Salivary Gland Tumors

Front 1

What is the most common salivary gland lesion?

Back 1

The most common salivary gland lesion is a mucocele.

Front 2

parotid gland has what type of glands?

Back 2

serous glands

Front 3

Submandibular gland has what type of glands?

Back 3

seromucinous glands

Front 4

minor salivary glands have what type of glands?

Back 4

predom mucinous glands

Front 5

Key feature of sialometaplasia to distinguish from tumor?

Back 5

sialometaplasia loses all serous and mucinous acinar cells

Front 6

What is the cause of mucocele?

Back 6

trauma

Front 7

what is the most common site of mucocele?

Back 7

lower lip
note: mucocele on upper lip is rare!! reconsider dx

Front 8

What type of lesion is associated with elderly pt with Sjogren's?

Back 8

lymphoepithelial lesion

Front 9

Canalicular adenoma, population? location?

Back 9

elderly, 99% upper lip

Front 10

Cannalicular adenoma, histology?

Back 10

one cell type columnar, cords/trabeculae

Front 11

Back 11

canalicular adenoma

Front 12

Back 12

canalicular adenoma

Front 13

most common salivary gland tumor?

Back 13

pleomorphic adenoma

Front 14

second most common benign salivary gland tumor?

Back 14

Warthin's tumor

Front 15

Top three malignant salivary gland tumors?

Back 15

1. Mucoepidermoid CA
2. Adenoid cystic CA
3. Acinic cell CA

Front 16

What tumor does polymorphous low grade adenocarcinoma most resemble?

Back 16

adenoid cystic carcinoma

Front 17

Differential dx of palate tumor in elderly?

Back 17

1. pleomorphic adenoma
2. polymorphous low grade adenocarcinoma
3. adenoid cystic carcinoma

Front 18

most common salivary gland tumor?

Back 18

pleomorphic adenoma

Front 19

second most common benign salivary gland tumor?

Back 19

Warthin's tumor

Front 20

Top three malignant salivary gland tumors?

Back 20

1. Mucoepidermoid CA
2. Adenoid cystic CA
3. Acinic cell CA

Front 21

What tumor does polymorphous low grade adenocarcinoma most resemble?

Back 21

adenoid cystic carcinoma

Front 22

Differential dx of palate tumor in elderly?

Back 22

1. pleomorphic adenoma
2. polymorphous low grade adenocarcinoma
3. adenoid cystic carcinoma

Front 23

microscopic of polymorphous low grade adenocarcinoma

Back 23

**key is many patterns, one cell type**
papillary, solid, ducts
single filing at periphery

Front 24

Back 24

Warthin tumor

Front 25

Major gland tumors

Back 25

Warthin tumor
acinic cell Ca
basal cell adenoma/carcinoma
oncocytoma/carc
epith-myoepith
salivary duct CA
lymphoepithelial CA

Front 26

Minor gland tumors

Back 26

canalicular adenoma (lip)
polymorphous low grade (palate)
cystadenoma/carc (lip, buccal)
inverted papilloma (lip, buccal)
intraductal papilloma (lip, buccal)
sialadenoma papilliferum (palate)

Front 27

List the top 3 malignant tumors in order of best to worse survival rates at 10 yrs

Back 27

mucoep, acinic cell, adenoid cystic

Front 28

Major micro features of pleomorphic adenoma

Back 28

circumscribed
2 cell types: epithelial, myoepithelial (plasmacytoid hyaline cells)
chondroid matrix
myoepithelial cells melt into stroma (focal)

Front 29

pleomorphic adenoma cytogenetics

Back 29

39%: 8q12 translocations
8%: 12q13-15 translocations
23%: other sporadic clonal changes

Front 30

Back 30

plasmacytoid hyaline cells
ddx: pleomorphic adenoma
myoepithelioma
epithelial myoepithelial carcinoma
these are myoepithelial cells.

Front 31

Back 31

pleomorphic adenoma
(melting)

Front 32

micro features of carcinoma ex pleomorphic adenoma

Back 32

larger
significant pleomorphism
high mitotic and atypical mits
necrosis/hemorrhage
expansile/infiltrative nodule: usually takes up most of volume

Front 33

carcinoma ex pleomorphic adenoma: most importnat prognostic factor

Back 33

extent of extracapsular invasion

Front 34

most common type of CA seen in carcinoma ex pleomorphic adenoma

Back 34

85% are high grade carcinoma such as adenocarcinoma NOS or salivary duct CA. Always consider carcinoma ex when you have a high grade salivary gland CA which is difficult to classify

Front 35

basal cell adenoma:
clinical

Back 35

60-70 yo F>M
70% parotid, 15% upper lip

Front 36

basal cell adenoma:
micorscopic

Back 36

circumscribed +/- capsule
NO chrondromyxoid stroma
SHARP demarc from stroma
monotonous blue cells/2 cell types scant cytopl, palisading
one architecture predom's, but can be solid (jigsaw), trabecular, tubular

Front 37

membranous type basal cell adenoma

Back 37

uncommon, multifocal (entrap nl)
abundant pink PAS+ BM material
equiv to dermal cylindroma

Front 38

Brooke-Spreigler syndrome

Back 38

membranous basal cell adenoma,
cylindromas, trichoep, eccrine spirad, milia; mut of CYLD on chr16
aka: familial cylindromatosis
aka: Turban tumor syndrome

Front 39

basal cell adenocarcinoma

Back 39

infiltrative growth
jigsaw puzzle lobules
low grade
most in parotid
higher recurrence if in minor sal glands

Front 40

Back 40

basal cell adenoma, trabecular pattern

Front 41

Back 41

basal cell adenoma

Front 42

Back 42

basal cell adenocarcinoma

Front 43

myoepithelioma:
predom cell pattern in parotid

Back 43

spindle or epithelioid

Front 44

myoepithelioma:
predom cell pattern in minor sal glands

Back 44

plasmacytoid

Front 45

myoepithelioma: capsule or no?

Back 45

yes, usually thin capsule

Front 46

myoepithelial carcinoma: capsule or no?

Back 46

usually no caspule
also: necrosis, atypia, no glandular, high mits
MUST show invasive growth

Front 47

DDX of oncocytic sal gland tumor

Back 47

oncocytoma
any w/ oncocytic change:
Warthin
pleomorphic adenoma
basal cell adenoma
mucoep CA
acinic cell CA

Front 48

distinguishing feature:
oncocytoma vs acinic cell CA

Back 48

acinic cell nuclei peripherally located
oncocytoma nuclei central and round

Front 49

oncocytic carcinoma:
low or high grade?

Back 49

high grade
less than 2 cm is better prog.