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Oral medicine > key points to learn SGs > Flashcards

key points to learn SGs Flashcards

1
Q

SG tumours by incidence

A 
pleomorphic adenoma
Warthin's tumour
adenoid cystic carcinoma
mucoepidermoid carcinoma
acinic cell carcinoma
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2
Q

pleomorphic adenoma location

A

PAROTID
(SM)
(minor - palate)

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3
Q

pleomorphic adenoma clinical

A

unilateral
painless
slow-growing
not fixed to underlying tissues

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4
Q

pleomorphic adenoma histology

A

epithelial: ducts/cystic
myoepithelial cells
stroma: myxomatous - CT
fibrous tissue capsule - often incomplete

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5
Q

pleomorphic adenoma tx and recurrence

A

surgery
recurrence - incomplete capsule
risk of malignant transformation 3-13%

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6
Q

Warthin’s tumour location

A

PAROTID

(SM)

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7
Q

Warthin’s tumour clinical

A

smoking
can be bilateral and multifocal
painless
slow-growing

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8
Q

Warthin’s tumour histology

A

well-defined CT capsule
epithelial tissue, cystic formations
dense lymphoid tissue stroma
- germinal centres

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9
Q

Warthin’s tumour - where is it thought to arise from?

A

remnants of salivary duct epithelium trapped in LNs during embryogenesis

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10
Q

Warthin’s tumour tx and recurrence

A

surgery (/monitor)
low recurrence rate
1% malignant transformation of epithelial component

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11
Q

Adenoid cystic carcinoma location

A

most common minor malignancy - palate

can get major

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12
Q

Adenoid cystic carcinoma clinical

A 
asymptomatic
can get ulcer
perineural invasion - neuropathies - parotid facial n palsy
slow growing
invasive
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13
Q

Adenoid cystic carcinoma histology

A 
cribiform
tubular
solid
swiss cheese
no capsule
perineural invasion
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14
Q

Adenoid cystic carcinoma tx and recurrence

A

surgery and radio
poor prognosis - local recurrence - hard to determine clinically how far tumour has spread
haematogenous spread to lungs most common

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15
Q

mucoepidermoid carcinoma location

A

50% parotid

minor - palate

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16
Q

mucoepidermoid carcinoma clinical

A 
swelling
pain
ulcer
infiltration
discolouration
facial paralysis
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17
Q

mucoepidermoid carcinoma histology

A

mucin secreting cells
intermediate cells
epidermoid cells
perineural spread

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18
Q

mucoepidermoid carcinoma tx

A

surgery and radio

high grade poorer survival

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19
Q

acinic cell carcinoma location

A

parotid >80%

can be bilateral

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20
Q

acinic cell carcinoma clinical

A

slowly enlarging
few symptoms
occ involves nerves / regional nodes
invasive

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21
Q

acinic cell carcinoma histology

A

serous acinar cell differentiation
clear/vacuolated cells
intercalated duct like cells
non-specific glandular cells

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22
Q

acinic cell carcinoma tx

A

slow growth, good prognosis

surgery

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23
Q

sialectasis

A

cystic dilatation of duct

24
Q

extrasalivary manifestations of mumps

A

oophoritis
orchitis
pancreatitis

25
Q

mumps clinical

A

bilateral enlargement parotid
pain
skin over unaffected
malaise, fever, headache

26
Q

mumps histology

A

accumulation of neutrophils and fluid in lumen of ductal structures

27
Q

acute bacterial sialadenitis clinical

A 
one gland
pus discharge
redness of overlying skin
trismus
pyrexia
28
Q

acute bacterial sialadenitis histology

A

acinar destruction with neutrophil infiltrates and bacterial presence

29
Q

acute bacterial sialadenitis underlying cause

A 
ALWAYS
dehydration and flow reduction
flow obstruction
DM
immune suppression
abnormal anatomy
hospital pts
SS
elderly
HandN radio
30
Q

mucocele recurrence

A

esp if traumatic habit persists

RFs = younger pt, ventral tongue

31
Q

mucocele histology

A 
vascular GT surrounding a mucus pool
foam cells
macrophage lined cavity
cystic cavity
severed duct if trauma
32
Q

sialolithiasis clinical

A 
unilateral SG swelling
worst pain periprandial
painful 
intermittent
affected gland can get infected - suppurative sialadenitis
33
Q

sialolithiasis histology

A

calcified structure
dilated ducts with calculi
chronic inflammatory cells
metaplasia of lining from columnar to SSE - irritation from stone

