Here are the answers to your questions:
1. Common types of salivary gland benign tumors with origin of each:
- Pleomorphic adenoma - originates from the intercalated duct cells and myoepithelial cells.
- Oncocytic tumors - originate from the striated duct cells.
- Acinous cell tumors - originate from the acinar cells.
- Mucoepidermoid tumors and squamous cell carcinomas develop in the excretory duct cells.
2. The histological features of mucoepidermoid carcinoma include:
- Containing mucin-producing cells and epithelial cells of the epidermoid variety.
- Divided into
2. SALIVARY GLAND DISEASES
Although diseases primary to the major
salivary glands are in general uncommon,
Among the many possible disorders,
attention is restricted here to
Sialadenitis and salivary gland
tumors.
Sialadenitis
• Inflammation of the major salivary glands
may be of viral, bacterial, or autoimmune
origin.
• Dominant among these causations is the
infectious viral disease mumps, which may
produce enlargement of all the major
salivary glands but predominantly the
parotids.
4. SALIVARY G……..
Although a number of viruses may cause mumps, the
dominant cause is a paramyxovirus, an RNA virus
related to the influenza and parainfluenza viruses.
It usually produces a diffuse, interstitial inflammation
marked by edema and a mononuclear cell infiltration
and, sometimes, by focal necrosis.
5. Although childhood mumps is self-limited and rarely
leaves residua, mumps in adults may be
accompanied by pancreatitis or orchitis.
Bacterial sialadenitis most often occurs secondary
to ductal obstruction resulting from stone formation
(sialolithiasis),
but it may also arise after retrograde entry of oral
cavity bacteria under conditions of severe systemic
dehydration such as the postoperative state.
6. Chronic sialadenitis arises from decreased production of
saliva with subsequent inflammation.
The dominant cause is autoimmune sialadenitis, which is
almost invariably bilateral.
This is seen in Sjögren syndrome: All of the salivary
glands (major and minor), as well as the lacrimal glands,
may be affected in this disorder, which induces dry mouth
(xerostomia) and dry eyes (keratoconjunctivitis sicca).
The combination of salivary and lacrimal gland
inflammatory enlargement, which is usually painless, and
xerostomia.
The causes include sarcoidosis, leukemia, lymphoma, and
idiopathic lymphoepithelial hyperplasia.
7. TREATMENT
Medical management - Hydration, antibiotics
(oral versus parenteral), warm compresses and
massage, sialogogues (increases the flow of sliva)
Surgical management - Consideration of
incision and drainage versus excision of the
gland in cases refractory to antibiotics, incision
and drainage with abscess formation, gland
excision in cases of recurrent acute sialadenitis
8. Salivary Gland Tumors
The salivary glands give rise to a diversity of tumors that
belies their small size.
About 80% of tumors occur within the parotid glands
and most of the others in the submandibular glands.
The dominant tumor arising in the parotids is the benign
pleomorphic adenoma, which is sometimes called a
mixed tumor of salivary gland origin.
9. SALIVARY GLAND BENIGN TUMORS
pleomorphic adenomas
originate from the
intercalated duct cells
and myoepithelial cells
oncocytic tumors
originate from the
striated duct cells
acinous cell tumors
originate from the acinar
cells,
Mucoepidermoid
tumors and squamous
cell carcinomas develop
in the excretory duct
cells.
10. STAGING SYSTEM FOR MAJOR SALIVARY
GLAND CANCER
Tx Primary tumor cannot be assessed
T0 No evidence of primary tumor
T1 Tumor < 2cm in greatest dimension
T2 Tumor 2-4 cm in greatest dimension
T3 Tumor 4-6 cm in greatest dimension
T4 Tumor > 6 cm in greatest dimension
All categories are subdivided: (a) no local extension; (b)
local extension.
Local extension is clinical or macroscopic invasion of skin,
soft tissue, bone, or nerve.
Microscopic evidence alone is not a local extension for
classification purposes.
13. PLEOMORPHIC ADENOMA
Epithelial Components
• Tubular and cord-like arrangements
• Cells contain a moderate amount of cytoplasm
• Mitoses are rare
Stromal or “mesenchymal” Components
• Can be quite variable
• Attributable to the myoepithelial cells
• Most tumors show chondroid (cartilaginous)
differentiation
• Osseous metaplasia not uncommon
• Relatively hypocellular and composed of pale blue to
slightly eosinophilic tissue.
14. PLEOMORPHIC ADENOMA
pleomorphic adenoma contains
both epithelial (E) and stromal
(S) components.
Pleomorphic adenoma. Slowly
enlarging neoplasm in the parotid
gland of many years duration.
The bisected, sharply circumscribed,
yellow-white tumor can be seen
surrounded by normal salivary gland
tissue
15. PLEOMORPHIC ADENOMA
Islands of cuboidal cells
arranged in duct like
structures is a common
finding.
