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AU15 - Oral Pathology Exam 2 > Salivary Gland Neoplasms > Flashcards

Salivary Gland Neoplasms Flashcards

1
Q

Salivary gland neoplasms comprise approximately __% of all head and neck neoplasms.

A

3%

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2
Q

Are salivary gland neoplasms more common in males or females? Childhood or adulthood?

A
  • females

- adulthood

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3
Q

What are salivary glands are most involved in the extraoral salivary gland neoplams?

A
  • parotid (61-80%)
  • minor (9-28%)
  • submandibular (8-11%)
  • sublingual (
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4
Q

What are the sites of involvement in the intraoral salivary gland neoplasms?

A
  • palate (50%)
  • lips (20%)
  • buccal mucosa (15%)
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5
Q

What are the salivary glands that are most likely to be malignant if a salivary gland neoplasm is found there?

A
  • sublingual (70-95%)
  • minor (45-50%)
  • submandibular (26-45%)
  • parotid (15-32%)
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6
Q

What are the intraoral sites that are most likely to be malignant if a salivary gland neoplasm is found there?

A
  • retromolar (90%)
  • tongue (80%)
  • lower lip (60%)
  • buccal mucosa (45%)
  • palate (45%)
  • upper lip (15%)
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7
Q

What is the most common salivary gland neoplasm?

A

pleomorphic adenoma

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8
Q

What is pleomorphic adenoma also known as? Why does it have its name?

A
  • “benign mixed tumor”
  • named because of the combination of neoplastic ductal epithelial and myoepithelial cells that often show a variety of histologic patterns
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9
Q

Where is pleomorphic adenoma often found?

A
  • 80% in parotid (makes up 63% of all parotid tumors)
  • 10% submandibular (makes up 60% of all submandibular tumors)
  • 10% intraoral (40% of all intraoral salivary gland tumors)
    (palate 54%, upper lip 22%, buccal mucosa 15%)
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10
Q

What age group is most common for pleomorphic adenoma? Male or female?

A
  • adult patient, in 4th to 6th decade (mean age is 45 years)

- slight female predilection

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11
Q

What is the clinical appearance of pleomorphic adenoma?

A
  • in major glands
  • slow-growing, painless, freely moveable mass
  • rubbery firm on palpation
  • palatal lesions usually to one side of the midline, no mobility, usually non-ulcerated
  • when the lesion is small, it is usually round, but it typically becomes bosselated as it grows larger
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12
Q

Describe the histology of pleomorphic adenoma.

A
  • encapsulated proliferation of ductal epithelial cells and myoepithelial cells in proportions that may vary tremendously from lesion to lesion
  • myoepithelial cells may appear spindled or plasmacytoid and they have the ability to produce a myxoid stroma, hyaline material, cartilaginous material, or even osteoid
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13
Q

What is the recommended treatment for pleomorphic adenoma?

A
  • PAROTID: remove the lesion with the involved lobe (subtotal parotidectomy)
  • SUBMANDIBULAR: remove the lesion and the involved gland
  • HARD PALATE: remove the lesion, includingthe overlying oral mucosa, down to the periosteum
  • SOFT PALATE, LABIAL MUCOSA, AND BUCCAL MUCOSA: enucleation (pull the hard process out of the soft tissue)
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14
Q

What is the prognosis of pleomorphic adenoma?

A
  • if inadequately treated, this lesion will recur
  • more of a problem with parotid lesions rather than oral lesions
  • if not removed, may undergo malignant transformation in 5% of cases
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15
Q

What is the technical name for “Warthin tumor”?

A

papillary cystadenoma lymphomatosum

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16
Q

What is the histogenesis of papillary cystadenoma lymphomatosum?

A

salivary duct epithelium entraped in parotid lymph nodes during development

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17
Q

Papillary cystadenoma lymphomatosum makes up __% of all salivary gland neoplasms and __% of parotid gland neoplasms.

A

5%

5-22%

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18
Q

What gland is papillary cystadenoma lymphomatosum almost exclusively found in? More often in males or females? Average age? Associated with what risk factor?

A
  • parotid gland
  • males
  • 55-60 years old
  • cigarette smoking
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19
Q

What are the clinical signs and symptoms of papillary cystadenoma lymphomatosum?

A
  • non-tender, slowly-growing, freely-movable mass of the parotid region
  • mostly metachronous lesions, may be bilateral or unilateral
  • grossly, encapsulated with cystic spaces containing serous, milky, or chocolate syrup-like fluid
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20
Q

Describe the histology of papillary cystadenoma lymphomatosum.

