11: Salivary pathology Flashcards
(223 cards)
1
Q
von ebner salivary glands – where, what secretions
A
tongue beneath circumvallate and foliate papillae; primarily serous
2
Q
salivary glands in tongue beneath circumvalate and foliate papillae and their secretions
A
von ebner, primarily serous
3
Q
ventral tongue salivary glands and secretions
A
blandin-nuhn, serous
4
Q
blandin-nuhn salivary glands – where, what secretions
A
ventral tongue, serous
5
Q
salivary gland aplasia syndromes
A
treacher collins, hemifacial microsomia, lacrimo-auriculo-dento-digital syndrome (LADD)
can also be isolated
6
Q
LADD genetics and clinical
A
FGF10 mutation
salivary and lacrimal gland aplasia, cup shaped ears, dental/digital anomalies
7
Q
salivary and lacrimal gland aplasia, cup shaped ears, dental/digital anomalies
what is and genetics
A
LADD
FGF10 mutation
8
Q
superficial mucoceles location
A
soft palate and retromolar pad
9
Q
superficial mucoceles which conditions
A
lichen planus, lichenoid drug reactions, GVHD, tartar control toothpaste
10
Q
connective tissue reaction to extravasated mucus
A
granulation
11
Q
origin of ranula
A
sublingual gland (body or ducts of Rivini)
12
Q
CT/MRI sign of submandibular ranula
A
tail sign
13
Q
plunging ranula dissects though
A
mylohyoid muscle
14
Q
salivary duct cyst location
A
upper lip
15
Q
systemic treatment for multifocal ductal ectasia
A
erythromycin and chlorhexidine
16
Q
most common sialolithiasis and histo look
A
submandibular
tortuous duct and mucoid secretion
17
Q
types of sialadenitis and causes
A
infections - viral-mumpsm bacterial - S aureus
non-infectious – Sjogrens, RT, sarcoid
18
Q
chronic sclerosing sialadenitis in submandibular leading to gland enlargement – evaluate for what
A
Kuttner tumor (IgG4) – eval for sclerosing pancreatitis
19
Q
how do bacteria cause sialadenitis
A
retrograde spread from reduced flow (dehydration, medication) or block (sialolith, tumor)
20
Q
sialadenitis most commonly where and presentation
A
fever and pus, usually parotid
21
Q
surgical mumps
A
after abdominal surgery, when patient is kept without food/fluids and receives atropine
22
Q
after abdominal surgery, when patient is kept without food/fluids and receives atropine
A
surgical mumps
23
Q
sausaging of stensen’s duct – what is, what modality, what diagnosis
A
dilation and strictures from scar tissue in sialadenitis on sialography
24
Q
subacute necrotizing sialadenitis histo, demographic, ulceration
A
no squamous metaplasia, mixed acute and chronic inflammation, younger patients, does not ulcerate
25
cheilitis glandularis what is
swelling and eversion of lower lip due to hypertrophy and inflammation of glands
26
swelling and eversion of lower lip due to hypertrophy and inflammation of glands
cheilitis glandularis
27
cheilitis glandularis etiologues
UV damage, tobacco, syphilis, poor hygiene, hereditary
28
forms of cheilitis glandularis
simple, superficial suppurative (Baelz's disease)m deep suppurative (cheilitis glandularis apostematosa)
29
Baelz's disease
superficial suppurative cheilitis glandularis
30
cheilitis glandularis apostematosa aka
deep suppurative
31
true sialorrhea causes
aphthae, new dentures, GERD (water brash), rabies, heavy metal poisoning, medications for alzheimers
32
relative sialorrhea what is and causes
can't keep saliva in mouth: Down's, cerebral palsy, Parkinson's, prior surgery
33
idiopathic paroxysmal sialorrhea presentation
short episodes 2-5min, prodrome of nausea and epigastric pain
34
xerostomia how ofetn
25% of adult population
35
xerostomia causes
developmental (SG aplasia)
water/metabolite (reduced intake, vomit, hemorrhage)
iatrogenic (drugs, RT, CT), systemic disorders (SS, sarcoidosis, diabetes, HIV, HCV, GVHD) and local (reduced mastication, smoking, mouth breathing)
36
benign lymphoepithelial lesion aka
lymphoepithelial sialadenitis, Mikulicz disease
painless enlargement of salivary glands, usually unilateral
pts may or may not have clinical sjogren
37
mikulicz syndrome what is
salivary gland enlargement from other causes (eg sarcoidosis)
38
benign lymphoepithelial lesion histo
