Chapter 11: Salivary Gland Pathology

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1

What condition is characterized by congenital absence of one or more major salivary glands?

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salivary gland aplasia

2

What is the most significant symptom associated with salivary gland aplasia?

xerostomia

3

Why might patients with salivary gland aplasia still maintain some degree of moisture?

Because of continued activity of minor salivary glands.

4

What autosomal dominant disorder is associated with salivary gland aplasia?

lacrimo-auriculo-dento-digital (LADD) syndrome

5

What are three treatments for salivary gland aplasia?

  1. saliva substitutes (e.g. carboxymethylcellulose)
  2. sialagogue medications (e.g. pilocarpine)
  3. preventive dental care to avoid caries
6

What condition results from rupture of a salivary gland duct and spillage of mucin into soft tissues?

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mucocele

7

What is the difference between mucocele and a salivary duct cyst?

The mucocele is not a true cyst because it lacks an epithelial lining.

8

What is the most common site for the mucocele?

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lower lip

9

What variant of mucocele tends to develop in the soft palate and retromolar area?

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superficial mucocele

10
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Microscopic examination shows of an oral lesion shows:

  • mucin surrounded by granulation tissue
  • numerous foamy histiocytes (macrophages)
  • a ruptured salivary duct

What is the likely diagnosis?

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mucocele

11

What is the treatments for mucocele?

Short-lived lesions rupture and heal; chronic lesions require surgical excision.

12

What is the term for mucoceles arising from the sublingual gland in the floor of the mouth?

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ranula (the Latin word rana means “frog”)

13
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What variant of ranula occurs when spilled mucin produces swelling within the neck?

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plunging ranula

14

What is the treatment for ranula?

Removal of the feeding sublingual gland and/or marsupialization (for small, superficial ranulas).

15

What is marsupialization?

Removal of the roof of an intraoral lesion and suturing to allow continued drainage.

16

What condition is characterized by an epithelium-lined cavity that arises from salivary gland tissue?

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salivary duct cyst

17

What is the difference between a salivary duct cyst and the more common mucocele?

The salivary duct cyst is a true developmental cyst that is lined by epithelium.

18

Where is the most common site for salivary duct cysts of the major salivary glands?

parotid gland

19

Where are the most common sites for salivary duct cysts of the minor salivary glands?

  1. floor of the mouth
  2. buccal mucosa
  3. lips
20
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Microscopic examination of a salivary duct shows thin cuboidal epithelium surrounding thin or mucoid secretions. What is the likely diagnosis?

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salivary duct cyst

21

Microscopic examination of a salivary duct shows:

  • dilation of the salivary duct
  • oncocytic metaplasia of the epithelial lining
  • papillary folds into the lumen

What is the likely diagnosis?

oncocytic salivary ductal ectasia

22

What is the treatment for isolated salivary duct cysts?

surgical excision

23

What condition is characterized by calcified structures that develop within the salivary ductal system?

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sialolithiasis

24

Where is the most common site for sialolith development within the salivary ductal system?

submandibular gland

25

Why are sialoliths most likely to develop within the ductal system of the submandibular gland?

Because of the long, upward path of submandibular (Wharton) duct and its thicker, mucoid secretions.

26
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A patient presents complaining of mouth pain at mealtimes; radiographic examination reveals a radiopaque mass located at the left angle of the mandible. What is the likely diagnosis?

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major gland sialolithiasis

27

What procedure involves insertion of a miniaturized endoscope into the salivary duct?

sialendoscopy

28
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A patient resents with a hard nodule in the upper lip; soft tissue radiograph revealed a laminated calcified mass. What is the likely diagnosis?

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minor gland sialolithiasis

29
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Microscopic examination of a salivary duct shows:

  • concentric laminated calcified mass
  • a central nidus of amorphous debris
  • squamous metaplasia of the duct

What is the likely diagnosis?

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sialolithiasis

30

What is the treatment for sialolithiasis?

Small sialoliths may be treated conservatively with massage, sialagogues, moist heat, and increased fluid intake; large sialoliths need to be removed surgically.

31

What condition is characterize by inflammation of the salivary glands?

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sialadenitis

32

What is the most common viral infection to cause sialadenitis?

mumps

33

What is the most common iatrogenic cause of sialadenitis?

surgical mumps

34

What is surgical mumps?

An acute parotitis that may develop when a patient has been kept without food or fluids and receives atropine.

