Dent 356-11 Lab Diseases of Salivary Glands

Dr. Rima Safadi

Salivary Glands: Major

Salivary Glands: Major

Parotid Gland

Salivary Glands: Major

Submandibular Gland

Salivary Glands: Major

Sublingual Gland

Salivary Glands: Minor

Salivary Glands: Minor

Chronic Bacterial Sialadenitis

Chronic Bacterial Sialadenitis

Histopathology: - varying degrees of ductal dilatation. - hyperplastic ductal epithelium. - periductal fibrosis. - acinar atrophy & replacement by fibrous tissue. - chronic inflammatory infiltration.

Cytomegalic Inclusion Disease (Salivary Gland Inclusion Disease)

Histopathology: 1. Salivary gland involvement is usually an incidental histological finding.
2. Large, doubly contoured

owl-eye inclusion bodies within nucleus or cytoplasm of duct cells of parotid gland.

Sarcoidosis
Granuloma, non caseating

Sialadenitis of Minor Glands

Periductal fibrosis

Inflamed lobule

Dilated duct

Salivary Calculi (Sialoliths)

Salivary Calculi (Sialoliths)

Salivary Calculi (Sialoliths)

sialolith

Hyperplastic ductal epithelium

Necrotizing Sialometaplasia
A relatively uncommon disorder. May be mistaken clinically and histologically for malignant disease. Most frequent on hard palate in middle-aged patients, especially males.

Nsmetaplasia May start as swelling

Later on it ulcerates

August 23

After 3 months it healed

Necrotizing Sialometaplasia
Histopathology:
1. Lobular necrosis. 2. Squamous metaplasia of

ducts & acini.

3. Mucous extravasation.
4. Inflammatory cell infiltration.

5. Features may be mistaken for

SCC or mucoepidermoid carcinoma.

Squamous metaplasia Of nec sialo metap

Lobular necrosis

Sjgren Syndrome: Clinical Features

Oral mucosa appears dry, smooth, and glazed.

Dorsum of tongue often appears red and atrophic with variable degrees of fissuring and lobulation.

Sjgren Syndrome: Clinical Features

Keratoconjuctivitis sicca manifests as: dryness of eyes conjunctivitis gritty, burning sensation.

1. 2. 3.

Sjgren Syndrome: Clinical Features

Salivary gland enlargement is variable. 30% of patients give history of enlargement. Only 15% present with enlargement. Usually bilateral. Predominantly affects parotid glands. Seldom painful.

Sjgren Syndrome: Clinical Features

Lacrimal gland enlargement is uncommon.
Although clinical involvement of minor salivary glands is uncommon, they are often involved microscopically.

SS infiltrate of lymphocytes

Sjgren Syndrome: Histopathological Features

Major glands: 4. Proliferation of duct epithelium to form epimyoepithelial islands. 5. The appearance is described as myoepithelial sialadenitis or benign lymphoepithelial lesion.

6. Unlike lymphoma, the infiltrate does not cross interlobular CT septa.

SS

Sialolith

Pleomorphic Adenoma: Clinical Features

Slowly growing, painless, rubbery swelling with intact overlying skin or mucosa. Patient may be aware of lesion for several years.

Pleomorphic adenoma
Sheets mainly of myoepith cells

Ducts formed by epithelial cells

Myoep. cells

Myxoid (mucoid) products

Pleomorphic Adenoma: Histopathologic Features

.

The tumor is Well demarcated But not encapsulated

Pleomorphic Adenoma: Histopathologic Features

Chondroid product

Pleomorphic Adenoma: Histopathologic Features

Epithelial component may be arranged in duct-like structures, sheets, clumps, and interlacing strands.

hyalinization

Extension of tumor lobules out side The main tumor border

Pleomorphic Adenoma: Histopathologic Features

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

Warthin Tumor: Histopathologic Features

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

Lymphoid tissue with germinal center

Warthin Tumor: Histopathologic Features

1.

2.

Tumor consists of: Epithelial component: double-layered epithelium lining cystic spaces in papillary arrangement. Lymphoid component within stroma, may contain germinal centers. Epithelial cells have granular cytoplasm rich in abnormal mitochondria, resembling oncocytes.

Basal Cell Adenoma: Histopathologic Features

Consists of cytologically uniform basaloid cells arranged in a variety of patterns.

Well-encapsulated.

Canalicular Adenoma
> 50 years of age. Almost all cases in upper lip.

Consists of anastomosing strands of basaloid epithelial cells arranged in canalicular structures.

May be partly or grossly cystic due to degeneration of loose vascular stroma.

Arrangement of cells in canalicular structures

Ductal papilloma
Ductal space

Papillary projections

Duct lining

Mucoepidermoid Carcinoma: Clinical Features

Often presents clinically in a similar manner to pleomorphic adenoma.

Mucoepid. carcinoma
Central lesion

Minor salivary gland lesion

Cystic space

Mucous cells

Mixture of cells

Mucoepidermoid Carcinoma: Histopathologic Features

Mucoous cells

Intermediate cells

Mucoepidermoid Carcinoma: Histopathologic Features Low grade MEC: 5.

Mucoepidermoid Carcinoma: Histopathologic Features

High grade MEC:

Mucoepidermoid Carcinoma: Histopathologic Features

High grade MEC:

Acinic Cell Carcinoma

Uncommon. Accounts for 2-3% of parotid tumors.

Regarded as a low grade malignancy.

80-100% 5-year survival rates reported for welldifferentiated tumors, 65% for poorly differentiated ones.

Acinic cell adenocarcinoma

Acinic Cell Carcinoma: Histopathologic Features

.
The most common variants consist of sheets or acinar groupings of large, polyhedral cells with basophilic, granular cytoplasm, similar to serous acinar cells.

Adenoid Cystic Carcinoma

Middle-aged & elderly. Up to 30% of minor SG tumors, but only ~6% of parotid tumors.

Adenoid Cystic Carcinoma: Clinical Features

May present as slowly enlarging tumors like pleomorphic adenoma, but pain and ulceration are much more common.

Parotid tumors may present with facial palsy.

Neurological manifestations reflect predilection to infiltrate and spread along nerves.

Adenoid Cystic Carcinoma: Histopathologic Features

cribriform or Swiss cheese pattern.

Epithelium consists of small, uniform, basophilic cells. Rare mitoses.

Perinueral invasion

Adenoid Cystic Carcinoma: Histopathologic Features Perineural invasion. Less commonly epithelium is arranged in a tubular or solid pattern. Prominent infiltration and invasion of adjacent tissues, and spread around and along nerves. In the maxilla, tumor may infiltrate along marrow spaces with no evidence of bone destruction.

Carcinoma Arising in Pleomorphic Adenoma

Also known as carcinoma ex pleomorphic adenoma. ~3% of SG tumors. Almost all arise in parotid or submandibular tumors that have been present for many years. Histological diagnosis requires evidence of pre-existing pleomorphic adenoma.

Carcinoma Arising in Pleomorphic Adenoma

Age Changes in Salivary Glands

Reduction in weight of parotid and submandibular glands related to atrophy of secretory tissue & replacement by fibrofatty tissue. Similar changes in labial minor glands. Oncocytic change in ductal epithelium. Reduction in flow rate in submandibular gland.