7. Pathology of the Salivary Glands Flashcards
(45 cards)
1
Q
• 3 major glands: ○ \_\_\_\_ ○ Submandibular ○ Sublingual • Minor glands: ○ Found primarily in \_\_\_\_ cavity ○ Can see in oral pharynx and \_\_\_\_ • Pathology can develop in any gland
A
parotid
oral
esophagus
2
Q
Submandibular gland
• Composed of serous acini, mucous acini or a combination ○ Go back to BSI where discuss salivary gland development • L: parotid gland is primarily \_\_\_\_ • Sublingual gland is primarily \_\_\_\_ but see some serous • Submandibular is a mixture of mostly \_\_\_\_ and \_\_\_\_ to go with it ○ Mixed acini > serous \_\_\_\_ § Around mucous acini you have a half-moon shape of \_\_\_\_ cells around the periphery
A
serous mucous serous mucous demilune serous
3
Q
• Minor glands are exclusively ____ except for in the posterior ____ tongue (base of circumvallate papilla - von ebner’s glands - exclusively serous)
A
mucous
dorsum
4
Q
Salivary gland anatomy
• All glands are attached to network of ducts > excrete saliva into the oral cavity or throat • Stenson's ○ \_\_\_\_ gland ○ Adjacent to the \_\_\_\_ in buccal mucosa • Wharton's ○ \_\_\_\_ gland ○ \_\_\_\_ of mouth through sublingual caruncle • Sublingual ○ \_\_\_\_ duct through sublingual caruncle ○ \_\_\_\_ ducts in the sublingual folds on both sides of the caruncle • Minor glands have no named ducts; each lobule has a distinct \_\_\_\_
A
parotid second molars submandibular floor bartholin ravinus duct
5
Q
Mucocele
• Clinical description: ____, mass, erythematous
○ DD may include ____, pyogenic granuloma
○ Can appear red-blue bc seeing extravasated ____ from the damaged duct
§ Escape of mucous into the surrounding tissue
• Superficial mucocele
○ May resemble a vesicle/small ____
○ Damage is not physical, but it’s ____ in nature
§ Have an ____ reaction > lichen planus, or CVHD > develops superficial mucoceles
§ Causes ____ damage to the ducts
A
nodule hemangioma mucous blister inflammatory immunologic cytokine
6
Q
Mucocele
• Clinical description: ____, mass, erythematous
○ DD may include ____, pyogenic granuloma
○ Can appear red-blue bc seeing extravasated ____ from the damaged duct
§ Escape of mucous into the surrounding tissue
• Superficial mucocele
○ May resemble a vesicle/small ____
○ Damage is not physical, but it’s ____ in nature
§ Have an ____ reaction > lichen planus, or CVHD > develops superficial mucoceles
§ Causes ____ damage to the ducts
A
nodule hemangioma mucous blister inflammatory immunologic cytokine
7
Q
• Plunging ranula
○ If mucocele occurring ____ in the tissue > lesion may manifest in the neck area
○ Resembles: ____ (??? from the quiz)
• Biopsy exposes extravasated ____ and not a lymphoepithelial cyst (branchial plexus represents)
A
deeper
branchial plexus
mucous
8
Q
• Superficial mucoceles
○ Multiple of these can be confused with ____ (if patient is young), and ____
A
herpes
pemphigoid
9
Q
Mucocele
• Surgically \_\_\_\_ the lesion
A
excise
10
Q
Mucocele
• \_\_\_\_ you make the diagnosis • Characterized by a pseudocystic structure ○ Not \_\_\_\_ lined structure § Can see a cavity and the tissue around it > not \_\_\_\_ ○ In the solid areas > blue/gray stuff > extravasated \_\_\_\_ > foreign substance by the body > recruitment of \_\_\_\_ that phagocytose the mucous > macrophages take on a foamy/bubbly appearance > \_\_\_\_
A
microscopically epithelial cystic mucin macrophages muciphages
11
Q
Mucus cyst
• True ____-lined cyst filled with ____
* This is a true cystic lesion * Doesn't look different than a mucocele clinically, but microscopically it's lined by an \_\_\_\_
A
epithelium
mucin
epithelium
12
Q
Mucous cyst
Mucocele
