Salivary Oral Path Autumn 2009

Front 1

. Know the most common salivary gland tumor and the most common oral location.

Back 1

Mixed tumor - pleiomorphic adenoma - 80% of all salivary gad neoplasms. Parotid is most common location, then submandibular, oral avity, palate, lips

Front 2

DDX for the palatal swelling:

Back 2

Torus palatines
Salivary gland neoplasm ie mixed tumor,
Soft tissue neoplasm i.e. leiomyoma

Front 3

DDX for the lateral face

Back 3

Salivary gland neoplasm ie pleomorphc adenom or mixed tumor
Sjogrens
HIV related benign epithelial cyst of the parotd
Alcoholic sialadenosis
Mumps (unlikely)

Front 4

Know the histology and the clinical presentation of Warthin's tumor.

Back 4

Warthins: occurs in older males, firm asymptomatic swelling, once thought to be exclusive to parotid. Histo: its encapsulated papillary projection with double layered lining of oncocytes and prominent lymphoid elements forming follicles.
Big pink clumnary epi cells with gran cytoplasm - oncocytes
Papillary projections with stents filled with lymphocytes
Capsule
Parotid


Both components can become malignant
Lymphocytes - lymphoma
Pink oncocytes

Front 5

Know the clinical presentation and histologic features of adenoid cystic carcinoma.

Back 5

Middle aged pt on the palate submandibular land and tongue, paralyss and pain lossible, fixation common, marked tendency for perineural invasion. Histo infiltrative growth pattern, cribiform swiss chesse pattern, nerve invasion, hyalinization.

Front 6

Know the significance of the clinical and histology of necrotizing sialometaplasia.

Back 6

More common in men, deep ulcerated well circumscribed painless swelling. Histo: ulcerations, pseudoepitheliomatous hyperplasia, acinar necrosis with retention of lobar architecture, salivary gland ducts exhibitng metaplstic changes.

Front 7

DDX Necrotizing sialometaplasia

Back 7

Traumatic ulcer
Injection necrosis
Necrotizing sialometaplasia
SCC/other malignant neoplasm

Front 8

Know the malignant salivary gland tumor that clinically resembles a mucocele.

Back 8

Mucoepidermoid carcinoma, especially in the retromolar pad area, can resemble mocceles.

Low grade is more common and low grade is the type that resembles mucoceles - form lecture slides

Front 9

Know the clinical significance of the answer to #5.
Consider what appears to be a mucocele in the retromolar pad area as

Back 9

mucoep until proven otherwise

Front 10

. Know the etiology of mucoceles.

Back 10

Mucuous extravasation type mucocele: trauma to the salivary gland ducts leading to pooling of mucous which stimulates granulatin tissue to attempt to wall it off.
8. Know the difference between mucous extravasation phenomenon
Other way: localaized dilatation of sublingual gland ducts with mucous pooling

Front 11

Major salivary glands

Back 11

Sites of Origin
1. Major salivary glands
a. Parotid (serous)
b. Submandibular (mixed) mostly serous
c. Sublingual (mixed) mostly mucous

Front 12

Minor salivary glands

Back 12

Minor salivary glands
a. Palatal (mucous)
b. Buccal mucosa (mixed)
c. Floor of mouth (mixed)
d. Anterior tongue (mucous)
e. Posterior tongue (serous)
f. Lip (mixed)

Front 13

Distribution of Salivary Gland Tumors in General

Back 13

Parotid, 64-80%
2. Submandibular, 8-11%
3. Sublingual, 1%
4. Minor, 9-23% of which
a. 42-54% in palate
b. Lips 22%, the upper lip is the second most common site (89%)
c. Buccal mucosa 15%

Front 14

Incidence of Benign and Malignant Tumors of Salivary Glands

Back 14

1. Parotid, 15-32% are malignant
2. Submandibular, up to 45% are malignant
3. Sublingual, up to 90% are malignant
4. Minor glands, 50% benign; 50% malignant
a. 75-86% upper lip tumors are benign, lower lip 50-86% are malignant
b. Most tongue tumors are malignant
c. Palatal and buccal mucosa tumor 50% are malignant
d. 91% of retromolar area tumors are malignant

Front 15

Canalicular adenoma
Clinical Features:

Back 15

These neoplasms occur predominantly in minor salivary glands, especially those of the
upper lip (75% occur in the upper lip). They are not common in the parotid. They present as
well-circumscribed, movable, slow-growing, painless nodules.

Front 16

DDX: Basal Cell Adenoma

Back 16

1. Fibroma, 2. Mucocele, 3. Soft tissue neoplasm, 4. Salivary gland
neoplasm (lower lip more likely malignant)

Front 17

Mixed Tumor (Pleomorphic adenoma)
It is the most common benign salivary gland neoplasm of both the major and minor salivary glands. It
originates from the

Back 17

the myoepithelial cells and the reserve cells of the intercalated duct.

