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OBMP Exam 2 > Salivary Pathology > Flashcards

Salivary Pathology Flashcards

1
Q

Major salivary glands

A

Parotid glands, submandibular glands, sublingual gland

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2
Q

Minor salivary glands

A
  • Palate (between midline and palatal gingiva)
  • Lining mucosa (cheeks, vestibules, FOM, lips)
  • Tongue (ventral & lateral surfaces)
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3
Q

The _____ nerve loops under the _____ duct.

A

lingual, submandibular

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4
Q

Gland with mostly serous acini

A

Parotid gland

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5
Q

Gland with mixed acini

A

Submandibular

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6
Q

Gland with purely mucous acini

A

Sublingual

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7
Q

_____ cells surround salivary acini and ducts

A

Myoepithelial

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8
Q

Non-infectious sialadenitis can be caused by

A
  • Post-irradiation
  • Immune mediated
  • Sarcoidosis
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9
Q

Infectious sialadenitis can be

A
  • Bacterial (acute, chronic, TB, Actinomycosis)

- Viral (mumps, cytomegalic inclusion disease, HIV)

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10
Q

Sialadenitis generally presents as

A

pain and swelling

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11
Q

Typically a retrograde infection, leading to progressive swelling of the gland 1-2 weeks + malaise, anorexia, dehydration +/- obstruction, fever & purulent exudate of stenson’s duct + pain exacerbated by eating or drinking

A

Acute bacterial parotitis

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12
Q

Predisposing factors of acute bacterial parotitis

A

Mouth dryness and/or dehydration, obstructed duct, poor oral hygiene, elderly pts

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13
Q

Acute bacterial parotitis appears microscopically as

A

sheets of neutrophils

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14
Q

Viral parotitis (Mumps) is a highly contagious viral disease caused by a member of

A

Paramyxovirus

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15
Q

Mumps is transmitted by

A
  • direct contact, droplet spread
  • Virus enter through nose/mouth and replicates in URT and LNs. Spreads to salivary glands and gonads, pancreas, meninges
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16
Q

Clinical symptoms of Mumps

A

Fever, malaise, headache/myalgia, painful swelling of parotids, submandibular, sublingual glands (pancreas, choroid plexus for the brain, ovaries, and testes in some cases)

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17
Q

Mumps breakouts occur in people living in

A

close quarters

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18
Q

Complications of Mumps

A

Deafness, pancreatitis, meningitis, inflammation of the testis and ovaries.

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19
Q

Children are vaccinated against mumps at what age with what vaccine?

A

1 y/o, MMR

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20
Q

Testing for Mumps

A

Clinical presentation, labs for Mumps specific IgM, IgG, or viral culture from parotid swab

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21
Q

Non-infectious sialadenitis includes

A

Immune-mediated sialadenitis (Sjogren syndrome), Sarcoidosis, Post-irradiation

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22
Q

Chronic swelling of the Parotid glands accompanied by dry mouth and eyes. More frequently accompanied by other autoimmune disease (RA, SLE)

A

Immune mediated sialadenitis (Sjogren syndrome)

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23
Q

Chronic non-tender swelling of the parotid and may be other salivary glands

A

Sarcoidosis

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24
Q

Severe dryness of mouth + mucositis + candidal infection

A

Post-irradiation

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25
Q

Mucoepidermoid carcinoma, adenoid cystic carcinoma, polymorphous low-grade adenocarcinoma, carcinoma ex pleomorphic adenoma all ex of

A

Malignant salivary gland tumors

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26
Q

Pleomorphic adenoma (Benign mixed tumor), Warthin’s tumor, monomorphic adenoma, Canalicular adenoma are ex of

A

Benign salivary gland tumors

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27
Q

Most (65%) of salivary gland tumors are found in the

A

Parotid gland

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28
Q

Accessory gland tumors are mostly found in the

A

palate

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29
Q

anatomic distribution of salivary gland tumors

A

1) Parotid (65%)
2) Accessory (25%)
3) Submandibular (10%)
4) Sublingual (<1%)

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30
Q

T or F: Salivary gland tumors are mostly Benign.

A

True (60%)

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31
Q

Most common salivary gland tumor is

A

Pleomorphic adenoma

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32
Q

Parotid gland is ____ benign

A

2/3

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33
Q

Submandibular is ____ benign

A

1/2

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34
Q

T or F: Sublingual gland tumors are mostly malignant.

A

T

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35
Q

Palate tumors are ____ benign

A

1/2

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36
Q

Upper lip tumors are mostly

A

benign

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37
Q

Lower lip tumors are mostly

A

malignant

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38
Q

Retromolar area tumors are mostly

A

malignant

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39
Q

Clinical cystic presentation could be

A

mucocele, ranula, cystic tumors

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40
Q

Ulcer clinical presentation could be

A

Necrotizing sialometaplasia, neoplasms

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41
Q

Mucoceles are mostly found on

A

the lower lip (80%)

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42
Q

Mucoceles are most common in what decades

A

1st-3rd

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43
Q

Mucoceles are caused by

A

trauma, laceration of salivary excretory salivary duct, mucin spillage into tissue.

