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25 Cards in this Set
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1. List 1 non neoplastic salivary gland lesion? 2. List 6 benign epithelial tumors? 3. What should be suspected w/ presentation of B/L tumors? |
1. necrotizing sialometaplasia 2. Pleomorphic adenoma (b9 mixed tumor) myoepithelioma basal cell adenoma canalicular adenoma oncocytoma warthin tumor (cystadenoma lymphomatosum papilliferum) 3. Warthin's account for 70%, but have a 10-15% chance themselves of being b/l |
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1. List 14 malignant tumors? include whether each one is low (L) or high (H) grade (some can be both b/c on a spectrum) 2. Whats the difference in tx for the groups? |
1. L acinic cell CA L /H Mucoepidermoid CA L (but agsv) Adenoid cystic CA L Polymorphous low grade ACA L Epithelial myoepithelial CA L myoepithelial CA Clear cell ACA L Basal cell ACA Oncocytic CA H Salivary duct CA H Lymphoepithelial CA H SCC ACA NOS CA ex pleomorphic adenoma 2. Low grade get complete resection, high grade get radical resection including involved nerves +/- LND determined clinically |
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Necrotizing sialometaplasia 1. Patient population, presentation and gland? 2. Histology? point out feature that distinguish this from malignancy? 3. tx and prognosis? 4. Assoc w/? |
1. M 2x > W w/ rapidly developing ulcer w/ in minor salivary glands of palate (75%) 2. lobular architecture of coagulative necrosis of solitary acini w/ bland sqamous metaplasia of the ducts trapping mucous cells w/ smooth edges, intense mixed inflammatory rxn and overlying bland mucosal pseudoepitheliomatous hyperplasia 3. benign will heal in 3-12 wks 4. traumatic injury, dental infection, dentures, adjacent cyst or rumor, prev sx, URI, allergy |
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Acinic cell carcinoma 1. list 3 most common MALIGNANT salivary gland tumors in order most to least? 2. Patient population & gland? w/ pertinent fact about location 3. histology? 4. Positive specials and IHC? 5. Prognosis? w/ fact about location and histo? |
1. mucoepidermoid > ACA NOS > acinic cell CA 2. 45y/o W >M in parotid gland (85%); most common malignancy to be B/L 3% 3. may be solid, papillary-cystic microcystic or follicular w/ large polygonal cells w/ basophilic granular cytoplasm and small uniform eccentric nuclei often w/ lyphoid infiltrate and peripheral lymphoid follicles 4. PAS + Diastase resistant, + CK, alpha 1 anti trypsin and alpha 1 antichymotrypsin, CEA, amylase, LEU M1 (CD15) 5. 5 yr survival 90%, local recurrence 20%, better prognosis if in minor salivary glands and worse if papilllary cystic variant |
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Acinic cell carcinoma 1. Cytology? |
1. clusters of grapes w/ no stroma or fat and bland cells larger than normal mucous cells in salivary glands |
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Mucoepidermoid carcinoma 1. Patient population, gland? 2. How common in kids? 3. Histology? include 4 cell types 4. Differentiate low and high grade tumors? 5. IHC? |
1. W>M, 45-65% parotid > minor glands 20% > bucal mucosa (lower lip > upper) 2. most common salivary malignancy in kids w/ acinic cell at #2 3. intermediate or basal cells, mucous cells, epidermoid cells (form nests or line cystic space) >> clear cells (glycogen) all w/in abundant hyalinized stroma 4. low grade has abundant mucous cells and cystic > solid; high grade has infiltrating pattern w/ epithelial and intermediat cells > mucous and solid > cystic 5. CK7+ in intermediate and epidermoid cells of low grade tumors |
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Mucoepidermoid carcinoma, low grade 1. Molecular alteration? list one variant and the assoc molecular alteration? 2. List the AFIP grading system and how it affects prognosis? 3. Assoc w/ ? |