Front 18

Include the following tumors under
monomorphic adenoma: DDX for submandibular swelling:

Back 18

1. Salivary gland neoplasm i.e. adenoid cystic
carcinoma, 2. Infection (unlikely), 3. Soft tissue neoplasm, 4. Lymph node hyperplasia (unlikely)

Front 19

Basal cell adenoma
Clinical Features:

Back 19

This is a painless, slow-growing nodule that is more common in older males. It is
treated by surgical excision. It is more common in the parotid. It rarely occurs in the oral cavity.
(Lips in pictures)

Front 20

DDX for bilateral face swelling: (Wartin's Tumor)

Back 20

1. Sjogrens syndrome (unlikely), 2. Salivary gland
neoplasm, 3. Alcoholic sialadenosis, 4. HIV related benign lympoepithelial cysts of the parotid.

Front 21

Oncocytoma (oxyphilic adenoma)
This is a rare neoplasm of salivary glands in general. This neoplasm mainly involves the major salivary
glands especially the parotid. However, a variant of this lesion has been found in the oral cavity and is
called oncocytic cystadenoma. Clinical Features:

Back 21

It occurs more commonly in elderly patients with female
predominance. Intraorally, it occurs on the buccal mucosa and upper lip. It presents as a small,
asymptomatic, encapsulated nodule.

Front 22

Oncocytoma DDX

Back 22

DDX: 1. Salivary gland neoplasm i.e. PA, 2. Sjogrens syndrome (usually
bilateral), 3. HIV related benign epithelial cyst of the parotid (usually bilateral), 4. Alcoholic sialadenosis
(usually bilateral), 5. Mumps (wrong age and usually bilateral).-5O\

Front 23

DDX MucoEP

Back 23

DDX: 1. Hemangioma, 2. Hematoma, 3. Mucoepidermoid carcinoma.

Front 24

Histopathology: MucoEP

Back 24

All three types show evidence of
invasion of the surrounding tissue. These tumors show a range of cells, the predominant being mucous
producing and epidermoid cells. Low grade: more mucous secreting cells and duct-like structures than
epidermoid cells. High grade: the reverse, more epidermoid cells than mucous producing

Front 25

This is a low grade malignant neoplasm of salivary gland origin. It was first reported by Batsakis as terminal
duct carcinoma. This lesion went through a number of name changes and polymorphous low grade
adenocarcinoma is the most used name today. It is most common in minor salivary glands and is very
rarely described in major salivary glands. Clinical Featuresm

Back 25

This is a slow growing, rarely metastasizing
neoplasm of salivary gland origin. It occurs mostly in the palate followed by the upper lip and buccal
mucosa. It is slow-growing painless mass; pain is described only rarely. It affects older patients in the sixth
to eighth decade and occurs more in females.arely

Front 26

DDX: Polymorphous low grade adenocarcinoma

Back 26

1.
Salivary gland neoplasm, 2. Torus palatinus (unlikely), 3. Soft tissue neoplasm. 4. Palatal abscess.

Front 27

It is the most common malignant neoplasm of the minor
salivary glands and the submandibular gland.

Back 27

Adenoid Cystic Carcinoma (Cylindroma):

Front 28

Adenoid Cystic Carcinoma (Cylindroma):Clinical Features:

Back 28

It occurs in middle-aged patients frequently on the palate, submandibular gland and
tongue. It is also seen in younger patients. It may present with local pain and facial nerve paralysis if
affecting the parotid. Fixation to deeper structures and local invasion is common. On the palate the tumor
may be covered with normal-looking epithelium and be indistinguishable from pleomorphic adenoma or
mucoepidermoid carcinoma, or may be ulcerated. It has a marked tendency for perineural invasion
explaining the signs of pain or paresis

Front 29

Adenoid Cystic Carcinoma DDX

Back 29

1. Salivary gland neoplasm, 2. Lymphoma, 3. Maxillary sinus pathology pressing down on the
palate, 4. Bone disease i.e. fibrous dysplasia or other bone neoplasms.

Front 30

Carcinoma Ex Mixed Tumor
This tumor represents

Back 30

a high-grade adenocarcinoma developing in a pre-existing, benign mixed tumor.
Rarely, both mixed tumor and the adenocarcinoma occur together and spontaneously.
Clinical Features: As described above this lesion usually occurs in a pre-existing mixed tumor with a
history of sudden enlargement. Therefore, the difference between this lesion and the benign mixed tumor
is the age of the patient. There is about 10 to 15 years difference in age

Front 31

DDX: 1. Mucocele,

Back 31

2. Fibroma, 3. Lymphangioma, 4. Burn blister (unlikely).

Front 32

vDDX: 1. Ranula,

Back 32

2. Hemangioma or lymphangioma, 3.
Mucoepidermoid carcinoma, 4. Dermoid cyst (unlikely).