The sialadenitis may be largely interstitial or cause focal areas of suppurative necrosis or even abscess formation.
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.
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
The diverse microscopic pattern of this lesion is one of its most characteristic features.
Islands of cuboidal cells arranged in ductlike 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.
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.
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.
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.
Stained + by musicarmine.
MECs constitute approximately 35% of salivary gland malignancy, and 80% to 90% of MECs occur in the parotid gland.
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, and they have pale and sometimes foamy cytoplasm, a distinct cell boundary, 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.
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.)
Nerve (N) invaded by adenoid cystic carcinoma (the blue area surrounding the nerve).
Spread may occur by emboli along the nerve lymphatics
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.