MAJOR AND MINOR SALIVARY GLANDS  Xerostomia

 RA
HETEROTOPIA
 Hypergammaglobunemia
Intranodal Extranodal
Irradiation effect:
-more frequent HIGH:
 Submaxillary gland swell and become firm
-salivary gland tissue is -mandible, ear, palatine
(mistaken for metastatoc Ca of submaxillary LN )
usually located in the tonsil, mylohyoid ms,
 Microscopy: atophy of acinar elements and chronic
medullary portion Pituitary gland, cerebro
inflamm cells in the stroma
-composed of intercalated pontine angle
 (+) prominent squamous metaplasia
and intralobular ducts
EPITHELIAL TUMORS
LOW:
-r/t brachial pouches Tumors with stromal metaplasia:
-assotiated with cyst and  Benign mixed tumor (pleomorphic adenoma)
sinuses in the lower neck and  Malignant mixed tumor
in thyroid gland. Benign Mixed Tumor (PLEOMORPHIC ADENOMA)
SIALOLITHIASIS -MC neoplasm of salivary gland
-calculi may for in the major ducts of submaxillary, sublingual -most frequent in Women, 40’s
and parotid gland. -10x more common in parotid > submaxillary
-more common in -most arise in superficial lobe
more saturated with salt. -forms a rubbery,resilient mass with a bosselated surface and
RADIOGRAPHIC EXAM: may grow larger size
(+)radiopaque mass -frequently misdiagnosed by the neophyte in pathology
SIALOGRAPHY: Malignant Mixed Tumor
(+) partial/total blocakage of the duct -epithelial appearance comparable to that of luminal cells
MICROSCOPIC EXAM: -MC sites of metastases are: Regional LN, lungs, bones (esp
(+) dilation of glands at times squamous metaplasia vertebra), abdominal organs
SIALADENITIS Tumors with oxyphilic(oncocytic) change
 ACUTE -Localized to 1 salivay gland (usually Oxyphilic -solid, well circumscribe mass
parotid or submaxillary) Adenoma -usually small, and with char of tan color
(oncocytoma; -round cell w/ abundant granular
 Viral Caused ny paramyxovirus (mumps), mitochondrioma)
EBV, coxsackie, ANC influenza A, and acidophilic cytoplasm
parainfluenza virus Oxyphilic - char by cell atypia, mitotic activity, and
 Suppurative Staph aureus, strep spp, gram – bacterias Carcinoma infiltrative growth
(malignant
Predisposing fx: Malnutrion oncocytoma; oncocytic
Immunosuppresion adenocarcinoma)
Sialolithiasis Warthin tumor -almost exclusively in the parotid gland
 CHRONIC -in the form of mild lymphocytic (cystadenoma -more common in males
infiltration of the maj salicary glnd lymphomatosum -(+) white fluid spaces separated by
unaccompanied by clinical symptoms is papilliferum) grayish septa
common -lymphoid tissue is promonent often w/
 KUTTNER -a chronic sclerosing sialadenitis of germinal centers
TUMOR submandibular glnd. -TX: Sx excision
Sclerosing -controversial entity Monomorphic adenoma
polycystic -(+) discrete mass (usually Parotid Glnd) Basal Cell -encapsulated and often cystic
adenosis -formed by fibrohyaline stroma Adenoma -palisading at the periphery of the
Granulomatous -result from TB, mycosis, sarcoidosis etc epithelial nest giving the tumor “basaloid
Sialadenitis -results from rupture of ducts that may appearance”
contain small pools of mucin. -Primary Ddx: Basal Cell Adenocarcinoma
KIMURA DSE -can involve salivary glands (parotid) -(-) perineural spread
-by spread from adjacent LN Basal Cell -malignant counterpart of BC adenoma
BENIGN LYMPHOEPITHELIAL CYST Adenocarcinoma -(+) p53,BCL2 and EGFR
(basaloid carcinoma) -(+) perineural spread
-lesions of the parotid or upper cervical LN
-char by multilocular cystic formation lined ny glandular or Tumors with SEBACEOUS DIFFERENTIATION
squamous epithelium Sebaceous Benign tumor with predominant
-surrounded by a florid lymphoid hyperplasia wit prominent Adenoma sebaceous component
germinal centers. Sebaceous When accompanied by a prominent
Lymphadenoma lymphoid stroma
HIV-related LESION Sebaceous Carcinoma MALIGNANT COUNTERPART!