lymphocytic sialadenitis + epimyoepithelial islands (ductal preservation with epithelial proliferation)
39
malignant lymphoepithelial lesion aka, histo, cause
aka lymphoepithelial carcinoma
| poorly differentiated salivary ca with prominent lymphoid stroma, EBV, de novo or from BLEL
40
primary sjogrens =
sicca syndrome = dry eyes + mouth
41
secondary sjogrens
sicca syndrome + RA, SLE, biliary cirrhosis
42
dry eyes in sjogrens aka
keratoconjunctivitis sicca
43
HLA in sjogrens (primary vs secondary)
HLA-DRw52 both
| HLA-DR3 and B8 primary only
44
fruit laden branchless tree
sialography for sjogrens
45
rose bengal dye
shows defects on ocular surface epithelium in sjogrens
46
dye to show ocular surface epithelium defects in sjogrens
rose bengal
47
test to confirm dry eyes and what's the metric in sjogrens
schirmer test - <5mm
48
labs in sjogrens
ANAs, anti-SSA (Ro), anti-SSB (La0, ESR, OgG, RF
49
sjogrens histo
multifocal lymphocytic sialadenitis (T cells)--> acini destruction
50
sjogrens biopsy criteria
2+ foci of 50+ lymphocytes within 4mm squared; smokers have fewer foci
51
risk with sjogrens
40x MALT lymphoma
52
HIV related parotid cysts presentation
usually bilateral
53
bilateral parotid cysts consider
HIV related parotid cysts
54
HIV related parotid cysts histo
cystic spaces lined with squamous epithelium; abundant reactive lymphoid stroma
epimyoepithelial islands and Warthin-Finkeldey giant cells
55
Warthin-Finkeldey cells
giant cells in HIV related parotid cysts
56
giant cells in HIV related parotid cysts name
Warthin Finkeldey
57
Sialadenosis aka, what is and why
sialosis
| accumulation of secretory zymogen granules due to innervation disruption
58
accumulation of secretory zymogen granules due to innervation disruption
Sialadenosis
59
sialadenosis risk factors
diabetes, malnutrition, alcoholism, bulimia
60
sialadenosis sialgraphy
leafless tree (compression of finer ducts by hypertrophic acinar cells)
61
leafless tree sialography why and what
sialadenosis (compression of finer ducts by hypertrophic acinar cells)
62
adenomatoid hyperplasia of minor salivary glands where and why
mostly on palate (pseudotumor); poss 2/2 chronic trauma
63
adenomatoid hyperplasia of minor salivary glands histo
coalescing lobules of normal mucinous acini in lamina propria and submucosa
64
coalescing lobules of normal mucinous acini in lamina propria and submucosa; say, palate
adenomatoid hyperplasia of minor salivary glands
65
polycystic (dysgenetic) parotid disease where and who
almost always in parotid, bilateral, usually childhood
66
polycystic (dysgenetic) parotid disease histo
parenchyma diffusely replaced by varying degrees of honeycombed cystic change, lined with a thin layer of flattened epithelium
67
polycystic (dysgenetic) parotid disease ddx
cystadenoma/carcinoma but they are localized masses
68
juxtaoral organ of chievitz what, where, function
vestigial organ of the developing parotid gland
bilateral in soft tissue overlying angle of mandible in buccotemporal space
poss mechanosensor in lateral wall of oral cavity -- avoid removal
69
juxtaoral organ of chievitz histo and ddx
2-10 islands of squamoid cells but no keratin
dark stained cells on periphery and clear cells in center
glandular/organoid pattern
ddx: well-diff SCC, MEC, met
70
necrotizing sialometaplasia causes
local ischemia and infarction
| factors: trauma, surgery, infection, dental injection
71
sclerosing polycystic adenosis where and why
pseudoneoplastic reactive inflammatory process, usually parotid
72
sclerosing polycystic adenosis histo
multiple densely sclerotic lobules composed of hyalinized collagen around multiple ducts with prominent cystic change
cells: apocrine, sebaceous-like, and paneth-like
has intraluminal rounded projections
73
salivary gland tumors = where most common, what's most common
66-75% of all tumors in parotid
| 66-75% are benign
74
salivary gland tumor occurrence by location
parotid (66) > minor (palate>upper lip> cheek) > submandibular > sublingual
75
```
what percentage of tumors are benign in
parotid
submandibular
minor salivary (overall)
