script for lab 7 .. SG disorders

8/3/2019 script for lab 7 .. SG disorders

1/19

DISEASES OF SALIVARY GLANDSLAB

A) Major Salivary Glands :We have three paired major salivary glands :

Parotid Submandibular Sublingual

Mainly Serous Mixed with

predominate serous

Mixed with

predominate mucous

Serous Acinus Serous Acinus Duct Mucous Acinus


2/19

The serous cells has plenty of granules and they look dark in color compared to the mucous

cells which has pail cytoplasm

B) Minor Salivary Glands :

1) Are all mucous

2) Present every where in the oral cavity except : ant. Region of the hard palat and the ant. Two

third of the dorsum of the tongue


3/19

SIALADENITIS1) Chronic Bacterial Sialadenitis

Histopathology -- >

Some times it presents as swelling in the

submandibular Salivary gland especially at

meal time specially when there Is obstruction

1 -- > Varying degrees of ductal dilatation

Hyperplastic ductal epithelium and

sometimes closing the ductal space .. not clear

in this picture

2 -- > Periductal fibrosis.

3 -- > Acinar atrophy & replacement by

fibrous tissue >> when u look carefully u will not

see the acini u will see them replaced with

inflammatory cells and fibrous tissue .. but in this

picture it is partially replaced

4 -- > Chronic inflammatory infiltration.


4/19

2) Cytomegalic Inclusion Disease (Salivary Gland InclusionDisease)

3) Sarcoidosis

which1>--inclusion bodyThis is the*

maybe in the cytoplasm ( like here ) or maybe

inside the nucleus it self

clearThe inclusion body surrounded by a*

2>--zone

pushed atrue nucleusThis is maybe the*

side -- > 3

We have deposition of granulomas -- > 1 and this granuloma

looks pail because it has a lot of histiocytes or macrophages ( they

have plenty of cytoplasm )

If u compare it to the surrounding lymphocytes -- > 2 .. the

lymphocytes have nucleus with little cytoplasm >> so the

lymphocytes look blue ( darker in color )

SO in sarcoidosis .. u will see

CaseatingNon>>Macrophages collection>--1

Pail>>Granuloma

Dark>>Lymphocytres Collection>--2
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%3A//images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dcytomegalovirus%2Binfection%26ei%3DUTF-8%26fl%3D0%26imgsz%3Dall%26fr%3Dsfp%26b%3D21&h=527&w=800&imgcurl=cnserver0.nkf.med.ualberta.ca%2Fcn%2FSchrier%2FVol5%2F10-24%2520copy.jpg&imgurl=cnserver0.nkf.med.ualberta.ca%2Fcn%2FSchrier%2FVol5%2F10-24%2520copy.jpg&size=132.6kB&name=10-24%20copy.jpg&rcurl=http%3A%2F%2Fcnserver0.nkf.med.ualberta.ca%2Fcn%2FSchrier%2FDefault5.htm&rurl=http%3A%2F%2Fcnserver0.nkf.med.ualberta.ca%2Fcn%2FSchrier%2FDefault5.htm&p=cytomegalovirus+infection&type=jpeg&no=37&tt=149&ei=UTF


5/19

4) Sialadenitis of Minor Glands

OBSTRUCTIVE AND TRAUMATIC LESIONS

1)Salivary Calculi ( Sialoliths : lith:stone )This is a picture for the glands and the ducts so u can understand the next clinical pictures :)

Dr gave the same information which I wrote about

Chronic Bacterial Sialadenitis

This is the general picture of chronic Sialadenitis and

with minor>>can put it with several conditionsI

Chronic Bacterial,salivary gland sialadenitis

>>And obstructive sialadenitisSialadenitis

esionbecause the lchronic featuresThese are the

fibrosis surrounding the ducttheneeds time to form

and..acement of the lobules and dilatationand repl

it is>>SOinflammatory infiltrate is lymphocyticthe

chronic

1- Dilated duct

2- Periductal fibrosis

3- Inflamed lobule


6/19

-

The Case >> A stone (1) appearing through

the duct orifice or it can be anywhere along

the dust >> but here it is through the duct

orifice

The Case >> A stone (2) appearing very

close to the duct orifice

This is the stone on a radiograph in

submandibular salivary gland -- > 3

This is the stone on another type of

radiograph -- > 4


7/19

1)Necrotizing Sialometaplasia

in this case>>it is very thick,epithelial liningplastic ductalmetahyperThis is the>--1

because of obstruction causing chronic irritation >> notice >> it is chronic bcz the duct needs time

)it was columnar(etaplasiasequamous mto form this hyperplastic epithelium with

closing the duct lumen SOstonesIn the center there are several>--2

1 -- > this is the sialolith and 2 -- > this is the hyperplastic ductal epithelium

in theswellingThe lesion may start aspalate with red points ..

