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BDS4 Oral Medicine > Salivary Gland Tumours > Flashcards

Salivary Gland Tumours Flashcards

1
Q

What are the causes of changes in salivary gland size?

A

Secretion retention
-> Mucocele
-> Duct obstruction

Chronic sialadenitis- associated with mumps, bacterial infections, other pathology

Gland hyperplasia
-> Sialosis
-> Sjögren’s Syndrome

Salivary neoplasms

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2
Q

What are the features of sialosis?

A

Gland enlargement not caused by infection, inflammation or neoplasm

  • Non-tender
  • Often occurs in parotid- marked change in size and shape
  • Associated with alcoholism, cirrhosis eating disorders, diabetes
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3
Q

How do major salivary gland tumours tend to present?

A

Localised swelling

Neurological change- swelling in parotid presses on facial nerve
-> Palsy, paraesthesia

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4
Q

What are the usual features of salivary gland tumours?

A

Painless

Slow growing

Well defined

Benign- 75%
-> malignant tumours are on increase

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5
Q

What is the prevalence of salivary gland tumours?

A

10 in every 100,000

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6
Q

Which factors may be involved in aetiology of salivary gland tumours?

A

Radiation
-> occupational
-> mobile phones

Viruses- EBV

Racial susceptibility

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7
Q

Distribution of Salivary Gland tumours:

A

Parotid- 80% of all tumours/15% malignant

Submandibular- 10% of all tumours/30% malignant

Sublingual- 0.5% of all tumours/80% malignant

Minor glands- 10% of all tumours/45% malignant

-> Smaller the major gland the smaller the incidence tumours- But more are malignant

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8
Q

What are the types of salivary gland tumours?

A

Epithelial Neoplasms
-> Benign (adenoma)- 11 types *
-> malignant (adenocarcinoma)- 20 types *

Non-epithelial
-> Saroma- fibrous tissue
-> Lymphoma

  • subgroups also present
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9
Q

What are the clinical signs of major gland tumours?

A

Lump in gland

Asymmetry

Obstruction

Later
-> Pain
-> Facial palsy

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10
Q

What are the clinical signs of minor gland tumours?

A

Occurring in Junction of hard/soft palate, upper or cheek
-> Ulcerate late (suggestive of malignancy)

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11
Q

What techniques are used to investigate and diagnose salivary gland tumours

A

Fine needle aspirate

Core biopsy (done under LA- gets more tissue than FNA)

Incisional biopsy

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12
Q

What are the features/functions of a FNA?

A
  • Can be done for any swelling underneath the skin
  • Used for breast and salivary gland pathology
  • Only gives small amount of tissue- can tell surgeon whether benign or malignant but may not help with definitive diagnosis
  • Non-invasive
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13
Q

What are the issues when diagnosis salivary gland tumours?

A

Number of tumour types

Variation within a tumour because tissues originate from different stem cell lines so pathology may be complex

Common features between types

Not all tumours fit the classification

Immunohistochemistry may be needed to differentiate many of these tumours.

-> Molecular markers/next generation sequencing used in some cases (key genomic alterations)

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14
Q

What is meant by the term Adenocarcinoma NOS and when is it used?

A

Not otherwise specified
- If tumour cannot be placed into a category

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15
Q

What is meant by pleomorphic?

A

There are a variety of tissue appearances within the tumour
-> no 2 will be the same

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16
Q

What are the histological features of a pleomorphic adenoma?

A
  • Presence of myoepithelial cells- look like muscles cells and can contract (can move saliva through duct)
  • Myxoid areas - loose and gelatinous (challenging removal- easy to leave bits behind, can give rise to other tumours)
  • Chondroid areas- looks like cartilage tissue formation
  • Fibrous Capsule- may be incomplete (allows tumour to grow out into other tissue)
17
Q

Where do pleomorphic adenomas tend to occur?

A

Parotid

18
Q

What % of all salivary gland tumours do pleomorphic adenomas make up?

A

75%

19
Q

How are pleomorphic adenomas managed?

A

Wide local excision
-> Healthy tissue around the PA is removed to help recurrence

Follow up for 5 years due to recurrence risk (larger risk with minor glands)

20
Q

Why do pleomorphic adenomas have a high recurrence rate?

A

Multifocal- recurrence can be 2 or 3 from one original tumour
- During removal due to myxomatous tissue parts can easily fall off and continue growing

21
Q

What is the risk of a Pleomorphic adenoma going undetected or untreated over the course of many years?

A

Malignant transformation into a Carcinoma ex-pleomorphic adenoma
-> 5%

22
Q

What are the presenting features of Warthin’s tumour?

A
  • Occasional multiple/bilateral
  • Mostly occurs in parotid
  • Multifocal
  • Occurring more in woman
23
Q

What are the histological characteristics of Warthin’s tumour?

A

Completely encapsulated (easy to remove, recurrence is rare, malignant transformation is rare)

Cystic spaces between epithelium with lymphoid tissue in between

Oncocytic epithelium- appears pink

24
Q

How are warthins tumours treated?

A

Excision

25
Q

What % of salivary gland tumours overall are malignant?

A

15%

26
Q

What is the incidence of Adenoid cystic carcinoma?

A

5% (more in minor glands)

27
Q

Where do adenoid cystic carcinomas typically spread to?

A

Local
-> Nerves
-> Bones

Late- spreads by blood to lung

28
Q

What are the issues with Adenoid Cystic Carcinomas?

A

Difficult to treat

High levels of recurrence

Poor prognosis- very infiltrative and difficult to complete irradicate (grows between trabeculae and along nerve fibres, can spread into myelin sheath)

Can cause disruption of nearby vital structures- nasal cavity, pharynx, maxillary sinus

29
Q

What are the histological patterns seen in adenoid cystic carcinomas?

A

Swiss cheese appearance (cribriform)- filled with ground substance (this type has better prognosis)

Tubular

Solid

30
Q

How does ACC progress?

A

Slow growing, painless nodule that becomes painful and ulcerated

31
Q

What are the 2 cell types in mucoepidermoid carcinoma?

A

Squamous- epidermoid

Glandular- mucous

32
Q

What are the types of mucoepidermoid carcinoma?

A

Cystic

Solid

33
Q

What are the features of mucoepidermoid carcinomas?

A
  • Unpredictable behaviour- variable speed of growth
  • Source within jaw bone- mucous cells
  • Lymphatic spread can occur
  • Bleeding can be present histologically
34
Q

What stain can be helpful for looking at MEC?

A

Alcian blue- special stain for mucous cells

35
Q

What is the scoring system in MEC?

A

Intra cystic component <20% = 2

Presence of neural invasion = 2

Presence of necrosis = 3

Mitoses = 3

Presence of anaplasia = 4

36
Q

What grade is given to each score in MEC?

A

Low grade malignancy- 0 to 4

Intermediate- 5 to 6

High grade- 7 to 14

37
Q

What are the features of acinic cell carcinoma?

A

Slow growing

Less aggressive

Varied histology and behaviour

Mostly occurs in parotid

38
Q

What are the features of polymorphous adenocarcinoma?

A

Occurs in minor glands in palate

Locally infiltrative (nerves)

BDS4 Oral Medicine (28 decks)

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