35

What is the most common hospital-acquired infection to cause sialadenitis?

Staphylococcus aureus

36
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A patient presents with a swollen parotid gland and a temperature of 100.2° F; a purulent discharge is expressed when the gland is massaged. What is the likely diagnosis?

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acute sialadenitis

37

What type of sialadenitis is caused by recurrent or persistent ductal obstruction by sialoliths?

chronic sialadenitis

38
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What is the characteristic pattern of dilatation plus ductal strictures in chronic sialadenitis called?

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“sausaging”

39

What condition is characterized by recurring episodes of non-suppurative parotid swelling, usually beginning between the ages of 3 and 6 years?

juvenile recurrent parotitis

40

What condition is characterized by a painful nodule of the minor salivary glands of the hard or soft palate that is covered by intact, erythematous mucosa?

subacute necrotizing sialadenitis

41
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Microscopic examination of a salivary gland shows:

  • nflammatory infiltrate
  • acinar atrophy
  • ductal dilatation
  • fibrosis

What is the likely diagnosis?

chronic sclerosing sialadenitis

42

What is the treatment for acute sialadenitis? (3)

  1. antibiotic therapy
  2. rehydration
  3. drainage (if necessary)
43

What is the treatment for chronic sialadenitis? (6)

  1. antibiotics
  2. analgesics
  3. short-term corticosteroids
  4. sialagogues
  5. glandular massage
  6. surgical removal (if conservative methods fail)
44

What condition is characterized by swelling and eversion of the lower lip as a result of hypertrophy and inflammation of the salivary glands?

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cheilitis glandularis

45

What are the three types of cheilitis glandularis?

  1. simple
  2. superficial suppurative (Baelz disease)
  3. deep suppurative (cheilitis glandularis apostematosa)
46

What is the treatment for cheilitis glandularis?

vermilionectomy (lip shave)

47

What condition is characterized by excessive salivation?

sialorrhea

48

What type of sialorrhea is characterized by episodes of excessive salivation lasting 2 to 5 minutes, associated with a prodrome of nausea or epigastric pain?

idiopathic paroxysmal sialorrhea

49

What is the treatment for sialorrhea? (2)

  1. For mild or transitory cases of sialorrhea , and no treatment is needed.
  2. For persistent severe drooling, therapeutic intervention (e.g. surgery) may be needed.
50

What surgical procedure involves repositioning the salivary ducts posterior to the tonsillar fossa, thereby redirecting salivary flow and minimizing drooling?

ductal relocation

51

What condition is characterized by a subjective sensation of a dry mouth?

xerostomia

52

Is xerostomia always due to salivary gland hypofunction?

It is frequently, but not always, associated with salivary gland hypofunction.

53

Why is xerostomia is associated with aging?

Age itself probably does not cause xerostomia; instead, is more likely to be the result of other factors, such as medications.

54

What is the relationship between xerostomia and the number of drugs a person takes?

The prevalence of xerostomia increases in relation to the total number of drugs that a person takes, regardless of whether the medications are xerogenic.

55

Why is there an increased prevalence of oral candidiasis and dental caries in patients with xerostomia?

Because of the reduction in the cleansing and antimicrobial activity normally provided by saliva.

56

What are caries called when they result from xerostomia caused by radiation therapy?

radiation-induced caries

57

What is the treatment for xerostomia? (4)

The treatment of xerostomia is difficult and often unsatisfactory:

  1. artificial salivas (e.g. carboxymethylcellulose)
  2. products that contain lactoperoxidase, lysozyme, and lactoferrin (e.g. Biotene)
  3. sialagogues (e.g. pilocarpine, cevimeline)
  4. fluoride to prevent decay
58

What is the mechanism of action of pilocarpine?

It is an parasympathomimetic agonist that can be used as a sialagogue.

59

What is the mechanism of action of cevimeline hydrochloride?

It is a cholinergic agonist with affinity for muscarinic M3 receptors that can be used as a sialagogue.

60

Both pilocarpine and cevimeline are contraindicated in patients with what condition?

narrow-angle glaucoma

61

Which condition is characterized by bilateral painless swelling of the lacrimal and salivary glands caused by an intense chronic inflammatory infiltrate?

IgG4-related disease

62

What was the original name for IgG4-related disease?

Mikulicz disease

63

What is the most frequent site of IgG4-related sialadenitis?

submandibular gland

64

What is the overall patter of heavy lymphoplasmacytic infiltrate, prominent interlobular fibrosis, and obliterative phlebitis of IgG4-related disease called?