• Won't have to differentiate one from the other for the exam • Mucoceles are common ○ History is of a lesion that's occurring in lower \_\_\_\_, that may have \_\_\_\_ and then grew back ○ As they pop > release the mass > and once surface heals up the mucus keeps accumulating • Treated via simple \_\_\_\_ ○ Surgeon needs to remove adjacent \_\_\_\_ tissue in order to keep it from recurring
A
lip
resolved
excision
salivary gland
13
Q
Sialolithiasis
• Usually \_\_\_\_ gland – Radiopaque mass • Blocks \_\_\_\_ flow • Increases risk for \_\_\_\_ infection • Eliminate stone – May require removal of \_\_\_\_
• Stone in salivary gland = sialoliths • Most common location > \_\_\_\_ of mouth > area that's fed by submandibular gland ○ Wharton's duct is \_\_\_\_ > room for saliva flow to be blocked • Block salivary flow > run risk of developing pain and infection within the blocked tissue ○ Robust microflora and these organisms are flowing back and forth; if not flowing properly > become static > run risk of growing and overgrowth/\_\_\_\_ • Clinically have a yellowish appearance • Radioopaque structure (calcified) ○ Stone in floor of mouth > subman gland associated • If located \_\_\_\_ in tissue > surgical removal ○ Found superficially > can tease it by squeezing and remove entirely
A
submandibular
salivary
retrograde
gland
floor
tortuous
infection
deeper
14
Q
Sialolith
Normal salivary gland tissue
With obstructive changes
• \_\_\_\_ structure • Adjacent tissue shows evidence of obstruction ○ Ducts get \_\_\_\_ ○ \_\_\_\_ inflam changes or \_\_\_\_ inflam changes which is reflective of an acute infection ○ If infected > remove stone and treat them for underlying infection; if not infected > just remove the stone
A
calcified
larger
chronic
acute
15
Q
Necrotizing sialometaplasia
Compromised blood supply to glands (____)
Initial painful ____ -> “a chunk of meat fell out” 75% on posterior ____
Unilateral or ____
• A \_\_\_\_ process that's caused by \_\_\_\_ to the hard palate • History: patient says in a lot of pain and bump on palate and woke up in morning something on tongue > ischemic event necrotized that tissue to the point where it fell off • \_\_\_\_ looking pathology around the midline • Whichever BV was strangulated ○ If distal > \_\_\_\_ disease ○ If proximal (before breaking into two branches) > \_\_\_\_ disease • Salivary acini exhibit metaplastic change to \_\_\_\_ epithelium (no longer mucous acini) • Will \_\_\_\_ in 2-4 weeks ○ Once the tissue falls out > will begin to resolve on its own
A
ischemia
swelling
palate
bilateral
reactive ischemia symmetric unilateral bilateral squamous resolve
16
Q
Cheilitis glandularis
• Lumpy bumpy appearance of lips – Usually ____
• Variety of potential etiologies – \_\_\_\_ – Alcohol – Chronic \_\_\_\_ – Poor hygiene
• Non-____ histology
• Chronic in nature with chronic inflam > change to lower lip > \_\_\_\_ line becomes more prominent in these patients ○ \_\_\_\_ of the lip - the labial mucosa becomes more apparent to the outside environment ○ Lumps and bumps > inflamed salivary gland acini • More commonly occurs in older \_\_\_\_ • Pathogenesis: ○ Smoking ○ Alcohol ○ Chronic sunlight ○ Poor hygiene § Top 3 associated with \_\_\_\_; at risk for condition to progress to SCC if left untreated and risk factors persist • Treat when esthetically displeasing ○ Actinic cheilitis > \_\_\_\_ > pull out labial mucosa to refabricate the lip ○ Warrants a \_\_\_\_ > no dysplastic change > will see just chronic inflammation > just observe and \_\_\_\_
A
lower lip
smoking
sunlight
specific
wet-dry males cancer vermillionectomy biopsy monitor
17
Q
Glandular enlargements
