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128 Cards in this Set
- Front
- Back
what are the major inflammatory conditions of the oral cavity?
|
herpes
canker sores (aphthous ulcers) thrush (oral candidiasis) glossitis xerostomia (dry mouth) |
|
what strain of herpesvirus causes most of the herpes infections in the mouth?
|
HSV-1
|
|
herpes general information
|
most are HSV-1
presents as a common cold sore primary infection usually 2-4 years old 10-20% present as gingivostomatitis |
|
describe acute herpetic gingivostomatitis
|
HSV-1 infection that causes diffuse involvement of mouth, especially the gingiva and the tongue
pt may have fever, lymphadenopathy, and anorexia |
|
gross morphology of herpes infection
|
vesicles form that range in size from millimeters to large bullae
the vesicles are initially filled with clear, serous fluid and they then rupture causing painful, red-rimmed, shallow ulcers |
|
microscopic morphology of herpes infection
|
intracellular and extracellular edema, leading to acantholysis (separation of dermal cells) and clefts
epidermal cells at the margin of the vesicles have intranuclear viral (HSV-1) inclusions OR many of them are fused into multinucleate giant cells |
|
acantholysis
|
loss of intercellular connections, such as desmosomes, resulting in loss of cohesion between keratinocytes
|
|
herpes clinical picture
|
primary infection (seen in 2-4 yo's) resolves in 3-4 weeks and the virus becomes dormant in local ganglia
if/when the virus is reactivated, usually in young adults, the cold sore is milder - the patient can get recurrent stomatitis at the primary site or in the adjacent mucosa (groups of 1-3mm vesicles resembling primary but milder) - and heals in 7-10 days |
|
what is the technical name for canker sores?
|
aphthous ulcers
|
|
aphthous ulcers (general information)
|
aka canker sores
present in about 40% of the population, more commonly in the first two decades painful, recurrent, shallow, hyperemic-rimmed ulcers covered with thin exudate that can heal in a week or linger for several weeks some seem to be familial |
|
gross morphology of aphthous ulcers
|
painful, recurrent, shallow, hyperemic-rimmed ulcers covered with thin exudate that can heal in a week or linger for several weeks
can be single or multiple |
|
microscopic morphology of aphthous ulcers
|
initially has a mononuclear infiltrate
ulcer gets a secondary bacterial infection, which attracts neutrophils |
|
what is the most common fungal infection of the oral cavity?
|
oral candidiasis (thrush)
|
|
oral candidiasis (general information)
|
presents as a grey-white superficial curdy membrane of candida organisms enmeshed in fibrinosuppurative exudate; the membrane is easily scraped off to show an erythematous base
candida is a normal mouth inhabitant that causes disease in immunosuppressed or diabetic pts, those with xerostomia (dry mouth), and those with antibiotic-altered oral flora |
|
define xerostomia
|
dry mouth due to a lack of saliva
|
|
glossitis
|
usually implies inflammation of the tongue, but can be applied to a "beefy" red appearance of the tongue caused by some nutritional deficiency states (B12, riboflavin, niacin, pyridoxine, iron deficiencies)
caused by atrophy of papillae and thinning of mucosa, which makes underlying vasculature more prominent can also be caused by real inflammation with ulcers (jagged carious teeth, bad dentures, syphilis) |
|
what deficiencies can cause glossitis?
|
riboflavin (B2) deficiency
niacin (B3) deficiency pyridoxine (B6) deficiency pernicious anemia (B12) sprue (gluten allergy) iron-deficiency anemia |
|
what is Plummer-Vinson syndrome?
|
aka paterson-brown-kelly syndrome
combination of Fe-deficiency anemia, glossitis, and dysphagia chronic iron deficiency anemia causes the glossitis as well as esophageal webs (ledge-like projections from esophageal mucosa into the esophageal lumen and cause dysphagia) |
|
what are the major manifestations of Sjogren syndrome?
|
xerostomia (dry mouth)**
keratoconjunctivitis sicca (dry eyes) **major and sometimes only symptom** |
|
what are the causes of xerostomia?
|
Sjogren syndrome
radiotherapy anticholinergic drugs |
|
what is the proposed autoantigen in Sjogren syndrome?