1-- > These dots are the orifices of the

minor salivary glands

This is swelling in the palate the patient

doesn't know what is this and he worried

bcz it took long time so he will think

about tumors


8/19

Histopathology -- >

Later on after 2 more months >> patient will

start healing from those ugly ulcers

Later on this lesion will ulcerate

The ulcers look like neoplastic >> deep with thickmargins and the margins maybe rolled and averted

The ulcerated state will last for 2 or 3 months

lobular necrosis>--1

* Squamous metaplasia of ducts & acini.

* Mucous extravasation.

* Inflammatory cell infiltration >> the black

dots

* Features may be mistaken for SCC or

mucoepidermoid carcinoma


9/19

1 -- > This is thickened ductal lining with

sequamous metaplasia it looks like the surfacesequamous epithelium of the oral mucosa

The abvious feature here is the>--2

>>within the lobulesequamous islands

flattened sequamous cells >> they look like the

surface epithelium >> these were ductal

epithelium ( were cuboidal ) but now they are

having metaplasia

Here is a higher magnification and here we can

mucous cells aresee mucous cells but these

t identify the'I can>>there without boundaries

boundaries of each mucous cell , it is just

mucous collection

U can I identify the borders of a lobule but u

can't identify the boundaries of the cells


10/19

SJGREN SYNDROME

Decrease of the salivary secretion

OOrraall mmuuccoossaa aappppeeaarrss ddrryy,, ssmmooootthh,,

aanndd ggllaazzeedd..

DDoorrssuumm ooff ttoonngguuee oofftteenn aappppeeaarrss rreedd

a

anndd aattrroopphhiicc wwiitthh vvaarriiaabbllee ddeeggrreeeess ooff

f

fiissssuurriinngg aanndd lloobbuullaattiioonn

Abnormal lacrimal gland

KKeerraattooccoonnjjuuccttiivviittiiss ssiiccccaa mmaanniiffeessttss aass ::

11.. ddrryynneessss ooff eeyyeess22.. ccoonnjjuunnccttiivviittiiss33.. ggrriittttyy,, bbuurrnniinngg sseennssaattiioonn

OOnnllyy 1155%% pprreesseenntt wwiitthh eennllaarrggeemmeenntt ooff tthhee

ssaalliivvaarryy ggllaanndd >>>> tthhee eennllaarrggeemmeenntt aallssoo sseeeenn iinn tthhee

ssiiaallaaddeenniittiiss

llyymmpphhooccyytteess iinnffiillttrraattiioonn>>>> mmaaiinnllyy TT cceellllss

RRiisskk ooffBB cceellll llyymmpphhoommaa ddeevveellooppiinngg iinn

aaffffeecctteedd ggllaanndd 4444 ttiimmeess tthhaatt ooff ggeenneerraall ppooppuullaattiioonn..


11/19

** Due to decrease the salivary secretion the patient may have caries and peridontitis .. etc

SALIVARY GLANDS TUMORS -- ADENOMAS

Proliferation of duct epithelium and the

surrounding myoepithelium >> obstructing the ducts

and forming epimyoepithelial islands -- > 1

Present in a sea of lymphocytes -- > 2

The appearance is described asmyoepithelial

sialadenitis or benign lymphoepithelial lesion.

This appearance also seen in AIDS but without

auto antibodies

Unlike lymphoma, the infiltrate does not cross

interlobular CT septa so here they are reactive not

malignant .. but if the infiltration cross the septa

then it is malignant >> lymphoma

CASE ::::>

Here we see swelling in the palate

1) This swelling is chronic

2) We don't see ulceration

3) Since 7 months

4) It is slowly increasing in size

We will think about benign tumor of salivary gland most likely Pleomorphic Adenoma bcz it is the

most common tumor of salivary glands but still we should take a biopsy


12/19

CASE ::::>

Here we see swelling in the tale of the

parotid gland -- > 1

1) This swelling is chronic

2) We don't see ulceration

3) Since 1 year

4) It is slowly increasing in size

5) No pain or neural dysfunction

CASE ::::>

Here enlarging nodule in the upper lip

which is very big in size >> we should thinkabout minor salivary gland tumor


13/19

Now we will take a biopsy to give specific diagnosis

1) Pleomorphic AdenomaHistopathology -- >

CT capsule doesn't always envelope the lesion completely .. the capsule may also show variation in

thickness and density but regardless of its completeness or not ,the tumor is clearly demarcated (

follow the arrows ) .. apparently isolated nodules -- >1 may be seen within or even outside the

capsule giving the impression of invasive growth

IInn tthhee cceenntteerr wwee hhaavvee wwhhaatt wwee ccaall lleedd cchhoonnddrrooiidd aappppeeaarraannccee

PPlleeoommoorrpphhiicc AAddeennoommaa hhaass ttwwoo ccoommppoonneennttss ::

