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Diseases of The Salivary Gland
Diseases of The Salivary Gland
Diseases of The Salivary Gland
In body there are three major salivary glands: parotid, sub-mandibular (submaxillary) and sub-lingual. In addition, numerous minor salivary glands are present in submucosa, in large part of oral cavity Main duct of parotid gland (Stensens duct) opens into oral cavity opposite the crown of 2nd maxillary molar. Duct of both submandibular (Whartons duct) and sublingual glands (Bartholins duct) opens into the floor of the mouth on each side of the frenulam. Microscopically, salivary glands are compound exocrine glands, i.e. they consist of multiple acini at the end of a highly branched duct system. The acinar portion can be either serous or mucinous. The parotid gland is totally serous, submandibular and sublingual glands are mixed in character. The intercalated ducts (terminal branches of duct system) and acini, together form what is known as ductoacinar unit. Some amount of lymphoid tissue may be normally present in stroma of the salivary glands.
Ducto-acinar unit
Sialadenitis
Sialadenitis may be
Acute
infectious or non-infectious
Chronic
infectious or non-infectious
Sialadenitis can be
Local, or Manifestation of a systemic disorder.
Chronic Sialadenitis
Chronic sialadenitis may be due to
Recurrent duct obstruction In association with conditions like
Rheumatoid arthritis Sjogrens syndrome (sialadenitis + xerostomia + dry eyes) Radiation therapy
Chronic Sialadenitis
Chronic Sialadenitis
It is characterized by Lymphocytic and plasma cell infiltration. Acinar atrophy Fibrosis that may be extensive enough to encase ducts in thick fibrous tissue called chronic sclerosing sialadenitis
Benign
Warthin tumor (5% - 10%) Oncocytoma (1%) Other adenomas (5% - 10%)
Malignant
Pleomorphic adenoma (50%) Mucoepidermoid carcinoma (15%) Adenocarcinoma (10%) Acinic cell carcinoma (5%) Malignant Mixed tumor (3% - 5%)
Pleomorphic Adenoma
Pleomorphic adenoma is the commonest tumor of salivary glands. It originates from a mixture of ductal and myoepithelial cells. Although also known as mixed tumor of salivary gland, it is not a true mixed tumor, since it is not composed of tissues derived from more than one germ cell layer. The tumor occurs most commonly in the parotid gland. It is also seen in palate, upper lip and buccal mucosa. It is rare in sublingual gland. In parotid gland, about 75% cases are seen in superficial lobe. Rest occur in deep lobe and these tumors may present as pharyngeal masses. Grossly, the tumor is rubbery and bosselated. It may reach massive proportions. Cut surface shows a variable appearance. Although well circumscribed, it sends extensions into surrounding normal tissue.
OHE, many different types of tissue may be seen. This may lead to a mistaken diagnosis of malignancy, although this tumor is entirely benign. In a typical case, a biphasic pattern consisting of epithelial and stromal cells are seen. Most commonly epithelial cells forms glands, often they may be squamous in nature. Stromal cells can be fibrous, myxoid, fatty , cartilaginous or of many other types. Myoepithelial cells are present in variable amount. Treatment consists of total excision along with a margin of surrounding tissue if feasible. Facial nerve is to be preserved. If simple enucleation of the tumor is done, multi focal recurrence can occur. The tumor if left untreated for a long time may undergo malignant transformation in up to 5% of cases.