1 / 47

DISEASES OF THE SALIVARY GLANDS

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

rodneywalker
Télécharger la présentation

DISEASES OF THE SALIVARY GLANDS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. DISEASES OF THE SALIVARY GLANDS

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

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

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

  5. MUCOCELE

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

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

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

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

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

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

  12. PLEOMORPHIC ADENOMA

  13. PLEOMORPHIC ADENOMA

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

  15. PLEOMORPHIC ADENOMA

  16. PLEOMORPHIC ADENOMA

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

  18. CARCINOMA ex PLEOMORHIC ADENOMA OR MALIGNANT MIXED TUMOUR Adenocarcinoma

  19. WARTHIN’S TUMOUR Papillary cystadenoma lymphomatosum Adenolymphoma

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

  21. WARTHIN’S TUMOUR

  22. 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

  23. WARTHIN’S TUMOUR

  24. 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 CARCINOMAGross • < 8 cms. • Apparently circumscribed / infiltrative • Cut surface : pale grey-white small mucin-filled cysts

  31. MUCO-EPIDERMOID CARCINOMAMicroscopy • Mixtures of threecell types arranged in cords, sheets, cystic 1. mucus-secreting cells 2. intermediate cells (hybrid) squamoid features with small to large mucus- filled 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 gradeHigh grade Spread Local invasion Metastasis(30%) Recurrence 15% 25-30% 5-yr survival >90% 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. ADENOID CYSTIC CARCINOMA

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

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

  42. Acinic cell carcinoma Gross • Small • Encapsulated

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

  44. Acinic cell carcinoma

  45. Acinic cell carcinoma CLINICAL ASPECTS • Good prognosis • Recurrence rare

More Related