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Chapter 11: Salivary Gland Pathology

front 1 Clinical Features more frequent in males than females (2 : 1) agenesis of major salivary glands normal facial appearance severe xerostomia dry, leathery tongue increase risk for caries	back 1 salivary gland aplasia
front 2 Dry, leathery tongue and diffuse enamel erosion in a child with absence of the major salivary glands. Some patients also may exhibit absence of lacrimal glands.	back 2 salivary gland aplasia
front 3 An autosomal dominant disorder caused by mutations in the fibroblast growth factor 10 (FGF10) gene, characterized by aplasia or hypoplasia of the lacrimal and salivary glands, cup-shaped ears, hearing loss, and dental and digital anomalies.	back 3 lacrimo-auriculo-dento-digital (LADD) syndrome
front 4 What is the treatment and prognosis for salivary gland aplasia?	back 4 saliva substitutes sialagogues (e.g. pilocarpine or cevimeline) salivary stimulation with sugarless gum or candy preventive dental care to avoid xerostomia-related caries

front 5 A common lesion of the oral mucosa that results from rupture of a salivary gland duct and spillage of mucin into the surrounding soft tissues.	back 5 mucocele
front 6 Clinical Features dome-shaped mucosal swelling 1 or 2 mm to several centimeters in size most common in children and young adults bluish translucent hue or normal color (if deeper) characteristically fluctuant, but some feel firm often periodically rupture then recur lower lip is by far the most common site occur lateral to the midline Histopathologic Features mucin surrounded by a granulation tissue numerous foamy histiocytes (macrophages) adjacent glands often contain chronic inflammatory cell infiltrate	back 6 mucocele
front 7 Blue-pigmented nodule on the lower lip. There is often a bluish translucent hue to the swelling, although deeper lesions may be normal in color.	back 7 mucocele
front 8 Nodule on the posterior buccal mucosa. The reported duration of the lesion can vary from a few days to several years; most patients report several weeks.	back 8 mucocele

front 9 Exophytic lesion on the anterior ventral tongue from the glands of Blandin-Nuhn. The lower lip is by far the most common site for this type of lesion.	back 9 mucocele
front 10 Clinical Features clinical variant of mucocele occurs on soft palate and posterior buccal mucosa single or multiple tense vesicles measure 1 to 4 mm in diameter often burst, leaving shallow, painful ulcers associated with lichenoid disorders	back 10 superficial mucocele
front 11 Vesicle-like lesion on the soft palate. The pathologist must be aware of this lesion and should not mistake it microscopically for a vesiculobullous disorder.	back 11 superficial mucocele
front 12 Mucin-filled cystlike cavity beneath the mucosal surface. Minor salivary glands are present below and lateral to the spilled mucin.	back 12 mucocele

front 13 High-power view showing spilled mucin that is associated with granulation tissue containing foamy histiocytes.	back 13 mucocele
front 14 What is the treatment and prognosis for mucocele?	back 14 short-lived lesions that rupture and heal by themselves chronic lesions may require local surgical excision adjacent minor salivary glands removed to minimize recurrence excised tissue should be submitted to rule out tumor prognosis is excellent despite occasional recurrence
front 15 A term used for mucoceles that occur in the floor of the mouth, lateral to the midline, arising from the sublingual gland.	back 15 ranula (rana means “frog”)
front 16 Clinical Features blue, dome-shaped, fluctuant swelling occur on floor of the mouth, lateral to midline arise from the sublingual gland most frequent in children and young adults may dissect mylohyoid and produce neck swelling ("plunging") Histopathologic Features similar to that of a mucocele spilled mucin elicits a granulation tissue response typically contains foamy histiocytes	back 16 ranula

front 17 Blue-pigmented swelling in the left floor of the mouth. Its located lateral to the midline, a feature that may help to distinguish it from a midline dermoid cyst	back 17 ranula
front 18 Soft swelling in the neck. CT and MRI often exhibit a slight extension of the lesion into the sublingual space, known as a “tail sign.”	back 18 plunging ranula
front 19 What is the treatment and prognosis for ranula?	back 19 removal of sublingual gland and/or marsupialization removal most important in preventing recurrence
front 20 An epithelium-lined cavity that arises from salivary gland tissue.	back 20 salivary duct cyst

front 21 Clinical Features usually occur in adults arise within either major or minor glands most common major gland is parotid slowly growing, asymptomatic swelling (major glands) minor glands on floor of the mouth, buccal mucosa, and lips soft, fluctuant swelling, may appear bluish (minor glands) may develop salivary ductal ectasia (“mucus retention cysts”) Histopathologic Features lining of cuboidal, columnar, or atrophic squamous epithelium thin or mucoid secretions in the lumen	back 21 salivary duct cyst
front 22 Nodular swelling overlying Wharton duct. Lesions on the floor of the mouth often arise adjacent to the submandibular duct and sometimes have an amber color.	back 22 salivary duct cyst
front 23 Low-power photomicrograph showing a cyst below the mucosal surface. High-power view of cystic cavity lined by thin cuboidal epithelium. Adjacent to the cyst is an excretory salivary gland duct lined by columnar epithelium.	back 23 salivary duct cyst
front 24 This dilated duct is lined by columnar eosinophilic oncocytes that exhibit papillary folds into the ductal lumen. Such lesions may develop secondary to ductal obstruction.	back 24 salivary ductal ectasia

