Salivary Glands and Pathologies Quiz

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Questions and Answers

How many major salivary glands are typically identified?

Two

Six

Three

Four (correct)

Which salivary gland is known for producing the majority of the saliva in the oral cavity?

Submandibular gland

Minor salivary glands

Parotid gland (correct)

Sublingual gland

What is a common histological feature of mucous cells in salivary glands?

Pyramidal shape

Granular appearance (correct)

Large nuclei

Basophilic cytoplasm

Which of the following pathologies is typically associated with salivary glands?

Sialolithiasis Signup and view all the answers

Which major salivary gland is located near the angle of the jaw?

Submandibular gland Signup and view all the answers

What is the primary mode of therapy for salivary gland cancers?

Complete surgical excision with free surgical margin Signup and view all the answers

What indicates a poor prognosis in head and neck cancer?

Presence of perineural invasion Signup and view all the answers

Which statement about lymph nodes and neck dissection is correct?

10 or more lymph nodes require a selective neck dissection Signup and view all the answers

What does extraparenchymal extension refer to?

Clinical or macroscopic evidence of tissue invasion Signup and view all the answers

What should never be assigned to adenoid cystic carcinoma?

Low grade/biologic potential category Signup and view all the answers

What is the first step in grossing a salivary gland resection?

Orientation (if present) Signup and view all the answers

Which aspect is NOT included in the CAP protocol for salivary glands?

Color Signup and view all the answers

What is the purpose of inking the outer surface of a salivary gland resection specimen?

To identify margins Signup and view all the answers

How many sections of a tumor should generally be submitted according to the guidelines?

2-3 sections Signup and view all the answers

What step follows the description of the outer surface in grossing a salivary gland?

Serially section perpendicular to long axis Signup and view all the answers

Which term is NOT part of the tumor assessment criteria in the CAP protocol for salivary glands?

Tumor type Signup and view all the answers

What should be described when taking sections of the lesion?

The lesion's appearance and any anomalies Signup and view all the answers

In the event of a parotid gland gross examination, what is a significant anatomical structure to identify?

Large nerves Signup and view all the answers

What type of secretion primarily comes from the parotid gland?

Serous Signup and view all the answers

Which duct is associated with the submandibular gland?

Wharton’s duct Signup and view all the answers

What is the primary component of saliva that helps decrease bacterial infections?

Immunoglobulin A Signup and view all the answers

What role do myoepithelial cells play in salivary glands?

Surround acini and mediate contractions Signup and view all the answers

What is the weight range of the sublingual gland?

2 – 4 grams Signup and view all the answers

What changes occur to salivary glands as one ages?

Decreased connective tissue Signup and view all the answers

Which structure is incorrectly associated with its gland?

Wharton's duct - Sublingual gland Signup and view all the answers

Which type of cells primarily produce zymogen enzymes in salivary glands?

Pyramidal shaped cells Signup and view all the answers

Which of the following glands primarily secretes mucin?

Sublingual gland Signup and view all the answers

What is the main function of saliva in the digestive system?

Break down carbohydrates Signup and view all the answers

What is the common presentation of xerostomia?

Dry mucosa and atrophy of the tongue Signup and view all the answers

Which major salivary gland is primarily involved in sialolithiasis?

Submandibular gland Signup and view all the answers

What is a typical consequence of sialadenitis?

Pain and swelling of the gland Signup and view all the answers

What is the most common salivary gland neoplasm?

Pleomorphic adenoma Signup and view all the answers

What type of histologic feature defines a serous demilune?

Mixed population of serous and mucous cells Signup and view all the answers

What is the relationship between the facial nerve and the parotid gland?

The facial nerve passes through but does not innervate the gland. Signup and view all the answers

Which of the following tumors is associated with a higher risk in smokers?

Warthin tumor Signup and view all the answers

What typically characterizes the clinical manifestation of sialolithiasis?

Pain and swelling of the gland Signup and view all the answers

What is a frequent clinical outcome of untreated pleomorphic adenoma?

Malignant transformation Signup and view all the answers

Study Notes

Major Salivary Glands

Function: Produce and secrete saliva.
Plays a role in digestion and protection.
Saliva composition (0.5%): Ions, Immunoglobulin A (decreases bacterial infections), Lysozyme (antibacterial enzyme), Mucin, and Lingual Lipase (from minor salivary glands).
Saliva amylase enzyme breaks down carbohydrates.