11)) CCeelllluullaarr ccoommppoonneenntt >>>> eeppiitthheelliiuumm (( dduuccttaall :::: mmaayybbee lliittttllee nnoott lleessss tthhaann 55%% ,, mmaayybbee aabbuunnddaanntt ,, aall ll

oovveerr tthhee lleessiioonn )) aanndd mmyyooeeppeetthhiill iiuumm (( sshheeeettss ooff cceell llss ))

22)) TThhee mmaattrriixx lliikkee ccoommppoonneenntt >>>> mmiixxooiidd >>>> iitt iiss vveerryy ppaaiill wwiitthh ssccaannnneedd ffiibbrriillss aanndd tthheerree aarree ttrraappppeedd

cceell llss >>>> mmyyooeeppeetthhiill iiuumm


14/19

2) Warthin Tumor

1 -- > Epithelial component arranged in duct-

like structures

2 -- > Myoepithelial-type cells

33 ---- >> AArreeaass ooff ssqquuaammoouuss mmeettaappllaassiiaa aanndd kkeerraattiinn

ppeeaarrll ffoorrmmaattiioonn mmaayy bbee pprreesseenntt

44 ---- >> PPoollyyggoonnaall,, ssppiinnddllee,, sstteell llaattee,, oorr

ppllaassmmaaccyyttooiidd cceell llss tthhoouugghhtt ttoo bbee ddeerriivveedd ffrroomm

mmyyooeeppiitthheelliiuumm..

SSoo tthhee eeppiitthheelliiaall cceellllss jjuusstt ll iinniinngg tthhee dduucctt .... aanndd aallll

ootthheerr ccoolllleeccttiioonn ooff cceellllss aarree MMyyooeeppiitthheelliiaall cceell llss

warthin tumor consists of:

1 ) Epithelial component : double-layered epithelium (

with oncocytic appearance >> they have pink

cytoplasm which is dark in color and it contains a lot

of mitochondria ) lining cystic spaces in papillary

arrangement.

2) Lymphoid component within stroma, may contain

germinal centers -- > 2


15/19

3) Basal Cell Adenoma U should know that this is adenoma not

adenocarcinoma so it is benign tumor

It is composed of single type of cells which is basal

cells

Basal cells looks small cuboidal and dark in color

Well-encapsulated

4) Canalicular Adenoma

Consists of anastomosing strands of basaloid

epithelial cells arranged in canalicular structures

And the tissue surrounding theCanalicular

Adenoma ( the stroma ) is very delicate ( ra8e8 :

containing blood vessels ) and sometimes it isdegenerated leaving empty ( cystic ) spaces ( the

arrow )

Now what is the stroma in the Pleomorphic Adenoma ??

It is myxoid, chondroid, or myxochondroid and hyalinization


16/19

5) Ductal Papillomas

SALIVARY GLANDS TUMORS--CARCINOMAS

1) Mucoepidermoid Carcinoma

Papillary structure projecting into the ductalsystem.

if it is low grade we can't differentiate it clinicallyfrom Pleomorphic Adenoma ( benign tumors ) >>

bcz it will be slowly enlarging , not causing ulceration

and no pain

if it is high grade will have ulceration and

aggressive clinical behavior

In the picture here there is small ulcer but this could

be secondary to a trauma

>> u should take a biopsy


17/19

Histopathology -- >

here it looks like aggressive tumor in the

retromolar pad area ( arrow ) >> inside the bone >>

called central MucoepidermoidCarcinoma

Some cases came to the clinic >> young aged with

retromolar pad area swelling >> biopsy ?? >>

Mucoepidermoid Carcinoma

Characterized by presence of 3 cell types: squamous (epidermoid), mucous, and

intermediate

if the cystic spaces larger and the number of cystic>>cystic spaces>>Low grade>>Left

spaces are higher specially if the spaces surrounded by mucous cells ( these mucous cells

infiltrative >> infiltrate the surrounding connective tissue ) >> then it goes more with low grade

but they are little in>>)the arrows(these are mucous cells>>high grade>>Right

number compared to the surrounding cells >> we can't see cystic spaces >> and there is

pleomorphism in the cells


18/19

2) Acinic cell adenocarcinoma

3) Adenoid Cystic Carcinoma

Differentiation from SCC may be difficult

specially if u can't identify the mucous cells

PAS is a special stain for mucous cells ( red

) >> some times I can't see the mucous cells

unless I ask for this stain >> when the cells

appear we will say >> this is mucoepidermoid

carcinoma

It looks like the serous cells >> it is dark in color

>> it containing a lot of fin granules

Numerous microscopic cyst-like spaces withinepithelial islands produce a cribriform or Swiss

cheese pattern Or ductal spaces And sometimes solid nests without any spaces

Although The cells aggressive with high

recurrence rate but they look small and bland ( noappearance of malignant features )


19/19

Done By ::: HaNaa JadAllah

Prominent infiltration and invasion of adjacent tissues,

and spread around and along nerves

script for lab 7 .. SG disorders

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