salivary gland pathology Flashcards
(25 cards)
definition of pleomorphic adenoma
PA is a benign epithelial tumor which consists of :
- ductal cells
- myoepthelial cells
- mesenchymal metaplasia
it is due to translocation of PLAG1 gene
clinical features
- painless slow growing
- age = 30 to 60 yrs
- female predilection
- major sites = parotid gland
- minor sites= posterolateral aspect of palate, upper lip, buccal mucosa
histopath OF PA
- well circumscribed , encapsulated
- mix of glandular epithelium and myospithelium like cells within a mesenchyme background.
- epithelium form sheets islands
- keratinising squamous cells and mucous secreting cells can be seen
- some myoepithelial cells look like plasma cells with eosinophilic cytoplasm and eccentric nucleus.
- excess accumulation of mucoid material causes myxomatous background.
its classified as
a. principally myxoid
b. myxoid with cellular comp
c. predominant cellular
d. extremely cellular
treatment OF PA
surgical excision.
for parotid do superficial parotidectomy to conserve the facial nerve
for submandibular. total removal is good.
adjuvant radiotherapy is needed.
complications OF PA
malignant transformation = 3 o 4 %
called as carcinoma ex pleomorphic adenoma.
freys syndrome / gustatory sweating
gross featuress OF PA
- irregular or ovoid
- well defined borders.
- may or may not have capsule
- cut surface is rubbery, fleshy mucoid glistening with a homogenous tan
etiology of mucoepidermoid carcinoma
- radiation exposure
- genetic mutations
clinical features OF MEC
- 2nd to 7th decade
- common in children
- location parotid gland , palate, lips,floor of mouth, tongue
- could be intaosseous as well
- painless slow growing
- not capsulated, contains cysts with viscid material
- blue or red coloured
- high grade ones cause pain and facial nerve paralysis
- in that case pt complains of trismus, ear drainage, dysphagia, numbness
histopath of MEC
- mix of mucous producing cells and epidermoid/ squamous cells
- mucous cells contain foamy cytoplasm that stain positive for mucin stains
- epidermoid cells have squamous polygonal abundenat eosniphlilic cytoplasm
- intermediate cells are progenitor of mucous and epidermoid cells. shape is small basaloid pale cyto
- clear cells may be there
grades of MEC
- low grade
- well formed glandular structures
- prominent mucin filled cystic spaces
- min cellular atypia
- lot of mucous cells - intermediate grade
- solid areas of squamous cells with intermediate cells
- cyst formation
- all cells +nt, intmd cells are more - high grade
- solid nets and chords of intmd and epidermoid cells
- nuclear pleomorphism
- less cysts
-necrosis and perineural invasion +nt
treatment OF MEC
early stage = subtotal parotidectomy preserve facial nerve
adv stage = total
intaosseous MEC/ central MEC
salivary gland tumour within jaws
due to ectopic tissue in jaws
or due to odontogenuc epithelium
clinical feat of intra osseous MEC
- middle ages females
- mandible
- cortical swelling , pain, trismus, parasthesia
- unilocular/ multilocular radiolucency with well defined borders.
treatment of IO MEC
radical surgical resection
11 to 13 % recurrance rate
metastases in 9 % cases
which is the second most common benign tumor of salivary gland
Warthins tumor
what is the other name for warthins tumor
papillary cystadenoma lymphomatosum
pathogenesis/ etiology of WARTHINS TUMOR
heterotrophic salivary gland tissue in lymph nodes
it is a delayed hypersensitivity rxn
and therefore the lymphocytes are present as response
smoking
obesity
EB virus
c.f. of warthin tumor
- disese of men
- 60 -70 yrs
- superficial tumor
- it doesnt exceed 3-4 cm
- painless, firm on palpation
- bilateral manifestation
histo of warthin tumor
- mix of ductal epithelium + lymphoid stroma
- double layer of oncocytic cpithelium around cystic spaces
inner layer is tall columnar and outer is polygonal - oncocytes are aged cells with high leevels of mitochondria and eosiniphilic with granules
- pappilary infoldings protrude into cystic spaces filled with fluid
- germinal centers are seen in lymphoid stroma
other name of adenoid cystic carcinoma
cylindroma
cf of cylindroma
- occurs in palatal minor salivary gland> parotid> submandibular
- middle aged women
- slow growing, + painful+
- radio, u can see bone destruction
hp of adenoid cystic carcinoma
- abluminal myoepithelial cells and luminal ductal cells
3 arrangemnets seen are cribiform, tubular, solid
cribriform =MC
- islands of basaloid cells that contain multiple cylindrical, cyst like spaces rrsembling swiss cheese
- contain mucoid eosinophilic material
- tumor cells are small and cuboidal
a characterustic feature is perineural invasion
+ve staining for CD43 and c-kit
treatment of cylindroma
surgical resection
adjuvant radiotherapy
polymorphous low grade adenocarcinoma - CF
misnomer low garde… it isnt low grade malignancy
hard palate> lip> buccal mucosa