Küttner tumor

65

What is the treatment for IgG4-related disease called?

systemic corticosteroids

66

What chronic, systemic autoimmune disorder principally involves the salivary and lacrimal glands?

Sjögren syndrome

67

What is the effects of Sjögren syndrome on the eye called?

keratoconjunctivitis sicca (sicca means “dry”)

68

What is the clinical presentation of both xerostomia and xerophthalmia refered to as?

sicca syndrome

69

What are the two forms of Sjögren syndrome?

  1. primary Sjögren syndrome (sicca syndrome alone; no other autoimmune disorder is present)
  2. secondary Sjögren syndrome (sicca syndrome with associated autoimmune disease)

*some authors have suggested that this distinction may now be obsolete

70

What is the most common autoimmune disease associated with secondary Sjögren syndrome?

rheumatoid arthritis

71

What is the principal oral symptom of Sjögren syndrome?

xerostomia

72
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A patient presents with a dry, fissured tongue with atrophy of the papillae and diffuse, firm enlargement of the major salivary glands. What is a likely diagnosis?

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Sjögren syndrome

73
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Sialographic examination of the parotid gland reveals punctate sialectasia and lack of normal arborization (a “fruit-laden, branchless tree” pattern). What is a likely diagnosis?

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Sjögren syndrome

74

What test can be used to confirm the decreased tear secretion in Sjögren syndrome?

Schirmer test

75

What value is considered abnormal in a Schirmer test after the sterile paper is placed in the eye for 5 minutes?

< 5 mm

76

What are four laboratory findings consistent with Sjögren syndrome?

  1. ↑ erythrocyte sedimentation rate (ESR)
  2. ↓ immunoglobulin levels (esp. IgG)
  3. (+) rheumatoid factor (RF) (60%)
  4. (+) antinuclear antibodies (ANAs) (80%)
77
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Microscopic examination of a salivary gland shows:

  • multiple lymphocytic foci
  • lymphocytic infiltration
  • destruction of the acini
  • hyperplastic myoepithelial cells forming epimyoepithelial islands

What is a likely diagnosis?

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Sjögren syndrome (benign lymphoepithelial lesion)

78

What is the treatment for Sjögren syndrome?

The treatment of the patient with Sjögren syndrome is mostly supportive:

  1. artificial salivas (e.g. carboxymethylcellulose)
  2. products that contain lactoperoxidase, lysozyme, and lactoferrin (e.g. Biotene)
  3. sialagogues (e.g. pilocarpine, cevimeline)
79

What type of cancer is associated with Sjögren syndrome?

lymphoma

80

What condition is characterized by noninflammatory salivary gland enlargement?

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sialadenosis

81

Which salivary glands are most commonly affected by sialadenosis?

parotid glands

82

What are the three categories of causes of sialadenosis?

  1. endocrine (e.g. diabetes, pregnancy, acromegaly)
  2. nutritional (e.g. malnutrition, alcoholism, bulimia)
  3. neurogenic (e.g. antihypertensives, sychotropics)
83

What is the treatment for sialadenosis?

The clinical management of sialadenosis relies on controlling the underlying cause (e.g. diabetes mellitus, general malnutrition, alcoholism, and bulimia, etc.).

84

What condition is characterized by localized swelling os the minor salivary glands that mimics a neoplasm?

adenomatoid hyperplasia

85

What is the most common location of the pseudotumor of adenomatoid hyperplasia?

hard or soft palate

86

What is the treatment for adenomatoid hyperplasia?

Biopsy is necessary to establish the diagnosis; once the diagnosis has been established, no further treatment is indicated and the lesion should not recur.

87

What condition is characterized by local inflammatory destruction of the salivary glands?

necrotizing sialometaplasia

88

What is the suggested cause of necrotizing sialometaplasia?

ischemia of the salivary tissue

89

What is the most common location for necrotizing sialometaplasia?

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palatal salivary glands

90
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A patient presents complaining that “a part of my palate fell out” where they have previously noticed a painful nonulcerated swelling. What is a likely diagnosis?

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necrotizing sialometaplasia

91
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Microscopic examination of a palatal lesion shows:

  • necrotic mucous acini
  • adjacent ductal squamous metaplasia

What is a likely diagnosis?

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necrotizing sialometaplasia

92

What is the treatment for necrotizing sialometaplasia?

