Chapter 11: Salivary Gland Diseases Flashcards
(183 cards)
1
Q
what is another name for a salivary duct cyst?
A
mucus retention cyst
2
Q
ranulas are typically associated with rupture of ___
A
the sublingual gland duct
3
Q
are polymorphous low-grade adenocarcinomas more common in males or females? older or younger?
A
F>M
older adults
4
Q
what are two places you will never see a salivary gland tumor?
A
gingiva, dorsal tongue
5
Q
what is another name for a mucocele?
A
mucus extravasation phenomenon
6
Q
what are malignant mixed tumors?
A
tumors that transfer to malignancy
7
Q
do adenoid cystic carcinomas have early or late recurrence and metastasis?
A
late
8
Q
carcinoma ex pleomorphic adenomas are most common in which gland?
A
major glands (>80% cases)
9
Q
what percent of cheek minor salivary gland neoplasms are benign? what percent are malignant?
A
- benign - 50%
- malignant - 50%
10
Q
what percent of minor salivary gland neoplasms are benign? what percent are malignant?
A
- benign - 50%
- malignant - 50%
11
Q
what percent of retromolar pad minor salivary gland neoplasms are benign? what percent are malignant?
A
- benign - 10%
- malignant - 90%
12
Q
are pleomorphic adenoma tumors encapsulated?
A
yes
13
Q
what are the common locations of polymorphous low-grade adenocarcinomas?
A
hard and soft palate (65% cases) > upper lip, buccal mucosa
14
Q
what percent of upper lip minor salivary gland neoplasms are benign? what percent are malignant?
A
- benign - 80%
- malignant - 20%
15
Q
what is the clinical presentation of cheilitis glandularis?
A
- swelling and pain, typically of the lower lip
- eversion of the lip
- red dots indicate duct orifices
- “weeping” mucopurulent secretions often are seen
- middle aged to older males
16
Q
70-90% of neoplasms in what location are malignant?
A
sublingual
17
Q
what are the most common sites of mucoceles?
A
- lower lip 81%
- floor of mouth (ranula)
- anterior ventral tongue
- buccal mucosa
18
Q
what is a salivary duct cyst?
A
epithelial-lined cavity that arises from salivary gland tissue
19
Q
sialoliths are usually associated with ___ or ___, especially at meal time
A
pain or swelling
20
Q
adenomatoid hyperplasia of the minor salivary glands often affect ___
A
minor glands, often on hard or soft palate
21
Q
what is the treatment for a ranula?
A
removal of the feeding sublingual gland and/or marsupialization
22
Q
A
salivary duct cyst
23
Q
patients who are <50 years old with a salivary gland neoplasm on the upper lip most likely have ___
A
pleomorphic adenoma
24
Q
___ is a slow growing, painless mass, blue or normal in color, and may be multifocal
A
canalicular adenoma
25
what are the infectious causes of sialadenitis?
* viral: mumps
* bacterial
26
ranula
27
\_\_\_ is the most common malignant salivary neoplasm
mucoepidermoid carcinoma
28
sialolith aka sialolithiasis aka salivary stone
29
intraosseious mucoepidermoid carcinoma
30
what percent of acinic cell adenocarcinoma undergo metastasis?
10-15%
31
what glands are most affected by adenoid cystic carcinomas?
minor gland (50% of cases), palate \> parotid, submandibular gland
\*most common malignant salivary gland tumor of the submandibular gland
32
what are some underlying systemic conditions that can cause sialadenosis?
* endocrine disorders: diabetes mellitus, hypothyroidism, pregnancy
* malnutrition: general malnutrition, alcoholism, anorexia nervosa, bulimia
* drugs: anti-hypertensive drugs, psychotropic drugs
33
what age patient are adenoid cystic carcinomas more common in?
middle aged adults, 30-60yo
34
whay should you biopsy an adenomatoid hyperplasia of the minor salivary glands?
rule out neoplasm
35
what is the treatment/management of sjogren's syndrome?
* manage xerostomia
* sugarless candies and gum, OTC dry mouth products, sialogogues (pilocarpine and cevimeline)
* emphasize oral hygiene, regular dental care
* monitor for lymphoma
36
what percent of submandibular major salivary gland neoplasms are benign? what percent are malignant?
