Chapter 16: Oral and Salivary Glands Flashcards
(127 cards)
1
Q
___________ is one of the most common diseases in the world and a major cause of tooth loss before 35YO.
A
Dental carries (tooth decay)
2
Q
What are dental carries?
Reversible?
A
-
Tooth decay that occurs when there is focal demineralization of a tooth – enamel and dentin—by acid metabolites of fermenting sugar that is made by bacteria.
- Reversible up until cavitation (hole is formed)
3
Q
Where are rates of dental carries highest and lowest?
A
- Dropping in countries like US where oral hygeine is improving and fluoridation of water occurs.
- Increase rate in developing countries (eating more processed food)
4
Q
What are symptoms of dental carries?
A
- Pain to the point where it affects activities of daily living
- WL/nutritional problems
- Loss of self-esteem/confidence
- Potentially life threatening infections
5
Q
What is gingivitis?
Who is it most common in?
A
a reversible inflammation of the gums due to poor oral hygeine.
Most common in adolescence.
6
Q
What causes gingivitis?
A
Gingivitis is caused by dental plaques that build up under gumline, which mineralized to form calculus (tarter).
7
Q
What are dental plaques?
A
- sticky, clear, biofilm that collects between and on the surface of the teeth.
- it contains a mixture of [bacteria, salivary proteins and desquamative epithelial cells]. If plaque is not removed => mineralized => forms calculus (tarter).
8
Q
What changes charcterize gingivitis?
A
- Redness of gums
- edema,
- bleeding,
- changes in countor,
- less of soft tissue adaptation of the teeth
9
Q
_________ is always preceeded by gingivitis, however gingivitis does not always progress into it.
A
Periodonitis (gum disease)
10
Q
What is Periodontitis?
A
Chronic inflammatory process affecting the supporting structures of the teeth (peridontal lig.), alveolar bone, and cementum, that causes teeth loss.
11
Q
Periodontitis can lead to what?
A
gums can pull away from the tooth, bone can be lost, and the teeth may loosen or fall out.
12
Q
Periodontitis is caused by _______________ in the mouth that affect surrounding tissue. What bacteria is normally found in our mouth?
A
- - Anaerobic and microaerophilic gram (-) bacteria
- - Facultative gram (+)
13
Q
Which systemic diseases increase the risk of Periodontitis?
A
- AIDS
- Leukemia
- Chron disease
- DM
- Down syndrome (high risk for leukemia)
- Sarcoidosis
- Dz asso. w/ defect in neutrophils (Chediak-Higashi, agranulocytosis, and cyclic neutropenia)
14
Q
Adult periodontitis is primarily associated with which bacteria?
A
- Aggregatibacter (actinobaccilus) actinomycetemcomitans
- Prophyromonas gingivalis
- Prevotella intermedia
15
Q
Which diseases can periodontal infections be the origin for?
A
- Infective endocarditis
- Pulmonary and Brain abscesses
16
Q
Common, often recurrent, painful superficial oral mucosal ulcers whose cause is not known.
A
Aphthous ulcers (canker sores)
- D/t stress and gray/blue base surrounded by erythema.
17
Q
Reactive lesions in the mouth (fibrous proliferations) include ___________ and are ALL __________.
A
- Traumatic fibroma/irritation fibroma
- Pyrogenic granuloma
- all BENIGN
18
Q
Which inflammatory lesion is typically found on the gingiva of children, young adults, and pregnant woman (pregnancy tumor)?
A
Pyogenic granuloma
19
Q
Trauma fibroma (irritation fibroma)
A
Trauma fibroma (irritation fibroma)
Submucosal nodule of CT that formed due to trauma, most common along bite line and ginigiva.
20
Q
What are the 3 important inflammatory/reactive lesions?
A
- 1. Aphthous ulcers (canker sores)
-
Fibrous proliferative lesions
* Irritation fibroma/traumatic fibroma
* Pyogenic granuloma
-
Fibrous proliferative lesions
21
Q
Canker sores (apthous ulcers) are most common when?
A
0-20 YO
22
Q
Canker sores are commonly seen in what diseases?
A
- 1. Celiacs disease
- 2. IBD
- 3. Behcets disease
CIB
23
Q
What is an ulcer?
A
-
Breach in the surface of a tissue or organ that is made by the shedding of inflamed necrotic tissue.
- ONLY occurs when tissue necrosis and inflammation exist on or near a surface.
24
Q
Where do ulcers most commonly occur?
