Pathology of the GI Tract- Oral cavity and salivary glands (part 4 of 4)

Question 1

what is the incidence of xerostomia?

Answer 1

as high as 20% of patients >70 years of age

Question 2

what are three etiologies of xerostomia?

Answer 2

medications, Sjogren syndrome, radiation therapy for head/neck cancers

Question 3

what medications are associated with causing xerostomia?

Answer 3

anticholinergics, antidepressants/antipsychotic, diuretic, antihypertensive, sedative, muscle relaxant, analgesic, and antihistamine drugs

Question 4

what are four etiologies of sialadenitis?

Answer 4

trauma, autoimmune disease, viral infection, bacterial infection

Question 5

what trauma can cause sialadenitis?

Answer 5

mucocele

Question 6

What is the most common lesion of the salivary glands?

Answer 6

mucocele

Question 7

where do mucocele’s occur and in what age groups?

Answer 7

usually on the lower lip as the result of trauma; occur at all ages but are most common in toddlers, young adults, and the elderly, who are more prone to falling

Question 8

from a histologic standpoint, how can mucocele’s be described?

Answer 8

they are called pseudocysts because there is no true epithelial lining; they are a cyst like cavity filled with mucinous material and lined by organizing granulation tissue

Question 9

what does xerostomia seen in sjogren syndrome result in?

Answer 9

difficulty swallowing foods, a decrease in the ability to taste, cracks and fissures in the mouth, and dryness of the buccal mucosa

Question 10

what is essential for the diagnosis of Sjogren syndrome?

Answer 10

biopsy of the lip

Question 11

what are patient’s with Sjogren syndrome at an increased risk of developing?

Answer 11

lymphoma

Question 12

what is the most common viral cause of sialadenitis?

Answer 12

mumps

Question 13

what are the two most common bacterial causes of sialadenitis?

Answer 13

staph aureus and strep viridans following ductal obstruction by stones or trauma

Question 14

salivary gland neoplasms usually occur in what population of people?

Answer 14

usually occur in adults, with a slight female predominance, but about 5% occur in children younger than age 16

Question 15

when do the benign salivary gland neoplasms often appear?

Answer 15

in the 5th -7th decade of life

Question 16

when do the malignant salivary gland neoplasms appear?

Answer 16

later in life when compared to the benign neoplasms

Question 17

how is salivary gland neoplasms malignancy related to size of the gland?

Answer 17

the likelihood of a salivary gland tumor being malignant is more or less inversely proportional to the size of the gland

Question 18

what are the two benign salivary gland neoplasms we discussed?

Answer 18

pleomorphic adenoma and warthin tumor

Question 19

what is the most common salivary gland neoplasm?

Answer 19

pleomorphic adenoma

Question 20

how can a pleomorphic adenoma be characterized?

Answer 20

it is a mixed tumor

Question 21

how do pleomorphic adenomas present?

Answer 21

as a well demarcated mass of varying sizes

Question 22

what happens if the pleomorphic adenoma is not completely excised?

Answer 22

it can recur; malignancy can arise the longer they remain untreated

Question 23

what gene rearrangement and mutation is associated with pleomorphic adenoma?

Answer 23

PLAG1 gene rearrangements or mutations of the HMGA2 gene

Question 24

what can an untreated pleomorphic adenoma progress to?

Answer 24

adenocarcinoma

Question 25

what is the dominant histologic feature of pleomorphic adenomas?

Answer 25

the great heterogeneity

Question 26

what are the other histologic features associated with pleomorphic adenomas?

Answer 26

epithelial elements in ductal formation, acini, irregular tubules, strands, or sheets; mesenchymal foci of cartilage, bone, fat in myxoid stroma

Question 27

what is the second most common salivary gland neoplasm?

Answer 27

warthin tumor

Question 28

how can warthin tumors be described?

Answer 28

round, encapsulated mass almost exclusively in the parotid gland

Question 29

who is at risk for getting warthin tumor?

Answer 29

M>F; SMOKERS have an 8X GREATER RISK

Question 30

what if you find a warthin tumor in a lymph node?

Answer 30

it is still benign; there were some embryologic remnants left in there

Question 31

the lining (epithelium) of warthin tumor is composed of a double layer of oncocytic cells; what do oncocytic cells contain that give them a pink/ eosinophilic nature?

Answer 31

mitochondria

Question 32

what are the two malignant salivary gland neoplasms we discussed?

Answer 32

mucoepidermoid carcinoma and adenoid cystic carcinoma

Question 33

what is the most common primary malignant tumor of salivary glands?

Answer 33

mucoepidermoid carcinoma

Question 34

what are more than 50% of mucoepidermoid carcinomas associated with?

Answer 34

a balanced chromosomal translocation (11:19)(q21;p13) produces a fusion gene product (MECT1-MAML2)

Question 35

which salivary gland neoplasm prognosis is based on grade?

Answer 35

mucoepidermoid carcinoma

Question 36

if you have a tumor in a minor salivary gland (palatine gland), which one should you think of first?

Answer 36

adenoid cystic carcinoma

Question 37

what gene rearrangements are present in a subset of adenoid cystic carcinomas?

Answer 37

MYB-NFIB gene rearrangements

Question 38

how can adenoid cystic carcinomas be described?

Answer 38

slow growing but they have an unpredictable behavior

Question 39

what is a special feature to remember about adenoid cystic carcinomas?

Answer 39

they grow along nerves (perineural) so pain is a common symptom

Question 40

what are the histologic features of adenoid cystic carcinoma?

Answer 40

the tumor cells are organized in a cribiform growth pattern that resembles swiss cheese; the spaces between the tumor cells are often filled with hyaline material thought to represent excess basement membrane