Readings

Robbins Chapter 16, pages 747-752
Netter plates 18, 70, 71
Lester, page 448-451
Hruban Chapter 7 (page 43)

Objectives

Identify major salivary glands and ducts anatomically.
Differentiate salivary gland cell types and their secretions/functions.
Recognize histological differences between major salivary glands.
Compare and contrast common salivary gland pathologies.
Formulate differential diagnoses based on gross pathology photos.
Summarize clinical features of common salivary disorders.
Formulate a gross plan for dissecting salivary gland resection.
Create a gross description of a salivary gland resection.

Outline

Anatomy
Histology
Common pathology
How to gross
CAP considerations
IOC considerations

Salivary Glands

Weight: 15–30 grams
Location: Anterior and inferior to the ear, between skin and masseter muscle.
Duct: Stensen's duct, empties into oral cavity opposite the second maxillary molar.
Secretions: Serous secretions, only serous acini.
Intraparenhymal Lymph Nodes: Present

Parotid Gland - Facial Nerve

Facial nerve controls facial movement and expression.
Parotid gland function can be lost or altered secondary to pathology.
Divides into superficial and deep lobes.

Submandibular Gland

Weight: 7–15 grams
Location: Inferior to the body of the mandible.
Duct: Wharton's ducts empty into the floor of the mouth on both sides of the lingual frenulum.
Secretions: Serous and mucous (mainly serous).
Dissections: Included in level 1B neck dissections.

Sublingual Gland

Weight: 2-4 grams
Location: Inferior to the tongue and deep to the oral cavity mucosa.
Secretions: Predominantly mucous, and mixed mucinous and serous.
Ducts: Bartholin's ducts empty into the floor of the mouth lateral to the sublingual caruncle.

Salivary Glands: Embryology/Aging

Develop from ectodermal origin, from solid epithelial buds of oral mucosa.
Aging: Connective tissue diminishes, myoepithelial cell function decreases, less saliva secretion, dry mouth (xerostomia) and halitosis, and altered protein content and reduced saliva production.

Salivary Glands: Histology

Function Unit: Tubuloacinar structure, serous or mucous cells.
Serous Acini: Secrete isotonic watery fluid, contain PAS+ intracytoplasmic granules, zymogen enzyme.
Mucinous Acini: Produce acid and neutral sialomucins, condensed basally located nuclei.
Myoepithelial Cells: Surround acini, mediate contractions/secretions.
Ducts: Intercalated (lined by secretory cells, cuboidal, and ions are resorbed). Striated (ions resorbed/secreted to produce hypotonic saliva).

Minor Salivary Glands: Histology

Found in lips, gingiva, floor of mouth, cheeks, hard palate, tongue, tonsils, oropharynx, including Von Ebner glands of the tongue (serous acini) , base/lateral border of tongue and palate (mainly mucinous); lips, cheeks, tongue apex (mixed).

Learning Check

Location of the parotid gland?
Submandibular gland duct name?
Compare parotid and sublingual gland histology?
Define a serous demilune?
Facial nerve relationship to parotid gland?
Salivary gland received in a Level 1B neck dissection?

Common Pathology: Major Salivary Glands

Xerostomia, Sialolithiasis, Sialadenitis, Pleomorphic adenoma, Warthin tumor, Mucoepidermoid Carcinoma,

Xerostomia

Dry mouth due to reduced saliva production.
Associated with Sjogren's syndrome, head/neck cancer radiation therapy, and certain medications.
Complications: Dry mucosa/atrophy of tongue, increased dental caries, candidiasis, dysphagia, and dyspnea.

Sialolithiasis (Stones)

Stones obstruct salivary duct orifice, from impacts with food or local edema.
Can cause bacterial infections (e.g., Staphylococcus aureus).
The result are dilated ducts, pain, swelling of the gland, necrosis, edema of the salivary gland.
Chronic inflammation can result in Sialadenitis.

Sialadenitis (Inflammation)

Causes: Trauma, viral (e.g., mumps), bacterial, autoimmune conditions (e.g., Sjogren's syndrome).
Most common viral cause: mumps.
Prevalent form is Mucocele (CPT 88304). Swelling of lower lip, often a blue hue caused by damage or blockage in minor salivary gland ducts.