A
- Mucosa of mouth, stomach, intestines, GU tract
- Skin or subQ tissue of LE in older people who have circulation problems that predispose to ischemic necrosis.
25
Describe the **bacterial infiltrates** in canker sores.
* At first, **largely mononuclear.**
* Secondary bacterial infection may be d/t **neutrophilic infiltrate.**
26
Describe the features of **pyogenic granuloma** and its course.
* **Red/purple lesion** that is ulcerated.
* Highly vascular proliferation of organzing granulation tissue.
Course:
* Regress into dense fibrous mass.
* Develop into a peripheral ossifying fibroma.
27
What **infections** can occur in the **oral cavity**?
1. **HSV 1 \*\* and oral HSV 2 (genital herpes)**
2. **Candida**
3. **Deep fungal infections**
28
What are other **viral infections** that can involve the oral cavity?
* 1. **Herpes zoster**
* 2. **EBV** (mononucleosis, nasopharyngeal carcinoma, lymphoma)
* 3. **CMV**
* 4. **Enterovirus** (herpangina, hand-foot-mouth disease, acutre lymphonodular pharyngitis)
* 5. **Rubeola** (meales)
29
**HSV** occurs most commonly in _________ and are often...
* **2-4 YO**
* **Asymptomatic** (& do not cause significant morbidity)
30
10-20% of primary infections of HSV can present as \_\_\_\_\_\_\_\_\_\_\_\_\_, with *abrupt onset* of vesicles and ulcers in the mouth, particularly the *gums*. These lesions are also accompanied by what symptoms?
**acute herpetic gingivostomatitis**
Symptoms:
* lymphadenopathy
* fever
* anorexia
* irritability
31
Which test is diagnostic for **Acute Herpetic Gingivostomatitis**?
What are you looking for?
- **Tzanck test (**microscopic examination of the vesicle fluid)
1. Multinucleate polykaryons (giant cells)
2. Eosinophilic intranuclear viral inclusions
32
What is the course of vesicles and ulcers seen in **Acute Herpetic Gingivostomatitis?**
* ***First:** vesicles* filled with a clear, serous fluid
* ***Rupture quickly*** and create painful, red-rimmed shallow ulcers.
- Spontaneously go away in 3-4 weeks, but the virus then travels along regional nerves and becomes latent in local ganglion (**trigeminal/semilunar ganglion)**
- Reactivated during stress or sunlight, leading to vesicles (cold sores) on the lips
33
With HSV, infection is most common and most adults have \_\_\_\_\_\_\_\_.
**latent HSV-1**
34
Viral reactivation of HSV (**recurrent herpectic stomatitis**) occurs where?
* Site of primary inoculation or adjacent mucosa assx with the same ganglion & go away in 7-10 days.
* Groups of small vesicles on the lips, nasal orifices, buccal mucosa, gum and hard palate.
35
What is the most common **fungal** infection of the oral cavity and a *NL part* of the oral flora in 50% of the population?
**Candidiasis (thrush)**
36
Which form of **Oral Candidiasis** is the most common?
How does it appear in the oral cavity?
- **Pseudomembranous (thrush)**
- Superficial, gray to white inflammatory membrane, that can be readily scraped off, revealing red inflammation.
37
**Oral candidiasis** remains \_\_\_\_\_\_\_\_, except in people with immunosupression.
**superficial**
38
Which infection produces a characteristic **dirty white, fibrinosuppurative**, **tough, inflammatory membrane** over the **tonsils** & **retropharynx**?
**Diptheria**
39
What oral findings do we see in patients with **measles?**
**1. Spotty enanthema (ulcers or eruptions in the buccal mucosa)** that occur before a skin rash
2. =\> Koplik spots via Stenson Ducts (small red lesions with blue/white centers)
40
Pt presenting w/ a fiery red tongue w/ prominent papillae (**raspberry tongue)**; white-coated tongue through which hyperemic papillae project (strawberry tongue) should raise suspicion of which infection and organism?
- **Scarlet Fever**
- **Strep pyogenes --\> Gram (+)**
41
What oral findings do you see in a patient with **infectious** **mono (EBV= a dsDNA virus)?**
1. **Acute pharyngitis** and **tonsilitis** with a **grey/white exudutaive membrane**
2. **Petechiae** on the **palate**
3. **Large LN in neck**
42
Which infection
* **HIV** predisposes ppl to oral infections \_\_\_\_\_\_\_\_, _______ and \_\_\_\_\_\_\_\_
* OR is a common diagnosis in people with ___________ and \_\_\_\_\_\_\_\_\_
1. **Herpes**
2. **Candida**
3. **Other fungi**
**Karposi sarcoma** and **hairy luekoplakia**
43
In addition to superficial funal infections, which occur at sites of infection, certain **deep fungal infections** have a predilection for the oral cavity, head and neck. What are they?
