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Oral candidiasis > 19. Non-neoplastic salivary gland disorders > Flashcards

19. Non-neoplastic salivary gland disorders Flashcards

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1
Q

Describe salivary glands?

A

Structurally a series of branched ducts terminating in spherical or tubular secretory pieces or acini.

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2
Q

What is the predominant duct in salivary glands?

A

Striated duct where the saliva is modified

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3
Q

What are ducts between acini called and what do they empty into?

A

Intercalated ducts- striated ducts- excretory ducts

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4
Q

What cells are associated with acini and intercalated ducts?

A

Myoepithelial cells

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5
Q

What does H and E stained section of salivary gland look like?

A

Pale mucous staining
Nuclei condensed at base of cell
Serous cells- blue
Mucous cells- bubbly

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6
Q

Where are myoepithelial cells found?

A

They are found between the plasma membrane of the secretory cell and basement membrane

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7
Q

What do myoepithelial cells contain, and how do they stain?

A

They contain contractile proteins which allows squeezing of the acini.
Microfilament characteristic of muscle cells but not epithelium

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8
Q

What can be used to stain myoepithelial cells?

A

SMA actin- they stain the myoepithelial cells brown and it is found around the acini.

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9
Q

What does parotid gland cells contain?

A

Mostly serous fluid
Serous contains zymogen granules- darkly stained and contain proteins

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10
Q

What does submandibular gland cells contain?

A

Mixture of serous and mucous secretory units.
Either mixed, or pure, eg. with serous demilunes.

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11
Q

What do sublingual gland contain?

A

Mostly mucous cells.
Poor staining with H and E.
Excretory duct lined by cuboidal epithelium.

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12
Q

What is the general architecture of salivary glands?

A

Many secretory units are grouped together in lobules
Connective tissue septa radiates between the lobules from the outer capsule and conveys blood vessels, nerves and large excretory ducts

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13
Q

What is aplasia of salivary gland?

A

Failure to develop salivary glands-rare

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14
Q

What is salivary gland ductal atresia?

A

Absence of normal opening of duct or failure of a structure to be tubular

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15
Q

Where are 3 places heterotopic salivary tissue can be found?

A
  1. Peri-parotid lymph nodes or other parts of head and neck
  2. Accessory parotid tissue common in masseter and cheek
  3. Stafne’s idiopathic bone cavity
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16
Q

What is acute bacterial sialadenitis mostly due to- ie. infectious origin?

A

Streptococcus Pyogenes
Staphlococcus Aureus

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17
Q

Which gland does acute bacterial sialadenitis affect most?

A

Parotid gland

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18
Q

What are the large reasons for acute bacterial sialadenitis?

A
  1. Used to be post-op complication in dehydrated/debilitated patients
  2. Reduced salivary flow- eg, sjogren, drugs, immunocompromised
  3. Could be acute exacerbation with chronic bacterial sialadenitis
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19
Q

What are the clinical symptoms of acute bacterial sialadenititis?

A

Rapid onset
Pain
Swelling
Fever
Redness
Pus from affected ducts

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20
Q

What is chronic bacterial sialadenitis usually due to?

A

Usually non-specific
Associated with duct obstruction

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21
Q

What gland does chronic bacterial sialadenitis affect most?

A

Submandibular over parotid

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22
Q

What are the symptoms of chronic bacterial sialadenitis?

A

Unilateral
Purulent discharge
Replacement of parenchyma by fibrous tissue- salivary gland becomes firm, harder, like a neoplasm- chronic sclerosing sialadenitis

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23
Q

What is the histology of chronic bacterial sialadenitis?

A
  1. Chronic- lymphocytic/plasma cell infiltration
  2. Atrophy of acinar cells
  3. Periductal fibrosis
  4. Fibrous replacement
  5. Ductal hyperplasia
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24
Q

When the parotid is massaged, what do you see in chronic sialadenitis?