34
Q

sialolithiasis diagnosis

A 
hx
attempt to palpate calculus
radiograph - not always
sialography
CT - check for other causes of obstruction
35
Q

sialolithiasis tx

A 
conservative
 - moist heat and gentle massage
 - hydration
 - sialogogues e.g. lemon drops - try to remove it if in proximity of exit
 - NSAIDs
 - AB if infection
surgery
lithotripsy
sialendoscopy
surgical removal of gland - recurrent stones/irreversible damage to gland
36
Q

sialosis

A

non-inflammatory, non-neoplastic, chronic, diffuse enlargement of major SGs
painless
bilateral
can be reactive mechanism e.g. EDs/alcoholism
clinical diagnosis
no tx

37
Q

sialosis histology

A

hypertrophy of serous acini

oedema of interstitial CT

38
Q

causes of xerostomia

A 
dehydration
psychological
mouth breathing
neurological dysfct
disease e.g. SS, sarcoidosis
meds - tricyclics, antihistamines, diuretics
SG tumour
SG trauma
nutritional deficiencies and/or EDs
39
Q

pilocarpine dose

A

5mg up to 30mg

40
Q

pilocarpine contraindications

A 
iritis and narrow angle glaucoma
CV disease
chronic pulmonary disease inc uncontrolled asthma
pts taking B adrenergic blockers
active gastric ulcers
41
Q

pilocarpine SEs

A 
vision changes
hiccups
bradycardia
hypotension
bronchoconstriction
hyperhidrosis
nausea, vomiting, diarrhoea
cutaneous vasodilation
increased urinary freq
42
Q

frey’s syndrome

A

gustatory sweating

excision from parotid gland and damaged nerve fibres

43
Q

indication of malignant change

A

rapid growth
pain
fixation to deep tissues
facial palsy

44
Q

acute necrotising sialometaplasia process

A

vascular damage of palatine vessels

ischaemic necrosis and infarction of minor SGs

45
Q

acute necrotising sialometaplasia histology

A

hyperplasia
metaplasia of ducts
necrosis of salivary acini

46
Q

sarcoidosis

A

collections of granulomas

can occur in any organ but often affect SGs causing large masses and facial palsy

47
Q

duct atresia

A

failure of a duct to canalise

can result in salivary retention cysts

48
Q

HIV

A

parotid enlargement in 10% pts

49
Q

CF

A

causes plugging of acinar ducts with precipitated secretions

essentially microscopic sialoliths

50
Q

gland infiltration - amyloidosis

A

build up of amyloid protein fibrils

lymphoepithelial cysts

51
Q

aplasia

A

congenital absence of 1 or more SGs

ectodermal dysplasia

52
Q

why are SG tissues sensitive to radio?

A

because of their highly differentiated and specialised state

- not because of high mitotic figures

53
Q

SG and chemo

A

reduced secretion

early apoptosis of SG cells

54
Q

radioiodine

A

reduction of gland fct

increased lymphocytic infiltrate

55
Q

SS investigations

A 
1 - dry eyes subjective
2 - dry eyes objective
3 - dry mouth subjective
4 - dry mouth objective
5 - autoAB findings
6 - HP
American european consensus group revised international criteria
4 or more positive criteria (must inc 5 and/or 6)
56
Q

SS minor gland histology

A 
focal lymphocytic sialadenitis
 - focal collections of 50+ lymphocytes
 - ≥1 collection/4mm2
acinar loss
fibrosis
57
Q

SS major gland histology

A

lymphocytic infiltration
atrophy of acini
ductal epithelium shows hyperplasia which eventually occludes ducts - myoepithelial islands

Oral medicine (14 decks)

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