|
alpha-fodrin (a cytoskeletal protein)
|
|
Sjogren syndrome pathogenesis
|
lymphocytic infiltrate of activated CD4 helper T cells, with some B cells that secrete antibody to alpha-fodrin locally in the lacrimal and salivary glands
EBV, HCV, or HTLV-1 may be viral triggers in genetically susceptible individuals 75% have rheumatoid factor (w/ or w/o RA) 50-80% have ANAs 90% have anti-SS-A and anti-SS-B antibodies various HLA associations |
|
morphology of Sjogren syndrome
|
lacrimal and salivary glands are the main targets, but other exocrine glands can be involved
starts as periductal and perivascular lymphocytic infiltrate, which eventually becomes extensive and may develop germinal centers in the larger salivary glands (can be mistaken for a lymphoma) eventually the gland atrophies, becomes fibrotic, and the parenchyma is replaced by fat |
|
clinical features of Sjogren syndrome
|
- lack of tears leading to corneal erosions and ulcers
- lack of saliva leading to fissuring and inflammation of oral mucosa - ulcerations and perforations of nasal septum can cause nosebleeds - 1/2 of pts have parotid and/or lymph node enlargement - 1/3 of pts have involvement of kidney, lung, CNS, skin, muscle - more common in females 50-60 years old - 60% of pts have other autoimmune diseases |
|
what extraglandular organs are involved in Sjogren syndrome?
|
kidney, lung, CNS, skin, muscle
**in Sjogren syndrome glomerular lesions are rare, but in SLE glomerular lesions are common** |
|
in what gender and age group is Sjogren syndrome most common?
|
females, 50-60 years old
|
|
define Mikulicz syndrome
how does it differ from Sjogren's syndrome? |
Mikulicz syndrome is the combination of lacrimal gland and salivary gland enlargement of any cause
Sjogren's syndrome is a subclass of Mikulicz syndrome, where autoantibodies specifically destroy the salivary and lacrimal glands (lip biopsy to examine minor salivary glands is necessary to diagnose Sjogren's syndrome) |
|
what type of cancer is more common in patients with Sjogren's syndrome than in normal patients?
|
marginal zone lymphomas
Sjogren's syndrome increases risk 40x |
|
what is the other name for Sjogren's syndrome?
|
sicca syndrome
|
|
how are reactive lesions distinguished from more serious lesions?
|
biopsy
|
|
what are the reactive lesions of the oral cavity?
|
irritation fibroma
pyogenic granuloma peripheral ossifying fibroma peripheral giant cell granuloma |
|
irritation fibroma
|
reactive lesion of the oral cavity
located along the buccal mucosa, along the biteline or at the gingivodental margin fibrous tissue with few inflammatory cells, covered by squamous mucosa remove surgically |
|
pyogenic granuloma
|
reactive lesion of the oral cavity (not actually a granuloma)
most common in pregnancy (aka pregnancy tumor) and then subsequently regresses or has fibrous maturation; also seen in children and young adults red-purple pedunculated lesion located in the gingiva that consists of a vascular proliferation resembling granulation tissue (variant of capillary hemangioma); may ulcerate remove surgically may turn into peripheral ossifying fibroma |
|
peripheral ossifying fibroma
|
reactive lesion of the oral cavity
red-purple pedunculated lesion located in the gingiva that consists of a vascular proliferation resembling granulation tissue (resembles pyogenic granuloma grossly) can be caused by maturation of a pyogenic granuloma or can arise de novo most common in teenage or young adult females surgical removal, but must excise all the way down to the periosteum, or there is a 15-20% recurrence rate |
|
peripheral giant cell granuloma
|
reactive lesion of the oral cavity
nodular lesion that protrudes from the gingiva at a site of chronic inflammation (resembles a pyogenic granuloma, except that it has a bluer hue where a pyogenic granuloma tends to be purple-red); occasionally gingival mucosal covering ulcerates consists of many multinucleate foreign body type giant cells separated by fibroangiomatous stroma easily excised |
|
in what patients are 80% of cases of hairy leukoplakia seen?
|
patients with HIV, but it can be seen in other immunosuppressed patients
|
|
hairy leukoplakia
|
white, confluent, hairy, hyperkeratotic thickening, usually on the lateral border of the tongue
hyperparakeratosis & acanthosis with balloon cells in the upper spinous epidermal layer nuclei of underlying cells sometimes have koilocytosis, which indicates HPV infection, but EBV infection is the major cause 80% seen in HIV-infected pts but also seen in other immunosuppressed pts |
|
what disease commonly develops within 2-3 years of a patient having hairy leukoplakia?
