Salivary Gland Oral Path

Front 1

What is the most likely diagnosis for this?

Back 1

Malignant Lymphoma of bone

Front 2

What is the most likely diagnosis for this radiograph?

Back 2

Multiple myeloma

Front 3

What is the most likely diagnosis?

Back 3

Mucocele

Front 4

Ranula

Back 4

This patient presents with this fluid filled slightly vascular lesion on the floor of the mouth. What is most likely dx?

Front 5

Want to rule out any sort of tumor, but most likely is a mucocele that has extended deep in to the tissue and become firm.

Back 5

This patient presents with a firm mass deep in the lower lip. The lesion is recent. What is the differential DX?

Front 6

Ranula

Back 6

What is most likely dx of this soft fluid filled lesion?

Front 7

What is the most likely diagnosis?

Back 7

Mucocele (extravasation type)

Front 8

Patient presents with this lesion and you diagnose it as a mucocele. where are these most likely to be found? and what is the most common etiology? What is the treatment for this lesion?

Back 8

Lower lip (75% of the time), and severence of minor salivary excretory duct (trauma, young patients); Tx = conservative excision and removal of minor salivary glands in the area.

Front 9

This patient presents with a mucous extravasation type lesion which pools below the mylohyoid and causes significant swelling in the neck area. What is this lesion called and what are the potential problems associated with it?

Back 9

a Plunging ranula (BELOW the mylohyoid--regular ranulas occur above the mylohyoid). The risk involved is mainly a risk of airway obstruction.

Front 10

This lesion resembles a vesiculobullous lesion except it has been persistent after excision. It periodically ruptures and although here it is located in the buccal vestibule, they are especially found on the soft palate. What is the most likely Dx?

Back 10

Superficial mucocele

Front 11

This lesion occurred from blockage of a salivary gland duct with dilatation of that duct and accumulation of mucin within it. Histology shows epithelial lining. WHat is the most likely dx?

Back 11

mucocele (retention type) AKA a TRUE cyst

Front 12

What are the possible causes of a retention type mucocele?

Back 12

Blockage of the salivary duct with a sialolith, tumor or scarring

Front 13

This large mass occurred due to a large stone w/in a ductal system. What is this "stone" called and where is this most likely to occur? What are potential results/complications associated with this?

Back 13

Sialolith, MUCH more likely to see in Wharton's (submandibular) duct; complications include obstruction, mucous retention cyst, and chronic sclerosing sialadenitis

Front 14

Patient presents with this radiograph of a dome shaped asymptomatic lesion shown here in the floor of the maxillary sinus. It is a fluid filled lesion, well demarcated and homogenously opaque. What is the most likely Dx? What is the preferred Tx?

Back 14

Antral Pseudocyst; rule out other pathology, may spontaneously erupt, only observe periodically

Front 15

What are the 2 most likely diagnoses on your differential diagnosis for this crater-like ulcer on the palate?

Back 15

1. Necrotizing Sialaometaplasia (benign reactive condition)
2. Malignant lymphoma (or other malignancy such as SCCA) ALWAYS want to biopsy to rule out malignancy; self heals in 2-3 months but don't want to wait that long.

Front 16

Where do adenomatoid hyperplasia of salivary glands most commonly occur?

Back 16

on the palate

Front 17

Sialadenosis typically occurs BILATERALLY in the _______ gland, is non neoplastic and non-inflammatory. Causes include chronic alcoholism, malnutrition, and _______. anti-hypertensive medications and _________ can also be a cause.

Back 17

Parotid, Diabetes, Pancreatitis

Front 18

Primary Sjogren's disease involves autoimmune destruction of ONLY _______ gland and ____________ glands. This is also known as Sicca syndrome.

Back 18

Salivary; lacrimal

Front 19

Secondary Sjogren's involves salivary & lacrimal gland involvement PLUS _____________. 90% of pts w/ Sjogren's syndrome are _______

Back 19

Autoimmune CT diseases like Rheumatoid arthritis, scleroderma, SLE, myositis, etc.; Female (middle aged)

Front 20

50% of those w/ sjogren's syndrome have bilateral ________. Other problems associated w/ sjogrens' include all of the following except: xerostomia, dry eyes, hyperactivity, joint pain, peripheral neuropathy

Back 20

bilateral parotid enlargement; hyperactivity is false, they have fatigue.

