Pathology - Nichols I

Question 1

Sialadenitis

Answer 1

• infectious or noninfectious (Sjogren syndrome, sarcoidosis, radiation)
• Staph Aureus is often the pathogen

Question 2

Acute Bacterial Sialadenitis

Answer 2

• typically involves parotid gland
• parotid becomes slow and painful
• purulent discharge drains from the duct

Question 3

Chronic Sialadenitis

Answer 3

• usually secondary to recurrent or persistent ductal obstruction due to a stone (sialolith)
• episodic pain and swelling, usually at mealtime
• submandibular involvement may include persistent enlargement (Kuttner tumor)

Question 4

Sialadenitis - Treatment

Answer 4

Acute-abx, rehydration
Chronic-sialolith removal if appropriate

-surgical removal of gland may be indicated for chronic sialadenitis

Question 5

Salivary Gland Tumors

Answer 5

• uncommon (7% of head/neck tumors)
• 80% involve parotid gland
• 70% are benign
• the smaller the salivary gland, the more likely the tumor in it is malignant

Question 6

Submandibular Gland

Answer 6

11% of salivary gland tumors

45% are malignant

Question 7

Sublingual Gland

Answer 7

• rare site for tumors

- 90% malignant

Question 8

Pleomorphic Adenoma (Benign Mixed Tumor)

Answer 8

• most common type of salivary gland tumor (50% of total)
• tumor arises from mixture of ductal epithelium and mesenchymal elements (2 germ layers, hence it is a mixed tumor)
• 60% in females, middle age (50)

Question 9

Pleomorphic

Answer 9

variety of patterns that may be seen

Question 10

Presentation of Pleomorphic Adenoma

Answer 10

• slowly growing, painless, movable, firm mass
• carcinomas can arise in pleomorphic adenomas (rarely, typically a tumor slowly growing for may years that begins rapidly growing)

Question 11

Appearance of Pleomorphic Adenoma

Answer 11

• typically rounded in shape
• well circumscribed
• not tender
• movable
• commonly with a rubbery texture

Question 12

Pathology of Pleomorphic Adenoma

Answer 12

• encapsulated
• epithelial component usually in ductal or cystic formations
• mesenchymal component usually myoepithelial cells in a myxoid or chondroid (cartilaginous) matrix

Question 13

Treatment of Pleomorphic Adenoma

Answer 13

• surgical excision
• injury to facial nerve (CN VII) is main complication of parotidectomy
• good prognosis with removal

Question 14

Warthin’s Tumor (Papillary Cystadenoma Lymphomatosum)

Answer 14

• second most common benign tumor of parotid
• more common in males (60%)
• more common in late middle age (around 60)
• smoking

Question 15

Warthin’s Tumor Gross Pathology

Answer 15

• slowly growing mass, painless, firm or fluctuant, in tail of parotid
• 17% bilateral

Question 16

Warthin’s Tumor Histology

Answer 16

1. Cystic spaces lined by a double layer of oncocytes (epithelial cells with abundant granular eosinophilic cytoplasm)
2. Prominent lymphoid stroma (commonly with germinal centers)

Question 17

Warthin’s Tumor Pathogenesis

Answer 17

• uncertain, most polyclonal (not neoplastic)

- most ma be metaplastic lesions with lymphoid reaction

Question 18

Treatment of Warthin’s Tumor

Answer 18

• surgical removal
• very low recurrence
• with good surgical excision, good prognosis

Question 19

Mucoepidermoid Carcinoma

Answer 19

• uncommon (15% of all salivary gland tumors)
• most common malignant tumor of salivary gland
• highly variable biologic behavior
• middle age, women
• most common site = parotid & minor glands of palate

Question 20

Mucoepidermoid Carcinoma Symptoms

Answer 20

• typically an asymptomatic swelling

- intraosseous tumors sometimes occur

Question 21

Mucoepidermoid Carcinoma Histology

Answer 21

mixture of mucous and squamous cells in variable rations

-red (mucus) with mucicarmine stain

Question 22

Tumor Grade

Answer 22

how bad it looks under microscope

Question 23

Tumor Stage

Answer 23

anatomic extent of tumor

Question 24

What determines Prognosis of Mucoepidermoid Carcinoma?

Answer 24

GRADE

• low 90% 5 year
• high 50% 5 year

Question 25

Mucoepidermoid Carcinoma Treatment

Answer 25

• based on histologic grade, location, clinical stage
• surgical removal (some/all of gland)
• post-op radiation

Question 26

Mucoepidermoid Carcinoma Prognosis

Answer 26

• variable: grade, location, stage

- younger patients fare better