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44
Q

Mucoceles exclusively affect ______ glands

A

minor

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45
Q

Clinical presentation of mucoceles

A

Dome-shaped, translucent/bluish nodule, fluctuant, often increasing and decreasing in size

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46
Q

Less common that conventional mucocele, appear as small blisters, often burst/heal and recur

A

superficial mucocele

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47
Q

Mucocele of ventral surface of tongue

A

Cyst of Blandin Nuhn

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48
Q

Mucocele tx

A

surgical excision of swelling and damaged salivary glands.

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49
Q

Location of mucous pooling in ranula is dicated by

A

mylohyoid clinical presentation

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50
Q

Ranula tx:

A

excision of mass and associated sublingual gland

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51
Q

Mucocele in FOM

A

Ranula

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52
Q

A true cyst of salivary duct origin

A

Salivary duct cyst (mucous cyst, mucous retention cyst)

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53
Q

Most common sites of Salivary duct cyst

A

Palate, FOM

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54
Q

Salivary duct cysts rarely can be _____ cyst in major glands. (polycystic disease of parotid gland)

A

congenital

55
Q

Treatment of salivary duct cyst

A

simple excision

56
Q

Salivary duct cyst pathology

A

Uni- or multilocular cyst with glandular epithelial lining

57
Q

Mucous cysts are lined by

A

simple glandular epithelium

58
Q

Histologically has epimyoepithelial islands and lymphatic destruction of acini

A

Sjogren’s

59
Q

Increased RF, ANA, SS-A, and SS-B

A

Sjogren’s

60
Q

Autoimmune disease characterized by autoantibodies against salivary ductal cells

A

Sjogren’s

61
Q

Dry mouth and eyes with or w/o parotid tumor-like swellings

A

Primary Sjogren Syndrome (Sicca Syndrome)

62
Q

Dry mouth, eyes, and any collagen-vascular disease (RA, Lupus)

A

Secondary Sjogren Syndrome

63
Q

Sjogren’s patients have a 40 fold increased risk in developing

A

B cell non-hodgkin lymphoma

64
Q

How to diagnose Sjogren’s

A

1) Blood work (ANA, SS-A, SS-B, RF)
2) Sialography (contrast medium)
3) Schrimer test (tears)
4) Salivary biopsy (lymphocitic infiltration of normal salivary glands)

65
Q

Schrimer test should wet

A

<5 mm in 5 mins

66
Q

Rose Bengal score ___ according to van Bijsterveld system

67
Q

Salivary biopsy needs atleast ____ foci of periductal lymphocytes, ____ cells/4mm^2

68
Q

T or F: Salivary biopses are not consistently positive in pts with Sjogren syndrome. About 50% in labial salivary and 90% in parotid.

69
Q

Lab findings RH

70
Q

Lab findings ANA

71
Q

Lab findings SS-A

72
Q

Management of Sjogren Syndrome

A

Topical oral moisterizers, antifungal for candidiasis, restorative tx, immunosuppressive tx for associated autoimmune disorders, Periodic re-eval, FNA if needed to confirm or r/o lymphoma

73
Q

The most common malignant salivary gland neoplasm

A

Mucoepidermoid carcinoma

74
Q

Mucoepidermoid carcinoma in bone is called

A

Central mucoepidermoid carcinoma

75
Q

Mucoepidermois tumors are composed of varying ratios of both

A

epidermoid and mucous cells

76
Q

Ulcerated mass with blue compressible areas:

A

Mucoepidermoid carcinoma

77
Q

Mucoepidermoid carcinoma is most common in

A

Parotid gland

78
Q

T or F: Mucoepidermoid carcinoma can be asymptomatic or w/ pain, parasthesia

79
Q

Mucoepidermoid carcinoma is the most common

A

Salivary, intraoral, pediatric, and intraosseous gland malignancy

80
Q

T or F: Mucoepidermoid carcinoma is the 2nd most common salivary gland neoplasms

A

T

  • 10-15% of all neoplasms
  • 30% of all malignancies
81
Q

Mucoepidermoid carcinoma is graded low, intermediate, high and depends on

A

1) Ratio of mucous cell vs epidermoid cells
2) Cystic vs solid
3) Degree of cytologic atypia

82
Q

Lower grade mucoepidermoid carcinoma is identified by

A

more mucous cells and more cystic areas.

83
Q

Mucoepidermoid carcinoma tx

A

depends on histologic grade, location, and clinical stage

84
Q

Mucoepidermoid carcinoma can seemingly present as a

A

mucocele (especially in retromolar area)

85
Q

An ulcerated mass that proliferates quickly

A

“Non-Hodgkin lymphoma”

86
Q

3rd most common malignancy, low grade malignant salivary gland neoplasm

A

Polymorphous low-grade adenocarcinoma (PLGA)

87
Q

PLGA is usually found in

A

minor salivary glands

88
Q

PLGA is found more in

A

Females than males

89
Q

Why is PLGA called polymorphous?

