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DISEASES OF THE SALIVARY GLANDS

DISEASES OF THE SALIVARY GLANDS. Sialolithiasis & Nonspecific sialadenitis. Submandibular Stones nidus - impacted food debris - dehydration with decreased secretion Stone → duct obstruction Nonspecific interstitial inflammation Or suppuration (abscess) – Staph. Strep.

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DISEASES OF THE SALIVARY GLANDS

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  1. DISEASES OF THE SALIVARY GLANDS

  2. Sialolithiasis &Nonspecific sialadenitis • Submandibular • Stones nidus - impacted food debris - dehydration with decreased secretion • Stone → duct obstruction • Nonspecific interstitial inflammation • Or suppuration (abscess) – Staph. Strep

  3. Sialolithiasis &Nonspecific sialadenitis • Unilateral • Painful – during meals • Purulent ductal discharge + • Recurrent

  4. MUCOCELE • Trauma • Lower lip • Fluctuant swelling • Blockage / rupture of salivary duct → leakage of saliva into the surrounding stroma • RANULA – mucocele of the sublingual

  5. MUCOCELE

  6. Sjogren’s syndrome • Immune destruction • Salivary – xerostomia (dry mouth) • Lacrimal – keratoconjunctivitis sicca (dry eyes)

  7. TUMOURS • Approx. 30 in number • 2% of all tumours • Benign – 5th – 7th decade • Malignant – later than above

  8. BENIGN TUMOURS • PLEOMORPHIC ADENOMA – 50% • Warthin’s tumour • Oncocytoma • Basal cell adenoma • Canalicular adenoma • Ductal papilloma

  9. PLEOMORPHIC ADENOMA • Benign tumour of glands – ADENOMA • Remarkable histologic diversity - PLEOMORPHIC • Commonest • Also called Mixed tumour – epithelial and connective tissue components

  10. PLEOMORPHIC ADENOMA • Cell of origin → EPITHELIAL epithelial-myoepithelial / ductal reserve cells

  11. PLEOMORPHIC ADENOMAGross • < 6 cms • Bosselated • Well-demarcated / encapsulated / tongue-like protrusions • Cut surface: gray-white / variegated / myxoid / bluish translucent (chondroid)

  12. PLEOMORPHIC ADENOMA

  13. PLEOMORPHIC ADENOMA

  14. PLEOMORPHIC ADENOMAMicroscopy • HETEROGENITY ! → PLEOMORPHIC • EPITHELIAL : epithelial & myoepithelial cells arranged in ducts, acini, irregular tubules, strands, sheets NO DYSPLASIA • MESENCHYMAL : myxoid, hyaline, chondroid, osseous

  15. PLEOMORPHIC ADENOMA

  16. PLEOMORPHIC ADENOMA

  17. PLEOMORPHIC ADENOMACLINICAL ASPECTS • Slow growing • Painless • Parotid – swelling below & in front of the year • RECURRENT – tongue-like protrusions Enucleation – 25% with Parotidectomy – 4%

  18. CARCINOMA ex PLEOMORHIC ADENOMA OR MALIGNANT MIXED TUMOUR Adenocarcinoma

  19. WARTHIN’S TUMOUR Papillary cystadenoma lymphomatosum Adenolymphoma

  20. WARTHIN’S TUMOUR Gross • Encapsulated • Cut surface : pale-grey narrow cystic / cleft-like / convoluted spaces contain serous / mucinous fluid

  21. WARTHIN’S TUMOUR

  22. WARTHIN’S TUMOUR Microscopy Cystic spaces - Narrow / cleft-like CYSTADENOMA Lining – double-layered epithelium – infoldings PAPILLARY • Inner (lumen) – palisade of columnar cells with abundant finely granular eosinophilic cytoplasm (oncocytic) • Outer (below the first) – cuboidal / polygonal Stroma - dense lymphoid tissue (germinal centres + ) LYMPHOMATOSUM

  23. WARTHIN’S TUMOUR

  24. WARTHIN’S TUMOUR

  25. WARTHIN’S TUMOUR • HISTOGENESIS ? Aberrant inclusions of lymphoid tissue in salivary glands

  26. WARTHIN’S TUMOUR CLINICAL ASPECTS • Benign • Very rarely recurs

  27. MALIGNANT TUMOURS • Mucoepidermoid ca • Acinic cell ca • Adenoid cystic ca • Malignant mixed tumour

  28. Malignant tumours • Old age • Max (70-90%) – sublingual • Malignant tumours more in smaller glands

  29. MUCO-EPIDERMOID CARCINOMA • 15% • 60-70% in the parotid, also in others • MOST COMMON MALIGNANT • Most common radiation-induced

  30. MUCO-EPIDERMOID CARCINOMAGross • < 8 cms. • Apparently circumscribed / infiltrative • Cut surface : pale grey-white small mucin-filled cysts

  31. MUCO-EPIDERMOID CARCINOMAMicroscopy • Mixtures of threecell types arranged in cords, sheets, cystic 1. mucus-secreting cells 2. intermediate cells (hybrid) squamoid features with small to large mucus- filled vacuoles 3. squamous cells

  32. MUCO-EPIDERMOID CARCINOMA

  33. MUCO-EPIDERMOID CARCINOMA • LOW GRADE – Mucus cells predominant • HIGH GRADE – squamous cells predominant

  34. MUCO-EPIDERMOID CARCINOMA CLINICAL COURSE Low gradeHigh grade Spread Local invasion Metastasis(30%) Recurrence 15% 25-30% 5-yr survival >90% 50%

  35. ADENOID CYSTIC CARCINOMA • Mouth – minor, rare in parotid • Nose, paranasal sinuses • Upper airways

  36. ADENOID CYSTIC CARCINOMA Gross • Small • Poorly encapsulated, infiltrative • Gray-pink

  37. ADENOID CYSTIC CARCINOMA Microscopy • Small cells with dark compact nuclei, scanty cytoplasm • Arranged in tubules, solid, cribriform • SPACES BETWEEN CELLS FILLED WITH HYALINE MATERIAL – basement membrane material • Perineural invasion - pain

  38. ADENOID CYSTIC CARCINOMA

  39. ADENOID CYSTIC CARCINOMA

  40. ADENOID CYSTIC CARCINOMA CLINICAL ASPECTS • Malignant • Slow growing • Stubbornly recurrent • Painful – perineural invasion

  41. Acinic cell carcinoma (tumour) • Most PAROTID – composed of serous cells

  42. Acinic cell carcinoma Gross • Small • Encapsulated

  43. Acinic cell carcinoma Microscopy • Look like serous cells • Clear cytoplasm • Solid sheets, microcystic, glandular, follicular, papillary • Little anaplasia

  44. Acinic cell carcinoma

  45. Acinic cell carcinoma CLINICAL ASPECTS • Good prognosis • Recurrence rare

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