Once the diagnosis has been established, no specific treatment is indicated or necessary; the lesion typically resolves on its own in 5 to 6 weeks.

93

What is the most common site for salivary gland tumors?

parotid gland (61% to 80%)

94

What is the most common type of salivary gland tumor?

pleomorphic adenoma (50% to 77%)

95

How does the malignancy of parotid gland tumors compare to submandibular gland tumors?

Although fewer tumors occur in the submandibular gland (8% to 11%), the frequency of malignancy in this gland is much greater than that of the parotid gland.

96

How does the malignancy of submandibular gland tumors compare to sublingual gland tumors?

Although fewest tumors occur in the sublingual gland (1%), the frequency of malignancy in this gland is much greater than that of the submandibular or parotid glands.

97

What general statement can be made regarding the size of the salivary gland, the probability of a tumor occuring, and the likelihood of malignancy?

The smaller the gland is, the lower the probability of a tumor, but the greater the likelihood of malignancy.

98

What is the most frequent site for minor salivary gland tumors?

palate (42% to 54%)

99

What is the most frequent site for labial salivary gland tumors?

upper lip (74% to 87%)

100

What type of salivary gland tumor is characterized by a mixture of ductal and myoepithelial elements?

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pleomorphic adenoma (benign mixed tumor)

101

What is the most common salivary neoplasm?

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pleomorphic adenoma

102

What is the most common site for minor gland benign mixed tumor?

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palate

103
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Microscopic examination of a tumor shows:

  • a well-circumscribed, encapsulated tumor
  • mixed glandular epithelial and myoepithelial cells
  • rounded myoepithelial cells with eccentric nuclei

What is a likely diagnosis?

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pleomorphic adenoma

104
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What three possible of microscopic backrounds characterize pleomorphic adenoma?

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  1. myxomatous
  2. chondroid
  3. hyalinized
105

What are pleomorphic adenomas composed almost entirely of myoepithelial cells with no ductal elements called?

myoepitheliomas

106

What is the treatment for pleomorphic adenoma?

surgical excision (good prognosis)

107

What benign salivary gland tumor is composed of large epithelial cells known as oncocytes?

oncocytoma (onco- is derived from the Greek word onkoustai, which means "to swell")

108
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Microscopic examination of a tumor shows:

  • a well-circumscribed tumor
  • large eosinophilic cells with abundant cytoplasm
  • sparse stroma forming thin fibrovascular septa

What is a likely diagnosis?

oncocytoma

109

What is the treatment for oncocytoma?

surgical excision (good prognosis)

110

What type of salivary gland neoplasm is characterized by transformation of ductal and acinar cells to oncocytes?

oncocytic metaplasia

111

What term is used to describe the proliferation and accumulation of oncocytes within salivary gland tissue?

oncocytosis

112

Which gland is most often affected by oncocytosis?

parotid gland

113
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Microscopic examination of the salivary gland shows:

  • focal nodular collections of oncocytes
  • abundant granular, eosinophilic cytoplasm
  • numerous mitochondria

What is a likely diagnosis?

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oncocytosis

114

What is the treatment for oncocytosis?

It is a benign condition; after diagnosis, no further treatment is necessary.

115

Which benign neoplasm occurs almost exclusively in the parotid gland?

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Warthin tumor

116

What is the greatest risk factor for Warthin tumor?

smoking

117

What term is used to describe the distinctive histopathologic pattern of Warthin tumor?

papillary cystadenoma lymphomatosum

118
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Microscopic examination of the salivary gland shows:

  • ductal epithelium and a lymphoid stroma
  • oncocytic epithelium surrounding cystic spaces
  • an inner layer of tall columnar epithelium
  • an outer layer of cuboidal epithelium
  • multiple papillary infoldings into cystic spaces

What is a likely diagnosis?

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Warthin tumor

119

What is the treatment for Warthin tumor?

surgical removal

120

What term is used to describe benign salivary gland tumors demonstrating a more uniform histopathologic pattern than pleomorphic adenoma?

monomorphic adenoma

121

What is an uncommon tumor that occurs almost exclusively in the minor salivary glands?

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canalicular adenoma

122

What is the most common site for canalicular adenoma?

upper lip

123
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Microscopic examination of the salivary gland shows:

  • single-layered cords of epithelial cells
  • deeply basophilic nuclei
  • ductal structures forming long canals
  • a thin, fibrous capsule surrounding the tumor

What is a likely diagnosis?