|
AIDS
|
|
leukoplakia
|
white precancerous plaque that cannot be removed by scraping, and cannot be diagnosed clinically or microscopically as something else
has sharp or indistinct borders (usually located on buccal mucosa, floor, undersurface of the tongue, palate, or gingiva; can be single or multiple) ranges from benign thickenings to dysplasia that borders on carcinoma in situ most common in males (2:1) between 40-70 years old high association with tobacco (especially chew and pouches), alcohol, bad dentures, oral irritants, HPV 16 |
|
erythroplakia
|
red, velvety, possibly ulcerated, precancerous plaque, level with or slightly depressed from surrounding mucosa with sharp or indistinct borders (usually located on buccal mucosa, floor, undersurface of the tongue, palate, or gingiva; can be single or multiple)
more atypical histology than leukoplakia, with a higher rate of malignant transformation most common in males (2:1) between 40-70 years old high association with tobacco (especially chew and pouches), alcohol, bad dentures, oral irritants, HPV 16 |
|
microscopic morphology of leukoplakia
|
range from hyperkeratosis over an acanthotic but orderly epithelium to marked dysplasia or even to carcinoma in situ
the more dysplastic or anaplastic, the more likely there is to be underlying mononuclear inflammation with infiltrating lymphocytes and macrophages |
|
what type of cancer accounts for 95% of head and neck cancers?
|
squamous cell carcinoma
(6th most common cancer globally) |
|
what is the overall long-term survival of patients with squamous cell carcinoma?
|
<50% with no significant change in decades
with diagnosis in early stage, 5YS is 80%; with diagnosis in late stages, 5YS is 20% |
|
what is field cancerization? how does it apply to squamous cell carcinoma?
|
once you have one oral cancer lesion, the whole oral mucosa is at risk for a second primary cancer lesion
in squamous cell carcinoma, 3-7% of patients develop a second primary every year; patients who survive the first five years have a 35% chance of developing at least 1 new primary during the first five years these second primaries are the most common cause of death related to squamous cell head and neck cancer |
|
pathogenesis of squamous cell carcinoma of oral mucosa
|
risk factors: alcohol & tobacco (together increase risk 5-15x), pipe smoking, HPV, family history, sunlight, chewing betel nuts, chronic irritation
|
|
what virus is found in more than 50% of oropharyngeal cancers?
|
HPV
especially found in tonsillar cancers and those at the base of the tongue gives a better survival than those cancers without HPV |
|
what are the steps in the molecular pathogenesis of squamous cell carcinoma?
|
1) loss of regions of 3p and 9p21
- inactivation of p16 (inhibitor of CDK) - appearance of hyperplasia/hyperkeratosis 2) loss of heterozygosity at 17p - mutation of p53 - appearance of dysplasia 3) amplification & overexpression of 11q13 - cyclinD1 gene amplified - associated with invasiveness |
|
what cytokine receptor is overexpressed in many head and neck squamous cell carcinomas?
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epidermal growth factor receptor (EGFR)
useful in tx |
|
what are the commonest sites of squamous cell carcinoma of the oral cavity?
|
lower lip
ventral surface/base of tongue floor of mouth lower gingiva bucchal mucosa upper gingiva & palate |
|
gross morphology of squamous cell carcinoma of oral cavity
|
early, presents as raised, firm white plaques or warty thickenings that progress to protruding masses or irregular ulcers with firm, elevated, rolled borders
pt may have history of leukoplakia or erythroplakia |
|
microscopic morphology of squamous cell carcinoma of the oral cavity
|
varies from well differentiated to sarcomatoid, but the histologic grade doesn't correlate well with behavior
tend to infiltrate locally before distant metastases |
|
to what organs does oral squamous cell carcinoma metastasize?