front 25 What is the treatment and prognosis for salivary duct cyst?	back 25 conservative surgical excision lesion should not recur sialagogue medications
front 26 Calcified structures that develop within the salivary ductal system.	back 26 sialolith
front 27 Clinical Features submandibular ducts (80%) glands of upper lip or buccal mucosa young and middle-aged adults episodic pain or swelling, especially at mealtime hard mass palpable beneath mucosa radiopaque masses Histopathologic Features round, oval, or cylindrical hard mass typically yellow, white or yellow-brown concentric laminations surrounding nidus of debris squamous, oncocytic, or mucous cell metaplasia periductal inflammation	back 27 sialolith
front 28 Hard mass at the orifice of Wharton duct. The long, tortuous, upward path of this duct and its thicker, mucoid secretions may be responsible for this finding.	back 28 sialolith

front 29 Radiopaque mass located at the left angle of the mandible. They may be discovered anywhere along the length of the duct or within the gland itself.	back 29 sialolith
front 30 Periapical film showing discrete radiopacity superimposed on the body of the mandible. Care must be taken not to confuse this with intrabony pathosis. Occlusal radiograph of same patient demonstrating radiopaque mass in Wharton duct.	back 30 sialolith
front 31 A mass of a minor gland presenting as a hard nodule in the upper lip. A soft tissue radiograph revealed a laminated calcified mass.	back 31 sialolith
front 32 What is the treatment and prognosis for sialolith?	back 32 gentle massage sialagogues moist heat increased fluid intake surgical removal shock wave lithotripsy sialendoscopy with basket retrieval

front 33 Inflammation of the salivary glands.	back 33 sialadenitis
front 34 Inflammation of the salivary glands (sialadenitis) can arise from various infectious and noninfectious causes. Name at least one cause from each of the following categories: viral infection bacterial infection iatrogenic systemic	back 34 mumps Staphylococcus aureus recent surgery (especially abdominal) Sjögren syndrome
front 35 Clinical Features most common in parotid gland bilateral in 10% to 25% of cases gland is swollen and painful skin is warm and erythematous low-grade fever and trismus purulent discharge from duct orifice obstruction and sialectasia “sausaging” sialographic pattern Histopathologic Features inflammatory cell infiltrate acinar atrophy and ductal dilatation fibrosis may be present ("sclerosing")	back 35 sialadenitis
front 36 Tender swelling of the submandibular gland. An associated low-grade fever and trismus may be present.	back 36 sialadenitis

front 37 A purulent exudate can be seen arising from Stensen duct when the parotid gland is massaged.	back 37 sialadenitis
front 38 Parotid sialogram demonstrating “sausaging” ductal dilatation proximal to an area of obstruction.	back 38 sialadenitis
front 39 Chronic inflammatory infiltrate with associated acinar atrophy, ductal dilatation, and fibrosis.	back 39 chronic sclerosing sialadenitis
front 40 The most common inflammatory salivary disorder of children, characterized by recurring non-suppurative parotid swelling, beginning between ages 3 and 6.	back 40 juvenile recurrent parotitis

front 41 A form of salivary inflammation involving minor salivary glands of the hard or soft palate that presents as a painful nodule covered by erythematous mucosa.	back 41 subacute necrotizing sialadenitis
front 42 What is the treatment and prognosis for sialadenitis?	back 42 screening panoramic radiograph to check for sialolith bacterial culture and sensitivity if purulence is present antibiotic therapy, rehydration, surgical drainage (acute) antibiotics, analgesics, corticosteroids, sialagogues (chronic) sialoendoscopy and ductal irrigation surgical removal of the affected gland may be necessary
front 43 Clinical Features lower lip vermilion, upper lip, and palate swelling and eversion of the lower lip hypertrophy and inflammation of glands inflamed and dilated openings of ducts mucopurulent secretions from openings middle-aged and older men Histopathologic Features chronic sialadenitis ductal dilatation mucin accumulation oncocytic ductal metaplasia	back 43 cheilitis glandularis
front 44 Prominent lower lip with inflamed openings of the minor salivary gland ducts. An early squamous cell carcinoma has developed just lateral to the midline.	back 44 cheilitis glandularis

front 45 What is the treatment and prognosis for cheilitis glandularis?	back 45 vermilionectomy (lip shave) produces a satisfactory result associated with development of squamous cell carcinoma solar radiation likely responsible for malignant degeneration
front 46 Clinical Features excessive salivation drooling and choking macerated sores around mouth associated with gastroesophageal reflux rabies heavy-metal poisoning certain medications intellectual disability neurologic disorders	back 46 sialorrhea
front 47 Short episodes of excessive salivation lasting from 2 to 5 minutes associated with a prodrome of nausea or epigastric pain.	back 47 idiopathic paroxysmal sialorrhea
front 48 What is the treatment and prognosis for sialorrhea?	back 48 if transitory or mild, and no treatment is needed anticholinergic medications transdermal scopolamine (only over age 10) botulinum toxin (duration of action up to 6 months) surgery (e.g. gland excision, duct ligation, ductal relocation)