- ____
- Infectious
- ____
- Neoplastic• Any four categories could result in exact same manifestation of swelling in the neck/cheek area
A
idiopathic
autoimmune
18
Q
Sialadenosis
• Non-____, non-inflammatory
• Endocrine
– ____
– Pregnancy
– ____
• Nutritional
– ____
– Alcoholism
– ____ / anorexia
• Medications
– ____
• Idiopathic condition ○ \_\_\_\_ enlargements either unilaterally or bilaterally • Know what triggers, but do not know the mechanism ○ None of them are \_\_\_\_ together ○ Acromegaly - similar to gigantism - the tumor occurs later in life (after growth it completed) > released GH > adults become \_\_\_\_ over time • Enlargement is not a tumor or inflam ○ Develop more \_\_\_\_ within the parotid gland, OR ○ \_\_\_\_ of the glandular tissue > glandular hyperplasia • Warrant a \_\_\_\_ to make sure it's not neoplastic ○ Will see excess fat or normal appearing glandular tissue ○ Surgeons make go in and remove excess tissue - usually just \_\_\_\_ ○ Minimize risk \_\_\_\_ to decrease reoccurence
A
neoplastic
diabetes
acromegaly
malnutrition
bulimia
antihypertensives
painless linked larger fat hyperplasia biopsy monitor factors
19
Q
Bacterial sialadenitis
- Retrograde infection due to ____
- Increased pain upon ____
- ____ within ducts and acini
- Antibiotics, surgical drainage• This growth is painful
• Infection of glandular tissue because of a sialolith resulting in retrograde tissue; sometimes from another mechanism
○ If acute infection > acute signs and symptoms; will see hallmarks of infections > ____, acute inflam, ____
§ Patients require surgical drainage, and ____ therapy
• Patients will have pain upon eating
○ Begin to ____ > glands begin to work > triggers ____ for these patients
• Brought to ER > treated in house with ____, and the gland may be removed entirely
A
stasis
eating
abscesses
abscesses pus antibiotic salivate discomfort IV antibiotics
20
Q
Cat-scratch disease
• \_\_\_\_ • \_\_\_\_ or parotid swelling – Involvement of glandular \_\_\_\_ tissue • Persistent regional \_\_\_\_, fever, malaise, bone / joint pain • Self-\_\_\_\_ disease – Erythromycin – \_\_\_\_
• Cats harbor a bacteria > bartonella henselae • Scratch on face > can become infected > migrate to lymphoid tissue around the parotid or submandibular • \_\_\_\_ disease and will resolve on it's own ○ A lot of pain when patients have it ○ Systemic manifestations § Cervical lymphadenopathy (swelling of neck area) • Treat with antibiotics ○ Doesn't respond well with penicillin ○ Treat with a \_\_\_\_ agent: erythromycin/doxycycline ○ No \_\_\_\_ upon treatment
A
bartonella henselae submandibular lymphoid lymphadenopathy limiting doxycycline acute bacteriostatic recurrence
21
Q
Mumps (Epidemic parotitis)
• ____
• Infected saliva, urine, respiratory droplets
• 30% are ____ infections
• Mainly ____ parotid involvement
– Can occur in absence of salivary gland involvement
• Epididymoorchitis
– Pain and enlargement of ____
– Testicular ____ upon healing
• Oophoritis, mastitis, spontaneous abortion
• Life-altering infection ○ \_\_\_\_ disease • Caused by paramyxovirus • Subclinical > no idea they have mumps > more likely to infect other people, and can also cause real damage to body > can cause enlargement of salivary glands and infected (parotid glands usually - unilaterally or bilaterally) ○ Testes can be infected ○ In women, \_\_\_\_ can be infected • No cure/treatment > patients are \_\_\_\_ and bedrest > virus burns itself out • Male patients who are infected > severe testicular discomfort and infertility • Female patients > breast \_\_\_\_, ovarian inflammation; if pregnant > \_\_\_\_
A