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lymph nodes (cervical, then mediastinal)
liver lung bone |
|
oral squamous cell carcinoma has the best prognosis if diagnosed in what location?
|
lip
5 yr recurrence rate only 10% on the floor of the mouth or on the base of the tongue, recurrence rate is 70-80% |
|
dentigerous cyst
|
unilocular odontogenic cyst around the crown of an unerupted tooth, usually a wisdom tooth; a thin layer of stratified squamous epithelium lining with dense chronic inflammation in the stroma
surgical removal, but must remove entire lesion or risk recurrence only rarely transforms into a neoplasm |
|
odontogenic keratocyst
|
uni- or multilocular odontogenic cyst that can be aggressive; a thin layer of stratified squamous epithelium with prominent basal cell layer
incomplete surgical resection leads to 60% recurrence if multiple lesions are present, think of Gorlin (nevoid basal cell carcinoma) syndrome |
|
gorlin syndrome
|
aka nevoid basal cell carcinoma syndrome
inherited medical condition involving defects within multiple body systems such as the skin, nervous system, eyes, endocrine system, and bones people with this syndrome are particularly prone to developing a common and usually non-life-threatening form of non-melanoma skin cancers think about this syndrome if a person has multiple odontogenic keratocysts |
|
periapical cyst
|
relatively common odontogenic cyst in the apex of a tooth that starts as long-standing inflammation of tooth pulp (pulpitis); necrosis of the pulp can exit the apex forming an abscess that eventually fill in with granulation tissue
Tx must include killing the infecting bacteria |
|
ameloblastoma
|
odontogenic tumor that arises from odontogenic epithelium
usually cystic, slow-growing, locally invasive, and benign |
|
odontoma
|
most common type of odontogenic tumor, but more likely a hamartoma rather than a neoplasm
arises from epithelium, but has extensive enamel and dentin components cured by local excision |
|
what is the most common type of odontogenic tumor?
|
odontoma
|
|
allergic rhinitis
|
sensitivity to allergens, mediated by IgE immune reaction with early and late phase responses
present in 20% of the US population |
|
nasal polyps
|
protrusions in the nasal mucosa caused by recurrent attacks of rhinitis; reach 3-4cm and can impair sinus drainage
|
|
microscopic morphology of nasal polyps
|
edematous mucosa with loose stroma
often see hyperplasia or cystic mucous glands neutrophils, eosinophils and plasma cells are usually present (as are occasional lymphocyte clusters) |
|
chronic rhinitis
|
sequelae of repeated attack of allergic or microbial rhinitis
impairment of secretions by a deviated nasal septum or by nasal polyps contributes to microbial invasion may have desquamation or ulceration of mucosal epithelium; variable amount of inflammation is present |
|
sinusitis
|
inflammation of the sinuses, usually caused by oral organisms
usually preceded by acute or chronic rhinitis impairment of drainage via inflammatory edema of mucosa contributes to empyema (pus collection) in the sinus outflow obstruction may cause accumulation of mucous (mucocele) in absence of bacterial infection, usually in the frontal or anterior ethmoidal sinuses complications: spread to orbit, septic thrombophlebitis of dural sinus, osteomyelitis |
|
what type of sinusitis are diabetics particularly prone to? what are the complications of this?
|
chronic fungal sinusitis, especially mucormycosis
complications: spread to orbit, septic thrombophlebitis of dural sinus, osteomyelitis |
|
what is kartagener syndrome?
|
rare, ciliopathic, autosomal recessive genetic disorder that causes a defect in the action of the cilia lining the respiratory tract (lower and upper, sinuses, Eustachian tube, middle ear) and fallopian tube, and also of the flagella of sperm in males
main consequence of impaired ciliary function is reduced or absent mucus clearance from the lungs, and susceptibility to chronic recurrent respiratory infections, including sinusitis, bronchitis, pneumonia, and otitis media |
|
what type of sinusitis can be caused by periapical infection of a tooth?
|
maxillary sinusitis
|
|
what are the causes of necrotizing lesions in the nose and nasopharynx?
