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Lect.2. salivary gland pathology

Here are the answers to your questions: 1. Common types of salivary gland benign tumors with origin of each: - Pleomorphic adenoma - originates 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. 2. The histological features of mucoepidermoid carcinoma include: - Containing mucin-producing cells and epithelial cells of the epidermoid variety. - Divided into

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SALIVARY GLAND PATHOLOGY SMS 2044 DR. MOHANAD R. ALwAN
SALIVARY GLAND DISEASES  Although diseases primary to the major salivary glands are in general uncommon,  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.
Micrograph showing chronic sialadenitis.
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.
 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.
 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.
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
Salivary Gland Tumors  The 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 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.
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.
NORMAL HISTOLOGY
PLEOMORPHIC ADENOMA
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.
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
PLEOMORPHIC ADENOMA  Islands of cuboidal cells arranged in duct like 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.
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.
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
WARTHIN’S TUMOR Mid Power Thought to arise from salivary gland inclusions within lymph nodes.
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)
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
WARTHIN’S TUMOR o High Power o Lymphocytc infilterates. o Bilayer of epithilium.
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.
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
MALIGNANT SALIVARY GLAND TUMORS
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. MECs constitute approximately 35% of salivary gland malignancy, and 80% to 90% of MECs occur in the parotid gland.
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).
They contain three cellular elements in varying proportions: squamous cells, mucus-secreting cells, and intermediate" cells. Mucous cells (mucocytes) can occur singly or in clusters, pale and sometimes foamy cytoplasm 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.
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.)
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.
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
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.
HODGKIN'S LYMPHOMA Hodgkin's disease involving the parotid gland. Note the Reed-Sternberg cell. (Fine needle aspiration, Pap, 630x)
SALIVARY GLAND TUMORS •
Habis Question?????????????? Q1. Mention the common types of salivary gland benign tumors with origin of each. Q2. Identify the histological feature for mucoepidermoid carcinoma