and lymphadenocarci
HIV-assoc lympho -solid lyphoepitheliat lesion (so called
epithelial cyst epimypepithelial island ) similar to those Tumors with MYOEPITHELIAL DIFFERENTIATION
seen in Mikulicz dse. MYOEPITHELIOMAS Spindle cell type:
DDx  (+) stroma-like appearance
polycystic dysgenetic dse: developmental  Can be confused w/ lesions of
dse only females w/ bilateral gland fibroblast, Schwann cells, or smooth
enlargement ms cells
sclerosing polycystic adenosis Hyaline (plasmacytoid) type:
mucoepideemoid Ca  Cells with eccentric nuclei
sebaceous lyphadenoma  Cytoplasm is abundant
benign mixed tumor  (+) diffuse eosinophilia
Milkulicz Dse -benign lymphoepithelial lesion  Cell margins are polygonal and
-present as slowly increasing and sharply outlined
striking enlargement of salivary and Clear Cell type:
lacrimal glands .  Small tubules lined by a single layer of
-glands is enlarged and whitish, cubidal cells
sometimes admixed with occasional cyst  With hyaline material in between
SJOGREN SYNDROME  Variable amount of glycogen but NO
-generalized symptom complex fat or mucin
other components:
 Keratoconjunctivitis
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 Tumors with CLEAR CELL CHANGE  Adenoid cystic carcinoma
-clear cell containing neoplasm  Acinic cell carcinoma
DDx: Clinical Diagnosis -base on their clinical and gross char.
 Clear cell myoepithelion (+) glycogen -(+)Facial nerve paralysis: almost
 Sebaceous neoplasm (+) fat diagnostic of malignancy
 Mucoepidermoid carcinoma (+) mucin Staging -using TNM
 Acinic cell carcinoma (-) for all non-immune stain -based on 5 parameters:
MUCOEPIDERMOID CARCINOMA 1) Size of primary tumor
-MC malignant salivary gland tumor in Children  represent 2) Local extension
a secondary malignancy 3) Palpability of regional LN
4 cell types: 4) Degree of suspicion or the
1) Mucin-producing regional LN
2) Squamous 5) Presence or absence of distant
3) Intermediate metastases
4) clear
ACINIC CELL CARCINOMA
-male predominance
-peak: 3rd decade of life (30’s ba!)
-encapsulated round mass w/ solid , friable , grayish-white cut
surface < 3cm in diameter
-undergo cystic degeneration
0most char cell: acinic cytoplasmic appearance (granular
and basophilic)
ADENOID CYSTIC CARCINOMA
-originally known as cylindroma
-slow growing but HIGHLY malignant
-solid appearance infiltrative pattern cribriform
-PAS (+)
-main stx ft: pseudocyst, intercellular spaces, abundant basal
lamina, true glandular lumens
-frequently metastasize to the lungs
-tx: radical surgical approach
SALIVARY DUCT CARCINOMA
-elderly male
-resembles in situ, and invasive ductal Ca of breast.
PAPILLARY ADENOCARCINOMA
-grow large and accompanied by hemorrhage and necrosis
-(+) well defined papillary stx: most impt distinguishing ft.
-(+) mucin production
MALIGNANT LYMPHOMA
-may arise fr intraparotid LN or in the gland itself
-most present as unilateral mass
Other primary neoplasm
Benign Vascular -Capillary Hemagioma of the benign
tumors (infantile) hemangioendothelioma type
is the MC salivary gland tumor in infants
and childrem
Schwannoma -can arise from one of the fine radicles of
facila nerve and present clinicaly as
salivary gland tumor
Embryoma --highly cellular epithelial parotid tumor
(Sialoblastoma) of neonates and infants
-blastomatous appearance
Sarcomas -very rare
Giant Cell -similar sa bone! Kaso develop lang sa
Tumors salivary glands
-multinucleated giant cell resemble
osteoclasts.
METASTATIC TUMORS
 centered in intraparotid or submandibular LN
 MC malignant tumor in submaxillary region is a
metastatic carcinoma in the submaxillary node rather
primary salivary gland carcinoma
 MC types are:
squamous cell carcinoma (upper aerodigestiva and skin)
malignant melanoma
 Of the distant tumors metastasizing to ths area lungm
kidney and breast are the most common
 Other site: prostate and large bowel
General Features of Salivary Gland Tumors
Relative o 12x more frequent in the parotid than
Incidence & submaxillary
Malignancy o Most are unilateral and single
o MC salivary gland tumor is Benign
mixed tumor but proportion of
malignant tumors is higher in adults
o MC malignant neoplasm:
 Mucoepidermoid carcinoma

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