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canalicular adenoma

124

What is the treatment for canalicular adenoma?

surgical excision

125

What benign salivary tumor that derives its name from the basaloid appearance of the tumor cells?

basal cell adenoma

126

What is the most common site for basal cell adenoma?

parotid gland

127

What subtype of basal cell adenoma often occurs in combination with skin appendage tumors?

membranous basal cell adenoma

128
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Microscopic examination of the salivary gland shows:

  • a well circumscribed tumor
  • narrow cordlike epithelial strands
  • mall, round, ductlike structures

What is a likely diagnosis?

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basal cell adenoma (trabecular subtype)

129

What is the treatment for basal cell adenoma?

surgical removal

130

What are the three types of ductal papillomas?

  1. sialadenoma papilliferum
  2. intraductal papilloma
  3. inverted ductal papilloma
131

What is the most common site for the sialadenoma papilliferum?

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palate

132

What is the most common site for the inverted ductal papilloma?

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lower lip

133
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Microscopic examination of a salivary gland tumor shows:

  • multiple exophytic papillary projections
  • stratified squamous epithelium
  • multiple ductal lumina

What is a likely diagnosis?

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sialadenoma papilliferum

134
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Microscopic examination of a salivary gland tumor shows:

  • squamoid epithelium
  • multiple thick, bulbous papillary projections
  • scattered mucus-producing cells

What is a likely diagnosis?

inverted ductal papilloma

135

What is the treatment for ductal papilloma?

surgical excision

136

What is the is the most common salivary gland malignancy?

mucoepidermoid carcinoma

137

What chromosomal abnormality is associated with mucoepidermoid carcinoma?

t(11;19) reciprocal translocation, which results in the production of the CRTC1-MAML2 fusion oncogene

138

What is the most common site for major salivary gland mucoepidermoid carcinoma?

parotid gland

139

What is the most common site for minor salivary gland mucoepidermoid carcinoma?

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palate

140
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Microscopic examination of a salivary gland tumor shows:

  • mucus cells with abundant foamy cytoplasm that stains positively with mucin stains
  • squamous (epidermoid) cells with polygonal shape, and intercellular bridges
  • intermediate basaloid cells with scant, pale eosinophilic cytoplasm

What is a likely diagnosis?

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mucoepidermoid carcinoma

141

What three cell types characterize mucoepidermoid carcinomas?

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  1. mucus cells
  2. epidermoid cells
  3. intermediate cells
142

What three histopathologic features are used to grade mucoepidermoid carcinoma?

  1. amount of cyst formation
  2. degree of cytologic atypia
  3. relative numbers of cell types
143

What are the three histopathologic grades of mucoepidermoid carcinomas?

  1. low-grade
  2. intermediate-grade
  3. high-grade
144

A mucoepidermoid carcinoma shows:

  1. prominent cyst formation
  2. minimal cellular atypia
  3. numerous mucous cells

What would this be graded as?

low-grade

145

A mucoepidermoid carcinoma shows:

  1. minimal cyst formation
  2. prominent cellular atypia
  3. numerous squamous and intermediate cells

What would this be graded as?

high-grade

146

What grade of shows mucoepidermoid carcinoma shows histopathologic features that fall between those of the low-grade and high-grade neoplasms?

intermediate-grade

147

What is the treatment for mucoepidermoid carcinoma?

surgical removal (prognosis depends on the grade and stage of the tumor)

148

How does the presence of the t(11;19) translocation and CRTC1-MAML2 fusion gene affect the prognosis of mucoepidermoid carcinoma?

Tumors with this translocation have a better prognosis than tumors without it.

149

What is the most common and best-recognized intrabony salivary tumor?

intraosseous mucoepidermoid carcinoma

150

What is the most likely source for most intraosseous tumors?

odontogenic epithelium

151

What is the most common site for intraosseous tumors?

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molar-ramus area of the mandible

152

What is the treatment for intraosseous tumors?

surgical resection, sometimes supplemented by adjuvant radiation therapy

153

What salivary gland malignancy is characterized by cells that show serous acinar differentiation?

acinic cell carcinoma

154

What is the most common site for acinic cell carcinoma?

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parotid gland

155
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Microscopic examination of a salivary gland tumor shows sheets of granular, basophilic serous acinar cells. What is a likely diagnosis?

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acinic cell carcinoma

156

What are the four histopathologic varieties of acinic cell carcinoma?