* benign - 60%
* malignant - 40%
37
\_\_\_ is an autoimmune disease mainly affecting salivary and lacrimal glands, and is characterized by dry mouth and dry eyes
sjogren's syndrome (sicca syndrome)
38
necrotizing sialometaplasia is frequently found \_\_\_, and is \_\_unilatera/bilateral\_\_
* on the palate
* unilateral
39
what is sialorrhea?
excessive salivation
40
mucoepidermoid carcinomas affect what gland most commonly? second most?
1. parotid gland
2. minor glands, most commonly on the palate
41
what is the etiology of sialoliths?
calcification of salivary secretions within the duct system
42
treatment of mucoepidermoid carcinoma treatment depends on what?
location, histopathologic grade, and clinical stage
43
what is the management for xerostomia?
* elimination of alcohol, smoking, caffeine consumption
* drug modification, if possible
* sugarless candies, gum
* oral lubricants (mouthwash, gels, spray)
* prescription: pilocarpine (salagen), cevimeline (evoxac)
44
\_\_\_ is the subjective sensation of a dry mouth
xerostomia
45
oncocytoma:
the prefix onco- is derived from which greek word, and what does it mean?
onkoustai, which means to swell
46
what are 4 other intraosseous salivary tumors other than intraosseous mucoepidermoid carcinoma?
* adenoid cystic carcinoma
* benign and malignant mixed tumors
* acinic cell adenocarcinoma
* monomorphic adenoma
47
what population are oncocytomas common in?
older adults (peak 70yo)
48
what are 3 examples of malignant mixed tumors?
* carcinoma ex pleomorphic adenoma
* carcinosarcoma
* metastasizing mixed tumor
49
what locations do salivary duct cysts most often occur?
parotid gland, FOM, buccal mucosa, and lips
50
salivary gland neoplasms in the retromolar area are mostly \_\_\_
malignant (90%)
51
are oncocytomas common?
no they are rare, and represent approx 1% of all salivary tumors
52
what population is cheilitis glandularis common in?
middle aged to older males
53
sialolith aka sialolithiasis aka salivary stone
54
what is the most common malignant salivary gland tumor in children?
mucoepidermoid carcinoma
55
what is the most common site of acinic cell adenocarcinoma? second and third most common sites?
parotid is the most common site (85% of the cases) \> minor glands \> submandibular gland
56
what is the treatment for salivary duct cysts?
surgical excision
57
what are examples of things that slow or inhibit salivary glow through the duct system that can predispose to the development of calculi?
* mucous plug
* bacterial colonies
* chronic duct blockage phenomena
* normal ductal anatomy (wharton's duct)
* xerostomia - typically not associated with elevated serum calcium levels
58
necrotizing sialometaplasia
59
what is the definiton of sialadenitis?
salivary gland inflammation
60
what is the treatment of sialorrhea?
* treat the underlying cause
* anticholinergic medications, scopolamine transdermal patch (not for children)
* surgery: relocation of the salivary ducts to tonsillar fossa, tympanic neurectomy
61
\_\_\_ is another name for an oncocytoma
oxyphilic adenoma
62
\_\_\_ is another term for pleomorphic adenoma
benign mixed tumor
63
what percent of parotid major salivary gland neoplasms are benign? what percent are malignant?
* benign - 70%
* malignant - 30%
64
\_\_\_ is the second most common benign parotid tumor
warthin's tumor
65
what are the two typical presentations of salivary gland neoplasms?
* smooth surfaced dome shaped nodule
* an ulcerated mass lesion
66
chronic sialadenitis
67
what percent of lower lip minor salivary gland neoplasms are benign? what percent are malignant?
* benign - 40%
* malignant - 60%
68
what is the general prognosis for people with acinic cell adenocarcinoma?
relatively good prognosis
69
plunging (cervical) ranula
70
sialolith aka sialolithiasis aka salivary stones
71
mucoepidermoid carcinoma tumors in what location are associated with a poorer prognosis than in the parotid gland?
submandibular gland tumors
72
pleomorphic ademonas make up \_\_\_% of parotid tumors (superficial lobe) and \_\_\_% of submandibular tumors
* 53-77% of parotid tumors
* 44-68% of submandibular tumors
73
\_\_\_ is the most common malignant salivary gland tumor of the submandibular gland?
adenoid cystic carcinoma
74
mucoele
75
what percent of palate minor salivary gland neoplasms are benign? what percent are malignant?
* benign - 50%
* malignant - 50%
76
what is a common location for a sialadenosis?