A
  • encapsulated collection of lymphoid tissue that usually exhibits typical germinal center formation
  • contained within this tissue are dilated cystic spaces into which project papillary infoldings that are lined by double-row of columnar to cuboidal oncocytes (altered ductal epithelial cells)
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21
Q

What is the treatment for papillary cystadenoma lymphomatosum?

A

surgical excision

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22
Q

What is the prognosis of papillary cystadenoma lymphomatosum?

A

very low recurrence rate (5% range); recurrences may actually represent development of metachronous lesions

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23
Q

Which is more common: pleomorphic adenoma or monomorphic adenoma?

A

pleomorphic adenoma

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24
Q

What is the following salivary neoplasm?

“characterized by a proliferation of ONE cell type”

A

monomorphic adenoma

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25
Q

What are the 2 major subtypes of monomorphic adenoma?

A
  • canalicular adenoma

- basal cell adenoma

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26
Q

Where is canalicular adenoma usually seen? Most often?

A
  • seen in both major salivary glands and intraorally

- more common intraorally, especially in upper labial mucosa

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27
Q

What age group does canalicular adenoma usually affect? Gender?

A
  • 65 years old

- female

28
Q

What are the signs and symptoms of canalicular adenoma?

A

well-encapsulated, non-tender mass; may be blue/purple

29
Q

Describe the histology of canalicular adenoma.

A

encapsulated proliferation of cuboidal to columnar cells that form tubules and narrow trabecular cords, with the appearance of channels or “canals”

30
Q

What is the treatment for canalicular adenoma? Prognosis?

A
  • simple enucleation

- excellent prognosis (virtually no tendency to recur)

31
Q

What is the most common intraoral salivary gland malignancy?

A

mucoepidermoid carcinoma

32
Q

What is age group is most affected by mucoepidermoid carcinoma?

A
  • wide age range

- most common salivary gland malignancy in children (15% occur in patient

33
Q

Where is mucoepidermoid carcinoma more often found?

A
  • intraorally, palate is the most common site (28%), followed by the retromolar area (23%)
  • may also be found centrally within mandible or maxilla
  • a mucocele-appearing lesion of the retromolar area should be considered to be mucoepidermoid carcinoma until proven otherwise
34
Q

What is the clinical appearance of mucoepidermoid carcinoma?

A
  • well-demarcated or infiltrative mass
  • non-tender and non-ulcerated initially
  • may have blue tinge due to entrapped mucin
  • ulceration and pain may develop as the lesion progresses
35
Q

Describe the histology of mucoepidermoid carcinoma.

A
  • must have 2 cellular elements: MUCOUS CELLS and EPIDERMOID CELLS (both must be seen to make the diagnosis)
  • low-grade lesions are more common intraorally and have more mucous cells
  • high-grade lesions are more squamous (epidermoid) cells
  • lesional cells usually do not show significant pleomorphism or increased mitotic activity, but a spectrum of differentiation is recognized
36
Q

What is the recommended treatment for mucoepidermoid carcinoma?

A
  • low-grade: wide surgical excision

- high-grade: wide surgical excision, plus radiation and/or chemotherapy

37
Q

What is the prognosis of mucoepidermoid carcinoma? 10-year survival?

A
  • depends on tumor size and histologic grade

- lesions

38
Q

What is the second most common intraoral salivary gland malignancy?

A

polymorphous low-grade adenocarcinoma (PLGA)

39
Q

What gender is polymorphous low-grade adenocarcinoma (PLGA) more common in? What age group?

A
  • female (2:1 ratio)

- adult population, mean age of 56 years with range of 23-94 years

40
Q

What is the clinical appearance of polymorphous low-grade adenocarcinoma (PLGA)?

A
  • firm, painless swelling that may or may not be ulcerated
  • typically well-demarcated initially, but later becomes more infiltrative and diffuse
  • usually a very slow-growing lesion
41
Q

Where is polymorphous low-grade adenocarcinoma (PLGA) most often found intraorally?

A

most common in posterior hard/soft palate (65%), followed by upper lip and buccal mucosa

42
Q

What two conditions can polymorphous low-grade adenocarcinoma (PLGA) be confused with, histologically?

A
  • adenoid cystic carcinoma

- pleomorphic adenoma

43
Q

Describe polymorphous low-grade adenocarcinoma (PLGA) histologically.

A
  • low-power shows lobular growth pattern that infiltrates the surrounding normal tissue, although a pseudocapsule may be present in some areas
  • called “polymorphous” because one often sees a variety of growth patterns from lesion to lesion or within the same lesion (solid, trabecular, cribriform-like, ductal, and spindle cell areas)
  • lesional cells are usually cytologically bland
44
Q

What is the treatment for polymorphous low-grade adenocarcinoma (PLGA)?