front 49 A subjective sensation of a dry mouth; it is frequently, but not always, associated with salivary gland hypofunction.	back 49 xerostomia
front 50 A number of factors may play a role in the cause of xerostomia. Name at lease one cause from each of the following categories: developmental metabolic iatrogenic systemic local	back 50 salivary gland aplasia vomiting, diarrhea, impaired fluid intake medications, radiation, chemotherapy Sjögren syndrome, diabetes mellitus smoking, mouth breathing
front 51 More than 500 drugs have been reported to produce xerostomia as a side effect, including 63% of the 200 most frequently prescribed medications. Name at least one drug in each of the following classes that can cause xerostomia: antihistamines decongestants antidepressants antipsychotics anxiolytics antihypertensives anticholinergics	back 51 diphenhydramine loratadine fluoxetine haloperidol diazepam metoprolol atropine
front 52 Clinical Features reduction in salivary secretions foamy, thick, or “ropey” saliva dry, "sticky" mucosa fissured tongue with atrophic papillae difficulty chewing and swallowing increased prevalence of oral candidiasis more prone to dental decay associated with radiation therapy	back 52 xerostomia

front 53 What is the treatment and prognosis for xerostomia?	back 53 treatment is difficult and often unsatisfactory artificial salivas sugarless candy to stimulate salivary flow lactoperoxidase, lysozyme, and lactoferrin (e.g. Biotene) discontinuation or dose modification if drug-related sialagogues (pilocarpine and cevimeline) frequent dental visits daily fluoride application and chlorhexidine mouth rinses
front 54 Both pilocarpine, a parasympathomimetic agonist, and cevimeline, a cholinergic agonist, can be used as sialagogues except in patients with what condition?	back 54 narrow-angle glaucoma
front 55 Clinical Features middle-aged and older adults (mean age, 60 years) affects the pancreas and head and neck region unilateral or bilateral submandibular gland swelling from 1.5 cm to 5 cm in diameter pancreatitis and hepatic failure abdominal aortitis with aneurysm formation inflammatory pseudotumors of the kidney thyroid inflammation and lymphadenopathy Histopathologic Features chronic sclerosing sialadenitis heavy lymphoplasmacytic infiltrate hyperplastic lymphoid follicles acinar atrophy interlobular fibrosis (storiform pattern) obliterative phlebitis (highlighted with elastic stain) overall pattern termed "Küttner tumor"	back 55 IgG4-related disease
front 56 What is the treatment and prognosis for IgG4-related disease?	back 56 immediate, aggressive treatment with systemic corticosteroids glucocorticoid-sparing agents (e.g. azathioprine, methotrexate) most show rapid response and have a favorable prognosis

front 57 A chronic, systemic autoimmune disorder that principally involves the salivary and lacrimal glands, resulting in xerostomia (dry mouth) and xerophthalmia (dry eyes).	back 57 Sjögren syndrome
front 58 Sicca syndrome alone with no other autoimmune disorder is present.	back 58 primary Sjögren syndrome
front 59 Sicca syndrome in addition to another associated autoimmune disease.	back 59 secondary Sjögren syndrome
front 60 Clinical Features most common in middle-aged females xerostomia with "foamy" saliva fissured tongue and atrophic papillae red, tender oral mucosa secondary candidiasis and angular cheilitis dental decay, especially cervically enlargement of major salivary glands “fruit-laden, branchless tree” sialographic pattern keratoconjunctivitis sicca Laboratory Values high ESR high IgG positive RF positive ANA (75% to 85%) positive anti-SS-A (50% to 76%) positive anti-SS-B (30% to 60%) Histopathological Features lymphocytic infiltration of salivary glands destruction of acinar units hyperplastic ductal and myoepithelial cells groups of cells ("epimyoepithelial islands")	back 60 Sjögren syndrome

front 61 When the condition is associated with another connective tissue disease, it is called secondary Sjögren syndrome. What is the most common associated disorder?	back 61 rheumatoid arthritis
front 62 The reduced tear production by the lacrimal glands and pathologic effect on the epithelial cells of the ocular surface seen in Sjögren syndrome.	back 62 keratoconjunctivitis sicca
front 63 What is a focus score?	back 63 A calculation of the number of inflammatory aggregates per 4-mm² of salivary gland tissue used in the diagnosis of Sjögren syndrome.
front 64 Dry and fissured tongue. The patient also complained of difficulty in swallowing, altered taste, and a scratchy, gritty sensation in the eye.	back 64 Sjögren syndrome

front 65 Benign lymphoepithelial lesion of the parotid gland. A parotid sialogram revealed a “fruit-laden, branchless tree” pattern.	back 65 Sjögren syndrome
front 66 Parotid sialogram demonstrating demonstrating atrophy and punctate sialectasia producing a “fruit-laden, branchless tree” pattern.	back 66 Sjögren syndrome
front 67 Lymphocytic infiltrate of the parotid gland with an associated epimyoepithelial island. Lymphocytic infiltration of the minor glands also occurs, although epimyoepithelial islands are rarely seen in this location.	back 67 Sjögren syndrome
front 68 Labial gland biopsy showing multiple lymphocytic foci. A focus score ≥ 1 (i.e. one or more foci of 50 or more cells per 4-mm² area of glandular tissue) is considered supportive of the diagnosis of this disease.	back 68 Sjögren syndrome

