Lab 7 Diseases of Salivary Glands

8/3/2019 Lab 7 Diseases of Salivary Glands

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Dent 356-11Lab

Diseases of Salivary Glands

Dr. Rima Safadi


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Salivary Glands: Major


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Salivary Glands: MajorParotid Gland


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Salivary Glands: MajorSubmandibular Gland


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Salivary Glands: MajorSublingual Gland


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Salivary Glands: Minor


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Salivary Glands: Minor


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Chronic Bacterial Sialadenitis


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Chronic Bacterial Sialadenitis

Histopathology:

- varying degrees of ductaldilatation.

- hyperplastic ductalepithelium.

- periductal fibrosis.

- acinar atrophy &

replacement by fibroustissue.

- chronic inflammatoryinfiltration.


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Cytomegalic Inclusion Disease(Salivary Gland Inclusion Disease)

Histopathology:1. Salivary gland involvement is

usually an incidentalhistological finding.

2. Large, doubly contouredowl-eye inclusion bodieswithin nucleus or cytoplasmof duct cells of parotid gland.
http://rds.yahoo.com/S=96062857/K=cytomegalovirus+infection/v=2/SID=w/l=II/R=37/SS=i/OID=b1ba2588d8f1e57e/SIG=1k4qd589l/EXP=1121876532/*-http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=cytomegalovirus+infection&ei=UTF-8&fl=0&imgsz=all&fr=sfp&b=21&h=527&w=800&imgcurl=cnserver0.nkf.med.ualberta.ca/cn/Schrier/Vol5/10-24%20copy.jpg&imgurl=cnserver0.nkf.med.ualberta.ca/cn/Schrier/Vol5/10-24%20copy.jpg&size=132.6kB&name=10-24%20copy.jpg&rcurl=http://cnserver0.nkf.med.ualberta.ca/cn/Schrier/Default5.htm&rurl=http://cnserver0.nkf.med.ualberta.ca/cn/Schrier/Default5.htm&p=cytomegalovirus+infection&type=jpeg&no=37&tt=149&ei=UTF-8


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Sarcoidosis

Granuloma, noncaseating


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Sialadenitis of Minor Glands

Periductal fibrosis

Inflamed lobul

Dilated duct


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Salivary Calculi (Sialoliths)


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Hyperplastic ductal epithelium

sialolith
http://www.usc.edu/hsc/dental/opfs/SG/076big.html


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Necrotizing Sialometaplasia

A relatively uncommondisorder.

May be mistaken

clinically andhistologically formalignant disease.

Most frequent on hardpalate in middle-agedpatients, especiallymales.


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NsmetaplasiaMay start as swelling


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Later on it ulcerates


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August 23

After 3 months it healed


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Necrotizing Sialometaplasia

Histopathology:

1. Lobular necrosis.

2. Squamous metaplasia ofducts & acini.

3. Mucous extravasation.

4. Inflammatory cell infiltration.

5. Features may be mistaken forSCC or mucoepidermoidcarcinoma.


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Squamous metaplasiaOf nec sialo metap


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Lobular necrosis


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Sjgren Syndrome: Clinical Features

Oral mucosa appearsdry, smooth, andglazed.

Dorsum of tongueoften appears red andatrophic with variabledegrees of fissuringand lobulation.


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Keratoconjuctivitissicca manifests as:

1. dryness of eyes2. conjunctivitis

3. gritty, burningsensation.


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Salivary glandenlargement is variable.

30% of patients givehistory of enlargement.

Only 15% present withenlargement.

Usually bilateral.

Predominantly affectsparotid glands.

Seldom painful.


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Lacrimal glandenlargement isuncommon.

Although clinicalinvolvement of minorsalivary glands is

uncommon, they areoften involvedmicroscopically.
http://rds.yahoo.com/S=96062857/K=sjogren+syndrome/v=2/SID=w/TID=I999_73/l=II/R=1/SS=i/OID=28d8dd7e6305ad98/SIG=1j88mkssi/EXP=1121965964/*-http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=sjogren+syndrome&ei=UTF-8&fr=sfp&fl=0&x=wrt&h=336&w=313&imgcurl=www.hopkins-arthritis.som.jhmi.edu/other/images/salivarygland.jpg&imgurl=www.hopkins-arthritis.som.jhmi.edu/other/images/salivarygland.jpg&size=17.5kB&name=salivarygland.jpg&rcurl=http://www.hopkins-arthritis.som.jhmi.edu/other/oralsjogrens.html&rurl=http://www.hopkins-arthritis.som.jhmi.edu/other/oralsjogrens.html&p=sjogren+syndrome&type=jpeg&no=1&tt=303&ei=UTF-8


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SS infiltrate of lymphocytes


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Sjgren Syndrome: Histopathological Features

Major glands:

4. Proliferation of duct epitheliumto form epimyoepithelial

islands.

5. The appearance is describedas myoepithelial sialadenitisorbenign lymphoepithelial lesion.

6. Unlike lymphoma, the infiltratedoes not cross interlobular CTsepta.


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SS


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Sialolith


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Pleomorphic Adenoma: Clinical Features

Slowly growing, painless, rubbery swelling with intactoverlying skin or mucosa.