* mainly in parotid
* hypertrophy of acini
77
what are some things you would see in a patient with xerostomia?
fissured tongue, increased dental caries, halitosis, "sticky" palate and tongue, fungal infections like candidiasis and angular cheilitis
78
what is the pathogenesis of intraosseous (central) mucoepidermoid carcinoma?
* ectopic salivary gland tissue that was developmentally entrapped within the jaw
* odontogenic epithelium, mucous metaplasia
79
is primary sjogrens syndrome associated with other autoimmune diseases? what about secondary sjogren's syndrome?
* primary SS: no other autoimmune disease
* it's just dry mouth and dry eyes (aka sicca syndrome)
* secondary SS: associated with other autoimmune diseases
* technically this would be sjogren's syndrome
80
what is another name for warthin's tumor?
papillary cystadenoma lymphomatosum
81
salivary duct cysts are \_\_\_, ___ swellings
bluish (or normal color), soft fluctuant swelling
82
what is the incidence of salivary neoplasms?
1-6.5 cases per 100,000 people
83
patients who are \>60 years old with a salivary gland neoplasm on the upper lip most likely have \_\_\_
canalicular adenoma
84
an oncocytoma is a ___ tumor composed of large epithelial cells known as \_\_\_
* benign salivary gland tumor
* oncocytes
85
\_\_\_ is the most common site for minor salivary gland neoplasm (50%), especially in what location?
* palate
* especially posterior lateral hard or soft palate
86
what are the non-infectious causes of sialadenitis?
* sjogren syndrome
* sarcoidosis, granulomatous inflammation
* radiation induced
* recent surgery
* allergic reaction
* obstruction of the salivary duct
87
what is the prognosis for patients with intraosseious mucoepidermoid carcinoma?
90% survival
88
mucoceles of the ___ region are distinctly unusual, and most will prove to be \_\_\_
* retromolar region
* mucoepidermoid carcinoma
89
what other autoimmune diseases are associated with secondary sjogren's syndrome?
rheumatoid arthritis, SLE
90
mucocele
91
80-90% of sjogren's syndrome cases affect males or females?
females
92
what are anesthesia mumps?
* rare complication after general anesthesia
* swelling of parotid or submandibular glands after surgery
* spontaneously resolving in hours or in a few days
93
does sialadenitis have an infectious or non-infectious etiology?
can be either
94
what is the definition of a sialolith?
calcifications developed in a salivary duct
95
what is the definition of a neoplasm?
new growth with unlimited growth potential
neoplasm can also be called a tumor
96
mucoceles are the result of spillage of ___ into the soft tissues due to rupture of \_\_\_, usually caused by \_\_\_
* mucin
* salivary gland duct
* trauma
97
polymorphous low-grade adenocarcinomas and pleomorphic adenomas exhibit different \_\_\_
growth patterns histologically
98
what are 4 common benign salivary gland neoplasms?
* canalicular adenoma
* pleomorphic adenoma
* warthin tumor (papillar cystadenoma lymphomatosum)
* oncocytoma
99
carcinosarcoma has what two components?
carcinomatous and sarcomatous components
100
what is the treatment for sialoliths?
gentle massage, increase fluid intake, moist heat, sialogogue, surgery
101
canalicular adenoma is a type of ___ adenoma
monomorphic
102
what are predisposing factors for necrotizing sialometaplasia?
traumatic injuries, dental injections, ill-fitting dentures, upper respiratory infections, adjacent tumors, previous surgery
103
polymorphous low-grade adenocarcinomas occur almost exclusively in which glands?
minor glands
104
what age group is canalicular adenoma more common in? male or female prevalence?
older age group, 70s, slight female predominance
105
pleomorphic adenomas show a mixture of ___ and ___ cells
* ductal and myoepithelial cells
* remarkable microscopic diversity accounts for the name
106
prognosis of mucoepidermoid carcinoma depends on what?
grade and stage
107
what percent of sublingual major salivary gland neoplasms are benign? what percent are malignant?
* benign - 30%
* malignant - 70%
108
how are sialoliths diagnosed?
radiograph, sialography, ultrasound, CT
109
what are the most common sites of salivary neoplasms?
1. parotid gland (64-80% of all cases)
2. minor glands (9-23%)
3. submandibular
4. sublingual \<1%
110
what is the most common neoplasm?
pleomorphic adenoma (benign)
111
what is marsupialization?