sublingual
```
parotid 66 benign
submandibular 60 benign
minor salivary 50 benign
sublingual 10 benign
76
minor salivary glands, what percentage of tumors are benign:
upper lip
palate and buccal mucosa
retromolar pad, FOM, tongue, lower lip
upper lip 75 benign
palate and buccal mucosa 50 benign
retromolar pad, FOM, tongue, lower lip 10 benign
77
most common benign tumor in parotid
pleomorphic adenoma
78
most common malignant tumor in parotid
mucoep
79
most common benign tumor in submandibular
pleomorphic adenoma
80
most common malignant tumor in submandibular
adenoid cystic carcinoma
81
most common tumor of sublingual
mucoep
82
most common benign tumor of minor salivary glands overall
pleomorphic adenoma
83
most common malignant tumorS (list multiple) of minor salivary glands overall
PLGA/mucoep/ACC
84
most common salivary gland tumor
pleeomorphic adenoma
85
most common salivary gland tumor in children
pleomorphic adnoma
86
pleomorphic adenoma old aka and why; IHC?
myoepithelioma
composed of myoepithelial cells
calponin, p63+
87
which pleomorphic adenomas higher recurrence
myxoid
88
string of pearls on skin
recurrent pleomorphic adenoma
89
special histo finding in a small subset of pleomorphic adenomas and how common
tyrosinde crystals in 6%
90
tyrosine crystals which salivary gland tumor
pleomorphic adenoma, 6%
91
oncocytoma look of cells
oncocytes: swollen granular cytoplasm 2/2 increased mitochondria
92
oncocytoma location and origin
90% in parotid
| poss from striated duct
93
oncocytoma special stains
PAS+ diastase sensitive (glycogen)
| PTAH can show granules
94
```
oncocytosis aka (what kind of lesion?)
histo
```
multinodular oncocytic hyperplasia (not neoplastic)
small multiple nodules without tumor stroma
nested zellballen-like oncocytes with vascular spaces and numerous connective tissue septa
95
small multiple nodules without tumor stroma
| nested zellballen-like oncocytes with vascular spaces and numerous connective tissue septa
oncocytosis
| aka multinodular oncocytic hyperplasia
96
warthin tumor location, demographic, other name
```
tail of parotid
8x more common in smokers
10:1 M:F
5-17% bilateral (metachronous)
aka papillary cystadenoma lymphomatosum
```
97
papillary cystadenoma lymphomatosum what is?
warthin tumor
98
malignant warthin
carcinoma ex-papillary cystadenoma lymphomatosum
99
canalicular adenoma location
75% upper lip, then cheek
| can be multifocal
100
basal cell adenoma location
75% parotid
| then upper lip and cheek
101
basal cell adenoma histo types
solid, trabecular, tubular, membranous
102
membranous basal cell adenoma aka and histo findings
aka dermal anlage tumor
| jigsaw puzzle and thick hyaline material
103
distinctive histo pattern of basal cell adenomas
basosquamous whorls
104
brooke-spiegler syndrome components
hereditary membranous basal cell adenoma, dermal cylindromas, trichoepitheliomas
105
hereditary membranous basal cell adenoma, dermal cylindromas, trichoepitheliomas
brooke-spiegler syndrome
106
basal cell adenoma with worst prognosis
membranous basal cell adenoma
| 30% recurrence
107
sialadenoma papilliferum look, location, histo
ductal papilloma on palate, histo like papilloma
108
intraductal papilloma look, location, histo
submucosal swelling, mostly minor salivary glands
| unicystic structure with cuboidal/columnar epithelium
109
inverted ductal papilloma look, location, histo
nodule of lower lip and mandibular vestibule
| unicystic with squamous, bulbous epithelium
110
sialadenoma papillefreum of skin
syringocystadenoma papilliferum
111
sialoblastoma aka and what is
lymphadenoma
| congenital basaloid tumor
112
most common malignant ssalivary gland tumor in adults and children of the uS
mucoep
113
mucoep locations
parotid, then minor salivary glans
114
most common salivary gland tumor of lower lip, FOM, tongue, retromolar pad
mucoep
115
most common etiologic factor for mucoep
radiation
116
compare grade and prognosis for mucoeps in minor, submandibular, patorid
minor -- lower grade, better prognosis
| sub-MD worse prognosis than parotid
117
intraosseous mucoeps how?