A

wide surgical excision

45
Q

What is the prognosis for polymorphous low-grade adenocarcinoma (PLGA)? Recurrence? Lymph node metastasis? Death due to disease?

A
  • excellent
  • recurrence in 9-29%
  • lymph node metastasis in 9-17%
  • death due to disease is rare (
46
Q

Adenoid cystic carcinoma comprises __% of all salivary gland neoplasms.

A

5%

47
Q

What sites are most commonly affected by adenoid cystic carcinoma?

A
  • parotid and submandibular gland are affected about equally

- intraorally, the palate is the most common (approx 50% of intraoral lesions involve that area)

48
Q

Is adenoid carcinoma more common in male or female? What age group?

A
  • female
  • age range is reported 15-88 with mean 55 years
  • most tumor present in 5th decade
49
Q

What is the clinical appearance of adenoid cystic carcinoma?

A
  • initially a slow-growing, non-ulcerated infiltrative mass
  • frequently associated with pain/tenderness
  • ulceration may develop later in its course

*Note: on x-rays, no lamina dura or PDL, resorption of teeth, can be considered malignant

50
Q

Describe the histology of adenoid cystic carcinoma.

A
  • hyperchromatic basaloid cells with minimal cytoplasm
  • little pleomorphism or mitotic activity
  • perineural and intraneural invasion!
  • unencapsulated lesion with one of 3 growth patterns (tubular, cribriform, solid)
51
Q

Differentiate between the 3 growth patterns of adenoid cystic carcinoma.

A
  • tubular: well-differentiated
  • cribriform: classic “swiss-cheese” pattern; intermediate
  • solid: poorly differentiated; mitotic figures are seen
52
Q

What is the recommended treatment for adenoid cystic carcinoma?

A

wide surgical excision, with radiation therapy afterwards

53
Q

What is the prognosis of adenoid cystic carcinoma? 10-year survival? 20-year survival?

A
  • depends on the location of lesion, grade, anatomic structures involved, presence of tumor at surgical margins
  • generally poor (slow-growing and relentless)
  • death from disease up to 20-25 years after diagnosis
  • 10-year survival is 50%
  • 20-year survival is 25%

*it is the Freddy Kreuger who keeps coming back

54
Q

What types of metastasis are usually seen with adenoid cystic carcinoma?

A
  • usually go to the lung, followed by brain, bone, and liver

- lymph node involvement typically accounts for only 5% of metastatic deposits

55
Q

Acinic cell adenocarcinoma comprises __% of all salivary gland tumors.

A

2%

56
Q

What site is most often associated with acinic cell adenocarcinoma?

A

90% in parotid

10% intraorally (buccal mucosa or palate)

57
Q

What age is most often affected by acinic cell adenocarcinoma?

A

range of 5-84 years, with a mean age of about 45 years

58
Q

What is the clinical appearance of acinic cell adenocarcinoma?

A
  • fairly circumscribed, slow-growing mass in parotid region, buccal mucosa, or palate
  • pain/tenderness in 50% of cases
59
Q

Describe the histology of acinic cell adenocarcinoma.

A
  • appear to be pseudo-encapsulated
  • basophilic bland cells that are very similar to acinar cells (looks like acinar cells from salivary tissues, but no ductal cells)
  • cells are mostly very bland low-grade
60
Q

What is the recommended treatment of acinic cell adenocarcinoma?

A

surgical excision

61
Q

What is the prognosis of acinic cell adenocarcinoma?

A
  • guarded prognosis

- 35% recurred, 16% metastasized (usually lymph node), 16% died

62
Q

What age group is most often affected by carcinoma ex-pleomorphic adenoma?

A

6th to 8th decades of life

63
Q

What is the clinical appearance of carcinoma ex-pleomorphic adenoma?

A
  • long-standing asymptomatic mass that suddenly becomes tender or is associated with paresthesia
  • majority show areas of typical pleomorphic adenoma from which carcinomatous elements appear to arise
64
Q

Describe the histology of carcinoma ex-pleomorphic adenoma.

A
  • malignancy is usually a form of adenocarcinoma (NOS), sometimes PLGA, adenoid cystic carcinoma, or others
65
Q

What is the treatment of carcinoma ex-pleomorphic adenoma?

A

wide surgical excision

66
Q

What is the prognosis of carcinoma ex-pleomorphic adenoma?

A

varies with degree of invasion and type of adenocarcinoma

- invasion 8 mm = bad; all patients died

AU15 - Oral Pathology Exam 2 (4 decks)

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