Patient may be aware of lesion for several years.


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Pleomorphic adenoma

Ducts formed by epithelial cells

Sheets mainly of myoepith cells


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Myoep. cells

Myxoid (mucoid) product


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Pleomorphic Adenoma: Histopathologic Features

.

The tumor isWell demarcatedBut not encapsulated


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Chondroid product


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Epithelial component may bearranged in duct-like structures,sheets, clumps, and interlacingstrands.

hyalinization


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Extension of tumor lobules out sideThe main tumor border


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Areas of squamous metaplasia and keratin pearl formation may be present.


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Warthin Tumor: Histopathologic Features

Multiple, irregularcystic spaces

containing mucoidmaterial separatedby papillaryprojections of tumortissue.

Lymphoid tissue with germinal center


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Warthin Tumor: Histopathologic Features

Tumor consists of:1. Epithelial component:

double-layered epitheliumlining cystic spaces inpapillary arrangement.

2. Lymphoid component withinstroma, may containgerminal centers.

Epithelial cells have granularcytoplasm rich in abnormalmitochondria, resemblingoncocytes.


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Basal Cell Adenoma: Histopathologic Features

Consists of cytologicallyuniform basaloid cellsarranged in a variety ofpatterns.

Well-encapsulated.


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Canalicular Adenoma

> 50 years of age.

Almost all cases in upperlip.

Consists of anastomosingstrands of basaloidepithelial cells arrangedin canalicular structures.

May be partly or grosslycystic due todegeneration of loose

vascular stroma. Arrangement of cells in canalicularstructures


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Ductal papilloma

Duct lining

Ductal space

Papillary projections


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Mucoepidermoid Carcinoma: Clinical Features

Often presents clinicallyin a similar manner topleomorphic adenoma.


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Mucoepid. carcinoma

Central lesion

Minor salivary gland lesion


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Cystic space

Mucous cells

Mixture of cells


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Mucoepidermoid Carcinoma: Histopathologic Features

Intermediate cells

Mucoous cells


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Low grade MEC:

5.


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High grade MEC:


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High grade MEC:


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Acinic Cell Carcinoma

Uncommon.

Accounts for 2-3% ofparotid tumors.

Regarded as a low grademalignancy.

80-100% 5-year survival

rates reported for well-differentiated tumors,65% for poorlydifferentiated ones.


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Acinic cell adenocarcinoma


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Acinic Cell Carcinoma: Histopathologic Features

.

The most common

variants consist of sheetsor acinar groupings oflarge, polyhedral cellswith basophilic, granularcytoplasm, similar toserous acinar cells.


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Adenoid Cystic Carcinoma

Middle-aged &elderly.

Up to 30% of minorSG tumors, but only~6% of parotid

tumors.
http://images.google.com/imgres?imgurl=http://www.health-pictures.com/oral/images/Adenoid.jpg&imgrefurl=http://www.health-pictures.com/oral/Adenoid-cystic-carcinoma.htm&h=203&w=300&sz=5&tbnid=EyTuWdjGyWwJ:&tbnh=75&tbnw=111&hl=en&start=22&prev=/images?q=adenoid+cystic+carcinoma&start=20&svnum=10&hl=en&lr=&sa=N


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Adenoid Cystic Carcinoma: Clinical Features

May present as slowlyenlarging tumors likepleomorphic adenoma,but pain and ulcerationare much more common.

Parotid tumors maypresent with facial palsy.

Neurologicalmanifestations reflectpredilection to infiltrateand spread along nerves.
http://images.google.com/imgres?imgurl=http://www.health-pictures.com/oral/images/Adenoid.jpg&imgrefurl=http://www.health-pictures.com/oral/Adenoid-cystic-carcinoma.htm&h=203&w=300&sz=5&tbnid=EyTuWdjGyWwJ:&tbnh=75&tbnw=111&hl=en&start=22&prev=/images?q=adenoid+cystic+carcinoma&start=20&svnum=10&hl=en&lr=&sa=N


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Adenoid Cystic Carcinoma: Histopathologic Features

cribriform or Swiss cheesepattern. Epithelium consists of small,

uniform, basophilic cells.

Rare mitoses.


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Perinueral invasion


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Adenoid Cystic Carcinoma: Histopathologic Features

Perineural invasion. Less commonlyepithelium is arranged ina tubular or solid pattern.

Prominent infiltration and

invasion of adjacenttissues, and spreadaround and along nerves.

In the maxilla, tumor mayinfiltrate along marrowspaces with no evidenceof bone destruction.


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Carcinoma Arising in Pleomorphic Adenoma

Also known as carcinoma expleomorphic adenoma.

~3% of SG tumors.

Almost all arise in parotid orsubmandibular tumors thathave been present for manyyears.

Histological diagnosis requiresevidence of pre-existingpleomorphic adenoma.


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Carcinoma Arising in Pleomorphic Adenoma


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Age Changes in Salivary Glands

Reduction in weight of parotid andsubmandibular glands related to atrophy ofsecretory tissue & replacement by fibrofattytissue.

Similar changes in labial minor glands.

Oncocytic change in ductal epithelium.

Reduction in flow rate in submandibular gland.

Lab 7 Diseases of Salivary Glands

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