DISEASES OF THE SALIVARY GLANDS 1 Sialolithiasis Nonspecific

DISEASES OF THE SALIVARY GLANDS 1

Sialolithiasis & Nonspecific sialadenitis • Submandibular • Stones nidus - impacted food debris - dehydration with decreased secretion • Stone → duct obstruction • Nonspecific interstitial inflammation • Or suppuration (abscess) – Staph. Strep 2

Sialolithiasis & Nonspecific sialadenitis • • Unilateral Painful – during meals Purulent ductal discharge + Recurrent 3

MUCOCELE • • Trauma Lower lip Fluctuant swelling Blockage / rupture of salivary duct → leakage of saliva into the surrounding stroma • RANULA – mucocele of the sublingual 4

MUCOCELE 5

Sjogren’s syndrome • Immune destruction • Salivary – xerostomia (dry mouth) • Lacrimal – keratoconjunctivitis sicca (dry eyes) 6

TUMOURS • • Approx. 30 in number 2% of all tumours Benign – 5 th – 7 th decade Malignant – later than above 7

BENIGN TUMOURS • • • PLEOMORPHIC ADENOMA – 50% Warthin’s tumour Oncocytoma Basal cell adenoma Canalicular adenoma Ductal papilloma 8

PLEOMORPHIC ADENOMA • Benign tumour of glands – ADENOMA • Remarkable histologic diversity PLEOMORPHIC • Commonest • Also called Mixed tumour – epithelial and connective tissue components 9

PLEOMORPHIC ADENOMA • Cell of origin → EPITHELIAL epithelial-myoepithelial / ductal reserve cells 10

PLEOMORPHIC ADENOMA Gross • < 6 cms • Bosselated • Well-demarcated / encapsulated / tongue-like protrusions • Cut surface: gray-white / variegated / myxoid / bluish translucent (chondroid) 11

PLEOMORPHIC ADENOMA 12

PLEOMORPHIC ADENOMA 13

PLEOMORPHIC ADENOMA Microscopy • HETEROGENITY ! → PLEOMORPHIC • EPITHELIAL : epithelial & myoepithelial cells arranged in ducts, acini, irregular tubules, strands, sheets NO DYSPLASIA • MESENCHYMAL : myxoid, hyaline, chondroid, osseous 14

PLEOMORPHIC ADENOMA 15

PLEOMORPHIC ADENOMA 16

PLEOMORPHIC ADENOMA CLINICAL ASPECTS • Slow growing • Painless • Parotid – swelling below & in front of the year • RECURRENT – tongue-like protrusions Enucleation – 25% with Parotidectomy – 4% 17

CARCINOMA ex PLEOMORHIC ADENOMA OR MALIGNANT MIXED TUMOUR Adenocarcinoma 18

WARTHIN’S TUMOUR Papillary cystadenoma lymphomatosum Adenolymphoma 19

WARTHIN’S TUMOUR Gross • Encapsulated • Cut surface : pale-grey narrow cystic / cleft-like / convoluted spaces contain serous / mucinous fluid 20

WARTHIN’S TUMOUR 21

WARTHIN’S TUMOUR Microscopy Cystic spaces - Narrow / cleft-like CYSTADENOMA Lining – double-layered epithelium – infoldings PAPILLARY • Inner (lumen) – palisade of columnar cells with abundant finely granular eosinophilic cytoplasm (oncocytic) • Outer (below the first) – cuboidal / polygonal Stroma - dense lymphoid tissue (germinal centres + ) LYMPHOMATOSUM 22

WARTHIN’S TUMOUR 23

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WARTHIN’S TUMOUR 25

WARTHIN’S TUMOUR • HISTOGENESIS ? Aberrant inclusions of lymphoid tissue in salivary glands 26

WARTHIN’S TUMOUR CLINICAL ASPECTS • Benign • Very rarely recurs 27

MALIGNANT TUMOURS • • Mucoepidermoid ca Acinic cell ca Adenoid cystic ca Malignant mixed tumour 28

Malignant tumours • Old age • Max (70 -90%) – sublingual • Malignant tumours more in smaller glands 29

MUCO-EPIDERMOID CARCINOMA • 15% • 60 -70% in the parotid, also in others • MOST COMMON MALIGNANT • Most common radiation-induced 30

MUCO-EPIDERMOID CARCINOMA Gross • < 8 cms. • Apparently circumscribed / infiltrative • Cut surface : pale grey-white small mucin-filled cysts 31

MUCO-EPIDERMOID CARCINOMA Microscopy • Mixtures of three cell types arranged in cords, sheets, cystic 1. mucus-secreting cells 2. intermediate cells (hybrid) squamoid features with small to large mucusfilled vacuoles 3. squamous cells 32

MUCO-EPIDERMOID CARCINOMA 33

MUCO-EPIDERMOID CARCINOMA • LOW GRADE – Mucus cells predominant • HIGH GRADE – squamous cells predominant 34

MUCO-EPIDERMOID CARCINOMA CLINICAL COURSE Low grade Spread Local invasion Recurrence 15% 5 -yr survival >90% High grade Metastasis(30%) 25 -30% 50% 35

ADENOID CYSTIC CARCINOMA • Mouth – minor, rare in parotid • Nose, paranasal sinuses • Upper airways 36

ADENOID CYSTIC CARCINOMA Gross • Small • Poorly encapsulated, infiltrative • Gray-pink 37

ADENOID CYSTIC CARCINOMA Microscopy • Small cells with dark compact nuclei, scanty cytoplasm • Arranged in tubules, solid, cribriform • SPACES BETWEEN CELLS FILLED WITH HYALINE MATERIAL – basement membrane material • Perineural invasion - pain 38

ADENOID CYSTIC CARCINOMA 39

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ADENOID CYSTIC CARCINOMA 41

ADENOID CYSTIC CARCINOMA CLINICAL ASPECTS • • Malignant Slow growing Stubbornly recurrent Painful – perineural invasion 42

Acinic cell carcinoma (tumour) • Most PAROTID – composed of serous cells 43

Acinic cell carcinoma Gross • Small • Encapsulated 44

Acinic cell carcinoma Microscopy • Look like serous cells • Clear cytoplasm • Solid sheets, microcystic, glandular, follicular, papillary • Little anaplasia 45

Acinic cell carcinoma 46

Acinic cell carcinoma CLINICAL ASPECTS • Good prognosis • Recurrence rare 47