Opath Salivary Gland Lesions

Front 1

Mucocele

Back 1

Rupture of salivary gland duct due to local trauma, NEVER on upper lip, mucin-filled cyst-like (not a true cyst) cavity, granulation tissue and foamy histiocytes present

Front 2

Ranula

Back 2

Mucocele (blue, dome shaped swelling) on the floor of the mouth, spilled mucin from sublingual gland, granulation tissue and foamy histocytes, tx: remove roof of lesion for small lesions, remove entire gland for larger lesions

Front 3

Salivary Duct Cyst

Back 3

True cyst adjacent to gland duct, arises from salivary gland tissue, “Mucous Retention Cyst”, develops from ductal obstructions, lined by thin cuboidal epithelium, excretory gland duct lined by columnar epithelium, major and minor salivary glands

Front 4

Sialolithiasis

Back 4

Calcified structures that develop within the salivary duct system, most often submandibular gland duct, radiopaque masses, possible pain or swelling, concentric laminations around amorphous debris, squamous metaplasa of duct, tx: “milk” stone out of duct with massage or sialagogues (drugs)

Front 5

Sialadenitis

Back 5

Inflammation of salivary gland due to bacteria (s. aureus), viral (mumps), sialolithiasis, congential strictures or adjacent tumor; purulent exudates, chronic sclerosing sialadentitis: chronic inflammatory infiltrate with associated acinar atrophy and ductal dilation and fibrosis; acute tx: antibiotics and rehydration

Front 6

Sialadenosis

Back 6

Non-inflammatory, salivary gland enlargement, parotid gland most common, systemic issue -> dysregulation of autonomic control of salivary acini-> hypertrophy of acinar cells, excessive accumulation of secretory granules

Front 7

Sialorrhea

Back 7

Excessive salivation due to apthous ulcers or ill-fitting dentures, Water Brash (episodic hypersecretion of saliva), Drooling in mentally retarded

Front 8

Xerostomia

Back 8

Subjective dry mouth, usually due to medications in older people, saliva is ropey, thick or foamy, prone to dental caries and candidiasis, dorsal tongue is fissured and filiform papillae are atrophied

Front 9

Sjogren Syndrome

Back 9

Chronic systemic autoimmune involving salivary and lacrimal gland dysfunction, Sicca Syndrome (dry mouth and eyes), primary=sicca alone, secondary=sicca+another AI dz; Elevated IgG, RF, Anti-SS-A and B, antinuclear Abs; females >> males; confirm w/ shirmer test; lymphocytic infiltration of salivary glands, destruction of acinar cells, presence of FOCAL chronic inflammatory aggregates (more foci = more accurate diagnosis of SS)

Front 10

Benign Lymphoepithelial Lesion

Back 10

associated w/ Mikulicz disease, autoimmune disease, BILATERAL salivary and lacrimal enlargmenet, lymphocytic infiltration of the parotid gland with associated epimyoepithelial island

Front 11

Necrotizing Sialometaplasia

Back 11

Local inflammatory destruction of salivary glands, mimics malignant process, PALATAL salivary glands most common (hard>soft), H: necrotic mucous acini and adjacent ductal squamous metaplasia, ulceration in later stages, no tx necessary but biopsy to rule out malignancy

Front 12

Pleomorphic Adenoma

Back 12

MOST COMMON salivary gland tumor, Mixture of ductal and myoepithelial elements, parotid gland superficial lobe most common, palate>upper lip>buccal mucosa, H: well-circumscribed, encapsulated, benign tumor with variable microscopic pattern, mix of epith and myoepith present w/ mesenchyme-like background, fat or osteoid can be present, rare malignant transormation

Front 13

Oncocytosis

Back 13

Transformation of ductal and acinar cells to ONCOCYTES, proliferation and accumulation of oncocytes in salivary glands, H: focal nodular collections of oncocytes, polyhedral, w/ lots of granular eosinophilic cytoplasm (result of proliferation of mitochondria); no tx necessary

Front 14

Oncocytoma

Back 14

a type of Monomorphic Adenoma, benign salivary gland tumor composed of large epithelial cells (oncocytes), cells have swollen granular cytoplasm, well-circumscribed tumor made of SHEETS of polyhedral cells, abundant granular, eosinophilic cytoplasm (mitochondria)

Front 15

Warthin’s Tumor (Papillary Cystadenoma Lymphomatosum)

Back 15

Benign monomorphic adenoma tumor, parotid gland only near mandibular angle, associated with smoking, bilateral (but not at same time), caused by heterotropic salivary tissue w/in parotid lymph nodes; 2 layers: inner luminal layer with tall columnar cells, palasading, centrally placed nuclei, second layer of cuboidal or polygonal cells with more vesicular nuclei, epith has papillary infoldings that protrude into cystic spaces

Front 16

Canalicular Adenoma

Back 16

Monomorphic Adenoma, always in minor salivary glands, upper lip, H: uniform single layer of columnar or cuboidal cells forming canal-like ductal structures with deeply basophilic nuclei

Front 17

Basal Cell Adenoma

Back 17

Monomorphic Adenoma, Benign, unlike canalicular adenoma usu. affects parotid gland, H: encapsulated or well-circumscribed, cords of basaloid cells arranged in a trabecular pattern

Front 18

Mucoepidermoid Carcinoma

Back 18

most common salivary gland malignancy, wide age range, parotid gland, blue-pigmented mass, H: mixture of mucus-producing cells and squamous (epidermoid )cells, intermediate cells (progenitor cells), low grade: cyst formation w/ lots of mucous cells; high grade tumor: solid islands of squamous and intermediate cells w/ pleomorphism and mitotic activity

Front 19

Intraosseous Mucoepidermoid Carcinoma

Back 19

Malignant, salivary gland tumor within the jaw, most common intrabony salivary tumor, associated with impacted teeth or dentigerous (odontogenic) cysts

Front 20

Acinic Cell Adenocarcinoma

Back 20

Malignant, serous acinar differentiation, good prognosis

Front 21

Malignant Mixed Tumors

Back 21

Malignant counterpart to benign mixed tumor or pleomorphic adenoma, most common: “carcinoma ex pleomorphic adenoma” (Epithelial cells of benign pleomorphic adenoma -> malignant), H: areas of malignant degeneration of epithelial cells w/in tumor, cellular pleomorphism (pleomorphic nuclei) and abnormal mitotic activity

Front 22

Adenoid Cystic Carcinoma

Back 22

common salivary malignancy, dull ache -> incr intensity, mixture of myoepithelial cells and ductal cells; Three histo patterns: Cribriform, tubular, solid; PERINEURAL INVASION (not pathognomonic) ie pain due to cells around nerve bundle, bad prognosis over time

Front 23

Polymorphous Low-Grade Adenocarcinoma

Back 23

common malignancy, always minor salivary glands, H: Cribriform pattern mimics adenoid cystic carcinoma, perineural invasion common also mimics ACC, unlike ACC good prognosis