Salivary Gland Pathology PDF

SALIVARY GLAND PATHOLOGY DOM 8260 ORAL PATHOLOGY & RADIOGRAPHIC INTERPRETATION  MUCOCELE Mucus extravasation phenomenon Common lesion due to spillage of mucin Often result of local trauma Not a true cyst: no epithelial lining Dome-shaped: 1-...

SALIVARY GLAND PATHOLOGY DOM 8260 ORAL PATHOLOGY & RADIOGRAPHIC INTERPRETATION  MUCOCELE Mucus extravasation phenomenon Common lesion due to spillage of mucin Often result of local trauma Not a true cyst: no epithelial lining Dome-shaped: 1-2 mm to several cm Most common: children, young adults Mucin : bluish translucent hue Characteristically fluctuant  MUCOCELE History of recurrent swelling with periodic rupture and refilling of contents Lower lip most common site (75%) Rare on upper lip – Tumors not unusual in the upper lip but uncommon in lower lip To minimize recurrence, remove any adjacent feeder minor salivary glands  RANULA Mucocele in floor of mouth Derived from Latin rana Blue, dome-shaped, fluctuant swelling Larger than mucoceles Marsupialization and/or removal of gland  SALIVARY DUCT CYST True cyst lined by epithelium Usually in adults Arise within either major or minor glands Most frequent on floor of mouth, buccal mucosa, lips Resemble mucocele Treated by conservative surgical excision  SIALOLITHIASIS Calcified structures within salivary ducts Build-up of Ca++ around a nidus of debris Debris: Inspissated mucus, bacteria, or foreign bodies Most common in submandibular, less in parotid – Long, tortuous path of Wharton's duct – Thicker, mucoid secretions of the gland Episodic pain or swelling of affected gland, especially at mealtime  SIALOLITH Typically appear as radiopaque masses Although not all are visible on x-rays Small sialoliths can be treated by milking the stone out Larger sialoliths usually need surgery including removal of the gland  SIALADENITIS Inflammation of salivary glands Ductal obstruction or decreased flow Retrograde spread of bacteria (mostly Staph aureus) Blockage - sialolithiasis Noninfectious sources – Sjögren syndrome, sarcoidosis, radiation therapy  Clinical and Radiographic Features Periodic swelling and pain Usually at mealtime Sialography demonstrates ductal dilatation Can also occur in minor glands – Result of blockage of ductal flow or local trauma Treatment and Prognosis Antibiotic therapy Rehydration Removal of sialolith or other obstruction  CHEILITIS GLANDULARIS Rare inflammatory condition of minor salivary glands Malignant transformation potential- SCCA Most often in middle-aged and older men Actinic (sun) damage, smoking, trauma– Etiologic factors Characteristically on the lower lip Swelling, eversion, ductal openings inflamed & dilated Treatment - vermilionectomy (lip shave)  XEROSTOMIA (Discussed previously) Subjective sensation of dry mouth Women >>men, Common in older population Salivary gland aplasia, aging, smoking, mouth breathing , local radiation therapy, Sjögren syndrome, medications Saliva either foamy or thick and "ropey" Dorsum of tongue - atrophy of filiform papillae Increase in candidiasis More prone to cervical & root caries  Treatment and Prognosis Treatment difficult and unsatisfactory Artificial saliva, sugarless candy, gum, etc Pilocarpine, Cevimeline Discontinuation or dose modification of medication Frequent dental visits Fluoride applications  SJÖGREN SYNDROME Chronic, systemic autoimmune disorder – mainly involves salivary glands - xerostomia (dry mouth) – Lacrimal glands - xerophthalmia (dry eyes) Eye effects - keratoconjunctivitis sicca (sicca=dry) Xerostomia & xerophthalmia – Primary SS Strong genetic influence Middle-aged females With Rh arthritis, scleroderma, SLE – Secondary SS  SJOGREN SYNDROME Principal oral symptom is xerostomia Diffuse, firm enlargement of major salivary glands - usually bilateral Two nuclear autoantibodies - anti-SS-A (Ro) & anti-SS-B (La) Lymphocytic infiltration of glands with destruction Biopsy of minor salivary glands of lower lip  Treatment Mostly supportive Dry eyes - periodic use of artificial tears Artificial saliva, daily Fl, antifungal therapy Increased risk for lymphoma, 44 X higher, usually