Loose chondromyxoid
stroma, hyalinized connective
tissue, cartilage(arrows) and
even osseous tissue are
observed.
This neoplasm is typically
encapsulated, although tumor
islands may be found within
the fibrous capsule.
16. PLEOMORPHIC ADENOMA
A, Low-power view showing a well-demarcated tumor with adjacent normal
salivary gland parenchyma.
B, High-power view showing epithelial cells as well as myoepithelial cells found
within a chondroid matrix material.
17. WARTHIN'S TUMOR
Warthin's tumor (benign
papillary cystadenoma
lymphomatosum)
the second most common
benign tumor of the parotid
gland
It accounts for 2-10% of all
parotid gland tumors
Bilateral in 10% of the
cases
may contain mucoid brown
fluid
19. WARTHIN’S TUMOR
Epithelial Component
Consists of papillary fronds which demonstrate 2 layers
of oncocytic epitheilal cells
Cytoplasm stains deep pink and shows granularity of an
abundance of mitochondria
Occasionally undergoes squamous metaplasia (may
mistakenly diagnose SCCa)
20. WARTHIN’S TUMOR
Lymphoid Component
An abundance of this is present
Occasional germinal centres will be seen
Lymphoid tissue forms the core or papillary structures
Both lymphoid and oncocytic epithelial
elements must be present to diagnose Warthin’s
22. WARTHIN’S TUMOR
A, Low-power view showing epithelial and lymphoid elements. Note the
follicular germinal center beneath the epithelium.
B, Cystic spaces separate lobules of neoplastic epithelium consisting of a
double layer of eosinophilic epithelial cells based on a reactive lymphoid
stroma.
23. MONOMORPHIC ADENOMA
Similar to Pleomorphic Adenoma except no
mesenchymal stromal component
• Predominantly an epithelial component
More common in minor salivary glands (upper lip)
12% bilateral
Rare malignant potential
Types:
• Basal Cell Adenoma
• Canicular Adenoma
• Myoepithelioma Adenoma
• Clear Cell Adenoma
• Membranous Adenoma
• Glycogen-Rich Adenoma
25. MUCOEPIDERMOID CARCINOMA
Mucoepidermoid carcinoma (MEC) is the most
common malignant tumor of the parotid gland
and the second-most common malignancy
(adenoid cystic carcinoma is more common) of
the submandibular and minor salivary glands.
MECs constitute approximately 35% of salivary
gland malignancy, and 80% to 90% of MECs
occur in the parotid gland.
26. MUCOEPIDERMOID
CARCINOMA
• MECs contain two major
elements:
• Mucin-producing cells
and
• Epithelial cells of the
epidermoid variety.
• MEC is divided into low-
grade (well
differentiated).
• High-grade (poorly
differentiated).
27. They contain three cellular elements in varying proportions:
squamous cells, mucus-secreting cells, and intermediate"
cells.
Mucous cells (mucocytes) can occur singly or in clusters,
pale and sometimes foamy cytoplasm and small, peripherally
placed, compressed nuclei.
Mucocytes often form the lining of cysts or duct-like
structures.
Occasionally mucocytes are so scanty that they can be
identified with confidence only by using stains such as
mucicarmine.
Epidermoid cells may be uncommon and focally
distributed.
They have abundant eosinophilic cytoplasm, but they
rarely show keratin pearl formation or dyskeratosis.
Oncocytic metaplasia is seen occasionally.
28. MUCOEPIDERMOID CARCINOMA
A, Mucoepidermoid carcinoma showing islands having squamous cells as
well as clear cells containing mucin.
B, Mucicarmine stains the mucin reddish-pink. (Courtesy of Dr. James
Gulizia, Brigham and Women's Hospital, Boston.)
29. ADENOID CYSTIC CARCINOMA
Adenoid cystic carcinoma
with Swiss cheese pattern.
It is the second-most
common malignant tumor of
the salivary glands.
ACC is the most common
malignant tumor found in the
submandibular, sublingual,
and minor salivary glands.
30. ADENOID CYSTIC CARCINOMA
Nerve (N) invaded by
adenoid cystic carcinoma
(the blue area surrounding
the nerve).
Spread may occur by emboli
along the nerve lymphatics
31. ADENOID CYSTIC CARCINOMA
Adenoid cystic carcinoma in a salivary gland.
A, Low-power view. The tumor cells have created a cribriform pattern enclosing
secretions.
B, Perineural invasion by tumor cells.
34. Habis
Question??????????????
Q1. Mention the common types of salivary gland benign
tumors with origin of each.
Q2. Identify the histological feature for mucoepidermoid
carcinoma
Hinweis der Redaktion
Pleomorphic Adenomas: PAIM
Batsakis- pg 6
Figure 16-16 .
Batsakis-Pg 6
Figure 16-17 Pleomorphic adenoma.
Batsakis-Pg 8
Batsakis-Pg 8
Warthins: WHALE = W arthins H as A bundant L ymphoid and E pithelial components