  1. solid
  2. microcystic
  3. papillary-cystic
  4. follicular
157

What is the treatment for acinic cell carcinoma?

surgical excision

158

What salivary gland malignancy share histopathologic and molecular features that are similar to secretory carcinoma of the breast?

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mammary analogue secretory carcinoma

159

What chromosomal abnormality is associated with mammary analogue secretory carcinoma?

t(12;15) balanced translocation, which results in the formation of an ETV6-NTRK3 fusion gene

160

What is the most common site for mammary analogue secretory carcinoma?

parotid gland

161
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Microscopic examination of a salivary gland tumor shows:

  • bland, vesicular nuclei surrounded by slightly granular or vacuolated cytoplasm
  • larger cystic spaces may with papillary infolding tumor cells with a “hobnail” appearance

What is a likely diagnosis?

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162

What is the treatment for mammary analogue secretory carcinoma?

surgical resection, sometimes supplemented by adjuvant radiation therapy

163

What type of neoplasma represent malignant counterparts to the benign mixed tumor or pleomorphic adenoma?

malignant mixed tumors

164

What are the three malignant mixed tumors?

  1. carcinoma ex pleomorphic adenoma
  2. carcinosarcoma
  3. metastasizing mixed tumor
165

Which malignant mixed tumor is characterized by malignant transformation of the epithelial component of benign pleomorphic adenoma?

carcinoma ex pleomorphic adenoma

166

Which malignant mixed tumor is characterized by both carcinomatous and sarcomatous elements?

carcinosarcoma

167

Which malignant mixed tumor is characterized histopathologic features that are identical to the pleomorphic adenoma, but metastasizes?

metastasizing mixed tumor

168

What is the most common site for carcinoma ex pleomorphic adenoma?

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parotid gland

169
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Microscopic examination of a salivary gland tumor shows:

  • a benign portion of the tumor showing sheets of plasmacytoid myoepithelial cells
  • a malignant portion of the tumor showing epithelial cells with pleomorphic nuclei

What is a likely diagnosis?

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carcinoma ex pleomorphic adenoma

170

What are the three subcategories of carcinoma ex pleomorphic adenoma?

  1. invasive (malignant cells penetrating >1.5 mm into adjacent tissues)
  2. minimally invasive (malignant cells penetrating <1.5 mm into adjacent tissues)
  3. noninvasive (no penetration of malignant cells)
171

What is the treatment for the three malignant mixed tumors?

  1. surgical excision
  2. adjunctive radiation therapy
172

What is one of the more common and best-recognized salivary malignancies, originally called a cylindroma?

adenoid cystic carcinoma

173

What is the most common site for adenoid cystic carcinoma?

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palate

174
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A patient presents complaining of a constant, low-grade, dull ache, which gradually increases in intensity; a CT scan shows extensive destruction of the hard palate. What is the likely diagnosis?

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adenoid cystic carcinoma

175

What are the three histopathological patterns of adenoid cystic carcinoma?

  1. cribriform
  2. tubular
  3. solid
176
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Which histopathological pattern of adenoid cystic carcinoma is characterized by islands of basaloid epithelial cells that contain multiple cylindrical, cystlike spaces resembling Swiss cheese?

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cribriform

177
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Which histopathological pattern of adenoid cystic carcinoma is characterized by tumor cells arranged in multiple small ducts or tubules within a hyalinized stroma?

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tubular

178

What highly characteristic feature of adenoid cystic carcinoma probably corresponds to the common clinical finding of pain in these patients?

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perineural invasion

179

What is the treatment for adenoid cystic carcinoma?

surgical resection

180

What adenocarcinoma is almost exclusively a tumor of the minor salivary glands?

polymorphous low-grade adenocarcinoma

181

What is the most common site for polymorphous low-grade adenocarcinoma?

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palate

182
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Microscopic examination of a salivary gland tumor shows:

  • cribriform arrangement of uniform tumor cells with pale-staining nuclei
  • peripheral cells invading the adjacent tissue in a single-file fashion
  • perineural invasion

What is a likely diagnosis?

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polymorphous low-grade adenocarcinoma

183

What protein can be used to differentiate polymorphous low-grade adenocarcinoma from pleomorphic adenoma?

glial fibrillary acidic protein (GFAP)

184

What is the treatment for polymorphous low-grade adenocarcinoma?

surgical excision

185

What term is used for salivary tumors that defy the existing classification schemes?

adenocarcinomas, not otherwise specified (NOS)