1. t(11;19); oncocytic variant has MAML1 rearrangment 2. AFIP point system: 0-4 points low grade w/ 98% 5 year survival >7 points high grade w/ 55% % year surfival 3. prior radiation, most common radiation induced neoplasm of salivary gland |
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Adenoid cystic carcinoma 1. Cytology? 2. IHC on ductal/epithelial cells and those surrounding in stroma? 3. Molecular alteration? |
1. land cells w/ sharply defined metachromatic ACELLULAR bubble gum matrix 2. Ductal cells are + S100 CEA, EMA, CD117 and alpha 1 antichymotrypsin (maybe both); Surrounding cells are S100 and SMA positive 3. t(6;9) resulting in MYB-NFIB fusion transcript |
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Adenoid cystic carcinoma 1. Patient population, gland? 2. List 3 architectural patterns and describe histology? 3. Prognosis related to patterns? |
1. M=W 40-60 yrs; submandibular= parotid sublingual, minor 2. cribriform> tubular > solid ( >70% is high grade, 30-70% is intermediate grade) patterns of banal basaloid myoepithelial like tumor cells w/ indistinct cell borders and scattered pink ductal cells w/in collagenous stroma commonly w/ peripheral nerve involvment 3. Recurrence rates by pattern: solid (100%), cribriform (89%), tubular (59%) |
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Polymorphous low grade adenocarcinoma (PLGA) 1. Patient population and gland? 2. Location related to adenoid cystic? 3. Histology w/ triad? 4. Prognosis? |
1. W 2/3 > M in minor salivary glands and palate 2. ACC #1 palate tumor and PLGA #2 3. infiltrative w/ multiple architectural/growth patterns (solid trabecular tubular ductular cribriform cystic papillary) and banal uniform cells that are in small nests or single file infiltrating periphery in mucoid, collagenized or hyalinized stroma 4. 10-30% recurrence and 10-15% LN mets |
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Epithelial myoepithelial carcinoma 1. Patient population and gland? 2. Histology? 3. Prognosis? Very rare tumor! 4. Positive and negative IHC and SS for epithelial and myoepithelial components? 5. Name one variant and its unquie IHC that may make dx of metastaic lesions difficult? |
1. older 70 yrs adults slight F predominance, parotid in 80% 2. Biphasic population of ductal, cuboedal epithelial cells (25%) w/ pink cytoplasm and large round nuclei mixed w/ myoepithelial cells (75%) that are large polygonal w/ clear indistinct cytoplasm and irregularly shaped nuclei; cells may be shets, organoid or nested w/in hyalinized stroma that varies from loose/mysoid to collagenous 3. low grade w// recurrence in 30% and LN mets in 20% 4. Epithelial are CK EMA and CKIT + but neg for EMA; myoepithelial are + for S100, P63 and SMA 5. apocrine variant is HER2 and GCDFP-15 positive |
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Clear cell (adeno)carcinoma (w/ hyalinized stroma, aka hyalinizing subtype) 1. Patient population and gland? 2. Histology? 3. Positive IHC? 4. Prognosis? 5. What is the molecular alteration for the subtype shown? 6. What tumor on the DDX is most likely to have clear cells? |
1. W ~>M 30+ usualy 5-7th decade and 70-90% occur in minor salivary glands 2. uniform round to polygonal cells w/ clear cytoplasm or (fewer) pale granular cytoplasm and round eccentric nuclei w/ small nucleoli, low N/C radio arranged in sheets nests or cords w/ varying stroma (thin thick collagenous sclerotic or hyalinized) often w/ PNI 3. PAS+ diastase Sensitve (b/c it's glycogen), + CK S100 (variable), CEA, EMA 4. low grade but locally aggressive 5. EWSR1-ATF1 rearrangement 6. Mucoepidermoid CA |
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Oncocytoma 1. Gland and patient population? 2. Histology? 3. EM and IHC? 4. Prognosis & assoc? |
1.80-90% in parotid F>M mean 60 yrs, peak 70-90yrs 2. onocytes arranged in organoid pattern w/ distinct cell borders, thin bands of fibrovascular stroma, w/ abundant very pink finely granular cytoplasm 3. ck5/6 P63 and phosphotungistic acid hemotoxylin (PTAH) +; EM shows cytoplasm filled w/ round to oval mitochondria 4 B9 w/ uncommon recurrence; 20% w/ radiation |
