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Oral pathology > OP19 non-neoplastic diseases of salivary glands > Flashcards

OP19 non-neoplastic diseases of salivary glands Flashcards

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1
Q

What are the major salivary glands?

A

Parotid, submandibular, sublingual

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2
Q

How are salivary glands arranged?

A

Structurally a series of branched ducts terminating in a spherical or tubular secretory piece of acini.

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3
Q

What are the 4 components/cells of salivary glands?

A

Mucous acinar cells, serous acinar cells, ductal cells, myoepithelial cells

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4
Q

What is the order of the ducts and how are they arranged in normal salivary glands?

A

Intercalated ducts –> striated ducts –> excretory ducts
The predominant ductal component = striated = where saliva is modified
Ducts between acini are intercalated

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5
Q

What are the excretory ducts for each gland?

A

Stenson for parotid, Wharton for submandibular, Rivinus for sublingual

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6
Q

What are the types of acinar secretory cells?

A

Serous, mucous, or mixed

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7
Q

What is the role of myoepithelial cells?

A

Associated with acini and intercalated ducts.
Epithelial in origin but have contractile proteins, can squeeze acini and intercalated ducts to secrete saliva

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8
Q

What do plasma cells do in salivary glands?

A

Type of B lymphocyte, normal residents producing IgA

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9
Q

What might be stained on a SMA (actin) stain of salivary glands?

A

Microfilament characteristic

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10
Q

Is the parotid gland mainly serous or mucous?

A

Mainly serous secretory units

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11
Q

Is the submandibular gland mainly serous or mucous?

A

Mixture of serous and mixous
Either ‘mixed’ units or pure mucous and pure serous

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12
Q

Is the sublingual gland mainly serous or mucous?

A

Mucinous acini predominate
Poor H&E staining

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13
Q

What colour do mucous vs serous glands stain and why?

A

Serous cells contain many zymogen granules - darkly staining and contain proteins
Mucous is lighter

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14
Q

What is the general architecture of saliva glands?

A

Lobules each contain many secretory units
Connective tissue septa radiate between lobules from the outer capsule and convey blood vessels, nerves and large excretory ducts

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15
Q

What are some developmental anomalies of salivary glands?

A

Aplasia, ductal atresia, heterotropic salivary tissue

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16
Q

What is aplasia?

A

Failure to develop
No saliva secreted, rare

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17
Q

What is ductal atresia?

A

Absence of a normal opening or failure of a structure to be tubular, rare

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18
Q

What are examples of heterotopic salivary tissue (eg choristoma)?

A

Peri-parotid lymph nodes, other parts of head and neck
Accessory parotid tissue within masseter or cheek is common
Stafne’s idiopathic bone cavity

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19
Q

What are the different types of sialadenitis (inflammation of SGs)?

A

Bacterial, viral, post-irradiation, sarcoidosis

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20
Q

What is acute bacterial sialadenitis caused by?

A

Mostly in parotid by Strep pyogenes and Staph aureus

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21
Q

How does acute bacterial sialadenitis occur?

A

As a postoperative complication in dehydrated/debilitated patients (not anymore)

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22
Q

How does acute bacterial sialadenitis present clinically?

A

Main factor = reduce salivary flow
Clinically - rapid onset, swelling, pain, fever, redness, pus from affected ducts

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23
Q

What glands does chronic bacterial sialadenitis most commonly affect and what is it associated with?

A

Submandibular
Usually non-specific, associated with duct obstruction, unilateral, purulent discharge

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24
Q

What happens in chronic bacterial sialadenitis to the salivary gland?