ectopic salivary tissue, sinus lining, or odontogenic epithelium from cyst lining
118
acininc cell adenocarcinoma location, gender, prognosis
85% parotid
F>M
childhood, most commonly bilateral
prognosis good, better in minor glands
119
second most common malignant salivary tumor of childhood (what's first)
2 - acinic cell adenocarcinoma
| 1 - mucoep
120
acinic cell adenocarcinoma special stain and histo
PAS, diastase resistant (not glycogen)
can be solid, cystic, microcystic, papillary-cystic
well-diff, dediff, follicular
has tumor associated lymphocytes
121
types of malignant mixed tumors of salivary glands and locations. which most common?
carcinoma ex-PA (95%; most parotid, then minor)
carcinosarcoma (parotid, sub-MD, minor)
metastasizing PA (lungs or bones)
122
malignant mixed tumors of salivary glands what's the histo
usually poorly diff adenoca or salivary duct ca
123
grades of invasion and worse prognosis for malignant mixed tumors of salivary glands
non-invasive (in situ), minimally invasive (<1.5mm), invasive (>1.5mm -- worse prognosis obvi)
124
salivary carcinosarcoma components usually
adenocarcinoma + chondrosarcoma
125
basal cell adenocarcinoma arises from; location
de novo (most) or basal cell adenoma -- 90% parotid
126
types of basal cell adenocarcinoma
solid, membranous, tubular, trabecular
127
ddx basal cell adenoma from basal cell adenocarcinoma
invasive growth and/or perineural or vascular invasion
128
adenoid cystic carcinoma location
most in palate; then parotid in sub-MD
129
adenoid cystic carcinoma histo patterns, IHC, special stain
classic (cribiform swiss cheese), tubular, solid, and de-differentiated
IHC CD43+ and CD117+
Giemsa -- metachromatic staining myxoid material
130
adenoid cystic pattern with best prognosis
tubular
131
adenoid cystic pattern and location with worst prognosis
solid
| mx sinus and subMD gland
132
most common malignancy of subMD salivary gland
adenoid cystic carcinoma
133
polymorphous low grade adenocarcinoma location
almost exclusively minor salivary glands of palate
134
polymoprhous low grade adenocarcinoma IHC (helps to distinguish from?)
weak CD43, CD117 (strong in adenoid cystic) and GFAP (strong in PA)
135
epithelial-myoepithelial carcinoma histo, variants
biphasic:
inner layer epithelial cells; outer layer myoepithelial (clear cells)
variants: oncocytic, double clear
136
epithelial-myoepithelial carcinoma locations
60-80% parotid
| remaining in sub-MD, sinonasal tract, minor
137
epithelial-myoepithelial carcinoma IHC
inner cells: AE1/3 and CAM5.2
outer: PAS, SMA, calponin, p63+ (p63 is best -- participates in epidermal-mesenchymal interactions during embryonic development)
138
hyalinizing clear cell carcinoma histo and IHC
low-grade, monomorphic, glycogen rich (PAS+, diastase sensitive) carcinoma
dense fibrous stroma around chords/nests/sheets/trabeculae of tumor cells
myoepithelial markers negative
139
low-grade, monomorphic, glycogen rich (PAS+, diastase sensitive) carcinoma; negative myoepithelial markers
hyalinizing clear cell carcinoma
140
salivary duct carcinoma histo, location
```
aggressive adenocarcinoma ( similar to high grade breast ductal carcinoma)
comedonecrosis in ducts; Roman bridge formation
```
most in parotid
90% are high grade
141
comedonecrosis in ducts; Roman bridge formation
salivary duct carcinoma
142
sebaceous carcinoma aka; age
lymphadenocarcinoma (malignant of sebaceous lymphadenoma -- RAREST (6 cases))
30s and 80s
143
lymphadenocarcinoma aka; age
sebaceous carcinoma (malignant of sebaceous lymphadenoma -- RAREST (6 cases))
30s and 80s
144
mammary analogue secretory carcinoma histo
macro and microcysts; secretion in cysts PAS+
prominent hobnailing
cells with granular pink vacuolated cytoplasm
145
macro and microcysts; secretion in cysts PAS+
prominent hobnailing
cells with granular pink vacuolated cytoplasm
in salivary
mammary analogue secretory carcinoma
146
mammary analogue secretory carcinoma IHC and genetics
IHC: vimentin, S100+
FISH: ETV6-NTRK3
147
ETV6-NTRK3
mammary analogue secretory carcinoma
148
mucinous adenocarcinoma aka and histo
colloid carcinoma
| epithelial clusters with large pools of extracellular mucin
149
epithelial clusters with large pools of extracellular mucin in salivary
mucinous adenocarcinoma
150
mucinous adenocarcinoma IHC
CD20+
breast colloid carcinoma markers?