front 69 What is the treatment and prognosis for Sjögren syndrome?	back 69 treatment is mostly supportive artificial tears and artificial saliva sugarless candy or gum for salivary stimulation lactoperoxidase, lysozyme, and lactoferrin (e.g. Biotene) sialagogues (e.g. pilocarpine or cevimeline) daily fluoride applications antifungal therapy for secondary candidiasis lifetime risk for lymphoma of 5% to 15% (20 times incresed)
front 70 An unusual noninflammatory disorder characterized by salivary gland enlargement, particularly involving the parotid glands.	back 70 sialadenosis
front 71 Sialadenosis is frequently associated with an underlying systemic problem. Name at least one possible cause from each of the following categories: endocrine nutritional neurogenic	back 71 diabetes, acromegaly, hypothyroidism malnutrition, alcoholism, bulimia antihypertensive, psychotropic, or sympathomimetic drugs
front 72 Clinical Features slowly swelling of parotid glands may or may not be painful usually bilateral decreased salivary secretion “leafless tree” sialographic pattern Histopathologic Features hypertrophy of acinar cells nuclei displaced to cell base cytoplasm engorged with zymogen granules acinar atrophy and fatty infiltration no inflammation	back 72 sialadenosis

front 73 Enlargement of the parotid and submandibular glands secondary to alcoholism. Sialography demonstrates a “leafless tree” pattern.	back 73 sialadenosis
front 74 What is the treatment and prognosis for sialadenosis?	back 74 control underlying cause (e.g. hypothyroidism, alcoholism) partial parotidectomy can be performed pilocarpine is reportedly beneficial in reducing enlargement
front 75 Clinical Features localized swelling of minor salivary glands mimics neoplasm hard or soft palate fourth to sixth decades of life sessile, painless masses normal color, or red or bluish Histopathologic Features lobules of normal-appearing mucous acini glands situated close to mucosal surface occasional chronic inflammation	back 75 adenomatoid hyperplasia
front 76 What is the treatment and prognosis for adenomatoid hyperplasia?	back 76 biopsy is necessary to establish diagnosis once diagnosed, no further treatment is indicated should not recur

front 77 An uncommon, locally destructive inflammatory condition of the salivary glands, thought to result from ischemia of salivary tissue leading to local infarction.	back 77 necrotizing sialometaplasia
front 78 Clinical Features palatal salivary glands posterior palate (75%) unilateral (two-thirds) most often in adult males nonulcerated swelling with pain or paresthesia necrotic tissue sloughs, leaving craterlike ulcer 1 cm to more than 5 cm “a part of my palate fell out” Histopathologic Features acinar necrosis in early lesions squamous metaplasia of salivary ducts preservation of lobular architecture liberation of mucin	back 78 necrotizing sialometaplasia
front 79 Early lesion demonstrating swelling of the posterior lateral hard palate. Within 2 to 3 weeks, necrotic tissue sloughs out, leaving a craterlike ulcer.	back 79 necrotizing sialometaplasia
front 80 Later-stage lesion showing craterlike defect of the posterior palate. The patient may report that “a part of my palate fell out.”	back 80 necrotizing sialometaplasia

front 81 Necrotic mucous acini (left) and adjacent ductal squamous metaplasia (right). The overall lobular architecture of the involved glands is still preserved.	back 81 necrotizing sialometaplasia
front 82 What is the treatment and prognosis for necrotizing sialometaplasia?	back 82 biopsy is indicated to rule out malignant disease once diagnosed, no specific treatment is necessary resolves on its own, with healing time of 5 to 6 weeks
front 83 What is the most common site for salivary gland tumors? parotid gland submandibular gland sublingual gland minor glands	back 83 A. parotid gland The most common site for salivary gland tumors is the parotid gland, accounting for 61% to 80% of all cases.
front 84 What is the most common type of parotid gland tumor? Warthin tumor mucoepidermoid carcinoma pleomorphic adenoma acinic cell carcinoma	back 84 C. pleomorphic adenoma The pleomorphic adenoma is overwhelmingly the most common tumor, representing 50% to 77% of all cases in the parotid gland. Warthin tumors are also fairly common, accounting for 5% to 22% of cases.

front 85 What is the most common malignant tumor of the submandibular gland? mucoepidermoid carcinoma acinic cell carcinoma adenoid cystic carcinoma squamous cell carcinoma	back 85 D. adenoid cystic carcinoma Only 8% to 11% of salivary tumors occur in the submandibular gland, but frequency of malignancy is much greater than for the parotid, ranging from 26% to 45%.
front 86 What is the most likely site for a malignant salivary gland tumor? parotid gland submandibular gland sublingual gland minor glands	back 86 C. sublingual gland Tumors of the sublingual gland are rare, comprising no more than 1% of all salivary neoplasms. However, 70% to 95% of sublingual tumors are malignant.
front 87 What is the most common malignant tumor of the minor salivary glands? mucoepidermoid carcinoma acinic cell carcinoma adenoid cystic carcinoma squamous cell carcinoma	back 87 A. mucoepidermoid carcinoma Mucoepidermoid carcinoma is the most frequent malignancy of minor gland origin, comprising 13% to 23% of all tumors.
front 88 Excluding rare sublingual tumors, it can be stated that the ___ the gland is, the ___ is the likelihood of malignancy for a salivary gland tumor. larger, greater larger, lesser smaller, lesser smaller, greater	back 88 B and D The smaller (larger) the gland is, the greater (lesser) is the likelihood of malignancy for a salivary gland tumor.

