salivary swellings

Question 1

A pt presents with a hard swelling, complains of pain or fever and infection. When prescribed antibiotics, the lump did not respond and is still present on the neck.

What are your 4 differential diagnoses.

Answer 1

1. Oral Cancer
2. Lymphoma (primary malignancy)
3. Salivary Cancer
4. Chronic Sialadenitis

Question 2

Which process of repair follows inflammation and may account for the hard nature of a lump?

Answer 2

Fibrosis

Question 3

What is atrophy?

Answer 3

A decrease in size.

Question 4

What are the 2 mechanisms of salivary epithelial atrophy?

Answer 4

1. Decrease in the NUMBER of cells via apoptosis.
2. Decrease in the SIZE of cells via autophagy of organelles and secretory organelles (lysosomes).

Question 5

Describe the mechanism of chronic sialadenitis (5 steps):

Answer 5

1. Obstruction
2. Epithelial Atrophy
3. Ascending Infection (via ducts)
4. Inflammation
5. Fibrosis

Question 6

Describe the composition of salivary stones (sialoliths):

Answer 6

1. Cholesterol and pigment.
2. Calcium oxide and urine acid.
   3. Calcium phosphates.

Question 7

What is a sialomicrolith?

Answer 7

A concentration in a salivary gland that can only be seen microscopically and is often calcified.

Question 8

Where does salivary calcium come from?

Answer 8

Secretory granules in acinar cells.

Question 9

What is formed within phagosomes where redundant secretory granules rich in acidic glycoproteins and calcium are degraded?

Answer 9

Sialomicroliths

Question 10

What is the main reason for sialomicrolith formation?

Answer 10

Secretory inactivity.

Question 11

How are microliths removed?

Answer 11

Either by uptake from natural scavengers (e.g: macrophages) or being released into the microenvironment.

Question 12

What is the most common type of salivary cyst?

(I get them sometimes)

Answer 12

Mucous Extravasation Cyst (MUCOCELES)

Question 13

Who would typically present with a mucocele and where?

Answer 13

Mucoceles are most common in younger patients on the lower lips.

Question 14

Why do clinically overt mucoceles occur in minor and sublingual glands, but not in parotid and submandibular glands?

Answer 14

Because these glands have smaller ducts that are more prone to obstruction in comparison to the larger ducts of the parotid and submandibular glands.

Question 15

One criteria to determine between low and high grade epithelial tumours is their growth pattern. Which 2 terms can be used to determine this?

Answer 15

Pushing vs Infiltrative

Question 16

What are the 6 criteria for classifying malignant epithelial tumours in salivary glands?

(high vs low grade)

Answer 16

1. Growth pattern / silhouette.
2. Cystic vs Solid
3. Differentiation
4. Neural Invasion
5. Proliferative Index
6. Metastasis

Question 17

Which criteria is regarded to be of increased significance?

Answer 17

Growth pattern / silhouette.