paramyxovirus subclinical bilateral testicles atrophy preventable ovaries quarantined inflammation spontaneous abortion
22
Q
HIV-associated salivary gland disease
Benign ____ cysts
Increased frequency of ____
HIV-infected cells found in salivary gland
– ____ protein
Triggers lymphoid proliferation – ____-positive lymphocytosis
• Trigger of salivary gland disease • Lymphoepithelial cyst ○ In HIV patients > will get these cysts occurring in the \_\_\_\_ gland > pathognomic for HIV disease (usually \_\_\_\_ cysts) • Triggers immune response despite immunity is reduced > \_\_\_\_ cells cause damage to salivary ducts > HIV patients are at risk for mucoceles/\_\_\_\_ within the mouth ○ HIV virus is found within salivary gland tissue > infects ductal cells ○ CD8 cells can take over (over the CD4) > at risk to develop a lymphoid \_\_\_\_ comprised of CD8 cells (damaging cells) > disease phenotypes • No \_\_\_\_ ○ Mucoceles treated \_\_\_\_ ○ Epithelial cysts no treatment - unless surgery ○ Reduce the \_\_\_\_ burden > phenomenon are reduced in frequency
A
lymphoepithelial
ranulas
HIV-1 p24
CD8
parotid multifocal CD8+ ranulas storm treatment locally viral
23
Q
Sarcoidosis
• Uni- or \_\_\_\_ glandular involvement • Heerfordt’s syndrome (uveoparotid fever) – \_\_\_\_ enlargement – \_\_\_\_ nerve palsy – \_\_\_\_ – Fever • Radiographic “\_\_\_\_” sign
• \_\_\_\_ inflammatory disease ○ Tuberculosis, deep fungal infection (histoplasmosis), Crohn's, foreign body reactions, oral facial granulomatous ○ Can affect any organ - usually the \_\_\_\_ first • One clinical variation of sarcoid that includes the parotid > Heerfordt's syndrome ○ Affected by the sarcoid > manifest with massive enlargements of cheeks (either one or both sides) ○ Have facial nerve palsy if \_\_\_\_ it's on the same side of the disease ○ Inflammation of \_\_\_\_ > uveitis ○ Not infection but have a fever • Microscopically: ○ Granuloma with nucleated \_\_\_\_ cells
A
bilateral parotid facial uveitis panda
granulomatous lungs unilateral eyes giant
24
Q
Sarcoidosis
• Radiographically: ○ Panda sign if have HF syndrome § Not pathognomonic, but strong implications ○ \_\_\_\_ will prove it • Treatment: ○ \_\_\_\_ ○ Same drugs for \_\_\_\_/psoriasis § Biologic therapies: \_\_\_\_-mediated therapies
A
biopsy
steroids
chron’s
ab
25
Sjögren syndrome
Primary Sjögren (sicca syndrome)
– ____
– ____ (keratoconjunctivitis)
Secondary Sjögren
– ____ syndrome
– Other autoimmune disease
– (other systemic manifestations)
Female-to-male ratio ____:1
Uni- or ____ glandular enlargement
• Autoimmune salivary gland disorder
• No ____ for this disease
○ Treating the symptoms - dry mouth
• Dry eyes and dry mouth for sicca
• Secondary has other AI complications > ____, myasthenia gravis, systemic sclerosis or crest
○ May be more than one
○ Female predilection
§ When men get it > much ____ prognosis
• Will manifest with a glandular enlargement
○ DD is broad
• Patients have a plethora of findings beyond the dry eyes/mouth phenotype
○ In ____ Sjogrens
xerostomia
xerophtalmia
```
sicca
9
bilateral
treatment
lupus
worse
secondary
```
26
Xerostomia
• ____ feeling of dry mouth
```
• Caused by
– Local factors
– Developmental
– Excessive water / metabolite loss
– Medications
– Radiation therapy
– Psychological illness
– Systemic diseases
```
• Patient is telling you they're experiencing it
○ The dryer the mouth > more ____ saliva
• Local ____ > inf alveolar block > saliva becomes ropey > sensation of dry mouth
• Haven't formed glands properly during ____ > dry mouth
○ Treacher-collins syndrome - ____ glands don't form properly
• Any medication used to treat ____ > para or symp medications???
