Diseases of salivary glands lab

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1- Serous Acini only2- Parotid salivary gland 3- Stensen's duct

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1- Mixed serous and mucous Acini (mainly serous)2- Submandibular salivary gland 3- Wharton's duct

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1- Mixed serous and mucous Acini (mainly mucous)2- Sublingual salivary gland3- Ducts of Rivinus

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1- Mucous Acini2-

Gingiva Anterior 1/3 of the hard palate Anterior 2/3 of dorsum tongue

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1- Chronic bacterial Sialadenitis of major salivary glands 2- Duct obstruction3- If patient states that he feels pain upon eating (during meal time)4- Submandibular salivary gland5- Sialography

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Chronic bacterial Sialadenitis of major salivary gland Sialadenitis of minor salivary gland Obstructive Sialadenitis

Slide 91- Large, doubly contoured (owl-eye) inclusion bodies within nucleus or cytoplasm of duct cells

of salivary gland

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2- Cytomegalic Inclusion Disease (Salivary Gland Inclusion Disease)3- CMV infection4- Inclusion body inside the cytoplasm surrounded by a clear zone

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1- Sarcoidosis 2- Abnormal collection of chronic inflammatory cells (granulomas) as nodules in the salivary

glands3- Parotid and minor salivary glands4- Heerfordt syndrome

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1- Salivary Calculus (Sialolith)2- Submandibular salivary gland3-

They cause pain & sudden enlargement of affected gland (especially at meal times when secretion is stimulated)

Reduction in flow predisposes to ascending infection & chronic bacterial Sialadenitis Calculi may be detected by palpation clinically and on radiographs

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1- Necrotizing Sialometaplasia 2- Etiology unknown, but ischemia leading to infarction of salivary lobules is most widely

accepted theoryIn some patients there may be history of trauma

3- Malignant ulcers

Sequamous cell carcinoma Mucoepidermoid carcinoma

4- Biopsy to confirm diagnosis then do nothing since it is a self-limiting condition that will heal within 10-12 weeks

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1- Xerostomia2- Xerophthalmia (kerato-conjunctivitis sicca)3- Sjögren syndrome

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1- Primary and secondary categories2- Secondary Sjögren syndrome3- European criteria for diagnosis of Sjögren syndrome:

Ocular symptoms Ocular signs Oral symptoms Salivary gland function Labial salivary gland histology Ro and La autoantibodies

4 of the 6 criteria need to be fulfilled to diagnose SS

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1- Females2- Primary Sjögren syndrome3-

Lymphocytic infiltration (20% B cells, 80% T cells) Acinar atrophy Proliferation of duct epithelium to form epimyoepithelial islands (The appearance is

described as Myoepithelial Sialadenitis or benign Lymphoepithelial lesion) Unlike lymphoma the infiltrate does not cross interlobular Connective Tissue septa

4- Minor salivary gland biopsy Estimation of parotid salivary flow rates (usually reduced) Sialography: shows sialectasia (snowstorm) pattern or (cherry tree in blossom)

appearance Ophthalmic opinion to assess ocular signs Serological findings: anti-Ro (SS-A), anti-La (SS-B)

5- B cell lymphoma

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1- Pleomorphic adenoma (Mixed Tumor)2- Parotid and palatal salivary glands3-

Composed of cells of epithelial and myoepithelial origin (mixed tumor)

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Great variety with complex intermingling of epithelial components & mesenchyme-like areas (Pleomorphic)

Although benign, Connective Tissue capsule is not always complete Tumor is clearly demarcated, but apparently isolated nodules of the tumor may be seen

within or even outside the capsule giving the impression of invasive growth Serial sections show that these represent outgrowths of the main mass (these masses are

NOT indicators of malignancy or malignant potential of the tumor)

4- Excision of the tumor with a safety margin all around , why?!

Encapsulation around the tumor is deficient Intra and extra capsular nodules of the tumor Simple enucleation could cleave within or just below the capsule leaving behind islands

of neoplastic tissues in the tumor bed which could give rise to Unifocal or multifocal recurrence

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1- Warthin tumor (Papillary Cystadenoma Lymphomatosum)2-

Multiple, irregular cystic spaces containing mucoid material separated by papillary projections of tumor tissue

Tumor consists of:

Epithelial component: double-layered epithelium lining cystic spaces in papillary arrangement

Lymphoid component: found within stroma and may contain germinal centers

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1- Basal cell adenoma 2-

Uniform basaloid cells (small cuboidal cells that are dark in color) arranged in a variety of patterns

Well-encapsulated

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1- Canalicular adenoma

2-

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Consists of anastomosing strands of basaloid cells arranged in canalicular structures May be partly or grossly cystic due to degeneration of loose vascular stroma

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1- Pleomorphic adenoma Low grade mucoepidermoid carcinoma

2- Low grade mucoepidermoid carcinoma3- Parotid and palatal salivary glands4-

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

Relative proportions and arrangements of cell types are used to distinguish between: High grade Mucoepidermoid Carcinoma (poorly differentiated) Low grade Mucoepidermoid Carcinoma (well differentiated)

5- Low grade :

Well-differentiated Mucous and epidermoid cells predominate No cellular pleomorphism Prominent cystic spaces Doesn’t invade or infiltrate

High grade:

Poorly differentiated Epidermoid and intermediate cells predominate Nuclear & cellular pleomorphism Cystic spaces NOT prominent Highly invasive and infiltrative Differentiation from SCC may be difficult

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1- Traumatic ulcer High grade mucoepidermoid carcinoma Sequamous cell carcinoma

2- High grade mucoepidermoid carcinoma

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1- Adenoid cystic carcinoma 2-

Epithelium is arranged as ovoid & irregularly shaped islands or anastomosing cords in scanty Connective Tissue stroma

Numerous microscopic cyst-like spaces within epithelial islands produce a (cribriform) or (Swiss cheese) pattern

Peri-neural invasion Prominent infiltration and invasion of adjacent tissues, and spread around and along

nerves

3- Radiotherapy doesn't result in permanent cure4- Cribriform types

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