4)

A
  • well-differentiated, encapsulated
  • slow-growing, presenting late
  • non-invasive, non-metastatic
  • symptoms usually cosmetic or pressure-induced
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7
Q

what are the two most common salivary neoplasms?

A

pleomorphic adenoma
Warthin tumour

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8
Q

list benign salivary gland neoplasms (10)

A
  • pleomorphic adenoma
  • Warthin tumour
  • myoepithelioma
  • oncocytoma
  • basal cell adenoma
  • lymphadenoma
  • cystadenoma
  • sebaceous adenoma
  • canalicular adenoma
  • ductal papilloma
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9
Q

describe pleomorphic adenoma
(what, clinical, age)

A
  • commonest salivary neoplasm
  • benign but may undergo malignant transformation over time
  • 30-60yo
  • painless, slow-growing, discrete, mobile rubbery mass; nodular
  • > 75% in parotid, less in submandibular or minor glands
  • may have pseudopodia (extensions)
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10
Q

pleomorphic adenoma histology (3)

A
  • haphazard arrangement of pleomorphic epithelial cells centred around ductal structures
  • bilaminar ducts containing mucin
  • myxochondroid stroma +/- cartilage-like material or bone
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11
Q

pleomorphic adenoma age group

A

30-60yo

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12
Q

pleomorphic adenoma management (2)

A
  • excision with wide margin
    (radiotherapy resistant)
  • monitor for malignant change
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13
Q

pleomorphic adenoma commonest site

A

superficial lobe of parotid

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14
Q

why are the pseudopodia of a pleomorphic adenoma important?

A

enucleation may leave parts of tumour in situ –> recurrence

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15
Q

why may some pleomorphic adenomas be difficult to remove?

A
  • may be mostly formed of myxochondroid stroma = jelly-like, fragile
  • prone to rupture and seeding of multiple foci
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16
Q

describe Warthin tumour (demographic, clinical)

A
  • > 60yo males with smoking history
  • mainly in parotid (lower pole)
  • benign, mobile, firm/fluctuant, well-defined mass
  • may be single/multiple, bi/unilateral
17
Q

Warthin tumour demographic

A

> 60yo males with smoking history

18
Q

Warthin tumour commonest site

A

lower pole of parotid

19
Q

Warthin tumour histology (3)

A
  • papillary structures growing into cystic spaces
  • lymphocyte-dense stroma - similar to lymph node with lymphoid follicles
  • pseudostratified columnar epithelium, usually bilaminar- densely eosinophilic cytoplasm
20
Q

Warthin tumour treatment

A

excision (low recurrence rate

21
Q

list the 5 main malignant salivary neoplasms

A
  • mucoepidermoid carcinoma
  • adenoid cystic carcinoma
  • acinic cell carcinoma
  • carcinoma ex-pleomorphic adenoma
  • polymorphous adenocarcinoma
22
Q

prognostic factors of malignant salivary neoplasms (5)

A
  • stage at presentation (most important)
  • grade
  • CN involvement (affects management)
  • perineural invasion (poor)
  • site (parotid»)
23
Q

describe mucoepidermoid carcinoma (age, site, clinical, histology)

A
  • wide age range
  • minor glands of palate or parotid, often a firm painless swelling
    histology:
  • grade varies - mucous, epidermoid and intermediate cells differentiate grades
    – more mucous = lower
    – more epidermoid = higher
  • majority have prominent cystic component (= lower grade)
24
Q

which is the most common malignant salivary neoplasm?

A

mucoepidermoid carcinoma

25
Q

mucoepidermoid carcinoma common sites (2)

A

minor glands of palate
parotid

26
Q

mucoepidermoid carcinoma treatment (2)

A

low grade (cystic mucus-filled) = excision with margin
high grade (solid epidermoid) = surgery +/- radiotherapy

27
Q

describe adenoid cystic carcinoma (site, symptoms, histology)

A
  • any gland
  • slow-growing, highly infiltrative
  • late diagnosis = pain, altered sensation, nerve palsy
    histology:
  • uniform hyperchromatic cells, sometimes true ducts, angulate peripheral layer
  • pseudocysts in cribriform/swiss-cheese pattern (degeneration of intercellular spaces)
  • areas with tubular patterns
28
Q

adenoid cystic carcinoma histology (3)

A
  • uniform hyperchromatic cells, sometimes true ducts, angulate peripheral layer
  • pseudocysts in cribriform/swiss-cheese pattern (degeneration of intercellular spaces)
  • areas with tubular patterns
29
Q

adenoid cystic carcinoma treatment

A

surgery but difficult to fully excise (infiltrative)

30
Q

describe acinic cell carcinoma (grade, age, site, histology)

A
  • most are low to intermediate grade but still invasive
  • young and middle aged pts
  • parotid gland = serous acinar origin, serous granules, PAS stain
  • multiple histological subtypes
  • commonly recurs
31
Q

acinic cell carcinoma common site

A

parotid (serous acinar origin)

32
Q

describe carcinoma ex-pleomorphic adenoma (what, types, histology)

A
  • develops from pre-existing pleomorphic adenoma = slow growth then suddenly enlarging/developing malignant symptoms
  • intracapsular type (behaves like pleomorphic adenoma)
  • minimally invasive type (4-6mm invasion)
  • invasive type (>4-6mm, worse prognosis)
  • histological evidence of pleomorphic adenoma but may be obliterated by scar tissue, wide variation
33
Q

describe polymorphous adenocarcinoma (site, prognosis, histology)

A
  • minor glands, esp on palate
  • overall good prognosis but local recurrence
  • various histological patterns
34
Q

polymorphous adenocarcinoma site

A

minor glands, esp on palate

35
Q

give two conditions that may mimic salivary neoplasm

A
  • necrotising sialometaplasia (benign, inflammatory)
  • IgG4 sclerosing disease
36
Q

surgical complications of parotid gland tumour surgery (8)

A
  • Frey’s syndrome
  • greater auricular nerve damage (ear lobe paraesthesia)
  • temporal nerve weakness
  • permanent facial nerve weakness, facial asymmetry
  • haematoma
  • necrosis near incision
  • salivary fistula or sialocele
  • recurrence
37
Q

what is Frey’s syndrome?

A

uncharacteristic sweating near parotid glands in response to food stimulus

38
Q

what are the three different types of parotid gland surgical intervention

A
  • extracapsular dissection
  • superficial parotidectomy (superficial to facial nerve)
  • total parotidectomy
39
Q

pros and cons of extracapsular dissection of parotid tumours

A

+:
- decreased risk of Frey’s syndrome, nerve damage, facial deformity
- decreased operating time and smaller flap size
-:
- careful case selection
- specific training and experience, less room for error

BDS5 oral disease (26 decks)

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