○ Reducing saliva flow from the parotid gland
```
subjective
mucousy
anesthesia
development
parotid
glaucoma
```
27
Clinical complications
* Inability to eat ____ foods
* Difficulty ____
* Higher incidence of ____ and periodontal disease
* Altered sense of ____
* Difficulty wearing ____
* Development of oral ____
• Don't get occlusal caries > get cervical caries
○ Saliva needed to wash bugs away gingival margin area
○ Inc risk for ____ disease over time as well
```
dry
speaking
taste
dentures
candidiasis
periodontal
```
28
Diagnostic tests
Positive ANA
– SS antigen ____ (SS-A/Ro)
– SS antigen ____ (SS-B/La)
____ test
Labial ____ gland biopsy
• Determine the cause of the dry mouth:
○ Biopsy
§ Blind ____ biopsy, but excising salivary glands
□ No clinical lesion here; lip looks ____, but if patients have S disease they will have immune cells in salivary gland tissue > remove salivary ____:
® Look for ____ inflam cells (lymph and/or ____) forming individual foci in the tissue
○ Serology
§ Blood sample > look for ANA > can see both or one and the other
□ Not ____, but found in a majority of S disease
□ ____ factor may be involved
□ ____ antigen may be involved
□ Just see ANA > autoimmune disease > then look for the specific antigens > narrow it down
○ Ophthalmology testing
§ Schirmer test > stick lithmus paper under ____ eyelid and wait for 5 mins > see how long it takes for it to change > if changes ____ > formation of tears
□ 20mm of wetting > normally wetting > negative
□ The woman > no coloration of lithmus paper > ____
```
A
B
schirmer
salivary
incisional
normal
acini
```
```
chronic
plasma cells
pathognomonic
rheumatoid
SMith
lower
color
```
xeropathalmia
29
Labial salivary gland biopsy
• ≥ ____ salivary gland lobules for analysis
```
• Chronic inflammatory cell aggregates
– ≥ ____ lymphocytes and plasma cells
– > ____ focal aggregate per 4 mm2
– More ____ -> greater the correlation
• Should not see ____ chronic inflammatory changes
```
```
4
50
1
foci
typical
```
30
• ____ areas > foci of lymphos/plasma cells together
○ 50+ cells within one aggregate
○ The more foci, the more likely you have disease
○ At least 4 lobules that work 4mm2 tissue in totality
• Don't see > no ____, no ____ to adj tissue, no ____ of ducts
○ All the other things are indicative of chronic inflammation
• No one test is diagnostic > the diagnosis is made ____
○ Associating clinical findings with the pathology you're seeing clinically
○ Nothing on the histo, but have the other tests and have dry mouth > S disease
```
dark
fibrosis
damage
atrophy
collectively
```
31
```
Treatment of xerostomia
Sugarless ____ / gum
Oral hygiene products
Parasympathetic ____ drugs
Frequent dental visits
• ____ or chlorhexidine rinses
```
• Treating just the ____ > dry mouth
○ Not with drugs (less commonly)
○ Some medications may be parasympathetic agonists
§ When treating ____ > antagonizing the parasymp flow from the glands
```
candy
agonist
fluoride
symptos
glaucoma
```
32
Prognosis of Sjögren disease
No ____
Fair – ____
High risk for ____
• Has no treatment at all that'll resolve disease > prognosis is progressively poorer over time
• What's causing swelling > glands are accumulating ____ cells > over time, bc of the number of cells > one cell can become bad > then more populate and becomes ____ > high risk of non-hodgkin B-cell lymphoma
```
cure
good
non-hodgkin B-cell lymphoma
inflam
neoplastic
```
33
Mucosa-associated lymphoid tissue (MALT) lymphoma
• ____ lymphoma
• Develops within lymphoid tissue found in
____ and glandular sites
• t(____) or t(____) chromosomal translocation
• Found in areas where there's lymphoid tissue: ____, GI tract, ____ glands
○ All it takes is one cell to undergo a chromosomal translocation > DNA will divide and new cells will be made > population of malignant cells