A

Purulent exudate from Stenson’s duct

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25
What is viral sialadenitis/mumps caused by?
Acute contagious infection by paramyxovirus
26
What does mumps affect, and how is it spread?
Commonest cause of parotid enlargement- 70% Childhood Direct contact/droplet spread
27
What should you always consider mumps in?
Acute salivary gland swelling
28
What are the symptoms of mumps?
2-3 weeks prodromal symptoms- fever, malaise then painful swelling of salivary glands, trismus, oedema, erythema of duct orifice. Subsides in 7 days
29
What other organs can be involved in mumps?
Testes Ovaries CNS Pancreas
30
What is cytomegalic inclusion disease caused by?
Cytomegalovirus HHV5
31
What are the symptoms of cytomegalic inclusion disease?
Primary infection-asymptomatic Can cause severe disease in neonates, immunocompromised and HIV positive
32
Where can cytomegalic inclusion disease spread to?
Kidneys Liver Brain Lungs Lethal multi-organ involvement
33
What is the histology of cytomegalic inclusion disease?
Owl eye inclusion bodes in nucleus or cytoplasm of duct cells
34
What is cytomegalic inclusion disease associated with?
Xerostomia in HIV
35
What is post-irradiation sialadenitis?
Occurs after radiotherapy Fibrous replacement of acini Direct correlation between dose and damage Persistent xerostomia
36
What cells does post-irradiation sialadenitis affect most?
Serous acini more than mucous acini
37
What is sarcoidosis?
Chronic condition of unknown aetiology
38
What are the symptoms of sarcoidosis?
Bilateral hilar lymphadenopathy Skin and eye lesions Pulmonary infiltration Malaise Cough Shortness of breath Athralgia
39
What is the histology of sarcoidosis?
Non-caseating granulomas No acid fast organisms Multinucleated giant cells Increased ESR
40
What is Heerefordt syndrome?
Sarcoidosis Fever Parotitis Facial paralysis Uveitis
41
Where does salivary calculi/sialoliths affect most?
Submandibular Then parotid, sublingual, minor
42
What is the symptoms for salivary calculi?
Usually unilateral Sudden enlargement at meals
43
What do salivary calculi look like?
Yellow/brown Round/ovoid Homogenous or lamellated structure
44
How are salivary calculi formed?
Calcium phosphate deposition on an organic nidus (mucin, microorganisms, desquamated cells)
45
What does the duct epithelium in salivary canculi contain?
Squamous or mucous cell metaplasia
46
What does the duct epithelium in salivary canculi contain?
Squamous or mucous cell metaplasia
47
What do the radiograph of salivary calculi show?
Axial CT scan Radiopacity
48
How large are mucous extravasation cysts?
1mm-3cm Dome shaped mucosal recurrent swelling
49
What do mucous extravasation cysts mostly look like and where are they mostly found?
Lower lip Superficial- blue-ish Deep- normal colour
50
What is the histology of mucous extravasation cyst?
No epithelium lining MN giant cells Foamy macrophages Granulation tissues Area of spilled mucin
51
What is the treatment for mucous extravasation cyst?
Some rupture and self heal If chronic may require surgical removal with associated glands Biopsy to rule out salivary gland tumour
52
What is mucus retention cyst?
Epithelium lined cavity from salivary gland tissue Due to obstruction or increased intraluminal pressure Almost never on lip
53
What is the treatment for mucous retention cyst?
Excision Remove calculus May remove gland
54
What is the histology of salivary retention cyst?
Lined by epithelium Contains double layer of low cuboidal to columnar cells Lack of inflammatory response
55
What is the cause for necrotising sialometaplasia?
Unknown, may be trauma, local anaesthetic, previous surgery, ischaemia
56
Where does necrotising sialometaplasia occur?
Mostly in hard palate
57
What does necrotising sialometaplasia commonly look like?
Deep, crater-like ulcer, takes 10-12 weeks to heal Sometimes preceded by an indurated swelling
58
What is the histology of necrotising sialometaplasia?
Necrosis of dead acini with just pale outlines of cells Pseudoepitheliomatous hyperplasia- mimics invading tumour
59
What is Sjogren disease?
Chronic autoimmune disease 50% have another AI disorder
60
What is primary sjogren syndrome?
Sicca Xerostomia Xeropthalmia
61
What is secondary Sjogren syndrome?
Xerostomia Xeropthalmia Another autoimmune disease- commonly rheumatoid arthiritis
62
What are the symptoms of Sjogren?
Xerostomia Candida Caries Taste dysfunction Swallowing problems Denture retention Speaking Bacterial sialadenitits Red atrophic tongue fissuring Salivary gland enlargement
63
What is the pathology reason for Sjogren causing its symptoms?
Lymphocytic infiltration Acinar destruction in lacrimal and salivary gland and other exocrine glands
64
What may Sjogren progress to?
B cell malignant lymphoma
65
How do you diagnose Sjogren syndrome?
Need 4 out of 6 of European diagnostic criteria Oral symptoms Ocular symptoms Ocular signs Salivary gland involvement Minor salivary gland histopathology Autoantibodies
66
What is the histology of Sjogrens syndrome?
Focal collections of B and T lymphocytes- not crossing connective septa but may do in lymhomatous change Loss of acini Ductal hyperplasia Periductal fibrosis
67
What is Myoepithelial sialadenitis?
Formation of epimyoepithelial islands Chronic lymphocytic infiltration of glandular parenchyma Glandular atrophy
68
What is myoepithelial sialadenitis seen in?
Sjogren Hep C HIV associated salivary gland disease
69
What is sialadenosis?
Non-inflammatory Non-neoplastic Recurrent bilateral swelling of salivary glands Not associated with meal times Maybe due to abnormal neurosecretory control
70
What is the histology of sialadenosis?
Hypertrophy of serous acinar cells No inflammation
71
What is HIV associated salivary gland disease?
Get xerostomia Gland affected is always almost parotid
72
What is the histology of HIV salivary gland disease?
Diffuse lymphocytic infiltration Changes similar to myoepithelial sialadenitis but without antibody profile of Sjogren Cytomegalovirus infections- inclusion bodies

Oral candidiasis (18 decks)

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