|
fungus, especially Mucor in diabetics
Wegener granulomatosis lethal midline granuloma |
|
lethal midline granuloma
|
non-Hodgkin lymphoma of NK cells; superimposed ulceration and bacterial infection produces granulomatous inflammation
no longer fatal since lymphoma can be treated |
|
nasopharyngeal angiofibroma
|
benign tumor of the nose/nasopharynx
common in adolescent males often presents with nosebleeds and can bleed profusely during surgery |
|
nasopharyngeal papillomas
|
benign nasopharyngeal tumor of squamous or columnar epithelial origin
HPV 6 & 11 have been implicated types: exophytic, inverted, cylindrical (a subtype of exophytic) |
|
inverted nasopharyngeal papillomas
|
benign but locally aggressive (extend into mucosa) squamous epithelial tumors located in the nose and paranasal sinuses; can invade the orbit or cranial vault
papillomatous proliferation of squamous epithelium growing inward has a high rate of recurrence with incomplete excision, but rarely develops into carcinoma |
|
nasopharyngeal plasmacytoma
|
malignant plasma cell tumor growing within soft tissue or within the skeleton that arises in adjacent lymphoid tissue and protrudes into the nose or sinus
rarely progresses to multiple myeloma |
|
olfactory neuroblastoma
|
uncommon, highly malignant tumor that arises from neuroendocrine cells (small, round, blue cells) in the olfactory mucosa; metastasizes widely
Tx: combination of surgery, Xray, and chemo (5 ys: 40-90%) |
|
nasopharyngeal carcinoma
|
common in parts of Africa (most common childhood CA)
common CA in adults in south China EBV is found in the tumor epithelial cells of most undifferentiated and nonkeratinizing squamous cell carcinomas types: 1) keratinizing squamous cell 2) nonkeratinizing squamous cell 3) undifferentiated (lymphoepithelioma) tend to grow silently (with few symptoms), so they are often metastatic and/or unresectable - 70% present as cervical node masses Tx: radiotherapy (3YS is 50-70%; most effective with (3)) |
|
undifferentiated nasopharyngeal carcinoma (lymphoepithelioma)
|
large epithelial cells admixed with abundant normal-appearing lymphocytes
tend to grow silently (with few symptoms), so they are often metastatic and/or unresectable - 70% present as cervical node masses most sensitive type of nasopharyngeal carcinoma to radiotherapy |
|
what are the types of laryngitis?
|
allergic
viral bacterial chemical |
|
croup
|
laryngotracheobronchitis in young children
inflammatory narrowing of passages creates inspiratory stridor |
|
acute epiglottitis
|
infection of epiglottis by H. influenzae, S. pyogenes (beta-hemolytic strep), respiratory syncytial virus (RSV)
causes a medical emergency by creating a laryngeal obstruction common in infancy and young children |
|
vocal cord polyps
|
reactive nodules (smooth, round excresences of a few mm diameter) on the true vocal cords in people with strain on vocal cords (singers) or heavy smoking
by convention, singers' polyps are bilateral and smokers' polyps are unilateral more often seen in males polyps can be hyperkeratotic or even slightly dysplastic; stroma consists of loose, myxoid tissue, variable fibrosis, and variable vascularity Sx: hoarseness virtually never cause malignancy, but can cause damage/change a singer's voice |
|
what are "singers' nodules"?
|
vocal cord polyps
|
|
where do laryngeal squamous papillomas usually occur?
|
usually on the true vocal cords and are a cm or less
|
|
laryngeal papillomas
|
finger-like projections of typical squamous epithelium with an central fibrovascular core
if on the free edge of the vocal cord, can ulcerate and cause hemoptysis; usually single in adults and multiple in kids caused by HPV types 6 & 11 rare malignant transformation, but can recur |
|
juvenile papillomatosis
|
presence of multiple 1cm finger-like projections of typical squamous epithelium with central fibrovascular cores on the true vocal cords
lesions often spontaneously regress at puberty Sx: hemoptysis (caused by ulceration of papillomas on the free edge of vocal cords) |
|
how quickly do laryngeal neoplasms transform to cancer?
|
neoplasms with mild dysplasia: 1-2% over 5-10 years
neoplasms with severe dysplasia: 5-10% over 5-10 years |
|
what type of neoplasms make up the largest part (95%) of malignant laryngeal neoplasms?
|
squamous cell carcinoma
|
|
what factors contribute to development of cancer?
|
tobacco smoke
alcohol asbestos HPV nutrition irradiation |
|
what is the most common location for malignant laryngeal cancers?
|
true vocal cords
can be above or below the cords, in the aryepiglottic folds, in the pyriform sinus, or on the epiglottis |
|
development of malignant laryngeal cancers
|
start as carcinoma in situ, and then progress to plaque, and finally ulcerated and/or fungating lesions (grows in or out)
|
|
clinical features of malignant laryngeal neoplasms
|
hoarseness
60% are confined to larynx at the time of dx (gives a better px) ulcerated lesions are often secondarily infected 1/3 of pts die from infection of the distal respiratory tract, metastases, or cachexia |
|
tx for malignant laryngeal neoplasms
|
advanced lesions - total laryngectomy with permanent tracheostomy and feeding tube (lose defense of URT)
early lesions - radiotherapy |
|
otitis media
|
middle ear infection in infants and children
usually a serous exudate and caused by viral infection; can have a suppurative secondary bacterial infection chronic otitis media caused by P. aeruginosa, S. aureus, fungus |
|
what cause of chronic otitis media is particularly problematic in diabetics?