Salivary Gland Neoplasms

65–85% arise in the parotid gland; 10% are in the submandibular gland.
Majority of sublingual tumors and 50% of minor salivary gland tumors are malignant.
Majority of parotid tumors are benign; 40% of submandibular tumors are malignant.
Most common neoplasm: Pleomorphic adenoma.

Pleomorphic Adenoma

Benign mixture of ductal, myoepithelial, and mesenchymal cells.
Can arise from radiation exposure.
Make up 60% of parotid tumors.
Recurrence possible if unencapsulated.
Morphology: Round, well demarcated, rarely exceeds 6 cm. Cut surface: gray-white, sometimes with myxoid/translucent chondroid stroma areas.

Warthin Tumor (Papillary Cystadenoma Lymphomatosum)

2nd most common salivary gland tumor (mostly parotid gland inferior lobe)
Benign
8x increased risk in smokers
Occurs more frequently in men.
Gross Features: Circumscribed, orange/tan, often cystic; thick brown/black fluid within cyst; cyst lined with papillary nodules; can be multifocal and 10% bilateral.

Mucoepidermoid Carcinoma

Most common primary malignant salivary gland neoplasm (60–70% in parotid gland).
Accounts for a large fraction of minor salivary gland tumors
Can be low-grade (well-circumscribed, cystic with mucin) or high-grade (infiltrative and solid).

Minor Salivary Gland Biopsy of the Lip

Sjogren Syndrome patients: Labial biopsy of normal appearing mucosa for diagnosis.
Recommended biopsy number: > 0.2 cm, at least 4; < 0.2 cm, minimum of the size; 3 levels are recommended.

Salivary Gland Resection

Orientation (if present), 3D measurements.
Describe outer surface (large nerves, etc.).
Ink the outer surface.
Serial sectioning perpendicular to long axis (2–3 mm).
Describe the lesion.
Describe remaining uninvolved cut surface.
Take sections

Example Dictation

Case example of a parotid gland with a 10g, 6 x 5 x 3 cm lesion.
Adipose tissue surrounding, 0.1 to 0.5 cm in thickness.
0.5 cm long, 0.2 cm diameter nerve.
Ink lesion/soft tissue margin.
No lymph nodes are grossly identified.
Sections A1-2: Full face of lesion (bisected); A3: lesion to closest soft tissue resection margin; A4: lesion to large nerve; A5: uninvolved gland.

CAP Protocol: Major Salivary Glands

Procedure: Parotidectomy, submandibular, sublingual resection.
Focality, Site, Laterality.
Size (3D).
Macroscopic extent (pT3, pT4a, pT4b).
Margin status.
Lymph nodes (size of nodal deposit if positive, ENE)

Tumor Classification (T)

TX - Primary tumor cannot be assessed.
T0 - No evidence of primary tumor.
Tis - Carcinoma in situ.
T1 - Tumor 2cm or smaller
T2, T3, T4 - Tumors greater in size or exceeding surrounding tissues (T4a and T4b are further classified by the specific tissues invaded).
Notes: This is not an exhaustive list of all possible tumor classifications

Key Points from CAP Protocol

Adenoid cystic carcinoma is not low-grade.
Perineural invasion is a poor prognosis indicator for head and neck cancers.
Facial nerve involvement necessitates neck dissection, postoperative radiation.
Primary salivary gland carcinoma involving the facial nerve is associated with recurrence and reduced survival.
Complete surgical excision with free surgical margin is crucial.
Lymph node metastasis cross-sectional diameter at time of gross is important.
Selective/Radical/Modified neck dissection LN counts are important staging factors.
Extraparenchymal extension implies invasion.
Microscopic evidence alone does not suffice.

IOC Considerations

Salivary gland tumors may be received for IOC (intraoperative consultation) if additional histological assessment is required during surgery.

Additional Note

There are diagrams and graphs that are not included in this summary, please note that these may be important components of the study material that are omitted or unavailable in a text-based format

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Description

Test your knowledge on salivary glands, their functions, and associated pathologies. This quiz covers key features, therapy modes, and histological aspects relevant to salivary gland health. Prepare to answer questions about the anatomy and clinical considerations of salivary glands.