CK7 neg, CDX2 neg, TTF1 neg
151
salivary gland aplasia syndromes
mandibulofacial dysostosis (treacher collins); hemifacial microsomia; lacrimo-auriculo-dento-digital syndrome (LADD)
152
LADD syndrome genetics and clinical
Lacrimo-auriculo-dento-digital (LADD) syndrome
```
AD / FGF10
Aplasia or hypoplasia of SG, LG
Cup shaped ears
Hearing loss
Dental and digital anomalies
```
153
plunging (cervical) ranula what happens, where
| sublingual looks like?
mucin dissects through mylohyoid muscle
Sublingual space known as “tail sign”
Lateral to midline (vs dermoid cyst )
154
tail sign in ranulas
plunging ranula
| Sublingual space known as “tail sign”
155
Most common inflammatory salivary gland disorder in children in the states; what happens to it
Juvenile recurrent parotitis; regresses at puberty
156
salivary gland inflammation in teenagers /young adults
| where and what happens to it
Subacute necrotizing sialadenitis:
Resolves in 2 weeks
Hard and soft palate
157
inflammation of minor salivary glands of lower lip
cheilitis glandularis
158
types of cheilitis galndularis
1. Simple
2. Superficial suppurative (Baelz disease)
3. Deep suppurative (Cheilitis glandularis apostematosa)
159
treatment of sialorrhea
Anti-emetic
| Anti-cholinergic
160
sialorrhea underlying conditions
Rabies , metal poisoning, meds (cholinergic agonist / clozapine), acid from GERD, dentures
161
super salivation of unknown cause (2-5 min /short episodes)
Idiopathic paroxysmal sialorrhea:
162
Idiopathic paroxysmal sialorrhea:
super salivation of unknown cause (2-5 min /short episodes)
163
IgG4 disease IgG4 levels
Normal IgG4 levels = 8-40 mg/l / IgG4 disease 25 x > than normal levels of IgG
164
mikulicz aphthae
minor aphthous ulcers
165
mikulicz disease vs mikulicz syndrome
```
disease = SG + LG swelling
syndrome = that but due to TB, sarcoid, lymphoma
```
166
locations for IgG4 disease
Pancreas > H&N ( submandibular)
167
Location for IgG-4 sialadenitis and special name
submandibular glands - Kuttner tumor
168
complications of IgG4 disease
Abdominal aortitis
Inflammatory pseudo tumors of the kidney
Thyroid inflammation ( Riedel thyroiditis )
lymphadenopathy
169
Kuttner tumor what is and histo
IgG4 sclerosing sialadenitis of submandibular gland
hyperplastic lymphoid follicle
acinar atrophy
170
clerosing sialadenitis of submandibular gland
hyperplastic lymphoid follicle
acinar atrophy
eval for what
Kuttner tumor, eval for IgG4 disease
171
malignancy in Sjogrens
Higher risk for MALT; Lymphoma extra nodal marginal zone B-cell lymphoma (20 X)
172
dry eyes in sjogrens special name
keratoconjunctivitis sicca
173
fruit laden branchless tree
Sjogren punctate sialectasia
174
what kind of dz is sjogren
autoimmune
175
special autoantibodies in Sjogrens and how often
SS-A (50-70%) SS-B ( 30-60%)
176
Sjogrens with other autoimmune, how often?
