Diseases of salivary glands lab Slide 3 1- Serous Acini only 2- Parotid salivary gland 3- Stensen's duct Slide 4 1- Mixed

serous and mucous Acini (mainly serous) 2- Submandibular salivary gland 3- Wharton's duct Slide 5 1- Mixed serous and mucous Acini (mainly mucous) 2- Sublingual salivary gland 3- Ducts of Rivinus Slide 6 1- Mucous Acini 2 Gingiva Anterior 1/3 of the hard palate Anterior 2/3 of dorsum tongue Slide 7 12345Chronic bacterial Sialadenitis of major salivary glands Duct obstruction If patient states that he feels pain upon eating (during meal time) Submandibular salivary gland Sialography

Slide 8 Chronic bacterial Sialadenitis of major salivary gland Sialadenitis of minor salivary gland Obstructive Sialadenitis Slide 9 1- 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 infection 4- Inclusion body inside the cytoplasm surrounded by a clear zone Slide 10 1- Sarcoidosis 2- Abnormal collection of chronic inflammatory cells (granulomas) as nodules in the salivary glands 3- Parotid and minor salivary glands 4- Heerfordt syndrome Slide 12 1- Salivary Calculus (Sialolith) 2- Submandibular salivary gland 3 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 Slide 16 1- Necrotizing Sialometaplasia 2- Etiology unknown, but ischemia leading to infarction of salivary lobules is most widely accepted theory In 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 Slide 18 1- Xerostomia 2- Xerophthalmia (kerato-conjunctivitis sicca) 3- Sjgren syndrome

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Slide 19 1- Primary and secondary categories 2- Secondary Sjgren syndrome 3- European criteria for diagnosis of Sjgren 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

Slide 20 1- Females 2- Primary Sjgren syndrome 3 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 Slide 24 1- Pleomorphic adenoma (Mixed Tumor) 2- Parotid and palatal salivary glands 3 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 Slide 29 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

Slide 31 1- Basal cell adenoma 2 Uniform basaloid cells (small cuboidal cells that are dark in color) arranged in a variety of
patterns

Well-encapsulated
Slide 32 1- Canalicular adenoma

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2-

Consists of anastomosing strands of basaloid cells arranged in canalicular structures May be partly or grossly cystic due to degeneration of loose vascular stroma Side 34 1 Pleomorphic adenoma Low grade mucoepidermoid carcinoma 2- Low grade mucoepidermoid carcinoma 3- Parotid and palatal salivary glands 4 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 Doesnt 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

Slide 39 1 Traumatic ulcer High grade mucoepidermoid carcinoma Sequamous cell carcinoma
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2- High grade mucoepidermoid carcinoma Slide 40 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 cure 4- Cribriform types

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