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16 Cards in this Set
- Front
- Back
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Salivary gland histology
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Parotid
-Granular, basophilic (serous) Submandibular -Mixed (serous and mucinous) Minor -Mucinous |
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Malignant tumors relative to benign neoplasms
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1.Grow more rapidly
2. Infiltrate superficial & deep tissues & thus be fixed; benign tumors are mobile 3.Invade nerves producing pain, paralysis, & parathesias |
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Breakdown of benign and malignant salivary neoplasms
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Parotid
-75% -9/2 benign/malignant Submandibular -15% -2/1 Minor -10% -1/1 |
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Benign salivary gland neoplasms
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Pleomorphic adenoma
-60-75% parotid -40-70% submandibular Warthin's tumor (on exam, know pictures too) -10-15% parotid -0% submandibular -Bilateral -Seen in children |
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Malignant salivary gland neoplasms
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Mucoepidermoid CA
-5% parotid -5% submandibular Adenoid cystic CA -<5% parotid -10-20% submandibular -High grade, track along nerves Polymorphous low grade CA Lymphoma |
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Sjogren's syndrome
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Xerostomia & Keratoconjunctivitis Sicca (corneal damage) from immunologically – mediated damage to salivary & lacrimal glands
90% middle aged or older women Bilateral parotid enlargement (Mikulicz’s) SS-A & SS-B; RF; ANAs Periductal & perivascular lymphocytic (CD4) infiltrates Degenerative & hyperplastic ductal changes Acinar atrophy; fibrosis & fat |
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Anatomy of esophagus
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Tubular muscular organ in mediastinum from oropharynx to infradiaphragmactic stomach
Mucosa: Nonkeratinizing stratified squamous epithelium; glandular epithelium in distal 1-2 cm Muscularis: - Upper 1/3 striated muscle - Lower 2/3 smooth muscle LES |
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Etiology of esophagitis
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GERD
Infections -Candida -HSV -CMV Caustic agents Radiation Chemotherapy |
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Candida esophagitis: gross and microscopic
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Gross:
Mid and distal esophagus most heavily involved White plaques and pseudomembranes Mucosa is nudular, friable, ulcerated Ulcers usually shallow Microscopic: PMNs in epithelium Erosions or ulcers Mesh of fibrin, PMNs, debris Degenerative changes, elongated squames Yeast and pseudohyphae |
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HSV esophagitis: gross and microscopic
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Gross:
Clusters of well delineated shallow ulcers with raised borders Serpinginous erosions Estensive denudation Unremarkable nonulcerated mucosa Microscopic: Erosion or ulcer Mixed inflammatory exudate Small vessel necrosis Enlarged squamous cells with round eosinophilic IN inclusions surrounded by halo and thickened membrane Multinucleated giant cells with molded "ground glass" quality |
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Histopathology of reflux esophagitis: acute and chronic changes
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Acute Changes:
-Intraepithelial segmented WBCs -Basal cell hyperplasia -Papillomatosis (elongation of papillae of LP) -Erosions Chronic Changes: -Fibrosis (stricturing) -Barrett’s esophagus |
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Barrett's esophagus (very important)
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Acquired condition secondary to GERD
Endoscopic: Columnar epithelium proximal to GEJ (saccular/tubular) into tubular esophagus (proximal SCJ or Z-line) Histologic: Intestinal metaplasia (goblet cells) Glandular dysplasia & adenocarcinoma |
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Eosinophilic esophagitis
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Idiopathic immune-mediated disorder of children & adults
Possibly related to food or aeroallergens. Possible roles of interleukin-5 & eotaxin-3 Clinical: heartburn, vomiting, food rerusal, dysphagia, unresponsive to PPIs. Pathology: >20 eosinophils/HPF in mucosa Rx: Corticosteroids, specific food elimination |
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Carcinoma of esophagus: epidemiology and prognosis
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Squamous cell carcinoma accounts for 80-90% cases worldwide
Highest incidence in China & Iran Epidemic of adenocarcinoma, especially in low prevalence areas Prognosis -Stage & depth of invasion -Nodal metastases -Overall, 30% 5 year survival |
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Carcinoma of esophagus: risk factors
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Squamous cell carcinoma
-Food & water rich in nitrates & nitrosamines, alcohol, tobacco, vitamin deficiencies, achalasia, Plummer-Vinson syndrome, erosive esophagitis with strictures, HPV, black men Adenocarcinoma: -Barrett's esophagus, white men |
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Glandular dysplasia in Barrett's esophagus
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Indefinite/low grade & high grade based on architectural and cytologic features
Problem of inflammation 5 year risk of adenocarcinoma: -Negative 4% -Indefinite/LG 8-12% -High grade 50-60% At initial dx of HGD, 50-66% have adenocarcinoma Surveillance |