front 89 What is the most frequent site for a minor salivary gland tumor? lip buccal mucosa palate floor of the mouth tongue retromolar	back 89 C. palate Most of these occur on the posterior lateral hard or soft palate, which have the greatest concentration of glands.
front 90 Which is a more common location for minor salivary gland tumors, the upper lip or the lower lip?	back 90 Labial tumors are significantly more common in the upper lip, which accounts for 74% to 87% of all lip tumors.
front 91 Which are the three most likely sites for a malignant minor salivary gland tumor? lip floor of the mouth tongue palate buccal mucosa retromolar	back 91 B, C, and F Up to 95% of retromolar tumors are malignant because of a predominance of mucoepidermoid carcinomas; most tumors in the floor of the mouth and tongue are also malignant.
front 92 Clinical Features young and middle-aged adults (30 to 60 years) slight female predilection superficial lobe of parotid gland painless, slowly growing, firm mass minor glands of the palate smooth-surfaced, dome-shaped masses Histopthologic Features well-circumscribed, encapsulated tumor mixture of glandular epithelium and myoepithelial cells myoepithelial cells resembing plasma cells ("plasmacytoid") accumulation of mucoid material vacuolar degeneration produces chondroid appearance areas of an eosinophilic, hyalinized change	back 92 pleomorphic adenoma

front 93 Small, firm nodule located below the left ear in the parotid gland, which represents the most common salivary neoplasm.	back 93 pleomorphic adenoma
front 94 Slowly growing tumor of the parotid gland. The patient may be aware of the tumor for many months or years before seeking a diagnosis.	back 94 pleomorphic adenoma
front 95 Tumor of the submandibular gland. The most common location for this mixed tumor is the superficial lobe of the parotid gland.	back 95 pleomorphic adenoma
front 96 Large tumor from the deep lobe of the parotid gland, which has resulted in a firm mass of the lateral soft palate. Contrast-enhanced axial magnetic resonance image (MRI) of a tumor of the deep lobe of the parotid gland.	back 96 pleomorphic adenoma

front 97 Firm mass of the hard palate lateral to the midline. Palatal tumors almost always are found on the posterior lateral aspect of the palate, presenting as smooth-surfaced, dome-shaped masses.	back 97 pleomorphic adenoma
front 98 Tumor of the pterygomandibular area. If the tumor is traumatized, then secondary ulceration may occur.	back 98 pleomorphic adenoma
front 99 Low-power view showing a well-circumscribed, encapsulated tumor mass. Even at this power, the mixture of glandular epithelium and myoepithelial cells is evident.	back 99 pleomorphic adenoma
front 100 These plasmacytoid myoepithelial cells are rounded and demonstrate an eccentric nucleus and eosinophilic hyalinized cytoplasm, thus resembling plasma cells.	back 100 pleomorphic adenoma

front 101 Ductal structures (left) with associated myxomatous background (right) produced from extensive accumulation of mucoid material between myoepithelial tumor cells.	back 101 pleomorphic adenoma
front 102 Chondroid material (right) with adjacent ductal epithelium and myoepithelial cells. The chondroid appearance results from vacuolar degeneration of tumor cells.	back 102 pleomorphic adenoma
front 103 Many of the ducts and myoepithelial cells are surrounded by a hyalinized, eosinophilic background alteration. At times, fat or osteoid also is seen.	back 103 pleomorphic adenoma
front 104 What is the treatment and prognosis for pleomorphic adenoma?	back 104 best treated by surgical excision with adequate surgery, prognosis is excellent (95% cure rate) malignant degeneration is a potential complication (3% to 4%)

front 105 A benign salivary gland tumor composed of large epithelial cells known as oncocytes.	back 105 oncocytoma
front 106 Clinical Features peak prevalence in the sixth to eighth decades primarily major salivary glands, especially parotid (85% to 90%) firm, slowly growing, painless mass rarely exceeds 4 cm in diameter occurs bilaterally on occasion Histopathologic Features well-circumscribed tumor sheets of large polyhedral cells (oncocytes) abundant granular, eosinophilic cytoplasm centrally located nuclei of variable appearance sparce stroma of thin fibrovascular septa overabundance of mitochondria	back 106 oncocytoma
front 107 Sheet of large, eosinophilic oncocytes. The granularity of the cells corresponds to an overabundance of mitochondria, which can be demonstrated by electron microscopy.	back 107 oncocytoma
front 108 What is the treatment and prognosis for oncocytoma?	back 108 best treated by surgical excision prognosis after removal is good, with a low recurrence rate rare malignant oncocytomas have been reported

front 109 The proliferation and the accumulation of oncocytes within salivary gland tissue.	back 109 oncocytosis
front 110 Clinical Features primarily in the parotid gland multifocal, nodular proliferation of oncocytes occurs most frequently in older adults Histopathologic Features focal nodular collections of oncocytes granular, eosinophilic cytoplasm from proliferation of mitochondria clear cytoplasm from accumulation of glycogen	back 110 oncocytosis
front 111 Multifocal collections of clear oncocytes (arrows) in the parotid gland. These cells have clear cytoplasm from the accumulation of glycogen.	back 111 oncocytosis
front 112 What is the treatment and prognosis for oncocytosis?	back 112 it is a benign condition, often only an incidental finding no treatment is necessary, and the prognosis is excellent