15% RA
| 30 % SLE
177
Sjogrens criteria
Patient must have at last 2 of the 3
1) + Anti-Ro ( SS-A) and /or Anti-La (SS-B) antigen or + RF and ANA titer ≥ 1:320
2) ≥ 1 focus / 4mm3
3) Keratoconjuctiva sicca with ocular score ≥ 3
178
pleomorphic adenoma genetics
PLGA1 gene
179
PLGA1 gene
pleomorphic adenoma
180
Warthin tumor aka
Papillary cystadenoma lymphomatosum
181
Papillary cystadenoma lymphomatosum aka
Warthin tumor
182
Niesse-Nicholson rests:
SG tissue trapped within LN seen in oncocytic change of Warthin tumor
183
SG tissue trapped within LN seen in oncocytic change of Warthin tumor
Niesse-Nicholson rests:
184
which basal cell adenoma is associated with hereditary disease
membranous basal cell adenoma:
| eg Brooke Spiegler syndrome
185
Brooke Spiegler syndrome
Membranous BCAC
Dermal Cylindroma
Spiroadenoma
Trichoepithelioma
186
oncocytoma staining and what exactly
m/ch; PTAH
187
mucoepidermoid carcinoma genetics
t(11:19) CRTC1-MAML2
188
t(11:19)
CRTC1-MAML2 mucoepidermoid
189
CRTC1-MAML2
t(11:19) mucoepidermoid
190
special cells in acinic cell carcinoma
zymogen cells
191
zymogen cells which salivary tumor
acinic cell carcinoma
192
which mucoeps have better prognosis
with genetic mutation
193
MASC translocation
t(12:15) ETV6-NTRK3
194
t(12:15)
MASC ETV6-NTRK3
195
ETV6-NTRK3
t(12:15) MASC
196
causes of sialosis
non-inflammatory
1) Endocrine : DI, DM, pregnancy, acromegaly, hypothyroidism
2) Nutritional: Bulimia, anorexia, cirrhosis
3) Neurogenic : medication
197
sialosis medical treatment
pilocarpine
198
pleomorphic adenoma IHC
+ GFAP
199
adenoid cystic IHC
+ CD117, CD43
200
polymorphous low grade adenocarinoma IHC -- ddx from what?
PLGA = - GFAP (vs PA), weak + CD117, CD43 (vs ACC)
201
von ebner glands where
in tongue beneath circumvalate and foliate papillae
202
minor glands in tongue beneath circumvalate and foliate papillae
von ebner
203
blandin-nuhn glands
ventral tongue
204
ventral tongue salivary glands
blandin-nuhn
205
superficial mucoceles seen in what
lichen planus, lichenoid drig reactions, GVHD
206
causes of sialadenitits
infections (viral-mumps, bacterial-staph aureus) and non-infections (Sjogrens, RT, sarcoid)
207
schirmer's test to confirm dry eyes measurement
<5mm
208
test to confirm dry eyes
Schirmer's, <5mm
209
dye to show defects on ocular surface epithelium and for what
sjogrens dry eyes, rose bengal
210
why is c/pl swollen in salivary oncocytoma
increased m/ch
211
increased m/ch in cells which tumor
oncocytoma
212
oncocytoma with stains
PAS+, diastase sensisitive glycogen
| PTAH for m/ch
213
oncocytosis aka
| neoplastic?
multinodular oncocytic hyperplasia
| non-neoplastic
214
membranous basal cell adenoma, dermal cylindromas, trichoepitheliomas what is
Brooke-Spiegler syndrom
215
most common subtype of basal cell adenoma
solid
216
worst prognosis for basal cell adenoma which subtype
membranous, 30% recurrence
217
types of ductal papillomas
sialadenoma papilliferum (papilloma-like); intraductal papilloma (submucosal swelling); inverted ductal papilloma (nodule)
218
clinical look of intraductal papilloma
submucosal swelling
219
clinical look of inverted ductal papilloma
nodule
220
best prognosis location for mucoep
minor salivary glands
221
adenoid cystic carcinoma IHC
CD43+ and CD117+
222
worst histo type prognosis of adenoid cystic
solid
223
worst location prognosis for adenoid cystic
mx sinus and subMD gland
