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103 Cards in this Set
- Front
- Back
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What % of parotid sialoliths are radiolucent? What about submandibular glands? |
65% are radiolucent in parotid; 65% are radioOPAQUE in submandibular gland
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Medications helpful for Sjogren's disease:
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1. Pilocarine (salagen) - cholinergic agonist 2. Cevimeline (Evoxac) - cholinergic agonist
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Medications for xerostomia
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1. Chemoprotectants - Amifostine 2. Pilocarpine (Salagen) 3. Cevimeline (Evoxac)
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What % of submandibular gland tumors are malignant?
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50-60%
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What % of parotid gland tumors are malignant?
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15-20%
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3 most common benign salivary tumors
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1. Pleomorphic adenoma 2. Warthin's tumor 3. Oncocytoma
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Histology of pleomorphic adenoma?
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epithelial, myoepithelial and stromal elements - benign mixed tumor
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Which benign salivary tumor has uptake on Technetium scans?
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Warthin tumors, Oncocytomas
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Histology of Warthin tumors?
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papillary cystadenoma lymphomatosum
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What % of salivary tumors are oncocytomas?
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2%
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Histology of Oncocytomas?
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Sheets, nests or cords of oncocytes (granular-appearing cells)
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Treatment of an oncocytoma:
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Excision with a cuff of normal tissue
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At what age are malignant salivary tumors seen?
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5th to 6th decade
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What clinical features imply malignant salivary tumors?
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Pain, CN VII involvment, fixation
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What are 6 malignant salivary tumors?
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1. Mucoepidermoid 2. Adenoid cystic 3. Adenocarcinoma 4. Malignant mixed tumor 5. Acinic cell carcinoma 6. Squamous Cell Carcinoma
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What is the most common parotid malignancy?
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Mucoepidermoid (85%)
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What is the second most common submandibular malignancy?
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Mucoepidermoid
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What are the two grades of mucoepidermoid?
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Low and High grade
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How does low grade mucoepidermoid appear histologically?
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Higher ratio of mucous to epidermoid cells Presence of cystic spaces Smaller and partially encapsulated
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How does high grade mucoepidermoid carcinoma appear histologically?
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Higher ratio of epidermoid to mucous cells
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What is the second most common parotid malignancy?
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Adenoid cystic
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What is the most common submandibular malignancy?
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Adenoid cystic
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What is the most common minor salivary gland malignancy?
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Adenoid cystic
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What are the three histologic subtypes of adenoid cystic carcinoma? |
Cribriform Tubular Solid
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What is the prognosis of adenoid cystic based on histology?
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Tubular (best) > Cribriform > solid (worst)
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When do metastases occur with adenoid cystic ca?
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Most commonly in 5 years, but will continue over 20 years
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Most common site of metastases for adenoid cystic carcinoma?
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Lung
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What percentage of salivary tumors are adenocarcinoma?
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18%
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Treatment of adenocarcinoma?
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Wide excision and post-operative XRT
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What percentage of salivary tumors are malignant mixed tumors?
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13%
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Where do most malignant mixed tumors arise?
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Parotid (75%)
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What are the two types of malignant mixed tumurs?
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1. Primary malignant mixed tumor 2. Carcinoma ex-pleomorphic adenoma
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What is the 5 year survival for primary malignant mixed salivary tumors?
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0% - highly lethal
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Where does carcinoma ex-pleomorphic commonly metastasize?
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lung
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What percentage of salivary gland malignancies are acinic cell?
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7%
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Where do most acinic cell tumors arise?
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parotid (80-90%)
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What is the histology of acinic cell carcinoma?
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serous acinar cells and cells with clear cytoplasm
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Is radiation effective in acinic cell carcinoma?
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NO
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Are metastases common for acinic cell carcinoma?
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No, but tend to be hematogenous to bone and lungs
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How common is SCCa of salivary tissue?
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Very rare - must exclude metastases, invasive SCCa and high grade mucoepidermoid carcinoma
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What is the histologic derivation of acinic cell carcinoma?
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acinar and intercalated duct cells
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What is the histologic derivation of malignant mixed tumors?
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myoepithelial and acinar cells
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What is the histologic derivation of Mucoepidermoid carcinoma
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excretory duct cells
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What is the histologic derivation of salivary Squamous cell carcinoma?
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excretory duct cells
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What is Frey syndrome clincially?
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Preauricular gustatory sweating
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What is the pathophysiology of Frey Syndrome?
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Parasympathetic salivary nerve from the auriculotemporal nerve innervate the sweat glands of the skin flap
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How is Frey syndrome diagnosed?
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Minor's starch-iodide test
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How do you treat Frey syndrome?
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Topical antiperspirant, topical glycopyyrolate, topical atropine, botox
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What is the true vocal fold?
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Superior edge of the cricothyroid ligament
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What is the thickness of the true vocal fold?
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1.7mm
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What are the layers of the true vocal fold?
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1. Stratified squamous epithelium 2. Superficial layer of the lamina propria (Reinke space) 3. Vocal ligament (intermediate and deep layers of lamina propria) 4. Vocalis muscle
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How does phonation occur?
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Air from lungs causes Bernoulli effect and vocal fold vibration
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How does the voice fundamental frequency change with age?
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Increases in aging men; Decreases in aging women
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Name 12 benign lesions of the larynx
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1. Amyloidosis 2. Chondroma 3. Cysts (ductal, saccular, thyroid cartilage foraminal) 4. GERD 5. Granuloma 6. Granular cell tumor 7. Nodules 8. Polyps 9. Recurrent respiratory papillomas 10. Reinke edema 11. Sarcoid 12. Tuberculosis
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What is the most common airway site for amyloidosis?
