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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-88/3/2019 Lab 7 Diseases of Salivary Glands
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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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Salivary Calculi (Sialoliths)
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Salivary Calculi (Sialoliths)
Hyperplastic ductal epithelium
sialolith
http://www.usc.edu/hsc/dental/opfs/SG/076big.html8/3/2019 Lab 7 Diseases of Salivary Glands
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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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Sjgren Syndrome: Clinical Features
Keratoconjuctivitissicca manifests as:
1. dryness of eyes2. conjunctivitis
3. gritty, burningsensation.
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Sjgren Syndrome: Clinical Features
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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Sjgren Syndrome: Clinical Features
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-88/3/2019 Lab 7 Diseases of Salivary Glands
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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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Pleomorphic Adenoma: Histopathologic Features
Chondroid product
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Pleomorphic Adenoma: Histopathologic Features
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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Pleomorphic Adenoma: Histopathologic Features
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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Mucoepidermoid Carcinoma: Histopathologic Features
Low grade MEC:
5.
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Mucoepidermoid Carcinoma: Histopathologic Features
High grade MEC:
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Mucoepidermoid Carcinoma: Histopathologic Features
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=N8/3/2019 Lab 7 Diseases of Salivary Glands
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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=N8/3/2019 Lab 7 Diseases of Salivary Glands
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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.
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