FPC4: Salivary Gland Pathology

Gingiva, Attached alveolar

mucosa, Mid-palatine raphe,

Dorsum tongue (anterior to CV papillae)

Salivary glands are NOT present in...

Salivary gland aplasia

rare condition where there is loss or missing of salivary gland tissue, can occur by itself or as a syndrome

Sialorrhea

excessive production of saliva

Sialadenitis

Inflammation of the salivary glands that can arise from various infectious and noninfectious causes; common culprits: mumps, S. aureus, medications, surgery, dehydration

Sialadenosis

non-inflammatory enlargement of a salivary gland or glands

-causes: endocrine disorders, pregnancy, nutritional conditions, neurogenic medications

Xerostomia

dry mouth, can note bubbles at the base of tongue where saliva pools

-causes: metabolite loss, iatrogenic, local factors, systemic

Xerostomia

bacterial sialadenitis

Sialadenosis

Mucocele

Damage or severing of salivary gland duct, Not a true cyst

Mucocele

what is one of the most common oral ST enlargements?

false ( they do: rupture, drainage,

reforming)

T or F: Mucocele do not fluctuate in size

Mucocele

• Granulation tissue

• Spilled mucin

• Inflamed salivary gland tissue

upper lip

What location is the LEAST common site for mucoceles?

excision, removal of adj salivary gland tissue

What are the treatments for a Mucocele

True

T or F: A Salivary Duct Cyst is a True Cyst

Epithelial lining

A true cyst has what type of lining?

Salivary Duct Cyst

Mimic mucoceles in

appearance

Major and minor salivary glands

Where is the site for Salivary Duct Cyst?

Ranula

Resembles frogs

underbelly, Less common type of mucocele

sublingual, submandibular gland

a ranula involves which gland?

Plunging Ranula

Dissects through mylohyoid

▫ Swelling in the neck

Marsupialization, Removal of feeder gland

What are some treatments for Ranulas?

Sialolith

Deposits of calcium salts in the salivary gland/ duct, Decreased salivary flow OR increased viscosity

submandibular

Sialolith most common in which gland?

Sialolith

Sialolith

Calcified mass, Surrounded by inflamed and fibrotic salivary glands

Necrotizing Sialometaplasia

Ischemia of the salivary glands of the hard palate, Often bilateral and symmetrical, starts out initially as a swelling

Necrotizing Sialometaplasia

What condition can mimic squamous cell carcinoma?

Necrotizing Sialometaplasia

Pseudoepitheliomatous hyperplasia, Coagulative necrosis of

the adjacent glands

Necrotizing Sialometaplasia

Sjogren Syndrome

Autoimmune disease, Enlargement of the salivary

glands

Primary Sjogren Syndrome

Dry mouth + eyes

Secondary Sjogren Syndrome

Dry mouth + dry eyes + CT disease (RA or SLE)

Minor salivary gland biopsy, Sialogram, Rheumatoid Factor (RF), Anti-SSA (anti-Ro), Anti-SSB (anti-La)

Sjogren Syndrome diagnostic tests

artificial tears, saliva, topical fluoride, OHI, Recalls

Sjogren Syndrome treatments

lymphoma (MALT)

In patients with Sjogren Syndrome, there is an increased risk of...

parotid

Salivary Gland Tumors most occur in the...

RM, FOM, tongue

which salivary gland tumors are considered aggressive

benign

In the parotid, 3/4 of the time, is it benign or malignant

benign

In the submandibular, 55% of the time, the tumor is

malignant

In the sublingual, 70-95% of the time the tumor is

benign/malignant

Minor salivary gland tumors in the palate (most common) 50% of the time are

benign/malignant

Minor salivary gland tumors in the buccal mucosa 50% of the time are

benign

Minor salivary gland tumors in the upper lip 80% of the time are

malignant

Minor salivary gland tumors in the lower lip 85% of the time are

malignant

Minor salivary gland tumors in the tongue 90% of the time are

malignant

Minor salivary gland tumors in the floor of the mouth 90% of the time are

malignant

Minor salivary gland tumors in the retromolar pads 95% of the time are

Pleomorphic Adenoma

Benign Salivary Gland Tumors:

Most common salivary gland neoplasm, Mix of epithelial and mesenchymal elements

Pleomorphic Adenoma

Various patterns within the tumor, Encapsulated

Double layered ductal structures and myoepithelial cells, Stroma appears myxoid, cartilaginous, and hylanized

surgical removal (Small percentage of tumors undergo malignant transformation)

Treatment for Pleomorphic Adenoma

Canalicular Adenoma

Benign Salivary Gland Tumors:

Most common site is the upper lip, bluish, happens most in middle aged females >50yrs

Canalicular Adenoma

Well encapsulated, Cell are similar in appearance, Look like canals

Basal Cell Adenoma

Benign Salivary Gland Tumors:

Uncommon, Primarily tumor of Parotid

Basal Cell Adenoma

Which condition presents a slow growing moveable tumor that is part of the superficial lobe of the parotid?