1. **Aspergillosis**
2. **Cryptococcosis**
3. **Murcomycosis**
Other:
* Histoplasmosis, Blastomycosis, Coccidiodomycosis, Zygmocosis
44
What is the key predisposing factor for **deep fungal infections** (infections that have a predilection for oral cavity/head and neck?
**Immunosupression**
45
46
* **Hairy leukoplakia** is caused by what virus?
* Found where in oral cavity?
* Oral manifestation of what systemic diseases?
- **EBV =\> squamous cell hyperplasia (**NOT pre-malignant and no dysplasia occurs)
- white, fluffy (hairy), hyperkeratotic patches on l**ateral border of the tongue**
**- Immunosupression (AIDS);**
47
It is __________ for oral lesions to be the 1st sign of some underlying systemic condition.
**common**
48
**Hairy leukoplakia** is characterized by what 2 distinct microscopic features?
* 1. **Hyperparakeratosis**
* 2. **Acanthosis (diffuse epidermal hyperplasia)** with "balloon cells" in the upper spinous layer
49
How is oral hairy leukoplakia different than candida in how it looks?
Oral hairy leukoplakia **CANNOT** be scraped off.
50
\_\_\_\_\_\_\_\_\_\_\_\_\_ are oral mucosa lesions that can undergo **malignant transformation (dyplasia)** to **squamous cell carcinoma**
**Leukoplakias** and **erythroplakias**
both precursor lesions
51
\_\_\_\_\_\_\_\_ is a **white patch** or **plaque** with **SHARP borders** that cannot be scraped off and cannot be characterized clinically or pathologically as another other disease.
**Leukoplakia**
Plakia = plate or flat plane
52
Until proven otherwise, **all** **leukoplakias** must be considered \_\_\_\_\_\_\_\_\_\_.
**Precancerous** (up to 25% are precancerous)
53
What is a **erythroplakia?**
How is it different from leukoplakia?
* **Red, velvety eroded patch** in the oral cavity that is at **level** or a **little depressed** with surrounding mucosa.
* Different from leukoplakia:
* **less common**
* **epithelium** is **VERY atypical**
* **malignant transformation is HIGHER.**
54
What are the histological changes of the epithelium seen in virtually all (90%) of **erythroplakia**?
1. Severe dysplasia
2. Carcinoma in situ
3. Minimally invasive carcinoma
55
What are the histological changes of the epithelium in **leukoplakias**?
**Hyperkeratosis** over a **thick, orderly acanthotic mucosal epithelium**, but can undergo severe dysplasia and become CIS.
56
Around **95% of the cancers** of the head and neck are of which type?
Remainder largely consists of which type?
* - **Squamous Cell Carcinoma (SCC)** = majority (95%)
* - **Adenocarcinomas of salivary gland** = remainder
57
The pathogenesis of **squamous cell carcinoma** is \_\_\_\_\_\_\_\_\_\_\_\_.
**_Multifactorial_**
1. **Smoked tobacco** & **alcohol**
2. **HPV (in oropharynx)**
3. **Betel quid** & **paan** (in **India** & **Asia**)
58
What are predisposing risk factors of **squamous cell carcinoma** of the **lower lip?**
1. **Actinic radiation (sunlight)**
2. **Pipe smoking**
59
The incidence of **oral cavity SCC** (particulary the tongue) is on the rise in whom?
**Ppl \< 40 YO** with **no known risk factors**
60
In the oropharynx, as many as **70% of SCCs,** particularly those involving the [**tonsils**, **base of the tongue**, and the **pharynx**] harbor what?
- Oncogenic variants of **HPV**
- Particularly **HPV-16**
61
Unlike the \_\_\_\_\_\_\_\_, **HPV-associated SCC** of the oral cavity is \_\_\_\_\_\_\_\_.
**oropharynx**
**uncommon**
62
_Survival of SCC is dependent on a number of factors including the etiology of SCC._
## Footnote
What is the prognosis (5-year survival rate) of the "classic" (smoking and alcohol related) early-stage SCC?