front 113 Clinical Features slowly growing, painless, nodular mass occurs almost exclusively in parotid gland firm or fluctuant to palpation unique tendency to occur bilaterally (5% to 17%) peak prevalence in the sixth and seventh decades frequency much lower in blacks than in whites decided male predilection associated with cigarette smoking Histopathologic Features one of the most distinctive histopathologic patterns mixture of ductal epithelium and lymphoid stroma uniform rows of cells surrounding cystic spaces abundant, finely granular eosinophilic cytoplasm inner layer of tall columnar cells with hyperchromatic nuclei outer layer of cuboidal or polygonal cells with vesicular nuclei multiple papillary infoldings protruding into cystic spaces	back 113 Warthin tumor
front 114 Mass in the tail of the parotid gland. This benign neoplasm occurs almost exclusively in the parotid gland and has a tendancy to occur bilaterally.	back 114 Warthin tumor
front 115 Low-power view showing a papillary cystic tumor with a lymphoid stroma. The epithelium is oncocytic, forming uniform rows of cells surrounding cystic spaces.	back 115 Warthin tumor
front 116 High-power view of epithelial lining showing double row of oncocytes with adjacent lymphoid stroma. The inner luminal layer consists of tall columnar cells with centrally placed, palisaded, and slightly hyperchromatic nuclei. Beneath this is a second layer of cuboidal or polygonal cells with more vesicular nuclei.	back 116 Warthin tumor

front 117 What is the treatment and prognosis for Warthin tumor?	back 117 surgical removal is the treatment of choice following surgery, a 2% to 6% recurrence rate has been reported malignancy has been reported but is exceedingly rare
front 118 An uncommon tumor that occurs almost exclusively in minor salivary glands, which was also called monomorphic adenoma due to its its uniform microscopic pattern.	back 118 canalicular adenoma
front 119 Clinical Features striking predilection for upper lip (75%) buccal mucosa is second most common peak prevalence in seventh decade of life definite female predominance (1.8:1) slowly growing, painless mass ranges from several millimeters to 2 cm firm or somewhat fluctuant to palpation overlying mucosa may be normal in color or bluish Histopathologic Features monomorphic microscopic pattern single-layered cords of columnar or cuboidal epithelial cells deeply basophilic nuclei adjacent rows of cells may result in a bilayered appearance cells enclose ductal structures or larger cystic spaces often surrounded by a thin, fibrous capsule	back 119 canalicular adenoma
front 120 Mass in the upper lip. The overlying mucosa may be normal in color or bluish and can be mistaken for a mucocele. However, this tumor shows a striking predilection for the upper lip, and mucoceles of the upper lip are rare.	back 120 canalicular adenoma

front 121 Uniform columnar cells forming canal-like ductal structures. The microscopic pattern of this tumor is monomorphic in nature.	back 121 canalicular adenoma
front 122 What is the treatment and prognosis for canalicular adenoma?	back 122 best treated by local surgical excision recurrence is uncommon
front 123 Clinical Features primarily a tumor of the parotid gland (75%) minor glands second most common peak prevalence in the seventh decade of life more common in females than males (2:1) slowly growing, freely movable mass less than 3 cm in diameter Histopathologic Features usually encapsulated or well circumscribed most common subtype is the solid variant islands and cords of epithelial cells small amount of fibrous stroma central cells form eddies or keratin pearls trabecular subtype demonstrates cordlike epithelial strands membranous subtype exhibits islands in a "jigsaw" pattern	back 123 basal cell adenoma
front 124 Parotid tumor showing cords of basaloid cells arranged in a trabecular pattern. This subtype is characterized by the formation of small, round, ductlike structures.	back 124 basal cell adenoma

front 125 A hereditary form of basal cell adenoma which often occurs in combination with skin appendage tumors, such as dermal cylindromas and trichoepitheliomas.	back 125 membranous basal cell adenoma
front 126 What is the treatment and prognosis for basal cell adenoma?	back 126 treatment consists of complete surgical removal recurrence is rare, except for membranous subtype (25% to 37%) malignant degeneration is rare but possible
front 127 Clinical Features most arise from minor salivary glands, especially on palate usually is seen in older adults more common in males than females (1.5 : 1.0) exophytic, papillary surface growth Histopathologic Features multiple exophytic papillary projections covered by stratified squamous epithelium ductal lumina lined by a double-rowed layer of cells luminal layer of tall columnar cells basilar layer of smaller cuboidal cells	back 127 sialadenoma papilliferum
front 128 Exophytic papillary mass on the palate. The tumor commonly arises from the minor salivary glands and appears clinically similar to the common squamous papilloma.	back 128 sialadenoma papilliferum