Front 21

T or F: pts w/ sjogren's have a 40x increase risk for lymphoma

Back 21

True

Front 22

T or F: pts w/ sjogren's have a 40x increase risk for lymphoma

Back 22

True

Front 23

middle aged female patient presents w/ parotid enlargement, xerostomia, fatigue, dry eyes and rheumatoid arthritis. What is the most likely Dx?

Back 23

Sjogren's syndrome

Front 24

This patient presents with swelling of the parotid glands. Biopsy is taken and shows T lymphocytes destroying salivary acini and hyperplastic duct epithelial cells. Patient has NO lacrimal gland involvment or arthritis. what is the most likely Dx? What could this be a precursor to?

Back 24

Benign lymphoepithelial lesion (aka lymphoepithelial sialadenitis); many times a precursor to sjogren's.

Front 25

HIV positive patient presents with parotid gland enlargement. You take a CT x-ray (since all of us will be able to afford those machines) and it shows multiple lesions in the parotid gland. What is the most likely dx?

Back 25

HIV-associated multiple LE cysts

Front 26

African American Female (yes, this female happens to have a mustache) presents with skin lesions on the face and trunk. Pulmonary radiograph shows hilar lypmhadenopathy. What is the most likely dx?

Back 26

Sarcoidosis (much more common in black women, that's why this is a woman)

Front 27

T or F: Sarcoidosis shows caseating granulomas.

Back 27

False: involves NON-caseating granulomas

Front 28

Patients with sarcoidosis can be diagnosed by elevated serum levels of ________ and a biopsy of labial minor salivary glands could show ________.

Back 28

Angiotensin 1 converting enzyme (ACE); non-caseating granulomas.

Front 29

Sarcoidosis of the parotid gland + ocular involvement + fever + facial nerve palsy is characteristic of what disease?

Back 29

Heerfordt's Syndrome (AKA uveoparotid fever)

Front 30

Patient presents with history of no childhood vaccinations, bilateral parotid swelling (as if that's the least of this guys problems), orchitis and encephalitis. What is the most likely Dx?

Back 30

Mumps (from paramyxovirus)

Front 31

Patient presents with pain, parotid swelling, fever, and purulent exudate from stenson's duct. What is most likely Dx?

Back 31

Acute bacterial parotitis

Front 32

Acute bacterial parotitis is caused by strep viridans, strep pneumo, and ______. It can occur in conjunction w/ dehydration and _______. It can also occur as a retrograde infection from _________.

Back 32

staph aureus, debilitation, the oral cavity

Front 33

MOST COMMON: SG tumor, benign SG tumor, neoplasm of parotid. Painless, slow growing, firm mass most common on palate. Histo: ductal + myoepithelial cells.

Back 33

Pleomorphic Adenoma

Front 34

What am I? The ONLY SG neoplasm linked to SMOKING; 2nd most common benign parotid tumor, 10% bilateral, parotid exclusively, men.

Back 34

Warthin's Tumor

Front 35

What is the generic term including canalicular adenoma commonly found on the upper lip

Back 35

Monomorphic adenoma

Front 36

MOST COMMON SG malignancy (children and adults) affecting major and minor SG’s, may mimic mucoceles

Back 36

Mucoepidermoid Carcinoma; Histo grading important for TX and Px based on epidermoid cell : mucous cell ratio, inc = poor prognosis and aggressive Tx.

Front 37

malignant SG tumor --> perineural spaces = VERY POOR long term survival (15 yr = 10-15%) may metastasize to distant sites such as lung. Affects both minor and major SG’s. Parotid --> CN-VII = weakness of facial muscles. Hard palate = surface ulceration common. Histo: cribiform “Swiss Cheese” (nests of dark basophilic cells).

Back 37

Adenoid Cystic Carcinoma

Front 38

Which malignancy: EXCLUSIVELY minor SG esp. palate and buccal mucosa  asymptomatic, non-ulcerating, firm swelling may be long-standing.

Back 38

Polymorphous Low Grade Adenocarcinoma (PLGA) --Not LPGA

Front 39

What malignancy: malignant transformation in long-standing pleomorphic adenoma, very common.

Back 39

Carcinoma Ex Pleomorphic Adenoma