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Oncocytic carcinoma 1. In this rare tumor what is patient population and gland? 2. Histology? 3. Positive IHC? what is spp stained and how does one help? 4. EM findings? 5. Prognosis? |
1. older 60+ M>W, 80% parotid gland 8% sumandibular 2. large round/polygonal cells in solid sheets islands cords or nests w/ fine granular eosinophilic cytoplasm and central vesicular nucleus w/ prominent nucleolus w/ invasion of muscle nerves and lymphatics "ACA like" architecture 3. P63, PTAH stains mitochondria rich cytoplasm and KI67 helps distinguish malignant from b9 4. shows larg # of misshapen mitochondria 5. multiple local recurrences and regional LN mets w/ 54% 5 year survival |
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Salivary duct carcinoma 1. Patient population, gland and presentation? 2. Histo? 3. Positive IHC? 4. Prognosis? |
1. M (75%) >W in 5-6th decades, in parotid gland (85%); w/ rapid on set facial swelling and nerve dysfunction (25%) and palpable cervical LNs (30-35%) 2. rounded nodules of cuboidal and polygonal eosinophilic cells w/ large nuclei often nodules are cystic w/ epithelium in band like, papillary, and cribriform patterns (usually all seen), frequent comedonecrosis, PNI and LVI (similar to breast IDC) 3. CK, EMA CEA, androgen receptor, PPARgamma, GCDFP-15, PSA in 60% and HER2 in 50% 4. very aggressive;55-60% die w/in 5 years of dx |
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Carcinoma ex pleomorphic adenoma 1. AKA? 2. patient population and gland? 3. Histology? 4. Stains? 5. Molecular alterations? 6. Prognosis? |
1. malignant mixed tumor 2. >30yrs, usualy 50-60yrs in parotid gland 3. Must have focus of pleomorphic adenoma in background often scattered thoughout the malignant areas w/ abrupt transition from b9, carcinomatous component (always arising from PA epithelial component and may resemble any other salivary gland malignancy) composed of enlarged pleomorphic cells w/ hyperchromatic nuclei and prominent nucleoli, lots of mits, necrosis, hemorrhage PNI and LVI 4. Epithelial components stain w/ keratins and EMA and if myoep diffis present then S100 +, not helpful rally just depends on differentiation 5. 8q & 12q rearrangments 6. cervical LN mets in 25-50%, recurrence 25-55% (signifies poor prognosis), 5 year survival 25-65%, drops to 10-35% at 15 and <40% at 20 |
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Pleomorphic adenoma 1. Cytology description? 2. patient population and gland? 3. Stains? 4. What mimics PA on frozen section? 5. Prognosis? |
1. bland epithelial cells w/in fibrillar metachromatic stroma (on diff quik) and tyrosine rich crystals 2.W>M 30-50yrs 75-85% in parotid (50% in tail) > submandibular 3. depends on comonents; epithelial is EMA CEA lysozyme alpha antitrypsihn, lactoferrin +; myoep react to actin, myosin S100 and P63 4. ACA NOS, Mucoep, adenoid cystic 5. benign but likely to recurr w/o total excision |
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Pleomorphic adenoma 1. histology? 2. What is a syndrome surgical complication? 3. Molecular alterations? |
1. biphasic tumor w/ myo/epithelial (spindled, clear, squamous, basaloid, cuboidal plasmacytoid, oncocytic mucous or sebaceous arranged in sheets, cysts, trabecule, tubules or fasicles) and mesenchyal (composes stroma which is myxoid, mucoid, hyalinized or > chondoid or osseous) components 2. Frey syndrome, injury to marginal mandibular branch of facial nerve leading to gustatory sweating 3. 8q12 or 12q14-15 |
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Myoepithelioma 1. Patient population and gland? 2. Histology? 3. Name and describe a variant? 4. Pertinent positive and negative IHC? 5. Prognosis? |
1. middle aged 45-55 yrs, M=W in parotid gland (40%) or hard palate minor (20%) 2. tumor cells are heteroreneous ranging from spindled mesenchmal-like appearing cells in fascicles, to large oval/polygonal epithelioid cells w/ pale or clear cytoplasm (often w/ cystic spaces) to plasmacytoid cells (in small aggregates w/ loos collgenous mucoid stroma) 3. Reticular variant has epithelioid cells in interconnecting cords surounded by lots of mucoid stroma 4. + P63, MSactin, keratin, S100 & - desmin 5. very infrequent recurrence |
