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DISEASES OF SALIVARY GLANDSLAB
A) Major Salivary Glands :We have three paired major salivary glands :
Parotid Submandibular Sublingual
Mainly Serous Mixed with
predominate serous
Mixed with
predominate mucous
Serous Acinus Serous Acinus Duct Mucous Acinus
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The serous cells has plenty of granules and they look dark in color compared to the mucous
cells which has pail cytoplasm
B) Minor Salivary Glands :
1) Are all mucous
2) Present every where in the oral cavity except : ant. Region of the hard palat and the ant. Two
third of the dorsum of the tongue
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SIALADENITIS1) Chronic Bacterial Sialadenitis
Histopathology -- >
Some times it presents as swelling in the
submandibular Salivary gland especially at
meal time specially when there Is obstruction
1 -- > Varying degrees of ductal dilatation
Hyperplastic ductal epithelium and
sometimes closing the ductal space .. not clear
in this picture
2 -- > Periductal fibrosis.
3 -- > Acinar atrophy & replacement by
fibrous tissue >> when u look carefully u will not
see the acini u will see them replaced with
inflammatory cells and fibrous tissue .. but in this
picture it is partially replaced
4 -- > Chronic inflammatory infiltration.
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2) Cytomegalic Inclusion Disease (Salivary Gland InclusionDisease)
3) Sarcoidosis
which1>--inclusion bodyThis is the*
maybe in the cytoplasm ( like here ) or maybe
inside the nucleus it self
clearThe inclusion body surrounded by a*
2>--zone
pushed atrue nucleusThis is maybe the*
side -- > 3
We have deposition of granulomas -- > 1 and this granuloma
looks pail because it has a lot of histiocytes or macrophages ( they
have plenty of cytoplasm )
If u compare it to the surrounding lymphocytes -- > 2 .. the
lymphocytes have nucleus with little cytoplasm >> so the
lymphocytes look blue ( darker in color )
SO in sarcoidosis .. u will see
CaseatingNon>>Macrophages collection>--1
Pail>>Granuloma
Dark>>Lymphocytres Collection>--2
http://rds.yahoo.com/S=96062857/K=cytomegalovirus+infection/v=2/SID=w/l=II/R=37/SS=i/OID=b1ba2588d8f1e57e/SIG=1k4qd589l/EXP=1121876532/*-http%3A//images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dcytomegalovirus%2Binfection%26ei%3DUTF-8%26fl%3D0%26imgsz%3Dall%26fr%3Dsfp%26b%3D21&h=527&w=800&imgcurl=cnserver0.nkf.med.ualberta.ca%2Fcn%2FSchrier%2FVol5%2F10-24%2520copy.jpg&imgurl=cnserver0.nkf.med.ualberta.ca%2Fcn%2FSchrier%2FVol5%2F10-24%2520copy.jpg&size=132.6kB&name=10-24%20copy.jpg&rcurl=http%3A%2F%2Fcnserver0.nkf.med.ualberta.ca%2Fcn%2FSchrier%2FDefault5.htm&rurl=http%3A%2F%2Fcnserver0.nkf.med.ualberta.ca%2Fcn%2FSchrier%2FDefault5.htm&p=cytomegalovirus+infection&type=jpeg&no=37&tt=149&ei=UTF8/3/2019 script for lab 7 .. SG disorders
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4) Sialadenitis of Minor Glands
OBSTRUCTIVE AND TRAUMATIC LESIONS
1)Salivary Calculi ( Sialoliths : lith:stone )This is a picture for the glands and the ducts so u can understand the next clinical pictures :)
Dr gave the same information which I wrote about
Chronic Bacterial Sialadenitis
This is the general picture of chronic Sialadenitis and
with minor>>can put it with several conditionsI
Chronic Bacterial,salivary gland sialadenitis
>>And obstructive sialadenitisSialadenitis
esionbecause the lchronic featuresThese are the
fibrosis surrounding the ducttheneeds time to form
and..acement of the lobules and dilatationand repl
it is>>SOinflammatory infiltrate is lymphocyticthe
chronic
1- Dilated duct
2- Periductal fibrosis
3- Inflamed lobule
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-
The Case >> A stone (1) appearing through
the duct orifice or it can be anywhere along
the dust >> but here it is through the duct
orifice
The Case >> A stone (2) appearing very
close to the duct orifice
This is the stone on a radiograph in
submandibular salivary gland -- > 3
This is the stone on another type of
radiograph -- > 4
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1)Necrotizing Sialometaplasia
in this case>>it is very thick,epithelial liningplastic ductalmetahyperThis is the>--1
because of obstruction causing chronic irritation >> notice >> it is chronic bcz the duct needs time
)it was columnar(etaplasiasequamous mto form this hyperplastic epithelium with
closing the duct lumen SOstonesIn the center there are several>--2
1 -- > this is the sialolith and 2 -- > this is the hyperplastic ductal epithelium
in theswellingThe lesion may start aspalate with red points ..
