Salivary Pathology Flashcards
1
Q
Major salivary glands
A
Parotid glands, submandibular glands, sublingual gland
2
Q
Minor salivary glands
A
- Palate (between midline and palatal gingiva)
- Lining mucosa (cheeks, vestibules, FOM, lips)
- Tongue (ventral & lateral surfaces)
3
Q
The _____ nerve loops under the _____ duct.
A
lingual, submandibular
4
Q
Gland with mostly serous acini
A
Parotid gland
5
Q
Gland with mixed acini
A
Submandibular
6
Q
Gland with purely mucous acini
A
Sublingual
7
Q
_____ cells surround salivary acini and ducts
A
Myoepithelial
8
Q
Non-infectious sialadenitis can be caused by
A
- Post-irradiation
- Immune mediated
- Sarcoidosis
9
Q
Infectious sialadenitis can be
A
- Bacterial (acute, chronic, TB, Actinomycosis)
- Viral (mumps, cytomegalic inclusion disease, HIV)
10
Q
Sialadenitis generally presents as
A
pain and swelling
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
12
Q
Predisposing factors of acute bacterial parotitis
A
Mouth dryness and/or dehydration, obstructed duct, poor oral hygiene, elderly pts
13
Q
Acute bacterial parotitis appears microscopically as
A
sheets of neutrophils
14
Q
Viral parotitis (Mumps) is a highly contagious viral disease caused by a member of
A
Paramyxovirus
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
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)
17
Q
Mumps breakouts occur in people living in
A
close quarters
18
Q
Complications of Mumps
A
Deafness, pancreatitis, meningitis, inflammation of the testis and ovaries.
19
Q
Children are vaccinated against mumps at what age with what vaccine?
A
1 y/o, MMR
20
Q
Testing for Mumps
A
Clinical presentation, labs for Mumps specific IgM, IgG, or viral culture from parotid swab
21
Q
Non-infectious sialadenitis includes
A
Immune-mediated sialadenitis (Sjogren syndrome), Sarcoidosis, Post-irradiation
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)
23
Q
Chronic non-tender swelling of the parotid and may be other salivary glands
A
Sarcoidosis
24
Q
Severe dryness of mouth + mucositis + candidal infection
A
Post-irradiation
25
Mucoepidermoid carcinoma, adenoid cystic carcinoma, polymorphous low-grade adenocarcinoma, carcinoma ex pleomorphic adenoma all ex of
Malignant salivary gland tumors
26
Pleomorphic adenoma (Benign mixed tumor), Warthin's tumor, monomorphic adenoma, Canalicular adenoma are ex of
Benign salivary gland tumors
27
Most (65%) of salivary gland tumors are found in the
Parotid gland
28
Accessory gland tumors are mostly found in the
palate
29
anatomic distribution of salivary gland tumors
1) Parotid (65%)
2) Accessory (25%)
3) Submandibular (10%)
4) Sublingual (<1%)
30
T or F: Salivary gland tumors are mostly Benign.
True (60%)
31
Most common salivary gland tumor is
Pleomorphic adenoma
32
Parotid gland is ____ benign
2/3
33
Submandibular is ____ benign
1/2
34
T or F: Sublingual gland tumors are mostly malignant.
T
35
Palate tumors are ____ benign
1/2
36
Upper lip tumors are mostly
benign
37
Lower lip tumors are mostly
malignant
38
Retromolar area tumors are mostly
malignant
39
Clinical cystic presentation could be
mucocele, ranula, cystic tumors
40
Ulcer clinical presentation could be
Necrotizing sialometaplasia, neoplasms
41
Mucoceles are mostly found on
the lower lip (80%)
42
Mucoceles are most common in what decades
1st-3rd
43
Mucoceles are caused by
trauma, laceration of salivary excretory salivary duct, mucin spillage into tissue.
