head and neck -- oral and salivary gland pathology

Question 1

What structures fall under the realm of head and neck?

Answer 1

Everything that touches air or food:

• oral cavity
• upper resp. tract
• ears
• nose
• salivary glands

Question 2

True/False….All mucosa within ENT domain behaves the same toward degenerative, inflammatory, and neoplastic incluences.

Answer 2

True. And they all have a thicker squamous mucosa to deal with contact with any non-air/food

Question 3

Which cells make the enamel for teeth?

Answer 3

amelioblasts

Question 4

How does tooth decay (or caries) occur?

Answer 4

• sugar is present in the oral cavity
• bacteria (strep mutans or lactobacilli) convert the sugar to acid
• acid degrades the teeth

Question 5

What results from buildup of bacteria/cells/proteins around the teeth?

Answer 5

plaque/calculus/tartar

Question 6

What is the difference between an irritation fibroma and pyogenic granulation?

Answer 6

fibroma is not well vascularized, will not blanch.

granuloma will blanch.

Question 7

How is a Tzanck test performed and what constitutes a positive?

Answer 7

blood smear to identify a herpetic lesion. gently scrape a vesicle, smear it, stain with about anything, examine.

looking for squamous cells with much larger than usual nuclei and inclusions. probably surrounded by PMNs.

Question 8

What type of mucosa does candida love?

Answer 8

moist, non-keratinized stratified squamous cell mucosa (mouth, vagina, genital skin)

Question 9

What treats candida very well?

Answer 9

gentian violet

Question 10

What is the Periodic acid–Schiff (PAS) staining method useful for?

Answer 10

good for polysaccharides, glycoproteins, and glycolipids in tissues.

also, stains yeasts and pseudo-hyphae (non-septate hyphae) a bright red.

Question 11

What could basic leukoplakia mean? What about hairy leukoplakia?

Answer 11

Basic could mean anything from nothing to sever.

Hairy almost always means HIV.

Question 12

What is the progression from normal tissue to SCC?

Answer 12

NORMAL | DYSPLASIA | CARCINOMA-IN-SITU (severe dysplasia) | INFILTRATING MALIGNANCY (into basement membrane)

Question 13

What is the classic presentation of infiltrative SCC of the mouth?

Answer 13

a plaque w/ ulceration and induration under the ulcer bed

Question 14

Where would you take the biopsy from an oral SCC (center or edge)?

Answer 14

From the edge…center is necrotic.

Question 15

What are three forms of SCC differentiation and what are the histologic findings with each?

Answer 15

• well: pearls
• moderate: intercellular bridges
• poor: can’t even tell it’s squamous (mayhem)

Question 16

What are the three major salivary glands?

Answer 16

parotid
submandibular
sublingual

Question 17

True/false: salivary glands are sensitive to inflammatory processes and the development of neoplasms

Answer 17

true

Question 18

What are some conditions which may produce salivary enlargement?

Answer 18

• Bacterial infection
• Viral infection (such as Mono or Mumps)
• Tuberculosis
• Sjogren’s syndrome
• Sarcoidosis
• Alcoholism
• Tumors (although salivary gland enlargement is usually nonneoplastic)

Question 19

What are the risk factors for salivary gland stones (sialolithiasis)?

Answer 19

obstruction (food/edema/cellular debris)
prior trauma
duct dehydration

Question 20

What is sialadenitis? What causes it? What is the distribution pattern?

Answer 20

inflammation of a salivary gland (with or without supra-infection). can be acute, chronic, or recurrent

frequently due to obstruction (such as a stone), bacteria/viral infx, trauma, autoimmune.

usually unilateral involving a single gland

Question 21

What is a common finding with chronic sialadenitis

Answer 21

squamous metaplasia of an interlobular duct

Question 22

What is the most common form of viral

sialadenitis?

Answer 22

Secondary to mumps

Question 23

What is the most common form of salivary duct calculi?

Answer 23

calcium phosphate stones

Question 24

In which gland are stones most commonly found?

Answer 24

submandiblar

Question 25

What is the classic place for ANY visible parotid swelling or tumor to present?

Answer 25

between the tip of the ear and the tip (angle) of the mandible.

Question 26

What is Mikulicz syndrome and what potentially causes it?

Answer 26

Combination of salivary and lacrimal gland enlargement (usually painless) plus xerostomia (dry mouth). Potential etiologies include but are not limited to leukemia, lymphoma, Sjogren, sarcoidosis, and other granulomatous diseases.

Question 27

Which autoimmune condition has a major feature of xerostomia?

Answer 27

Sjogren's (usually with dry eyes)

Question 28

What type of duct is involved in the formation of a mucocele and where do they typically occur?

Answer 28

Salivary gland duct. | Usually on the lower lip.

Question 29

What are mucoceles filled with? Lined with?

Answer 29

Filled with mucin, lined with inflammatory granulation or fibrous connective tissue

Question 30

How to get rid of mucocele?

Answer 30

Most resolve spontaneously. If not, cut it out. If excision is incomplete, it will likely grow back.

Question 31

W/r/t salivary neoplasms and Warthin tumors: Do they tend toward males/females? During which decades of life do benign and malignant tumors tend to present?

Answer 31

Salivary neoplasms: slight female dominance Warthin tumors: much more often males Benign tumors: 50s-70 Malignant tumors: 70+

Question 32

What is the ONLY clearly associated risk factor for salivary gland malignancy?

Answer 32

Head/neck radiation (like in cancer tx)

Question 33

Know the percentage of tumors that are malignant for parotid, submandibular, minor salivary, and sublingual glands

Answer 33

parotid: 15-30% (least likely to be malignant) submandibular: 40% minor salivary: 50% sublingual glands: 70-90% (almost all are)

Question 34

What form of cancer are all salivary gland malignancies?

Answer 34

Adenocarcinoma...they're all glands.

Question 35

What are the most common benign salivary tumors?

Answer 35

Mixed (pleomorphic adenoma) and Warthin's

Question 36

Which specific gland gets most salivary gland tumors?

Answer 36

Parotid

Question 37

With pleomorphic adenomas, how does the risk of malignancy change over time?

Answer 37

2% risk if less than 5 years, if it lasts 15 years there's a 10% risk.

Question 38

What is the 5-yr survival rate for salivary gland adenocarcinomas?

Answer 38

30-50%