1-- > These dots are the orifices of the
minor salivary glands
This is swelling in the palate the patient
doesn't know what is this and he worried
bcz it took long time so he will think
about tumors
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Histopathology -- >
Later on after 2 more months >> patient will
start healing from those ugly ulcers
Later on this lesion will ulcerate
The ulcers look like neoplastic >> deep with thickmargins and the margins maybe rolled and averted
The ulcerated state will last for 2 or 3 months
lobular necrosis>--1
* Squamous metaplasia of ducts & acini.
* Mucous extravasation.
* Inflammatory cell infiltration >> the black
dots
* Features may be mistaken for SCC or
mucoepidermoid carcinoma
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1 -- > This is thickened ductal lining with
sequamous metaplasia it looks like the surfacesequamous epithelium of the oral mucosa
The abvious feature here is the>--2
>>within the lobulesequamous islands
flattened sequamous cells >> they look like the
surface epithelium >> these were ductal
epithelium ( were cuboidal ) but now they are
having metaplasia
Here is a higher magnification and here we can
mucous cells aresee mucous cells but these
t identify the'I can>>there without boundaries
boundaries of each mucous cell , it is just
mucous collection
U can I identify the borders of a lobule but u
can't identify the boundaries of the cells
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SJGREN SYNDROME
Decrease of the salivary secretion
OOrraall mmuuccoossaa aappppeeaarrss ddrryy,, ssmmooootthh,,
aanndd ggllaazzeedd..
DDoorrssuumm ooff ttoonngguuee oofftteenn aappppeeaarrss rreedd
a
anndd aattrroopphhiicc wwiitthh vvaarriiaabbllee ddeeggrreeeess ooff
f
fiissssuurriinngg aanndd lloobbuullaattiioonn
Abnormal lacrimal gland
KKeerraattooccoonnjjuuccttiivviittiiss ssiiccccaa mmaanniiffeessttss aass ::
11.. ddrryynneessss ooff eeyyeess22.. ccoonnjjuunnccttiivviittiiss33.. ggrriittttyy,, bbuurrnniinngg sseennssaattiioonn
OOnnllyy 1155%% pprreesseenntt wwiitthh eennllaarrggeemmeenntt ooff tthhee
ssaalliivvaarryy ggllaanndd >>>> tthhee eennllaarrggeemmeenntt aallssoo sseeeenn iinn tthhee
ssiiaallaaddeenniittiiss
llyymmpphhooccyytteess iinnffiillttrraattiioonn>>>> mmaaiinnllyy TT cceellllss
RRiisskk ooffBB cceellll llyymmpphhoommaa ddeevveellooppiinngg iinn
aaffffeecctteedd ggllaanndd 4444 ttiimmeess tthhaatt ooff ggeenneerraall ppooppuullaattiioonn..
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** Due to decrease the salivary secretion the patient may have caries and peridontitis .. etc
SALIVARY GLANDS TUMORS -- ADENOMAS
Proliferation of duct epithelium and the
surrounding myoepithelium >> obstructing the ducts
and forming epimyoepithelial islands -- > 1
Present in a sea of lymphocytes -- > 2
The appearance is described asmyoepithelial
sialadenitis or benign lymphoepithelial lesion.
This appearance also seen in AIDS but without
auto antibodies
Unlike lymphoma, the infiltrate does not cross
interlobular CT septa so here they are reactive not
malignant .. but if the infiltration cross the septa
then it is malignant >> lymphoma
CASE ::::>
Here we see swelling in the palate
1) This swelling is chronic
2) We don't see ulceration
3) Since 7 months
4) It is slowly increasing in size
We will think about benign tumor of salivary gland most likely Pleomorphic Adenoma bcz it is the
most common tumor of salivary glands but still we should take a biopsy
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CASE ::::>
Here we see swelling in the tale of the
parotid gland -- > 1
1) This swelling is chronic
2) We don't see ulceration
3) Since 1 year
4) It is slowly increasing in size
5) No pain or neural dysfunction
CASE ::::>
Here enlarging nodule in the upper lip
which is very big in size >> we should thinkabout minor salivary gland tumor
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Now we will take a biopsy to give specific diagnosis
1) Pleomorphic AdenomaHistopathology -- >
CT capsule doesn't always envelope the lesion completely .. the capsule may also show variation in
thickness and density but regardless of its completeness or not ,the tumor is clearly demarcated (
follow the arrows ) .. apparently isolated nodules -- >1 may be seen within or even outside the
capsule giving the impression of invasive growth
IInn tthhee cceenntteerr wwee hhaavvee wwhhaatt wwee ccaall lleedd cchhoonnddrrooiidd aappppeeaarraannccee
PPlleeoommoorrpphhiicc AAddeennoommaa hhaass ttwwoo ccoommppoonneennttss ::
11)) CCeelllluullaarr ccoommppoonneenntt >>>> eeppiitthheelliiuumm (( dduuccttaall :::: mmaayybbee lliittttllee nnoott lleessss tthhaann 55%% ,, mmaayybbee aabbuunnddaanntt ,, aall ll
oovveerr tthhee lleessiioonn )) aanndd mmyyooeeppeetthhiill iiuumm (( sshheeeettss ooff cceell llss ))
22)) TThhee mmaattrriixx lliikkee ccoommppoonneenntt >>>> mmiixxooiidd >>>> iitt iiss vveerryy ppaaiill wwiitthh ssccaannnneedd ffiibbrriillss aanndd tthheerree aarree ttrraappppeedd
cceell llss >>>> mmyyooeeppeetthhiill iiuumm
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2) Warthin Tumor
1 -- > Epithelial component arranged in duct-
like structures
2 -- > Myoepithelial-type cells
33 ---- >> AArreeaass ooff ssqquuaammoouuss mmeettaappllaassiiaa aanndd kkeerraattiinn
ppeeaarrll ffoorrmmaattiioonn mmaayy bbee pprreesseenntt
44 ---- >> PPoollyyggoonnaall,, ssppiinnddllee,, sstteell llaattee,, oorr
ppllaassmmaaccyyttooiidd cceell llss tthhoouugghhtt ttoo bbee ddeerriivveedd ffrroomm
mmyyooeeppiitthheelliiuumm..