A

Chronic inflammation leads to fibrous replacement of parenchyma
(firm like a neoplasm: chronic sclerosing sialadenitis)

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25
What is the histology of chronic bacterial sialadenitis?
Ductal hyperplasia, periductal fibrosis, acinar atrophy, fibrosis replacement, lymphocytic/plasma cell infiltration
26
What causes viral sialadenitis?
Mumps - acute contagious infection caused by a paramyxovirus, common
27
What are the prodromal symptoms of mumps?
2-3 weeks: fever, malaise, then painful swelling of salivary glands. 70% parotid, subsides in 7 days
28
What is tx for mumps?
No tx, immunity from vaccine is long lasting and recurrence is rare
29
What other organs can be involved in mumps?
Testes, ovaries, pancreas, CNS
30
What is cytomegalic inclusion disease caused by?
Infection with cytomegalovirus (CMV or HHV-5)
31
What is cytomegalic inclusion disease?
Primary infection is asymptomatic, but can cause severe disease in neonates, immunocompromised and HIV + --> disseminated to kidney, liver, brain, lungs etc. Lethal multi-organ involvement (associated with xerostomia in HIV-infection)
32
What is histology of cytomegalic inclusion disease?
Owl-eye inclusion bodies in nucleus or cytoplasm of duct cells
33
What is postirradiation sialadenitis?
A common complication of radiotherapy esp head and neck cancer, causing persistent xerostomia
34
What is the correlation between dose and gland damage?
Direct correlation between irradiation dose and gland damage Epithelial cells are generally sensitive to radiation, so not only mucosa but salivary gland is reduce
35
Is the damage from postirradiation sialadenitis reversible?
Damage is often irreversible due to fibrous replacement of acini
36
Which acini are more sensitive to radiation?
Serous acini are more sensitive to radiation than mucous acini
37
What is sarcoidosis?
Chronic condition of unknown aetiology causing bilateral hilar lymphadenopathy, pulmonary infiltration, skin and eye lesions Malaise, cough, arthralgia, shortness of breath
38
What is the histology of sarcoidosis?
Non-caseating granuloma, no acid-fast organisms (mycobacterium)
39
What can be seen in a blood test for sarcoidosis?
Increased erythrocyte sedimination rate
40
What happens in Heerfordt syndrome?
When sarcoidosis presents with uveitis, parotitis (persistent enlargement), facial paralysis, fever
41
What are some obstructive/traumatic diseases of salivary glands?
Sialoliths, mucous cysts, necoritisng sialmetaplasia
42
What are sialoliths?
Salivary calculi
43
Where are sialoliths most frequent?
Submandibular parotid>sublingual>minor
44
What do calculi usually look like and what are they made up of?
Yellow brown, round, ovoid Homogenous or lamellated structure Calcium phosphate deposition on an organic nidus (mucin, desquamated cells, microorganisms)
45
Are sialoliths associated with hypercalcaemic syndromes?
No, local, not to do with blood Ca content
46
What can the duct epithelium around sialoliths exhibit?
Squamous and mucous cell metaplasia
47
What are mucous extravasation cysts?
Rupture (trauma) or salivary gland duct, spillage of mucin Not a true cyst Dome shaped mucosal (recurrent) swelling 1mm-3cm Common in young patients, common in lower lip (since associated with trauma which is more common here than upper) Superficial (bluish), deep (normal colour) Superficial mucoceles – similar to vesiculobullous disorder
48
What is histology of mucous extravasation cyst?
Area of spilled mucin Surrounded by granulation tissue Inflammatory cells and 'foamy' histiocytes (macrophages) Sometimes ruptured duct present
49
What are mucous retention cysts?
 Epithelium lined cavity arising from salivary gland tissue (major or minor)  Cause uncertain but ? obstruction and increased intraluminal pressure  Salivary duct ectasia rather than true cyst  Usually patients >50  Almost never on the lip  Cystic dilation of duct, no chronic inflammation  Tx and prognosis: conservation excision/remove calculus/may remove gland
50