Late stage?
- **Good (80%)**
## Footnote
**- 20%**
63
Patients with **HPV (+) SCC** have _______ long-term survival than those with **HPV (-) tumors?**
**BETTER** prognosis if p16+
- HPV (-) = worse prognosis
64
What is the basis of **"Field Cancerization"**?
* After repeated carcinogenic exposure, the entire superficial epithelium of the upper aerodigestive tract has a ↑ risk of developing pre-malignant lesions as a result of multiple genetic abnormalities
* Development of tumors **decreases survival.**
65
The 5-year survival rate of the first primary tumor is \_\_\_\_\_\_\_, but in the same people, second primary tumors are \_\_\_\_\_\_\_\_\_\_\_.
* better than 50%
* most common cause of death
66
Which genetic mutations are commonly associated with the **"classic - tobacco/alcohol" SCC subset**?
1. **p53 pathway**
2. Proteins that regulate squamous cell differentiation **(p63 and NOTCH1)**
67
What is typically overexpressed in **HPV-associated SCC's**?
Other common genetic alterations?
**Have fewer and different genetic alterations.**
1. **p16** (cyclin dependent kinase inhibitor) **overexpression**
2. **p53 inactivation** --\> E6 expression
3. **RB inactivation** --\> E7 expression
68
What is the molecular progression of **oral** **SqCC**?
Does it always progress in this manner?
**NL** =\> hyperplasia/hyperkeratosis =\> mild/moderate dysplasia =\> severe dysplasia/CIS =\> **SCC**
No, not always linear over a uniform period or time.
69
What is the most common genetic alteration associated with
1. **NL** =\> hyperplasia/hyperkeratosis and mild/mooderate dysplasia?
2. **Mild/moderate dysplasia** =\> severe dysplasia/CIS?
3. **Severe dysplasia/CIS** =\> SCC?
1. 9p21 (**p16)**, **3p**
2. **TP53**
3. **Cyclin D (11q13);** 4q, 6p, 8p, 13q, 14q
70
What is the typical age of onset and sex most affected by leukoplakia and erythroplakia?
**- Age 40-70**
**- M 2x** more than **F**
71
What are the 5 favored locations in the oral cavity for the development of **classic SCC**?
1. Ventral surface tongue
2. Floor of mouth
3. Lower lip (associated w/ sun exposure and pipe smoking)
4. Soft palate
5. Gum
72
What is the morphology of **oral SCC** in the early stage?
* _1. Raised, firm, pearly plaques_
* _2. Irregular, roughened or verrucous areas of mucosal thickening_ _(_may look like leukoplacia)
that are superimposed on obvi leukoplakia or erythroplakia
73
As early stages of **SCC carcinoma** enlarge, what do they look like?
**Ulcerated**, **protruding** mass that have **irregular and indurated (rolled) borders.**
74
What is the difference in progression of oral SCC and cervical cancer?
* **Oral SCC:** dysplastic lesions **MAY OR MAY NOT** progress into full-thickness dysplasia (CIS) before invading underlying CT.
* **Cervical cancer:** [full thickness dysplasia =\> invasion].
75
Is the degree of keratinization in **oral SCC** correlated with behavior?
**No.**
76
What are the favored sites for local metastasis of **oral SCC**?
Favored sites for distal metastasis?
- **Local** ---\> cervical LN's
- **Distal** ---\> mediastinal LN's, lungs, liver, and bones
* Often, when primary lesion is found distant metaseses has occured.
77
Overwhelming majority of **odontogenic cysts** are derived from what?
Remant of odontogenic epithelium within jaws.
78
Which type of **cyst** occurs when fluid accumulates between developing tooth and dental follicle, forming a cyst originating around the crown of an unerupted tooth?
**Detingerous cyst**
79
Radiographically, **dentigerous cysts** are seen as what type of lesions and most often associated with which teeth?
Treatment?
* **- Unilocular lesion**
* **- Impacted third molar (wisdom) teeth**
* - **Complete removal = curative**
80
What is the significance of **Keratocystic Odontogenic Tumors (OKC's)**?
Must be differentiated from other cysts due to its **aggressive behavior**
81
**Keratocystic Odontogenic Tumors (OKC's)** are most often diagnosed between what ages and which sex is more commonly affected?
Form where in the oral cavity?
- **Ages 10-40 yo;** most often in **males**
- **Posterior mandible**
82
How do you ID **OKC's** radiographically and histologically?
