Lec 15 (Exam 3): Salivary Gland Pathology

Mucocele

What is the most common reactive salivary gland lesion?

Mucocele

patient presents with a dome-shaped fluctuant vesicle that looks bluish in color on the lower lip. Patient admits to biting lip sometimes. Patient also said that "sometimes the bump gets big and then shrinks again", What is the diagnosis

Mucocele

-Common reactive salivary gland lesion

-Traumatized duct spills mucus into adjacent tissues

-Characteristic history of increasing and decreasing in size

lower lip

what is the most common location for mucocele to present?

Mucocele

ID the pathology:

Mucocele

ID the pathology:

Mucocele

ID the pathology based on the histology findings:

-Spilled mucin surrounded by granulation tissue

-Numerous neutrophils and foamy histiocytes/muciphages

-No epithelial lining

Ranula

A Mucocele on floor of mouth is called a ______

sublingual gland

A Ranula is usually associated with what gland?

mylohyoid

A Plunging ranula variant dissects through the _______ muscle into neck

Ranula

patient presents with a dome-shaped fluctuant vesicle that looks bluish in color on the floor of the mouth. What is the diagnosis?

floor of mouth

what is the most common location for a Ranula to present?

Ranula

ID the pathology:

Ranula

Salivary duct cyst

Dermoid cyst

Patient presents with a large nodule on the floor of the mouth lateral to the midline. What is in your differential diagnosis?

Salivary duct cyst (sialocyst)

ID the pathology:

•Acquire dilatation of salivary duct (due to obstruction)

•Usually seen in adults

•Clinically resembles mucocele

parotid gland

Salivary duct cyst (sialocyst) are MOST common originating from what gland?

Sialolithiasis

Patient present to your office complaining of pain when he sees food and while eating. A small firm , non-fluctuant mass is visible on the floor of the mouth lateral to the midline. Radiograph shows a radiopaque mass in the location of interest. What is the diagnosis?

Sialolithiasis

this pathology is associated with pain upon salivation:

submandibular gland

80% of Sialolithiasis are associated with what gland?

Sialolithiasis

ID the pathology:

Sialolithiasis

ID the pathology:

-Milking stone toward duct orifice

-Sialologues

-Surgical removal

What is the treatment for Sialolithiasis?

Sialadenitis

Inflammation of the salivary glands:

Acute Sialadenitis

Parotid swelling and tenderness and Low-grade fever are clinical features of what type of Sialadenitis?

Chronic Sialadenitis

Periodic pain and swelling, ductal dilatation are clinical features of what type of Sialadenitis?

Chronic sclerosing Sialadenitis

Persistent swelling in submandibular gland is a clinical features of what type of Sialadenitis?

-Antibiotics

-Rehydration

-Surgical drainage if necessary

what is the treatment for Acute Sialadenitis?

Remove obstruction or surgical gland removal, if advanced

what is the treatment for Chronic Sialadenitis?

Necrotizing Sialometaplasia

Patient presents with single ulceration on the hard palatal mucosa. Patient claims it "use to be red and swollen, now it's like a crater". Histo path report reveals Acinar necrosis with preservation of lobular architecture, squamous metaplasia and Pseudoepitheliomatous hyperplasia. What is the diagnosis?

Necrotizing Sialometaplasia

ID the pathology:

-Rare inflammatory, destructive condition of salivary glands

Mimics malignancy clinically AND microscopically

-Early swelling and erythema

-Later ulceration

-75% on hard palatal mucosa

-Initial swelling, then craterlike ulcer develops

-Rare destruction of palatal bone

hard palatal mucosa

the most common location for Necrotizing Sialometaplasia to present is the ______

Necrotizing Sialometaplasia

ID the pathology:

Sjögren Syndrome

ID the pathology:

-Chronic, systemic, autoimmune disorder

•Affects salivary glands and lacrimal glands

Sjögren Syndrome

Patient presents you your office complaining of xerostomia and dysphagia. Patient admits that they also experience dry eyes. Patient also has numerous cervical caries fissured tongue with atrophy of papillae, and a minor case of secondary candidiasis. Upon physical examination, you notice bilateral swelling of the parotid glands. Lab work up shows elevated IgG, positive rheumatoid factor (RF) and Antinuclear antibodies (ANA). What is the diagnosis?

parotid gland

Sjögren Syndrome is associated with bilateral swelling of which gland?

Sjögren Syndrome

this pathology is associated with elevated IgG

Positive rheumatoid factor (RF) and Antinuclear antibodies (ANA) (Anti SS-A (anti-Ro) and anti SS-B (anti-La)):

female

Sjögren Syndrome has a 9:1 _____ gender predilection

lymphoma

patients with Sjögren Syndrome have a 20-fold increased risk of developing ______

Primary Sjögren (Sicca) syndrome

this form of the autoimmune disorder only causes dry eyes and dry mouth:

Secondary Sjögren syndrome

this form of the autoimmune disorder causes dry eyes dry mouth, causes Rheumatoid arthritis and Systemic lupus erythematosus:

Rheumatoid arthritis

Systemic lupus erythematosus

along with dry eyes and dry mouth, Secondary Sjögren syndrome is associated with what other conditions?

