Salivary Gland Pathology

Question 1

Answer 1

Question 2

Answer 2

Question 3

What are the major salivary glands?

Answer 3

 Parotid
 Submandibular
 Sublingual

Question 4

Where are the minor salivary glands?

Answer 4

 Palate
 Buccal mucosa
 Tongue
 Floor of mouth
 Labial mucosa
 Retromolar pad
 Oropharynyx

Question 5

The parotid gland is 100% __________ cells

Answer 5

serous acinar

Question 6

The submandibular salivary gland is made of what cells?

Answer 6

serous acinar (mostly)
mucous acinar

Question 7

The sublingual salivary gland is made of what cells?

Answer 7

mucous acinar (mostly)
serous acinar

Question 8

What are the clear staining cells?
What are the purple granular cells?

Answer 8

Clear = mucous
purple granular = serous

Question 9

What is the distribution of the minor salivary gland locations?

Answer 9

 Palate - 60%
 Tongue - 10%
 Lips - 10%
 Cheeks - 10%
 Retromolar - 10%

Question 10

What are the minor salivary glands of the tongue?

Answer 10

Glands of Von Ebner
— Circumvalate papillae (serous)
Glands of Blandin and Nuhn
— Anterior ventral (mucous)
Glands of Weber
— Posterior lateral border (mucous)

Question 11

What are the glands of von ebner?

Answer 11

Circumvalate papillae part of tongue – serous

Question 12

What are the glands of blandin and nuhn?

Answer 12

Anterior ventral part of tongue – mucous

Question 13

What are the gland of weber?

Answer 13

Posterior lateral border of tongue (foliate papillae) - mucous

Question 14

What is a mucous extravasation reaction (mucocele)?

Answer 14

mucocele forms due to a disruption in the salivary system and the saliva does not go into the oral cavity

Question 15

How can you tell a superficial mucocele from a different chronic condition of vesicles?

Answer 15

• biopsy
• no pain
• goes away for a while

Question 16

What is a mucocele associated with the sublingual gland?

Answer 16

ranula

Question 17

Mucin dissects through mylohyoid muscle, presenting as a neck mass it is called a…

Answer 17

plunging ranula

Question 18

What is a sialolith?

Answer 18

Salivary stone
- mucin gets trapped in the salivary duct and calcifies

Question 19

Where do we typically see sialoliths in patients?

Answer 19

Wharton’s duct

Question 20

What are patient’s symptoms for sialolith?

Answer 20

• episodic swelling (especially around meal times)
• pain
• secondary infection

Question 21

How can you see/visualize a sialolith in warton’s duct?

Answer 21

occlusal radiograph

Question 22

What is necrotizing sialometaplasia?

Answer 22

reactive condition
- patient says “piece of roof of the mouth came out”
- areas of ulceration

Question 23

What is the histology of necrotizing sialometaplasia?

Answer 23

• Pseudoepitheliomatous hyperplasia (not cancer)
• Sialometaplasia
• Coagulative necrosis of the glands

Question 24

What are the symptoms of sjogren syndrome?

Answer 24

• Autoimmune disorder
• Dry mouth and dry eyes
• Primary vs. Secondary
• Bilateral enlargement of parotid gland

Question 25

If you biopsy the parotid gland of someone with sjogren what would the histology show?

Answer 25

- Benign lymphoepithelial lesion (BLEL) - Mikulicz’s disease

Question 26

What are the laboratory tests/values that are positive for sjogren syndrome?

Answer 26

 Anti-SS-A  Anti-SS-B  RF  ANA

Question 27

What is a different way to diagnose sjogrens syndrome besides parotid biopsy or labs?

Answer 27

lower lip biopsy - look for lymphoid clusters

Question 28

What is the percentage of benign/malignant tumors in parotid?

Answer 28

equally likely

Question 29

What is the percentage of benign/malignant tumors in submandibular (don't memorize %)?

Answer 29

- Slightly more malignant benign - 40% malignant - 60%

Question 30

What is the percentage of benign/malignant tumors in sublingual (don't memorize %)?

Answer 30

- way more likely to be malignant benign - 20% malignant - 80%

Question 31

What is the percentage of benign/malignant tumors in palate salivary glands (don't memorize %)?

Answer 31

equally likely

Question 32

What is the percentage of benign/malignant tumors in buccal mucosa salivary glands (don't memorize %)?

Answer 32

equally likely

Question 33

What is the percentage of benign/malignant tumors in upper labial mucosa salivary glands (don't memorize %)?

Answer 33

more likely to be benign

Question 34

What is the percentage of benign/malignant tumors in lower labial mucosa salivary glands (don't memorize %)?

Answer 34

more likley to be malignant

Question 35

What is the percentage of benign/malignant tumors in tongue salivary glands (don't memorize %)?

Answer 35

Up to 90% malignant

Question 36

What is the percentage of benign/malignant tumors in floor of mouth salivary glands (don't memorize %)?

Answer 36

Up to 90% malignant

Question 37

What is the percentage of benign/malignant tumors in retromolar pad salivary glands (don't memorize %)?

Answer 37

Up to 90% malignant

Question 38

What are the clinical features of benign salivary tumor?

Answer 38

- slow growth - movable - asymptomatic - intact mucosa

Question 39

What are the clinical features of malignant salivary tumor?

Answer 39

- rapid growth - fixed - symptomatic - ulcerated

Question 40

What is a pleomorphic adenoma?