* Radiographically
* Well-defined unilocular or multilocular
* Histologically
* Cyst is lined by thin layer of keratinized stratified squamous epthilium with a prominant basal layer and corrugated epithelial surface
83
Multiple Keratocystic Odontogenic Tumors (OKC's) occuring in a patient should prompt evaluation for what?
Nevoid basal cell carcinoma **(Gorlin syndrome);**
mutation in tumor suppressor PTCH on Chr 9q22
84
Tx of **OKC**
**Surgical removal,** because they are locally agressive and recurr
85
What is **xerostomia**?
**↓ production of saliva,** causing dry mouth and/or atrophy of papillae on the tongue with fissures and ulcers.
86
**Xerostomia** is a major feature of?
**Sjorgren Syndrome**
87
Complications of **Xerstomia** include increased rates of?
1. **Dental carries**
2. **Candidiasis**
3. **Difficulty swallowing** and **speaking**
88
**Xerostomia** is most frequently a side-effect of what?
**_Meds_**
1. Anti-cholinergic
2. Anti-depressant
3. Ant-psychotic
4. Diuretic
5. Anti-HTN
6. Sedative, muscle rexant, analgesic
7. Anti-histamine
89
\_\_\_\_\_\_\_\_\_\_ is an inflammation of the salivary glands, caused by what?
**Sialadenitis,** caused by trauma, infection or AI reaction
90
What is the most common type of **inflammatory** salivary gland lesion?
**Mucoceles**
91
* **Mucoceles** are caused by what?
* Most commonly found where in oral cavity and due to what?
* **Trauma** or **blockage** of a salivary gland duct, causing saliva to leak into the surrounding CT stroma.
* Most often _LOWER LIP_ due to TRAUMA
92
How do **mucoceles** present clinically (i.e., how do they look on examination)?
Patients often report what in regards to the size of the lesion?
- Fluctuant swellings of lower lip that have a blue translucent hue
- Often report hx of changes in size in assoc. w/ meals
93
What is the histological characteristics of **Mucoceles**?
Most common inflammatory cell present?
- Pseudocysts w/ cyst-like spaces, filled with mucin, lined by granulation tissue or fibrous CT
- **MACROPHAGES**
94
What is the Tx for **Mucoceles**?
Complete excision of the **cyst** and its accompanying minor salivary gland
95
What is a **Ranula**?
Epithelial-lined cysts that arise when duct of **sublingual gland** has been damaged
96
a 45 YO F presents with dry mouth followed by pain. Pain increases when eating. PMH dx Sjrogens sundrome. Which duct is asspocated with the involved gland?
## Footnote
***Secretion of which of the following is most likely affected?***
**Stensen's**
97
1. **Parotid gland** secretes what?
2. **Submucosa layer** of the tongue secretes what?
1. **Salivary amylase**
2. **Lingual lipase**
98
The prescence of **xerostomia** in **BMS** (**burning mouth syndrome**) suggests what?
The disease may involve **hypofunctioning of the parasympathetic NS**, a target of OMT to normalize activity.
99
**Bacterial sialadenitis**, most often involves the __________ glands and is a common condition secondary to \_\_\_\_\_\_\_\_\_\_\_
Bacterial sialadenitis, most often involves the **submandibular gland**s and is a common condition **secondary to sialolithiasis (ductal obstruction by stones)**
100
What are the 2 most common organisms responsible for **sialolithiasis** leading to sialadentitis?
Unilateral or bilateral process?
**1) S. aureus**
**2) S. viridans**
- UNILATERAL -
101
A patient presenting with **unilateral**, sialadentitis with **overt suppurative necrosis and abscess formation** should raise suspicion of?
**Sialolithiasis** causing sialadentitis, likely due to S. aureus or S. viridans.
102
Overall, **salivary gland neoplasms** are _______________ and occur in whom?
What is the difference between when benign and malignant tumors appear?
**- Relatively uncommon**
**- Adults (F)**
**- Benign (50-70s); malignant (later)**
103
The likelihood of a salivary gland tumor being malignant is more or less ___________ proportional to the size of the gland
* **Inversely**
* **\*Smaller the gland = higher risk of malignancy**
104
Majority of salivary gland tumors arise where?
**Parotid gland**
105
What is the most common tumor of the salivary gland and is it benign or malignant?