What is histology of mucous retention cysts?
Adjacent normal excretory duct in continuity with surface epithelium Lining consists of double layer of low cuboidal to columnar cells Lack of inflammatory response
51
What is necrotising sialometaplasia?
Clinically looks like a deep crater-like ulcer, taking 10-12 weeks to heal, sometimes preceded by an indurated swelling Unknown aetiology, uncommon, sometimes history of trauma
52
Where does necrotising sialometaplasia present?
Hard palate usually
53
Why is biopsy essential in necrotising sialometaplasia?
Clinically might mimic a malignant tumour, so biopsy is essential
54
What is the histology of necrotising sialometaplasia?
Necrosis of the gland tissue, squamous metaplasia of ducts and acini, mucous extravasation and inflammatory infiltration. Covering epithelium may show pseudo-epitheliomatous hyperplasia.
55
What is pseudoepitheliomatous hyperplasia?
Hyperplasia where cells proliferate and look like invading islands but are not malignant. Problematic. Cells do not show abnormal mitoses etc so clear investigation is required.
56
What are the immunological diseases of salivary glands?
Sjogren's syndrome, myoepithelial sialadenitis (MESA)
57
What is Sjogrens syndrome?
Chronic autoimmune disease causing xerostomia and xerophthalmia
58
What is the difference between primary and secondary SS?
Primary has no involvement of other autoimmune disease Secondary does, commonly RA
59
What symptoms does sjogrens cause?
Difficulty in swallowing, speaking, taste, dysfunction, oral candidosis, caries, bacterial sialadenitis, denture retention Red atrophic tongue, fissuring, salivary gland enlargement
60
What happens to the salivary glands and other exocrine glands in Sjogrens?
Lymphocytic infiltration and acinar destruction of lacrimal and salivary glands
61
What might sjogrens progress to?
B cell malignant lymphoma
62
To diagnose Sjogrens it must fit 4 out of the 6 of the following criteria:
 I. Ocular symptoms * Daily, persistent, troublesome dry eyes for more than 3 months? * Recurrent sensation of sand or gravel in the eyes? * Use tear substitutes more than 3 times a day?  II. Oral symptoms * Daily feeling of dry mouth for more than 3 months? * Recurrently or persistently swollen salivary glands as an adult? * Frequently drink liquids to aid in swallowing dry food?  III. Ocular signs * Schirmer's I test, performed without anaesthesia (/=4 van Bijsterveld's scoring system)  IV. Minor salivary glands histopathology * Focal lymphocytic sialoadenitis, with a focus score >/=1, lymphocytic foci (adjacent to normal appearing mucous acini & contain more than 50 lymphocytes) per 4 mm2 of glandular tissue  V. Salivary gland involvement * Unstimulated whole salivary flow (
63
What is histology of sjogrens?
Focal lymphocytic (T and B) sialadenitis Loss of acinic Ductal hyperplasia Periductal fibrosis
64
What is myoepithelial sialadenitis (MESA)?
Formation of epimyoepithelial islands causing chronic infiltration of glandular parenchyma and glandular atrophy
65
What is sialadenosis/sialosis?
Non-inflammatory, non-neoplastic, recurrent bilateral swelling of salivary glands, not associated with meal times
66
What causes sialadenosis?
Possibly due to abnormal neurosecretory control
67
What is sialadenosis associated with?
Hormonal disbalance, diabetes mellitus, hypothyroidism, pregnancy and adrenal disorders Malnutrition, bulimia, pellagra, beriberi Cirrhosis of the liver Following administration of some drugs (for hypertension, psychoactive, asthma)
68
What is histology of sialadenosis?
Hypertrophy of serous acinar cells, no inflammation
69
What happens in HIV-associated salivary gland disease?
Xerostomia, parotid gland swelling Diffuse lymphocyte infiltration Changes similar to myoepithelial sialadenitis but without antibody profile of sjogren Cytomegalovirus infections (inclusion bodies) Parotid swelling can also be due to intraparotid lymph nodes (as part of persistant generalised lymphadenopathy)

Oral pathology (27 decks)

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