A

varied morphologic growth patterns microscopically

90
Q

PLGA tx

A

complete excision

91
Q

PLGA ____ metastasize

A

rarely (10%)

92
Q

PLGA local recurrence rate

93
Q

Palatal mass with “orange peel” surface texture

94
Q

PLGA different histologic growth patterns

A

tubular, cribiform, solid, single cell files

95
Q

Most common neoplasm of minor salivary glands

A

Pleomorphic adenoma (40%-most commonly on palate)

96
Q

Pleomorphic adenoma (mixed tumor) characterized by

A

PLAG1 and HMGA2 rearrangements

97
Q

Pleomorphic Adenoma is “pleomorphic” bc

A
  • varied types of tissues noted (epithelial, cartilage, bone)
  • Striking variability between tumors
98
Q

Pleomorphic adenoma (mixed tumors are a mixture of

A

epithelial and mesenchymal elements (bone, cartilage, fat)

99
Q

Malignant transformation of Pleomorphic adenoma occurs in ____ of pts

100
Q

Time period for malignant transformation is __

101
Q

T or F: Pleomorphic adenoma malignant transformation rarely occurs in the oral cavity bc early clinical detection

102
Q

Risk factors for malignant transformation of pleomorphic adenoma

A

-Longevity and recurrence, histological hyalinization, increased mitotic activity

103
Q

Features that are NOT associated with malignant transformation of PA

A

capsular violation, increased cellularity, areas of necrosis

104
Q

Invasive carcinoma ex-PA happens at

105
Q

A benign salivary gland tumor w/ limited growth potential

A

Warthin’s Tumor

106
Q

Tumor with strong association in adult men and smoking

A

Warthin’s tumor

107
Q

Second most common tumor in parotid after PA

A

Warthin’s tumor

108
Q

Warthin’s tumor is most likely to be found in which gland?

109
Q

T or F: Pathogenesis of Warthin’s tumor is unknown

A

T

-May be entrapped salivary gland w/in intraparotid lymph nodes

110
Q

Frequently “multicentric” tumor within the same gland

A

Warthin’s tumor

111
Q

Warthin’s tumor presents microscopically as

A

prominent cystic spaces w/ intraluminal papillary projections and lymphoid-rich stroma

112
Q

Well-demarcated mass w/ papillary structures outline by rows or columnar cells, cystic spaces, and lymphoid stroma

A

Warthin’s tumor

113
Q

High grade salivary gland cancer (regardless of histologic variant)

A

Adenoid cystic carcinoma

114
Q

Tendency for neural invasion

A

Neurotripism

115
Q

Slow-growing, but w/ symptoms of pain, numbness, nerve paralysis owing to tendency for local invasion and seeding outside primary mass

A

Adenoid cystic carcinoma

116
Q

High rate of recurrence and late metastasis (after >10 yrs)

A

Adenoid cystic carcinoma

117
Q

Firm mass of parotid, palate with pain/anesthesia due to neurotripism

A

Adenoid cystic carcinoma

118
Q

Pathology variants of adenoid cystic carcinoma

A

Cribriform, tubular, solid, mixed patterns

119
Q

Tx of Adenoid cystic carcinoma

A

wide sx excision, associated with overall poor prognosis

120
Q

Adenoid cystic carcinoma most likely to be found in

A

parotid gland

121
Q

Common “swiss cheese” pattern histologically

A

Adenoid cystic carcinoma

122
Q

Sialolithiasis most commonly found in

A

submandibular gland

123
Q

Calcification within the salivary gland/duct

A

Sialolithiasis

124
Q

How does Sialolithiasis start?

A

Viscous mucus plug, bacteria, cellular debris-> mineralizes

125
Q

T or F: Sialolithiasis is a localized process and has no relation to hypercalcemia (kidney/gall stones)

126
Q

Risk factors for Sialolithiasis

A

hyposalivation/xerostomia

127
Q

Major gland Sialolithiasis clinically presents as

A

tender swelling during meal times

128
Q

Minor gland Sialolithiasis clinically presents as

A

Firm, often asymptomatic but may cause tenderness or swelling

129
Q

____ films most helpful for Sialolithiasis

A

occlusal

-Not all stones sufficiently calcified to be visible

130
Q

Cross section of Sialolithiasis reveals

A

concentric laminations

131
Q

Ductal epithelium becomes ______ with Sialolithiasis

A

squamatized

132
Q

Non invasive removal of sialiths

A
  • gland massage, “milking” technique
  • Sialagogues
  • Infection and purulent discharge in long-standing cases: prescribe antibiotic
133
Q

Surgical invasive removal of sialoliths

A
  • Intraoral approach under local anesthesia

- Incision & removal of stone.

OBMP Exam 2 (4 decks)

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