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What is a mucocele never found?
What is the most common cause of a ranula?
ruptured mucin from sublingual gland (Ducts of Rivini)
What is the treatment for a ranula?
marsupialization and/or removal of gland(sublingual, large glands)
Where is the most common area for sialolithiasis formation?
ductal system of submandibular gland
What is the effect of a sialolithiasis on the ductal system?
What is the most common site of sialadenosis?
parotid, leads to aberrant secretions from deregulated autonomic innervation and accumulation of zymogen stored in acinar cells
What are sialagogues and their contraindications?
- pilocarpine and Cevimeline HCl
- contraindicated: glaucoma
What clinical test is used to confirm Sjogrens?
Shirmer test: tear production
What histopatholgical findings is not supportive to Sjogrens?
Chronic sclerosis sialadenitis: scattered inflammation with ductal dilation and fibrosis
What tumor is commonly associated with Sjogrens?
- low-grade non-Hodgkin's B cell lymphomas of mucosa-associated lymphoid tissue
- detect Ig gene rearrangements from labial salivary gland biopsies to predict.
What is Mikulicz disease?
bilateral parotid and lacrimal gland enlargement apart from other diseases
benign lymphoepithelial lesion
Where is the most common location of necrotizing sialometaplasia?
- palatal salivary glands>>parotid>>submand, subling(rare)
- hard palate>>soft
- unilaeral>bilateral or midline
What is the histo hallmark of necrotizing sialometaplasia?
necrotic mucous acini and adjacent ductal squamous metaplasia
What is the treatment for necrotizing sialometaplasia?
- nothing, resolves 5-6 weeks
- biopsy to rule out malignancy
What are the salivary gland tumors rates of malignancy?
- Sublingual(highest) and minor salivary (50%)
- parotit has most(2/3-3/4) tumors and most are benign
- PLEOMORPHIC ADENOMA most common
- Warthin tumores also common
- Malignant: mucoepidermoid carcinoma and adenoid cystic carcinoma
What is the most common salivary gland tumor?
- Pleomorphic adenoma: mix of ductal and myoepithelial w/ mesenchymal background. Well circumscribed, encapsulated.
- location: parotid, superficial lobe
- palate(posterior, lateral)> upper lip> buccal mucosa
- TX: surgical excision, malginant transformation rare.
What is the difference of oncocytosis and oncocytoma?
oncocyte: epithelial cell with polyhedral granular eosinophilic cytoplasm from mitochondrial proliferation.
oncocytosis: multifocal ductal and acinar transform to oncocytes within gland tissue.
oncocytoma: well circumscribed, benign salivary gland tumor of oncocytes. Risk increases with age, found in other endocrine organs, thyroid, parathyroid, kidney. Tx: surgical excision.
What is unique about warthin tumor?
- papillary cystadenoma lymphomatosum
- parotid, smoking
- POLYCLONAL epithelial(oncocytic) and lymphoid components, may be tumor process not true neoplasm.
- proliferation of salivary ductal epithelium that is associated with secondary lymphoid tissue formation.
What is the histo presentation of warthin tumor?
- mix of ductal epithelium and lymphoid stroma
- Epithelium: oncocytic, lining has multiple papillary infoldings that protrude into the cystic spaces, some focal squamous metaplasia or mucous cell prosoplasia
- inner luminal layer: tall columnar cells with centrally placed, palasaded and slightly hyperchromatic nuclei
- second layer: cuboidal or polygonal cells with vesicular nuclei
What salivary gland tumor is found mostly in minor salivary glands?
canalicular adenoma: upper lip, older, females. Uniform monomorphic single layer of columnar (or cuboidal) cells with basophilic nuclei forming canal-like ducts
What are the features of basal cell adenoma?
benign parotid of encapsulated cords of basaloid cells in trabecular pattern.