SSoo tthhee eeppiitthheelliiaall cceellllss jjuusstt ll iinniinngg tthhee dduucctt .... aanndd aallll
ootthheerr ccoolllleeccttiioonn ooff cceellllss aarree MMyyooeeppiitthheelliiaall cceell llss
warthin tumor consists of:
1 ) Epithelial component : double-layered epithelium (
with oncocytic appearance >> they have pink
cytoplasm which is dark in color and it contains a lot
of mitochondria ) lining cystic spaces in papillary
arrangement.
2) Lymphoid component within stroma, may contain
germinal centers -- > 2
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3) Basal Cell Adenoma U should know that this is adenoma not
adenocarcinoma so it is benign tumor
It is composed of single type of cells which is basal
cells
Basal cells looks small cuboidal and dark in color
Well-encapsulated
4) Canalicular Adenoma
Consists of anastomosing strands of basaloid
epithelial cells arranged in canalicular structures
And the tissue surrounding theCanalicular
Adenoma ( the stroma ) is very delicate ( ra8e8 :
containing blood vessels ) and sometimes it isdegenerated leaving empty ( cystic ) spaces ( the
arrow )
Now what is the stroma in the Pleomorphic Adenoma ??
It is myxoid, chondroid, or myxochondroid and hyalinization
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5) Ductal Papillomas
SALIVARY GLANDS TUMORS--CARCINOMAS
1) Mucoepidermoid Carcinoma
Papillary structure projecting into the ductalsystem.
if it is low grade we can't differentiate it clinicallyfrom Pleomorphic Adenoma ( benign tumors ) >>
bcz it will be slowly enlarging , not causing ulceration
and no pain
if it is high grade will have ulceration and
aggressive clinical behavior
In the picture here there is small ulcer but this could
be secondary to a trauma
>> u should take a biopsy
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Histopathology -- >
here it looks like aggressive tumor in the
retromolar pad area ( arrow ) >> inside the bone >>
called central MucoepidermoidCarcinoma
Some cases came to the clinic >> young aged with
retromolar pad area swelling >> biopsy ?? >>
Mucoepidermoid Carcinoma
Characterized by presence of 3 cell types: squamous (epidermoid), mucous, and
intermediate
if the cystic spaces larger and the number of cystic>>cystic spaces>>Low grade>>Left
spaces are higher specially if the spaces surrounded by mucous cells ( these mucous cells
infiltrative >> infiltrate the surrounding connective tissue ) >> then it goes more with low grade
but they are little in>>)the arrows(these are mucous cells>>high grade>>Right
number compared to the surrounding cells >> we can't see cystic spaces >> and there is
pleomorphism in the cells
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2) Acinic cell adenocarcinoma
3) Adenoid Cystic Carcinoma
Differentiation from SCC may be difficult
specially if u can't identify the mucous cells
PAS is a special stain for mucous cells ( red
) >> some times I can't see the mucous cells
unless I ask for this stain >> when the cells
appear we will say >> this is mucoepidermoid
carcinoma
It looks like the serous cells >> it is dark in color
>> it containing a lot of fin granules
Numerous microscopic cyst-like spaces withinepithelial islands produce a cribriform or Swiss
cheese pattern Or ductal spaces And sometimes solid nests without any spaces
Although The cells aggressive with high
recurrence rate but they look small and bland ( noappearance of malignant features )
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Done By ::: HaNaa JadAllah
Prominent infiltration and invasion of adjacent tissues,
and spread around and along nerves
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