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Larynx
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How does amyloidosis appear clinically?
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submucosal mass of the true or false fold
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What is the histology of amyloidosis?
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Apple-green birefringence after staining with congo red dye
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How is amyloidosis of the larynx treated?
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Excision
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Can laryngeal cysts involve any laryngeal structure?
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NO - anyplace except the free edge of the True Vocal Fold
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What type of epithelium lines laryngeal cysts?
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Cilliated pseudostratified columnar epithelium, columnar epithelium, squamous epithelium or a combination of all three
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What are three types of laryngeal cysts?
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1. Ductal cyst 2. Saccular cyst 3. Thyroid cartillage foraminal cyst
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What is a laryngeal ductal cyst?
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Most common (75%) - Develops from obstructed mucous gland, which subsequently leads to cystic dilation of the mucous gland
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What is a laryngeal saccular cyst?
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Represents a spectrum from enlargd laryngeal saccule to laryngocele to saccular cyst (mucous filled dilation of the laryngeal saccule
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Where do you find anterior saccular cysts of the larynx?
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Protrude anteromedially between the true and false vocal folds
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Where do you find lateral saccular cysts of the larynx?
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Extend superolaterally to involve the false vocal fold, aryepiglottic fold and vallecula and may extend to the extralaryngeal tissues via the thyroihyoid membrane
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What is a thryoid cartillage foraminal cyst?
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Rare herniation of subglottic mucosa through a persistent thyroid ala foramen
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Three findings of laryngeal GERD?
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1. Erythema and edema 2. Pachydermia 3. Pseudosulcus
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What causes a laryngeal granuloma?
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Extrinsic trauma (intubation, GERD, etc)
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Where are laryngeal granulomas found?
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Posteriorly in the region of the vocal process of the arytenoids
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Treatment for larygneal granulomas?
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Speech therapy, PPI's and removal of the source of trauma
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Where are laryngeal granular cell tumors typically found?
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Posterior 1/3 of the vocal fold
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Where in the body are granular cell tumors found?
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larynx, tongue, skin, breast, sub-q tissue, respiratory tract
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What is the histology of granular cell tumors?
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pseudoepitheliomatous hyperplasia
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What % of granular cell tumors become malignant?
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3%
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Treatment for granular cell tumors?
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conservative excision
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What causes vocal fold nodules?
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Vocal trauma
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Where are vocal fold nodules found?
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Bilateral white lesions found at the junction of the anterior 1/3 and posterior 2/3 of the vocal fold
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Treatment of vocal fold nodules?
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Voice therapy
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What are vocal fold polyps associated with?
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Vocal trauma and smoking
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How do vocal fold polyps typically appear?
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Unilateral, pedunculated lesions commony found between the anterior 1/3 and posterior 2/3 of the vocal fold
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Treatment of vocal fold polyps?
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micro DL and excision
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Typical onset of Recurrent respiratory papillomatosis?
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2-4 years
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Which virus is Recurrent respiratory papillomatosis associated with?
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HPV 6 and 11
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In which layer of the vocal fold do papillomas reside?
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Superficial epithelial layer
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Where are two often missed sites for respiratory papillomas?
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nasopharynx and undersurface of true vocal folds
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What is the treatment for respiratory papillomas?
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micro DL with stripping and/or CO2 laser ablation; Intralesional injection of cidofovir (5mg/mL)
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What type of ventillation should be avoided with recurrent respiratory papillomatosis?
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Jet ventillation as this can potentially seed lower respiratory airways
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What is Reinke's edema associated with?
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smoking
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What is Reinke's edema?
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Fluid accumulation in the superficial layer of the lamina propria
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How does Reinke's edema appear?
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Bilateral edematous changes of the vocal fold
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Most common laryngeal site for sarcoid?
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Epiglottis
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How does sarcoid typically appear in the larynx?
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Pale, pink turban like epiglottis
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Where is tuberculosis typically seen in the larynx?
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Interarytenoid area and laryngeal surface of the epiglottis
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What are risk factors for malignant lesions of the larynx?
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1. Tobacco and ETOH 2. HPV 16 and 18 3. GERD 4. Radiation
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What are three types of malignant lesions of the larynx?
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1. SCCA (90%) 2. Minor salivary gland malignancies (Adenoid cystic, mucoepidermoid) 3. Chondrosarcoma
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What does fixed vocal folds usually represent?
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Involvement of the thyroarytenoid
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Distinguish between T1-T4 malignant cancers of the larynx
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Different schema for supraglottis, glottis and subglottis T1: one subsite T2: spread to adjacent subsite +/- impaired vocal fold mobility T3: fixed vocal fold (supraglottic tumors with preepiglottic, post cricoid involvment) T4: Extralaryngeal spread
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Treatment of laryngeal carcinoma in situ?
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serial micro DL and sripping until removed - laser excision after biopsy documentation
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Treatment of laryngeal chondrosarcoma?
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narrowly excised without post op radiation
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Treatment of stage I and II laryngeal SCCa?
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Surgery or XRT
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Treatmetn of stage III and IV laryngeal SCCa?
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Concominant chemoradiation or surgery +/- XRT
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When can you perform a hemilaryngectomy?
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For unilateral T1/T2 disease. Tumor can have less than 1cm subglottic extension and can involve the anterior commissure or anterior aspect of contralateral true fold
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When can you perform a supraglottic laryngectomy?
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Voice preserving approach for T1, T2 or T3 (pre-epiglottic space involvment only) supraglottic lesions without anterior commisure involvement, tongue involvment past the cirumvallate papillae or apical involvemnt of the pyriform sinus.
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