front 129 Low-power view showing a papillary surface tumor with associated ductal structures in the superficial lamina propria. High-power view of cystic areas lined by papillary, oncocytic epithelium.	back 129 sialadenoma papilliferum
front 130 Clinical Features minor salivary glands of adults lower lip and mandibular vestibule asymptomatic nodule may show a pit or indentation Histopathologic Features proliferation of squamoid epithelium multiple thick, bulbous papillary projections cuboidal or columnar cells lining projections scattered mucus-producing cells	back 130 inverted ductal papilloma
front 131 Exophytic mass with central papillary projections on the lower labial mucosa. This rare tumor has been described only in the minor salivary glands of adults.	back 131 inverted ductal papilloma
front 132 Papillary intraductal proliferation located beneath the mucosal surface. Higher-power view shows both squamous cells and mucous cells (inset).	back 132 inverted ductal papilloma

front 133 What is the treatment and prognosis for ductal papillomas (sialadenoma papilliferum, intraductal papilloma, or inverted ductal papilloma)?	back 133 best treated by conservative surgical excision recurrence is rare
front 134 What is the most common salivary gland malignancy?	back 134 mucoepidermoid carcinoma
front 135 Clinical Features occurs in second to seventh decades of life most common in the parotid gland appears as an asymptomatic swelling pain or facial nerve palsy may develop minor glands second most common site sometimes fluctuant and have blue or red color Histopathologic Features mixture of mucus and epidermoid cells mucous contain abundant foamy cytoplasm stains positively with mucin stains epidermoid cells characterized by squamoid features intermediate progenitor cells histopathologic grade based on: cyst formation (associated with low-grade) cytologic atypia (associated with high-grade) cell types (mucous cells associated with low-grade)	back 135 mucoepidermoid carcinoma
front 136 Blue-pigmented mass of the posterior lateral hard palate. The minor glands constitute the second most common site for this malignancy.	back 136 mucoepidermoid carcinoma

front 137 Mass of the tongue. Although the lower lip, floor of mouth, tongue, and retromolar pad areas are uncommon locations for salivary gland neoplasia, this is the most common salivary tumor in each of these sites.	back 137 mucoepidermoid carcinoma
front 138 Low-power view of a moderately well-differentiated tumor showing ductal and cystic spaces surrounded by mucous and squamous (epidermoid) cells.	back 138 mucoepidermoid carcinoma
front 139 This low-grade tumor shows numerous large mucous cells surrounding a cystic space. Higher grade tumors show consist of solid islands of squamous and intermediate cells, demonstrating considerable pleomorphism and mitotic activity.	back 139 mucoepidermoid carcinoma
front 140 High-power view showing a sheet of squamous epidermoid cells with focal mucus-producing cells (left). A third type of cell—the intermediate cell— is believed to be a progenitor of both the mucous and the epidermoid cells.	back 140 mucoepidermoid carcinoma

front 141 Clear cell tumor. The typical presentation for this tumor is a mixture of mucus-producing cells and squamous (epidermoid) cells	back 141 mucoepidermoid carcinoma
front 142 High-power view showing a sheet of pleomorphic squamous epithelial cells intermixed with mucous and intermediate cells. Lower grade tumors show cyst formation, minimal cellular atypia, and a greater proportion of mucous cells.	back 142 mucoepidermoid carcinoma
front 143 What is the treatment and prognosis for mucoepidermoid carcinoma?	back 143 usually treated by surgical excision neck dissection is indicated if clinical evidence of metastasis low-grade tumors have a good prognosis (90% to 98% cured) high-grade tumors is more guarded (30% to 54% survive) submandibular tumors have poorer outlook than parotid tumors
front 144 Clinical Features intrabony salivary tumor most common in middle-aged adults slight female predilection more common in the mandible (molar-ramus area) presenting symptom is cortical swelling unilocular or multilocular radiolucency well-defined borders Histopathologic Features similar to mucoepidermoid carcinoma	back 144 intraosseous mucoepidermoid carcinoma

front 145 Multilocular lesion of the posterior mandible. The most frequent presenting symptom is cortical swelling, although some lesions may be discovered incidentally.	back 145 intraosseous mucoepidermoid carcinoma
front 146 What is the treatment and prognosis for intraosseous mucoepidermoid carcinoma?	back 146 radical surgical resection preferred over conservative adjunctive radiation therapy also sometimes is used recurrence rat of 40% (conservative) or 13% (radical) metastasis has been reported in about 12% of cases around 10% die, usually as a result of local recurrence
front 147 Clinical Features 85% to 90% occur in parotid gland even prevalence from second to the seventh decades appears as a slowly growing mass may be otherwise asymptomatic pain or tenderness sometimes is reported facial nerve paralysis is an infrequent but ominous sign Histopathologic Features highly variable microscopic appearance well circumscribed, sometimes appearing encapsulated cells with features characteristic of serous acinar cells abundant granular basophilic cytoplasm round, darkly stained eccentric nucleus pattern resembling normal parotid gland tissue (solid type) small cystic spaces containing mucinous material (microcystic type) large cystic areas with papillary projections (papillary-cystic type) appearance similar to thyroid tissue (follicular type)	back 147 acinic cell carcinoma
front 148 Large, firm mass of the right parotid gland. Almost all of these tumors occur in the parotid, because this is the largest gland and composed entirely of serous elements.	back 148 acinic cell carcinoma