44
Mucoceles exclusively affect ______ glands
minor
45
Clinical presentation of mucoceles
Dome-shaped, translucent/bluish nodule, fluctuant, often increasing and decreasing in size
46
Less common that conventional mucocele, appear as small blisters, often burst/heal and recur
superficial mucocele
47
Mucocele of ventral surface of tongue
Cyst of Blandin Nuhn
48
Mucocele tx
surgical excision of swelling and damaged salivary glands.
49
Location of mucous pooling in ranula is dicated by
mylohyoid clinical presentation
50
Ranula tx:
excision of mass and associated sublingual gland
51
Mucocele in FOM
Ranula
52
A true cyst of salivary duct origin
Salivary duct cyst (mucous cyst, mucous retention cyst)
53
Most common sites of Salivary duct cyst
Palate, FOM
54
Salivary duct cysts rarely can be _____ cyst in major glands. (polycystic disease of parotid gland)
congenital
55
Treatment of salivary duct cyst
simple excision
56
Salivary duct cyst pathology
Uni- or multilocular cyst with glandular epithelial lining
57
Mucous cysts are lined by
simple glandular epithelium
58
Histologically has epimyoepithelial islands and lymphatic destruction of acini
Sjogren's
59
Increased RF, ANA, SS-A, and SS-B
Sjogren's
60
Autoimmune disease characterized by autoantibodies against salivary ductal cells
Sjogren's
61
Dry mouth and eyes with or w/o parotid tumor-like swellings
Primary Sjogren Syndrome (Sicca Syndrome)
62
Dry mouth, eyes, and any collagen-vascular disease (RA, Lupus)
Secondary Sjogren Syndrome
63
Sjogren's patients have a 40 fold increased risk in developing
B cell non-hodgkin lymphoma
64
How to diagnose Sjogren's
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
Schrimer test should wet
<5 mm in 5 mins
66
Rose Bengal score ___ according to van Bijsterveld system
>4mm
67
Salivary biopsy needs atleast ____ foci of periductal lymphocytes, ____ cells/4mm^2
2, 50
68
T or F: Salivary biopses are not consistently positive in pts with Sjogren syndrome. About 50% in labial salivary and 90% in parotid.
T
69
Lab findings RH
75
70
Lab findings ANA
90
71
Lab findings SS-A
80
72
Management of Sjogren Syndrome
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
The most common malignant salivary gland neoplasm
Mucoepidermoid carcinoma
74
Mucoepidermoid carcinoma in bone is called
Central mucoepidermoid carcinoma
75
Mucoepidermois tumors are composed of varying ratios of both
epidermoid and mucous cells
76
Ulcerated mass with blue compressible areas:
Mucoepidermoid carcinoma
77
Mucoepidermoid carcinoma is most common in
Parotid gland
78
T or F: Mucoepidermoid carcinoma can be asymptomatic or w/ pain, parasthesia
T
79
Mucoepidermoid carcinoma is the most common
Salivary, intraoral, pediatric, and intraosseous gland malignancy
80
T or F: Mucoepidermoid carcinoma is the 2nd most common salivary gland neoplasms
T
- 10-15% of all neoplasms
- 30% of all malignancies
81
Mucoepidermoid carcinoma is graded low, intermediate, high and depends on
1) Ratio of mucous cell vs epidermoid cells
2) Cystic vs solid
3) Degree of cytologic atypia
82
Lower grade mucoepidermoid carcinoma is identified by
more mucous cells and more cystic areas.
83
Mucoepidermoid carcinoma tx
depends on histologic grade, location, and clinical stage
84
Mucoepidermoid carcinoma can seemingly present as a
mucocele (especially in retromolar area)
85
An ulcerated mass that proliferates quickly
"Non-Hodgkin lymphoma"
86
3rd most common malignancy, low grade malignant salivary gland neoplasm
Polymorphous low-grade adenocarcinoma (PLGA)
87
PLGA is usually found in
minor salivary glands
88
PLGA is found more in
Females than males
89
Why is PLGA called polymorphous?