non-Hodgkin's B-cell lymphoma  SIALADENOSIS Asymptomatic enlargement, particularly of parotid Usually bilateral Almost always associated with an underlying systemic problem – Diabetes mellitus – Alcoholism – Anorexia nervosa – Bulimia – Malnutrition – Drug reactions  NECROTIZING SIALOMETAPLASIA Locally destructive inflammatory condition Results from ischemia leading to infarction Mimics SCCA both clinically and microscopically Most frequent in palate >75% posterior Initially non-ulcerated swelling, often with pain or paresthesia Within 2-3 wks, necrotic tissue sloughs out, a crater-like ulcer 1-5 cm in diameter Pseudoepitheliomatous hyperplasia - squamous metaplasia of ducts - very similar to carcinoma  SALIVARY GLAND TUMORS Most common site – parotid - 64-80% Overall, 2/3rds to 3/4ths of all tumors 2/3rds to 3/4ths benign 8-11% in submandibular gland, but malignancy almost double 37- 45% Sublingual gland tumors rare but 70-90% malignant “Smaller the gland, the greater the chances of malignancy"  MINOR SALIVARY GLAND TUMORS 9 to 23% Almost 50% malignant Palate - Most frequent site (42 to 54%) Most on the posterior lateral hard or soft palate Lips- second most common  MONOMORPHIC ADENOMA Canalicular Adenoma Almost exclusively in minor salivary glands Striking predilection for upper lip (>75%) Nearly always occurs in older adults Slowly growing, painless mass  MONOMORPHIC ADENOMA Basal Cell Adenoma – Basaloid appearance of the tumor cells – Primarily parotid lesion  WARTHIN’S TUMOR Papillary cystadenoma lymphomatosum - Accurately describes microscopic features Benign neoplasm, almost exclusively parotid Smokers – 8 X risk than non-smokers Slow growing, painless, nodular mass Tendency to occur bilaterally Male predilection  PLEOMORPHIC ADENOMA Benign Mixed Tumor, most common salivary neoplasm 2/3rds to 3/4ths of parotid tumors Painless, slowly growing, firm mass Young adults 30 to 50, slight female predilection Best treated by surgical excision Malignant degeneration possible in long standing lesions - about 5%  CARCINOMA EX PLEOMORPHIC ADENOMA Mean age about 15 years more than benign counterpart Mass present for many years with recent rapid growth with pain or ulceration Treated by wide excision, with local node dissection and radiation Prognosis guarded, with 50% local recurrence or metastases  MUCOEPIDERMOID CARCINOMA Most common salivary gland malignancy Most common malignant salivary gland tumor in children Most common in parotid, Minor salivary gland – palate Minor gland - asymptomatic fluctuant swellings blue / red May arise in jaws from odontogenic epithelium of dentigerous cysts – More common in mandible, molar-ramus area – Overall prognosis fairly good  MUCOEPIDERMOID CARCINOMA Mixture of mucus-producing cells and epidermoid or squamous cells Usually treated by surgical excision Low-grade tumors have good prognosis, >90% are cured High-grade tumors prognosis is guarded, only 30% survive  ACINIC CELL ADENOCARCINOMA Malignancy with serous acinar differentiation Most common in the parotid Variable microscopic appearance May even appear encapsulated Better prognosis than others  ADENOID CYSTIC CARCINOMA Approx. 50% within minor SG - Palate most common site Pain common & important early finding, occasionally occurring before there is noticeable swelling Tendency to show perineural invasion Excision usually the treatment of choice 5-year survival rate as high as 70%  POLYMORPHOUS LOW-GRADE ADENOCARCINOMA Almost exclusively in minor SG, 60% on hard or soft palate 2/3rds in females Tumor cells have deceptively uniform appearance Different growth patterns, hence, "polymorphous“ Perineural invasion common Wide surgical excision Overall prognosis relatively good, with 80% cure rate  Frequency Of Salivary Gland Tumors By Location Palate Parotid – Pleomorphic adenoma – Pleomorphic adenoma – Adenoid cystic ca – Warthin’s tumor – Mucoepidermoid ca – Basal cell adenoma – PLGA – Mucoepidermoid ca – Monomorphic adenoma – Acinic cell ca – Adenoid cystic ca – Ca ex mixed tumor  Reading Assignments Neville & Damm, Oral & Maxillofacial Pathology, 5TH ed. Chapter- Salivary Gland Diseases