Answer 40

benign mixed tumor - painless slowly growing mass

Question 41

What is the most common salivary gland neoplasm?

Answer 41

pleomorphic adenoma

Question 42

What demographic is most affected by pleomorphic adenoma?

Answer 42

middle-aged females

Question 43

What does the histology of pleomorphic adenoma look like?

Answer 43

Variable histology Mixture of ductal and myoepithelial elements Encapsulated

Question 44

If a tumor is encapsulated what does that often suggest?

Answer 44

benign

Question 45

What is a monomorphic adenoma?

Answer 45

- painless slowly growing mass (upper lip)

Question 46

What demographic is most affected by monomorphic adenoma?

Answer 46

middle-aged females

Question 47

Where is a monomorphic adenoma commonly found?

Answer 47

upper lip

Question 48

What does the histology of monomorphic adenoma?

Answer 48

 Uniform pattern  Single layered cords of columnar or cuboidal epithelium  May demonstrate papillary projections  Loose connective tissue stroma, with prominent vascularity  Thin fibrous capsule

Question 49

What does a histology slide of monomorphic adenoma look like?

Answer 49

No matter what type it is the slide all looks the same/uniform

Question 50

What is another name for papillary cystadenoma lymphomatosum?

Answer 50

Warthin's tumor

Question 51

What is a papillary cystadenoma lymphomatosum (warthin's tumor)?

Answer 51

- painless slowly growing nodular mass - parotid gland (bilaterally)

Question 52

What is the 2nd most common benign salivary gland neoplasm?

Answer 52

papillary cystadenoma lymphomatosum (warthin's tumor)

Question 53

What demographic is papillary cystadenoma lymphomatosum (warthin's tumor) usually seen?

Answer 53

Middle-aged males (lower in blacks) - more common in smokers

Question 54

What does the histology of papillary cystadenoma lymphomatosum (warthin's tumor) look like?

Answer 54

- Oncocytic ductal epithelium --- Uniform double rows - Lymphoid aggregate - Papillary cystic configuration

Question 55

What is the only salivary gland tumor that has smoking as an etiology?

Answer 55

papillary cystadenoma lymphomatosum (warthin's tumor)

Question 56

What is an oncocytoma?

Answer 56

- painless slowly growing mass (multifocal) - parotid - rare

Question 57

What demographic are oncocytomas usally found?

Answer 57

Females, 8th decade

Question 58

What does the histology of oncocytoma look like?

Answer 58

- Large polyhedral cells abundant in granular eosinophilic cytoplasm ---mitochondria - Limited stroma ---Thin fibrovascular septa - Lymphoid infiltrate

Question 59

What are the malignant salivary gland tumors?

Answer 59

 Mucoepidermoid Carcinoma  Adenoid Cystic Carcinoma  Polymorphous Low-Grade Adenocarcinoma  Acinic Cell Carcinoma  Carcinoma ex-Mixed Tumor  Adenocarcinoma NOS

Question 60

What is the most common malignant salivary gland neoplasm?

Answer 60

mucoepidermoid carcinoma

Question 61

What demographic are mucoepidermoid carcinomas most often found?

Answer 61

middle-aged females

Question 62

What are mucoepidermoid carcinomas sometimes mistaken for?

Answer 62

mucocele

Question 63

What is the histology of mucoepidermoid carcinoma?

Answer 63

- Mucous producing cells - Epidermoid (squamous) cells - May be cystic and/or solid

Question 64

How can you tell the difference between high-grade mucoepidermoid carcinoma and squamous cell carcinoma?

Answer 64

presence of mucus cells in histology

Question 65

What is an adenoid cystic carcinoma?

Answer 65

- Slowly growing mass, painful - best recognized salivary gland tumor

Question 66

What demographic are adenoid cystic carcinomas common in?

Answer 66

middle-aged females

Question 67

What is the histology of adenoid cystic carcinomas look like?

Answer 67

SWISS CHEESE Myoepithelial and ductal cells Perineural and perivascular invasion Cribiform pattern

Question 68

What is polymorphous low-grade adenocarcinoma (PLGA)?

Answer 68

- Common malignant MINOR salivary gland neoplasm - usually on palate

Question 69

What demographic are polymorphous low-grade adenocarcinomas common in?

Answer 69

middle-aged females

Question 70

What is the histology of polymorphous low-grade adenocarcinoma?

Answer 70

 Deceptive uniform appearance  Different growth patterns  Perineural and perivascular invasion  Indian filing

Question 71

What is acinic cell carcinoma?

Answer 71

- low-grade malignancy - serous acinar differentiation - parotid - slow growing

Question 72

What is the demographic for acinic cell carcinoma?

Answer 72

middle-aged females

Question 73

What is the histology of acinic cell carcinoma?

Answer 73

 Well circumscribed  May be infiltrative  Serous acinar cell --- Abundant granular basophilic cytoplasm and a round, stained eccentric nucleus

Question 74

What is a carcinoma ex-pleomorphic adenoma?

Answer 74

- Long standing pleomorphic adenoma - pain and ulceration - rapid growth - older adults

Question 75

What is the histology of carcinoma ex-pleomorphic adenoma?

Answer 75

 Typical benign mixed tumor  Malignant degeneration --- Cellular pleomorphism --- Abnormal mitotic activity --- Capsular invasion

Question 76

What is an adenocarcinoma NOS?

Answer 76

- Uncommon salivary gland neoplasm - middle-aged females - variable histology