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Basal cell adenoma 1. patient population and gland? 2. Histology overall? Include 5 patterns 3. Which variant is different from the rest and how? describe histology 4. Describe which syndrome is associated w/ the above variant? include inheritance and genetic alteration? 5. What is another name for this variant? |
1. W2x>M, older 55-60, in parotid 70% 2. nests of basaloid epithelial cells w/ peripheral palasading in fibrous stroma w/ patterns: Solid, trabecular, trabecular-tubular (subtly spindled), tubular, and membranous 3. Membranous is NOT encapslated and has high recurrence rate at 25% andmore likely to undergo malignant transformation (25% vs only 4%); nest of cells fittng together like jigsaw puzzle w/ coalescent membrane droplets surrounded by hyaline bands of basal lamina 4.AD Brook Spiegler syndrome; membranous adenomas coexist w/ skin adnexal tumors 25-40% of time, often on head (Turban Tumors) including cylindromas, trichoepitheliomas, siradenomas, 16q12-13 CYLD gene 5. Dermal analog tumor |
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Cannilicular adenoma 1. patient population and gland? 2. Histology? 3. IHC? 4. Prognosis? |
1. 50+ y/o W>M in upper lip!!! 2. double rows of short columar epithelial cells in branching interconnecting cords that separate forming narrow channels w/in loose stroma 3. + CK, S100 and GFAP (in distinct linear pattern at periphery near stromal interface) 4. benign w/ uncommon local recurrence |
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Warthin tumor 1. patient population and gland? 2. Histology? 3. IHC? 4. Prognosis? 5. How common is this tumor? 6. What other salivary neoplasms have lymphoid proliferation? 7. Assoc? |
1. middle aged (mean 62 >40) > W and unusual to see in blacks 2. double layer of oncocytic columnar cells lining papillae and cysts w/ lymphoid stroma often w/ GCs, cyst content has secretion and cellular debris resembling corpora amylacea 3. + for PTAH due to mitochondria which are seen on EM; 4. recurrence rate <2% 5. Second most common benign parotid tumor after PA (which is also most common salivary neoplasm overall) 6. mucoep, acinic cell, cystadenoCA, LElike CA 7. SMOKING!!!!!!! tuberculosis and brucella mellitensi |
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Adenocarcinoma NOS 1. How frequent? 2. Patient population and gland? 3. Histology? 4. positive IHC? not really helpful 5. Prognosis? 6. Molecular alteration? |
1. Second most common salivary malignancy b4 acinic cell CA and after Mucoepidermoid CA 2. 50-60s, 60% in parotid and 40% in minor glands 3. ductal or glandular differentation w/ no defining morphologic w/ infiltrative growth and a variety of architectural patterns composed of oval or uoidal clear and oncocytic cells ranging from low to high grade 4. CK7 5. 5 year survival is 57%, LN mets 23% and distant mets 37% 6. EGFR and HER2 amplification |
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Lymphoepithelial cyst 1. associated w/ what 2 diseases? 2. In the viral one what are the lymphocytes positive for? |
1. Sjogren syndrome and HIV 2. HIV ones have CD8+ lymphs |
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Lymphoepithelioma like CA 1. patient population, presentation and gland? 2. Histology? 3. IHC? 4. Prognosis? |
1. familial in Eskimos and Chinese adults; presents as unilateral mass of parotid gland, submandibular gland or minor salivary glands 2. Malignant epithelial islands resembling nonkeratinizing large cell carcinoma and lymphoid tissue with germinal centers Occasional spindled areas Often perineurial invasion 3. Keratin EBV positive 4. Metastases common to regional lymph nodes; distant metastases to liver, lung, bone
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