Basal Cell Adenoma

Encapsulated, Islands with

palisaded cells, Jigsaw pattern, May form ducts

False, common

T or F: Recurrence after surgical removal of basal cell adenoma is uncommon

Ductal Papilloma

Benign Salivary Gland Tumors:

Exophytic and Papillary, Minor salivary glands

Inverted type

▫ lower lip and MD vestibule

▫ indentation

squamous papilloma

Ductal Papilloma mimics which papilloma?

Ductal Papilloma

• Papillary projections

• Inflammation

• Intraductal

▫ inside a duct

Warthin Tumor

Benign Salivary Gland Tumors:

-More common in males

-6th to 7th decades of life

-Association with smoking (8x)

-Slow growing painless mass of the parotid gland

-Proliferation of oncocytic cells and lymphoid cells

Warthin Tumor

-Cyst lined by uniform rows of oncocytic cells

-The lining is papillary in appearance

-The cyst wall is composed of abundant lymphocytes

Warthin Tumor

6-12%

Warthin tumor has what percent recurrence after surgical removal?

Oncocytoma

Benign Salivary Gland Tumors:

• Rare salivary gland tumor

▫ Common in older

females

▫ Occurs in the parotid gland (85-90%)

▫ Presents as slow growing painless mass

Oncocytoma

Large polyhedral cells with abundant granular cytoplasm

▫ Mitochondria

Cells are separated by thin fibrous septal

Mucoepidermoid Carcinoma

what is the Most common malignant salivary gland tumor?

Mucoepidermoid Carcinoma

Malignant Salivary Gland Tumors:

-Most common malignant salivary gland tumor

-Most common malignant salivary gland tumor in children

Parotid gland (major salivary

gland) (45%), Hard palate (minor) (21%)

Most common sites for Mucoepidermoid Carcinoma

mucocele

What can Mucoepidermoid Carcinoma mimic?

Mucoepidermoid Carcinoma

-Epidermoid cells

-Mucous cells

-Ductal structures

-Cystic spaces

-CRCT1-MAMl2 translocation ⇒ t(11;19)

Mucicarmine Stain

Adenoid Cystic Carcinoma

Malignant Salivary Gland Tumors:

-Slowly growing mass

-Middle-aged females

-Painful or present with facial paralysis

-50% occur in minor glands (palate= most common)

Adenoid Cystic Carcinoma

• Swiss Cheese pattern

▫ Islands with a

cribriform pattern

▫ Myoepithelial and ductal cells are present

▫ Perineural and perivascular invasion

Adenoid Cystic Carcinoma

Surgical excision, Adjunct radiation (Relentless tumor)

Treatment for Adenoid Cystic Carcinoma

Polymorphous Adenocarcinoma

Malignant Salivary Gland Tumors:

-Tumor of the minor salivary glands

-6th -8th decades of life

-Female predilection

-Painless slow growing lesion

-Almost exclusively in minor salivary glands

-May infiltrate bone

Polymorphous Adenocarcinoma

-Various histologic patterns

-Cells line up in single file line "Kindergarten filing"

-Perineural and Perivascular invasion

Acinic Cell Carcinoma

Malignant Salivary Gland Tumors:

-Low grade malignant tumor

▫ serous acinar cells

-Wide age range 2nd-7th decade of life

-Most common site: parotid gland (85%)

▫ 9% minor salivary glands

-Female predilection

Acinic Cell Carcinoma

• Well circumscribed

• May show infiltration

• Serous acinar cell

▫ Cells containing abundant granular cytoplasm

▫ Zymogen granules

Normal Parotid Parenchyma

Acinic Cell Carcinoma

Secretory Carcinoma

Malignant Salivary Gland Tumors:

Used to be part of acinic cell carcinoma

▫ “zymogen poor”

parotid

What is the most common location for secretory carcinoma?

Secretory Carcinoma

-Bland cytology

-Varying appearances

▫ "hobnail" cells

• Translocation!▫ ETV6-NTRK3 ⇒t(12;15)(p13;q25)

Carcinoma Ex PA

Malignant Salivary Gland Tumors:

-Malignant transformation of a PA(pleomorphic adenoma)!

-Middle aged and older

-History of a lesion present

for many years

-Rapid growth

▫ pain, ulceration

▫ facial nerve palsy

-Most in parotid

-Minor SG→ most on

palate

Carcinoma Ex PA

A: benign

B: Malignant

pleomorphic adenoma

The most common salivary gland tumor is...