(exteriorization) entails removal of the roof of the intraoral lesion
112
what are other names for a sialolith?
sialolithiasis (multiple) and salivary stones
113
what is the presentation of necrotizing sialometaplasia?
non-ulcerated swelling, pain, and parasthesia → necrotic tissue sloughs out, ulcer → heals in 5-6 weeks
114
what type of carcinoma is slow-growing, widely infiltrative, and has a tendency for perineural spread?
adenoid cystic carcinoma
115
\_\_\_ is a locally destructive inflammatory condition of the salivary glands, believed to be due to ischemia
necrotizing sialometaplasia
116
sialolith aka sialolithiasis aka salivary stone
117
the incidence of mumps decreases due to \_\_\_
MMR vaccine
118
\_\_\_ infection primarily affect the salivary glands, causing mumps
paramyxovirus
119
what is the ocular staining score using as a diagnostic criteria for sjogrens syndrome?
sum of fluorescein staining of cornea (0-6) and lissamine green staining of both nasal and temporal bulbar conjuntiva (0-3)
120
\_\_\_ is a mucocele in the floor of the mouth, usually located \_\_\_
* ranula
* lateral to the midline
121
what is the swollen granular cytoplasm of oncocytes due to?
excessive accumulation of mitochondria
122
is a mucocele a neoplastic or non-neoplastic salivary gland condition?
non-neoplastic
123
\_\_\_ is the most common salivary neoplasm (benign OR malignant)
pleomorphic adenoma
124
\*there are often "weeping" mucopurulent secretions
cheilitis glandularis
125
clinical mucoceles of the upper lip are more likely to be a ___ tumor
salivary gland
126
what locations do canalicular adenomas commonly occur?
1. upper lip - 75% (only pleomorphic adenoma is found more commonly in the upper lip; canalicular adenoma is second most common)
2. buccal mucosa
3. exclusively in minor glands
127
where are warthin's tumors commonly found?
almost exclusively in the parotid gland, may occur bilaterally
128
what is the clinical presentation of sialadenosis?
* parotid swelling
* usually slowly evolving
* usually bilateral
* +/- pain
129
\_\_\_ is a localized, sessile painless swelling that mimics a neoplasm, defined as hyperplasia and/or hypertrophy of the normal gland
adenomatoid hyperplasia of the minor salivary glands
130
where are sialoliths most common?
* submandibular gland, upper lip, buccal mucosa
* long and tortuous (curvy) duct with thick secretions
131
what is the diagnostic criteria for primary sjogren's syndrome?
must have 2/3 of these be positive to be sjogren's syndrome
* positive serum anti-SSA and/or anti-SSB (or positive RF and ANA titer \>/= 1:320)
* ocular staining score \>/= 3
* presence of focal lymphocytic sialadenitis with a focus score \>/= 1 focus/4mm2 in labial salivary gland biopsy samples
132
is xerostomia common? what % of older adults is it seen in?
yes, and it is seen in 25% of older adults
133
what are 8 common causes of xerostomia?
* medications
* caffeine/alcohol
* smoking
* radiation therapy to head and neck
* sjogren's syndrome
* diabetes mellitus
* sarcoidosis
* surgery of salivary glands
134
\_\_\_ is a non-inflammatory asymptomatic salivary gland enlargement
sialadenosis (sialosis)
135
salivary gland neoplasms in the upper lip are mostly \_\_\_, while salivary gland neoplasms in the lower lip are mostly \_\_\_
* benign
* malignant
136
what age patient is instraosseious mucoepidermoid carcinoma most common in? more common in the maxilla or mandible? what specific location is most common?
* middle aged adults
* mandible \> maxilla
* molar-ramus region
137
what is criteria used to exclude sjogren's syndrome?
* past head and neck radiation treatment
* hepatitis C infection
* acquired immunodeficiency syndrome (AIDS)
* preexisting lymphoma
* sarcoidosis
* graft-versus-host-disease (GVHD)
* use of anticholinergic drugs
138
what is the histology of cheilitis glandularis?
chronic sialadenitis and ductal dilation
139
what percent of tongue minor salivary gland neoplasms are benign? what percent are malignant?
* benign - 15%
* malignant - 85%
140
salivary duct cysts occur mostly in what population?
adults
141
necrotizing sialometaplasia mimics ___ clinically and histologically
malignancy (except for too acute onset)
142
what is another name for mumps?
epidemic parotitis
143
what are 11 salivary gland non-neoplastic conditions?
