Lect.2. salivary gland pathology
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  • 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
  • Batsakis-Pg 8
  • Figure 16-18 Warthin tumor.
  • Batsakis- Pg 8
  • Figure 16-19
  • Figure 16-20
  • Batsakis-Pg 22

Transcript

  • 1. SALIVARY GLAND PATHOLOGY SMS 2044 Dr. Mohanad r. alwan
  • 2. SALIVARY GLAND DISEASES
    • Although diseases primary to the major salivary glands are in general uncommon, the parotids bear the brunt of these involvements.
    • 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.
  • 3. Micrograph showing chronic sialadenitis .
  • 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.
    • 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.
  • 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.
    • T he 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.
    Salivary Gland Tumors
  • 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.
  • 11. NORMAL HISTOLOGY
  • 12. PLEOMORPHIC ADENOMA
  • 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
    • 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.
  • 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 in FNA
  • 18. WARTHIN’S TUMOR
    • Mid Power
    • Thought to arise from salivary gland inclusions within lymph nodes.
  • 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 on FNA)
  • 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
  • 21. WARTHIN’S TUMOR
    • High Power
    • Lymphocytc infilterates.
    • Bilayer of epithilium.
  • 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
  • 24. BASAL CELL ADENOMA
    • A monomorphic adenoma
    • It is composed of uniform basaloid epithelial cells with a monomorphous pattern.
    • The arrangement of tumor cells may be trabecular, tubular or solid.
    • Histologically, these tumors are distinguished from pleomorphic adenomas by their absence of chondromyxoid stroma and the presence of a uniform epithelial pattern.
  • 25. MALIGNANT SALIVARY GLAND TUMORS
  • 26. 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.
    • Stained + by musicarmine.
    • MECs constitute approximately 35% of salivary gland malignancy, and 80% to 90% of MECs occur in the parotid gland.
  • 27. 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).
  • 28.
    • They contain three cellular elements in varying proportions: squamous cells, mucus-secreting cells, and &quot;intermediate&quot; 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.
  • 29. 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.)
  • 30. 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.
  • 31. 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
  • 32. 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.
  • 33. ACINIC CELL CARCINOMA
    • The acinic cell adenocarcinoma occurs mainly in the parotid gland, also known as blue dot tumor.
    • Classic multicystic pattern.
    • Stained by PAS.
    • Cells heavily stained.
  • 34. ACINIC CELL CARCINOMA
    • This lesion is characterized by a benign histomorphologic picture but by occasional malignant behavior.
    • Bilateral involvement occurs in 3% of patients, making acinic cell carcinoma the second-most common neoplasm, after Warthin’s tumor, to exhibit bilateral presentation.
  • 35. HODGKIN'S LYMPHOMA
    • Hodgkin's disease involving the parotid gland. 
    • Note the Reed-Sternberg cell.  (Fine needle aspiration, Pap, 630x)
  • 36. SALIVARY GLAND TUMORS
  • 37. HABIS QUESTION?????????????? Q1 . Mention the common types of salivary gland benign tumors with origin of each. Q2. Identify the histological feature for mucoepidermoid carcinoma