○ Treat lymphomas with ____ and ____
• Both translocations result in the same ____
○ Fusion protein not found in physiology > now oncogenic
○ Found in true salivary gland tumors
```
small b-cell
mucosal
11;18
1;14
stomach
salivary
surgery
chemotherapy
phenotype
```
34
Neoplasms
• Parotid
– Majority of all tumors
– >75% ____
• Submandibular
– < 10% of all tumors
– ≈ 1:1 ____
• Sublingual
– 1% of all tumors
– Majority ____
• Minor glands
– < 20% of all tumors
– Overall, ____ benign:malignant
* Palate: ____
* Upper lip: mostly ____
* Lower lip: mostly ____
* Buccal mucosa: ____
* Retromolar pad, tongue, FOM mostly ____
• The larger the major gland > the more likely it is to harbor a tumor
○ More likely it's ____
• The smaller the major gland > the least likely it is to harbor a tumor
○ More likely it's ____ (cancer)
• Submandibular is 50:50 in distribution
• Site specificity
○ Palate and buccal mucosa is 50:50
○ Lips are opposite one another
§ Tumor in upper lip > benign
§ Tumor in lower lip > malignant
○ Tissues with minimal salivary gland tissue > more likely to be ____ and not benign
benign
benign:malignant
malignant
1:1
```
50:50
benign
malignant
50:50
malignant
```
benign
malignant
malignant
35
Benign tumors
```
• Pleomorphic adenoma (mixed tumor)
– Most ____
• Monomorphic adenoma
– ____ most common
• Warthin’s tumor
– Always in ____ gland
```
• Nothing clinically that's indicative of it being cancer
• A submucosal mass on palate is a ____ tumor until proven otherwise
○ Warrants a ____
• Most commonly occurring tumor of all > pleomorphic adenoma (benign)
• Monomorphic adenoma
○ Occur in any ____
```
common
second
parotid
salivary gland
biopsy
location
```
36
Pleomorphic adenoma
* t(____) chromosomal translocation
* Overexpression of ____ proto-oncogene
```
• Histology
– ____
– Double-layer ducts
– ____ tissue
– Plasmacytoid cells
```
• Complete ____ excision
• Benign tumor that can continue to grow if left untreated
• PLAG1
○ Proto-oncogen
• Easily removable > encapsulated tumors
○ Schwannoma is a benign encpasulated tumor
• Diagnose mass:
○ Double-layer ducts
§ Ducts are arranged in two ____ of cells
□ ____ for this tumor
○ Plasmacytoid cells
§ Resemble plasma cells, but they're actually ____ cells
○ Myxochondroid tissue
§ ____ appearance
○ Histology has an array of appearances > pleomorphic
```
3;8
PLAG1
encapsulated
myxochondroid
surgical
```
layers
pathognomonic
epithelial
cartilagenous
37
```
Monomorphic adenoma
____th decade, ____ > M
Two variants
– ____ adenoma
– ____ adenoma
Complete surgical excision ____ prognosis
```
• Looks all the same
○ Microscopically > uniform appearance
• Secondly most commonly occurring benign salivary occurring
• Occur in older people and female predilection
○ Pleomorphic can occur in any ____ group
• Within each variant > all tumor cells look the same in basal and canalicular in each variant
• Clinically > ____ mass on palate
• Can be found in patients with genetic disease > ____ > patients have skin tumors > turban tumors
○ Each tumor of skin > ____ adenomas of the skin, also have parotid gland tumors that are ____ adenomas
```
7
F
canalicular
basal cell
good
```
age
submucosal
cylindromatosis
basal cell
basal cell
38
Malignant Tumors
```
Mucoepidermoid carcinoma
– Most ____
Adenoid cystic carcinoma
– Histology ____ recognizable
Polymorphous low-grade adenocarcinoma
– Only in ____ glands and usually ____
```
• Mucoepidermoid carcinoma > most common salivary gland malignancy
○ All sites
○ Most comomonly in ____ gland
○ Second most common site > oral cavity > palate
○ Chracterized by ____-producing cancer cells
§ Clinically > may look like ____, hemangiomas, or ____
□ Red-blue appearance
○ Repetitive ____
Polymorpgous low-grade adenocarcinoma > only found in ____ cavity