* mucocele, ranula
* salivary duct cyst
* sialolith
* sialadenitis
* sialadenosis
* adenomatoid hyperplasia of the minor glands
* necrotizing sialometaplasia
* cheilitis glandularis
* sialorrhea
* xerostomia
* sjogren's syndrome
144
what are 5 malignant salivary neoplasms?
* mucoepidermoid carcinoma
* acinic cell adenocarcinoma
* adenoid cystic carcinoma
* polymorphous low-grade adenocarcinoma (terminal duct adenocarcinoma)
* malignant mixed tumor
145
what can happen if a pleomorphic adenoma is untreated?
it can grow to grotesque proportions if untreated
146
\_\_\_ is a low-grade malignant neoplasm showing serous acinar differentiation
acinic cell adenocarcinoma
147
canalicular adenoma
148
what is the survival rate for a person with acinic cell adenocarcinoma?
80-94%
149
what is the female to male ratio of the prevalence of acinic cell adenocarcinoma?
F:M
2:1
150
what is another name for sjogren's syndrome?
sicca syndrome
151
what is another name for polymorphous low-grade adenocarcinoma?
terminal duct carcinoma
152
what is the cause of cheilitis glandularis?
unknown, but possibly due to sun damage, tobacco, syphilis, poor hygiene, heredity
153
what is the pathogenesis of adenomatoid hyperplasia of the minor salivary glands?
unknown, possibly trauma
154
salivary gland neoplasms are more common in the upper or lower lip?
upper lip
155
what is the survival rate for high-grade mucoepidermoid carcinoma?
30-54% survival rate
156
what are the common locations of oncocytomas?
occur mainly in major glands, mostly parotid (85-90%)
157
why should you biopsy necrotizing sialometaplasia
to rule out possible malignancy
158
in addition to salivary glands, oncocytes have been identified in a number of other organs, including what?
thyroid, parathyroid, and kidney
159
carcinoma ex pleomorphic adenoma includes malignant transformation of which cells?
epithelial cells
160
mucocele
161
what are some things that sialorrhea is caused by?
* local irritations: ex. aphthous ulcers, ill-fitting dentures
* GERD
* rabies, heavy metal poisoning
* medications: lithium, cholinergic agonists
* idiopathic paroxysmal sialorrhea
* drooling: down syndrome, neurological disorder, ex. cerebral palsy
162
\_\_\_ is a mass present for many years but a recent rapid growth with pain or ulceration, is most common in major glands, and involves malignant transformation of epithelial cells
carcinoma ex pleomorphic adenoma
163
what is the most common malignant neoplasm?
mucoepidermoid carcinoma
164
what is the survival rate for low-grade mucoepidermoid carcinoma?
90-95% survival
165
salivary duct cysts occur in ___ and ___ glands, and there can be \_\_\_
major and minor glands, and there can be multiple cysts
166
\_\_\_ is swelling and eversion of the lower lip as a result of hypertrophy and inflammation of the minor salivary glands
cheilitis glandularis
167
top photo is from the submandibular gland, lower photo is from the parotid gland (stenson's duct)
sialadenitis
168
what are sjogren's syndrome patients at increased risk for?
* lymphoma (40x)
* marginal zone lymphoma (MALT lymphoma)
169
what is the treatment of mucoceles?
* surgical excision, remove with the adjacent minor salivary gland
* submit to pathology
170
what is the local recurrence of acinic cell adenocarcinoma?
1/3
171
what is the 5 year survival rate for adenoid cystic carcinoma? 20 year survival rate?
* 5-year: 70%
* 20-year: 20%
172
mumps is diagnosed based on what?
* clinical findings
* viral culture
* serological tests
173
what are 3 complications associated with xerostomia?
* candidiasis
* prone to cervical and root caries
* alteration of taste
174
adenoid cystic carcinoma is associated with pain and paralysis of which nerve?
facial nerve
175
anything that slows or inhibits salivary flow through the duct system may predispose to the development of \_\_\_
calculi
176
is acinic cell adenocarcinoma associated with pain? is it fast or slow growing?
* + or - pain
* slow growing mass
177
necrotizing sialometaplasia
178
what is another name for sialadenosis?
sialosis
179
sialadenosis
180
what are complications that arise from mumps?
* epididymorchitis in males
* oophoritis
* mastitis in females
181
what population is warthin's tumor most common in?
60-70 yo, male predominance (10:1), increasing incidence in females in recent studies (possibly due to smoking)
smokers have 8x increased risk
182
mucocele's are common in what populations?
children and young adults
183
sialolith aka sialolithiasis aka salivary stone