|
P. aeruginosa
it is aggressive and spreads widely causing destructive necrosis |
|
cholesteatoma
|
1-4cm cystic lesion with a squamous or mucus secreting epithelial lining and a lumen filled with amorphous debris and sometimes cholesterol spicules; surrounded by chronic inflammatory reaction
can rupture or can erode adjoining structures as it enlarges associated with chronic otitis media |
|
otosclerosis
|
bilateral abnormal bone deposition around the rim of the oval window into which the footplate of the stapes fits
starts as fibrous ankylosis of the footplate, eventually being replaced by bone; degree of immobility determines severity of hearing loss (minimal is common and severe is uncommon) AD inherited disorder |
|
what type of tumors of the ear are common in elderly men?
|
basal and squamous cell cancers on skin of external ear
usually related to sun exposure begin as papules and undergo local invasion, but rarely spread |
|
what type of tumors of the ear are common in elderly women?
|
squamous cell carcinoma in the ear canal
not related to sun exposure begin as papules and can invade cranium or metastasize to regional nodes 5 year survival is 50% |
|
branchial cyst
|
anterolateral 2-5cm cyst in the neck that arises from remnants of branchial arches, or from salivary inclusions within cervical lymph nodes
walls lined with stratified squamous or pseudostratified columnar epithelia; underlying intense lymphocytic infiltrate or well developed lymphoid tissue with reactive follicles; cyst contains watery to mucinous fluid or desquamated material DDx: lymphoma (usually too superficial to be the case) |
|
thyroglossal duct (tract) cyst
|
midline 1-4cm cyst lined by squamous epithelium if near the base of the tongue or by pseudostratified epithelium if lower; wall has lymphoid aggregates or recognizable thyroid tissue
may move if pt sticks their tongue in or out |
|
paraganglioma
|
aka carotid body tumor
rare neuroendocrine tumor similar to pheochromocytoma occur around great vessels along the aorticopulmonary chain (parasympathetic ennervation) non-chromaffin lesions, so infrequently release catecholamines usually occur in the 6th decade of life; usually single and sporadic though can be familial as a part of MENII carotid body tumors are most frequent - cells sense O2 and CO2 in adjacent vessels (chemodectoma) |
|
where are 70% of extra-adrenal paragangliomas located?
|
head and neck - generally around the great vessels along the aorticopulmonary chain of parasympathetic ennervation
|
|
what is a chemodectoma?
|
carotid body tumor (most frequent form of paraganglioma)
non-chromaffin neuroendocrine tumor of the carotid body cells sense O2 and CO2 levels in adjacent vessels |
|
morphology of paraganglioma
|
arises close to or envelops bifurcation of common carotid
pink-to-brown round to oval cells with abundant cytoplasm and uniform nuclei; arranged in zellballen (pattern of nests/balls unique to paraganglioma) stain for neuroendocrine markers and spindle shaped stromal cells stain for S100 |
|
clinical course of paraganglioma
|
slow growing, painless tumor around the carotid body occuring in the 5-6th decade
difficult to resect b/c they are entangled with the carotid artery and b/c they are very infiltrative, and frequently recur if resection is incomplete can metastasize neither histology nor vascular invasion can predict clinical course (whether benign or malignant) 50% are fatal |
|
what is the most common salivary lesion?
|
mucocele - blockage or rupture of a duct with leakage of saliva in the stroma
|
|
mucocele
|
most common salivary lesion
blockage or rupture of a duct with leakage of saliva in the stroma; seen as a bluish, translucent cyst-like space containing mucin and inflammatory cells and lined by granulation tissue or fibrous tissue most often found on lower lip |
|
ranula
|
mucocele from damage to duct of the sublingual gland
|
|
what is the most common infectious cause of sialadenitis?
|
mumps
|
|
what is the most common autoimmune cause of sialadenitis?