varied morphologic growth patterns microscopically
90
PLGA tx
complete excision
91
PLGA ____ metastasize
rarely (10%)
92
PLGA local recurrence rate
30%
93
Palatal mass with "orange peel" surface texture
PLGA
94
PLGA different histologic growth patterns
tubular, cribiform, solid, single cell files
95
Most common neoplasm of minor salivary glands
Pleomorphic adenoma (40%-most commonly on palate)
96
Pleomorphic adenoma (mixed tumor) characterized by
PLAG1 and HMGA2 rearrangements
97
Pleomorphic Adenoma is "pleomorphic" bc
- varied types of tissues noted (epithelial, cartilage, bone)
- Striking variability between tumors
98
Pleomorphic adenoma (mixed tumors are a mixture of
epithelial and mesenchymal elements (bone, cartilage, fat)
99
Malignant transformation of Pleomorphic adenoma occurs in ____ of pts
10%
100
Time period for malignant transformation is __
20 years
101
T or F: Pleomorphic adenoma malignant transformation rarely occurs in the oral cavity bc early clinical detection
T
102
Risk factors for malignant transformation of pleomorphic adenoma
-Longevity and recurrence, histological hyalinization, increased mitotic activity
103
Features that are NOT associated with malignant transformation of PA
capsular violation, increased cellularity, areas of necrosis
104
Invasive carcinoma ex-PA happens at
>5mm
105
A benign salivary gland tumor w/ limited growth potential
Warthin's Tumor
106
Tumor with strong association in adult men and smoking
Warthin's tumor
107
Second most common tumor in parotid after PA
Warthin's tumor
108
Warthin's tumor is most likely to be found in which gland?
Parotid
109
T or F: Pathogenesis of Warthin's tumor is unknown
T
| -May be entrapped salivary gland w/in intraparotid lymph nodes
110
Frequently "multicentric" tumor within the same gland
Warthin's tumor
111
Warthin's tumor presents microscopically as
prominent cystic spaces w/ intraluminal papillary projections and lymphoid-rich stroma
112
Well-demarcated mass w/ papillary structures outline by rows or columnar cells, cystic spaces, and lymphoid stroma
Warthin's tumor
113
High grade salivary gland cancer (regardless of histologic variant)
Adenoid cystic carcinoma
114
Tendency for neural invasion
Neurotripism
115
Slow-growing, but w/ symptoms of pain, numbness, nerve paralysis owing to tendency for local invasion and seeding outside primary mass
Adenoid cystic carcinoma
116
High rate of recurrence and late metastasis (after >10 yrs)
Adenoid cystic carcinoma
117
Firm mass of parotid, palate with pain/anesthesia due to neurotripism
Adenoid cystic carcinoma
118
Pathology variants of adenoid cystic carcinoma
Cribriform, tubular, solid, mixed patterns
119
Tx of Adenoid cystic carcinoma
wide sx excision, associated with overall poor prognosis
120
Adenoid cystic carcinoma most likely to be found in
parotid gland
121
Common "swiss cheese" pattern histologically
Adenoid cystic carcinoma
122
Sialolithiasis most commonly found in
submandibular gland
123
Calcification within the salivary gland/duct
Sialolithiasis
124
How does Sialolithiasis start?
Viscous mucus plug, bacteria, cellular debris-> mineralizes
125
T or F: Sialolithiasis is a localized process and has no relation to hypercalcemia (kidney/gall stones)
T
126
Risk factors for Sialolithiasis
hyposalivation/xerostomia
127
Major gland Sialolithiasis clinically presents as
tender swelling during meal times
128
Minor gland Sialolithiasis clinically presents as
Firm, often asymptomatic but may cause tenderness or swelling
129
____ films most helpful for Sialolithiasis
occlusal
| -Not all stones sufficiently calcified to be visible
130
Cross section of Sialolithiasis reveals
concentric laminations
131
Ductal epithelium becomes ______ with Sialolithiasis
squamatized
132
Non invasive removal of sialiths
- gland massage, "milking" technique
- Sialagogues
- Infection and purulent discharge in long-standing cases: prescribe antibiotic
133
Surgical invasive removal of sialoliths
- Intraoral approach under local anesthesia
| - Incision & removal of stone.