Labial salivary gland biopsy

this test is used to diagnose Sjögren Syndrome:

true

t/f: for salivary gland tumors, malignancies mimic benign tumors both clinically and histologically

palate

upper lip

buccal mucosa

what oral cavity locations are most common sites for minor gland tumors?

false

t/f: Malignancies are more likely in minor salivary glands than major

parotid gland

About 64-80% of salivary tumors are in the ______, but only about 15-32% are malignant

submandibular gland

About 10% of salivary tumors are in the ______, and about 45% are malignant

sublingual gland

About 1% of salivary tumors are in the ______, and about 90% of them are malignant

minor glands

About 9-23% of salivary tumors are in the ______, and about 50% of them are malignant

Asymptomatic swelling

What is the most common presentation of salivary gland tumors?

false

t/f: for Salivary Gland Tumors, pain is indicative of malignancy

true

t/f: for Salivary Gland Tumors, paresthesia is indicative of malignancy

paresthesia

what clinical presentation of salivary gland tumors suggests poor prognosis/malignancy?

Pleomorphic Adenoma

What is the most common salivary gland tumor?

Pleomorphic Adenoma

Patient presents with firm swelling on the palatal mucosa. Patient is asymptomatic. Patient says they noticed the growth, but didn't realize it had gotten so big because it took a while to grow. Histopath report shows well-circumscribed/encapsulated, Double-layered ducts and Plasmacytoid cells. What is the diagnosis?

Pleomorphic Adenoma

this common salivary gland tumor is at risk of undergoing malignant transformation:

upper lip

What is the most common location for a Canalicular Adenoma to present?

parotid gland

What is the most common location for a Basal Cell Adenoma to present?

female

Basal Cell Adenomas have a ______ gender predilection

Warthin Tumor

this salivary tumor is associated with cigaret smoking:

male

Warthin Tumors have a ______ gender predilection

bilateral parotid gland

What is the most common location for Warthin Tumors to present?

Warthin Tumor

What is the most likely salivary gland tumor to be bilateral

Warthin Tumor

Male patient presents with bilateral swelling of the parotid glands. Patient has a long history of cigaret smoking. Biopsy was performed and histo path report shows papillary formations, cystic, with lymphoid stroma in walls. What is the diagnosis?

parotid gland

What is the most common location for an Oncocytoma to present?

true

t/f: Most minor salivary gland tumors are malignant

Mucoepidermoid Carcinoma

What is the most common salivary gland malignancy?

Mucoepidermoid Carcinoma

What is the most common childhood salivary gland malignancy?

parotid gland or palate

What is the most common location for a Mucoepidermoid Carcinoma to present?

Mucoepidermoid Carcinoma

20 y/o female presents with ulcerated nodule on the palatal mucosa. Histopath report shows mucous cells

and epidermoid cells. What is the diagnosis?

submandibular gland

Although Mucoepidermoid Carcinomas most commonly present in the parotid gland or palate, tumors located on the ________ associated with worse prognoses

hard palatal mucosa

What is the most common location for an Adenoid Cystic Carcinoma to present?

Adenoid Cystic Carcinoma

65 y/o female presents with a large firm nodule on the hard palatal mucosa. Patient reports pain as well as some unilateral paresthesia in the face. Histopathology shows perineural infiltration with a cribriform

(swiss cheese) appearance. What is the diagnosis?

Adenoid Cystic Carcinoma

this pathology is associated with perineural infiltration with a cribriform (swiss cheese) appearance:

lung and bone

in patients with Adenoid Cystic Carcinoma, what is the most common site for metastasis?

recurrence

in patients with Adenoid Cystic Carcinoma, what presentation would suggest that it is incurable?

Parotid > submandibular > minor glands

between the Parotid, submandibular and minor glands, order them from best to worst prognosis for a case of Adenoid Cystic Carcinoma:

Adenoid Cystic Carcinoma

this pathology is associated with a good short term but poor long term survival:

minor salivary glands

Polymorphous Adenocarcinoma is limited to what type of salivary glands?

conservative complete excision

what is the treatment for Polymorphous Adenocarcinoma ?

Polymorphous Adenocarcinoma

this pathology is associated with a VERY good prognosis of a 98% 10 year survival rate if detected and excised:

Adenocarcinoma

ID the pathology:

•Diagnosis of exclusion

•5th-8th decades

•65% in major glands (mostly parotid)

35% in minor glands

prognosis: High grade - 40% 5-year survival

-Minor gland tumors have improved survival over those of major glands