**Pleomorphic adenoma** -- 50% of benign tumors, but 60% of tumors in parotid.
106
**Pleomorphic adenomas** contain a mixture of _________ and _________ cells
Pleomorphic adenomas contain a mixture of **ductal (epithelial)** and **myoepithelial cells**
* \*MIXED tumor
107
Exposure to what increases risk for **Pleomorphic Adenomas**?
Associated with what genetic mutation?
- **Radiation**
- **PLAG1 overexpression** --\> ↑ cell growth
108
How do **pleiomorphic adenomas** present clinically (i.e., mass where, any pain, and rate of growth)?
* **Painless**, **slow-growing**, **mobile**, **discrete masses** in the _parotid/__submandibular gland_ or in the **buccal cavity**
109
What type of tumor is shown here and how can you tell?
* **Pleomorphic adenoma**
* DOMINANT histological feature = **GREAT heterogeneity**
* Well-demarcated tumor w/ epithelial cells and myoepithelial cells arranged in ducts, strands or sheets within a chondroid matrix.
110
In most cases of **pleomorphic adenoma,** is there epithelial dysplasia or mitotic activity?
**No**
111
What is the prognosis of a **malignant pleomorphic adenoma** (i.e., carcinoma ex pleomorphic adenoma)?
- Most aggressive of all salivary gland tumors
- Mortality rates of 30-50% at 5 years
112
Which **benign** tumor almost always occurs in the **parotid gland**?
**Warthin Tumor** (aka papillary cystadenoma lymphomatosum): a cystic tumor with alot of lymphocytes + germinal centers that almost ALWAYS occurs in parotid gland
113
When do **Warthin tumors** usually arise?
Which sex is most affected?
What is a major risk factor?
- **50-70s**
- **Males**
- **Smokers** have 8x the risk
114
What are some of the distinct morphological characteristics of a **Warthin tumor**?
- Round to oval encapsulated mass (2-5 cm in diameter) in superficial parotid gland
- Lined by double layer of cells resting on dense lymphoid stroma, sometimes w/ GERMINAL centers
* Upper layer = palisading columnar cells w/ abundant, finely granular, eosinophilic cytoplasm.
* Granular bc many mT (oncocytic)
* Lower layer = cuboidal to polygonal cells
115
What is the reason for the granular appearance of the cytoplasm in the upper layer of cells seen in **Warthin Tumors?**
**NUMEROUS mitochondria**, feature referred to as "oncocytic"
116
What is the most common primary **malignancy** of the **oral mucosal**?
**Mucoepidermoid carcinoma** (makes up 15% of all salivary gland tumors)
117
Where do **mucoepidermoid carcinom**a occur most often?
**60-70%** occur in **parotid gland**, but also minor salivary glands
118
Which genetic mutation (i.e., translocation and gene products) is thought to play a key role in **Mucoepidermoid carcinoma?**
- **Balanced (11;19) (q21;p13) translocation,** creating **MECT1-MAML2 fusion gene.**
119
The prognosis of **mucoepidermoid carcinoma** depends on what?
**GRADE**
120
What are the histological characteristics of a **mucoepidermoid carcinoma**?
How large do they grow?
- Cords, sheets, or cystic configurations of **squamous**, **mucous**, or **intermediate cells**
- Grow to 8 cm in diameter and are **circumscribed**, but **lack well-defined capsules** and are **infiltrate** at margins
121
Which stain helps to visualize a **mucoepidermoid carcinoma?**
**Mucin stains**
122
What is the prognosis of both low-grade and high-grade Mucoepidermoid Carcinomas?
- **Low grade** ---\> 5-year survival of **90%**
- **High grade** ---\> 5-year survival of **50%**
123
**Adenoid cystic carcinoma** is most often seen where?
- **Minor salivary glands** (particularly the *palatine glands); 50%*
- May also be seen in major salivary glands (parotid and submandibular)
124
What is the morphology of **Adenoid cystic carcinomas?**
- Small, poorly encapsulated, infiltrative, gray-pink lesions that create a a cribiform pattern
- Small cells w/ dark, compact nuclei and scant cytoplasm
125
**Describe the cancer seen here and its distinct morphology.**
Adenoid cystic carcinoma of the salivary gland creating a **Cribiform pattern**
\*Gaps between the cancer cells within the duct, with an appearance similar to the ‘holes in swiss cheese‘ or perhaps ‘ripples‘.
126
**Adenoid cystic carcinomas** cause what distinct symptom?
**Pain**, bc invade perineural spaces and metastize to bone, liver, and brain
127