|
Sjogren syndrome
|
|
nonspecific sialadenitis
|
inflammation of salivary glands
particularly involves submandicular glands bacteria can infect, usually secondary to ductal obstruction by stones |
|
etiology of sialolithiasis
|
sialolithiasis = stones in salivary ducts
poorly understood etiology, but dehydration with decreased secretion may have a role |
|
statistics for salivary neoplasms
|
<2% of human tumors overall
- 65-80% arise in the parotid gland (20% are malignant) - 20% arise in submandibular gland (40% are malignant) - 50% of minor salivary gland tumors and 70-90% of sublingual tumors are malignant |
|
what is the rule of thumb for malignancy of tumors in salivary glands?
|
the smaller the salivary gland is, the more likely the tumor is to be malignant
|
|
when do salivary gland tumors generally present?
|
benign tumors in the 5th-7th decades of life
malignant tumors slightly older malignant usually grow more rapidly |
|
pleomorphic adenoma (mixed tumor of salivary glands)
|
60% of parotid tumors; less common in other salivary glands
benign tumor derived from a mix of ductal epithelial and myoepithelial cells (epithelial and mesenchymal differentiation, with either dominating) |
|
morphology of pleomorphic adenoma
|
aka mixed tumor of salivary glands
grey-white tumor with myxoid or bluish areas; size rarely exceeds 6cm capsule not fully developed and often small protrusions into surrounding gland epithelial component can be ductal, acinar, sheets, myoepithelial cells mesenchymal component is loose, often with areas of cartilage and occasionally bone |
|
clinical course of pleomorphic adenoma
|
painless, slow growing tumor that can develop into a carcinoma (adenocarcinoma or undifferentiated carcinoma; 2% if pt has tumor <5 yrs; 10% if pt has tumor >15 yrs)
very aggressive (30-50% 5yr mortality) 4% recurrence with lobectomy; 25% recurrence with enucleation w/o lobectomy |
|
warthin tumor
|
aka cystadenoma lymphomatosum
bilateral and/or multifocal benign 2-5cm encapsulated tumor in the superficial lobe grey surface with narrow cystic or cleft-like spaces filled with mucinous or serous contents and lined by double layer of columnar epithelium with abundant fine granular eosinophilic cytoplasm; underlying stroma is dense and lymphoid and can have germinal centers only found in parotid glands; more common in males and in smokers |
|
what is the second most common tumor in salivary glands?
|
warthin tumor (aka cystadenoma lymphomatosum)
|
|
mucoepidermoid carcinoma
|
15% of all salivary tumors (60-70% occur in parotid, but accounts for a large number of minor salivary gland tumors)
up to 8cm circumscribed tumor with infiltrative margins grey-white with small mucin containing cysts; cords, sheets or cysts of squamous or mucous epithelium or intermediates range from low to high grade (low grade tends to have more mucin producing cells and high grade have a larger squamous component) |
|
what is the most common malignancy of salivary glands?
|
mucoepidermoid carcinoma
|
|
what is the most common radiation induced neoplasm?
|
mucoepidermoid carcinoma
|
|
clinical course of mucoepidermoid carcinoma
|
low grade - recurrence/local invasion in 15%, but don't tend to metastasize (5 year survival is 90%)
high grade - 30% recurrence and tend to metastasize (5 year survival is only 50%) |
|
molecular pathology of mucoepidermoid carcinoma
|
about 1/2 of pts have a t(11;19) creating fusion gene of portions of MECT1 and MAML2
(disturbs notch and cAMP dependent signaling pathways) |
|
adenoid cystic carcinoma
|
50% occur in minor salivary glands, especially those in the palate; also occur in parotid and submandibular glands
small, poorly encapsulated, infiltrative lesions that consist of small cells (with dark nuclei and scant cytoplasm) with hyaline material between them; cribriform, solid or tubular patterns adenoid cystic pattern (punched out holes) |
|
clinical course of adenoid cystic carcinoma
|
recurrent, slow growing tumor that tends to invade perineural spaces (quite painful)
50% or more have wide dissemination, but it takes years to manifest five year survival is 60-70%; fifteen year survival is 15% |
|
acinic cell tumor
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2-3% of salivary tumors (mostly occuring in parotid glands)
may be bilateral and/or multicentric cells resemble normal serous cells of salivary glands, with cleared cytoplasm in sheets, glands, papillary formation recurrence is uncommon but 10-15% metastasize to nodes 5 year survival is 90%; 20 year survival is 60% |