• Clinical description is not definitive > cannot tell whether benign or ____
common
easily
minor
palate
```
parotid
mucous
mucoceles
pyogenic granuloma
translocations
oral
malignant
```
39
```
Mucoepidermoid carcinoma
• ____ gland most common site
• ____ glands 2nd most common site
– ____ > everywhere else
– ____ color -> r/o mucocele
• t(____) chromosomal translocation
```
```
parotid
minor
palate
bluish
11;19
```
40
Mucoepidermoid carcinoma
```
• Prognostic factors
– ____
– Efficacy of surgery
– Histologic ____
– Clinical stage
____ tumors have worse prognosis than parotid tumors
```
____ gland tumors have good prognosis
location
grage
submandibular
minor
41
Histologic grading of ME
```
• I – intracystic component < 20 %
- ____ points
• N – perineural invasion
- ____ points
• N – necrosis
- ____ points
• M – mitoses (numerous)
- ____ points
• A – anaplasia
- ____ points
```
* Low grade – up to ____ points
* Intermediate grade – ____ points
* High grade - ≥ ____ points
• Hisotology of this cancer is prognostic
○ Also for melanomas
• INNMA
• Some tumors may have a cystic component > if cystic it's a ____ feature, if it's a solid tumor it's a ____ feature
○ Solid is 2 points
• If tumor cells show perineural invasion
○ Cells are wrapped about ____ bundles > bad feature > 2points
• Anaplastic > ____ feature > very poorly differentiated
• Higher the grade > the worse the prognosis
```
2
2
3
3
4
```
4
5-6
7
bad
good
nerve
worst
42
Adenoid cystic carcinoma
t(____) chromosomal translocation
50 : 50, ____ : major
Parotid = ____
____ growing, dull pain, ____ paralysis
• Most easily recognizable characterized > cribiform/____ pattern to the histology
○ Tumor islands composed of big holes
• High propensity for ____ invasion > dark stuff is cancer around the nerve bundle
○ Patients will have parasthesia or ____ (numbness)
• Any cancer can cause perineural invasion, but most commonly seen in this cancer
• Good 5 year survival rate
○ When showing perineural invasion > creeps nerve bundles far from site of tumor > tumors ____ because of left over cancer following after surgery
○ Will die of their cancer at some point because of this (____+ year survival is very poor)
```
6;9
minor
submandibular
slow
facial
```
```
swiss-cheese
perineural
anesthesia
recur
10
```
43
Adenoid cystic carcinoma
```
• Histology
– ____ (“swiss cheese”) pattern
– ____ invasion
• Prone to local ____
• 5-year survival ≈ 70%
• ____ tumors worse than others
```
cribriform
perineural
recurrence
submandibular
44
Frey syndrome
• ____ sweating
• Abnormal regeneration of autonomic nerves after surgical damage
– Sympathetic for ____ gland
– Parasympathetic for regional ____ glands
• Starch-iodine test
– Affected area becomes ____ if positive
* ____ of the tumor and nerve fibers > after reconstruction may experience frey syndrome
* Characterized by a mixing of the ANS/PNS to the wrong structures after healing > when begin to salivate > they ____ in skin overlying the parotid gland; when sweating > start to ____ bc the stimulation becomes the opposite
* Starch changes to ____ color
* Treatment > ____ > destroy the nerve that's causing these changes
* Not ____, just annoying for patients; common following surgery
gustatory
parotid
sweat
dark
```
reconstruction
sweat
salivate
brown
botox
consequential
```
45
Sialorrhea
• Excessive ____
```
• Variety of etiologies
– Local ____
– New denture
– Severe mentally delayed / ____
– Extensive jaw resection
– Gastroesophageal reflux disease
– ____
– Heavy-metal poisoning
```
• Constantly ____ up > salivate more
• Treatment > reposition the salivary ducts ____ in the mouth > saliva is swallowed
○ Done in patients with a ____ cause (cerebral palsy) that they can't retain their saliva in their mouth
salivation
anesthetic
cerebral palsy
rabies
throwing
posteriorly
developmental