front 149 Parotid tumor demonstrating sheet of granular, basophilic serous acinar cells. The most characteristic cell is one with features of the serous acinar cell, with abundant granular basophilic cytoplasm and a round, darkly stained eccentric nucleus.	back 149 acinic cell carcinoma
front 150 High-power view of serous cells with basophilic, granular cytoplasm. The most characteristic cell is one with features of the serous acinar cell, with abundant granular basophilic cytoplasm and a round, darkly stained eccentric nucleus.	back 150 acinic cell carcinoma
front 151 What is the treatment and prognosis for acinic cell carcinoma?	back 151 parotid tumors treated by lobectomy or total parotidectomy minor gland tumors are treated with surgical excision adjunctive radiation therapy may be considered one of the better prognoses of any malignant salivary gland tumors 10% to 20% of patients have recurrences locally metastases develop in 8% to 11% of patients 10% of patients will die of their disease
front 152 A newly recognized salivary gland malignancy with histopathologic and molecular features that are similar to secretory carcinoma of the breast.	back 152 mammary analogue secretory carcinoma

front 153 Clinical Features most common in parotid salivary gland (58%) less frequent in minor (31%) and submandibular (9%) glands mean age is 47 years slightly more often in males than in females slowly growing, painless mass Histopathologic Features similar to secretory carcinoma of the breast tumor cells exhibit bland, vesicular nuclei slightly granular or vacuolated cytoplasm arranged in solid, tubular, microcystic, or macrocystic structures large cystic spaces with papillary infoldings (“hobnail” appearance)	back 153 mammary analogue secretory carcinoma
front 154 Bluish swelling of the anterior buccal mucosa, which could be mistaken clinically for a mucocele. Histopathologic examination revealed microscopic features similar to those of secretory carcinoma of the breast.	back 154 mammary analogue secretory carcinoma
front 155 Medium-power view showing papillary-cystic spaces and small solid islands. Larger cystic spaces may exhibit papillary infolding of tumor cells with a “hobnail” appearance.	back 155 mammary analogue secretory carcinoma
front 156 What is the treatment and prognosis for mammary analogue secretory carcinoma?	back 156 low-grade malignancy with favorable prognosis local recurrence and metastases have been documented treatment is surgical resection, sometimes with adjuvant radiation

front 157 Malignant mixed tumors represent malignant counterparts to the benign mixed tumor or pleomorphic adenoma. What are the three malignant mixed tumors?	back 157 carcinoma ex pleomorphic adenoma carcinosarcoma metastasizing mixed tumor
front 158 Clinical Features peak prevalence in sixth to eighth decades mostly in major glands (80%), primarily the parotid two-thirds of minor salivary gland cases occur on the palate many cases present as a painless mass Histopathologic Features areas of typical benign pleomorphic adenoma areas of malignant epithelial degeneration cellular pleomorphism and abnormal mitotic activity invasive (malignant cells penetrating >1.5 mm) minimally invasive (invasion ≤1.5 mm) noninvasive (malignant focus in encapsuled tumor)	back 158 carcinoma ex pleomorphic adenoma
front 159 Mass of the parotid gland. Although pain or recent rapid growth is not unusual, many cases present as a painless mass that is indistinguishable from a benign tumor, despite this being the most common malignant mixed tumor.	back 159 carcinoma ex pleomorphic adenoma
front 160 Granular exophytic and ulcerated mass filling the vault of the palate. Histopathologic examination shows areas of typical benign pleomorphic adenoma with areas of malignant degeneration of the epithelial component.	back 160 carcinoma ex pleomorphic adenoma

front 161 A, Medium-power view of the benign portion of the tumor showing sheets of plasmacytoid myoepithelial cells within a myxoid background. Malignant portion of the tumor showing epithelial cells with pleomorphic nuclei.	back 161 carcinoma ex pleomorphic adenoma
front 162 What is the treatment and prognosis for carcinoma ex pleomorphic adenoma	back 162 best treated by wide excision possibly lymph node dissection and adjunctive radiation therapy prognosis is guarded 5-year survival rate ranges from 25% to 65% survival drops to 10% to 35% at 15 years
front 163 Clinical Features 40% to 45% in minor salivary glands (mostly palatal) most common in middle-aged adults more common in females than males (1.4:1) slowly growing, painful mass constant, low-grade, dull ache of increasing intensity can be smooth surfaced or ulcerated radiographic evidence of bone destruction Histopathologic Features mixture of myoepithelial cells and ductal cells islands of basaloid epithelial cells with cystlike spaces (cribriform pattern) multiple ducts or tubules within a hyalinized stroma (tubular pattern) islands or sheets of cells without duct or cyst formation (solid variant) tends to show perineural invasion	back 163 adenoid cystic carcinoma
front 164 Painful mass of the hard palate and maxillary alveolar ridge. Patients often complain of a constant, low-grade, dull ache, which gradually increases in intensity.	back 164 adenoid cystic carcinoma

front 165 Computed tomography (CT) scan of this massive palatal tumor shows extensive destruction of the hard palate with extension of the tumor into the nasal cavity and both maxillary sinuses.	back 165 adenoid cystic carcinoma
front 166 Islands of hyperchromatic cells forming cribriform and tubular structures. Inset shows a high-power view of a small cribriform island. The cribriform pattern is the most classic appearance, characterized cystlike spaces resembling Swiss cheese.	back 166 adenoid cystic carcinoma
front 167 The tumor cells are surrounded by hyalinized material. In the tubular pattern, the tumor cells are similar but occur as multiple small ducts or tubules within a hyalinized stroma.	back 167 adenoid cystic carcinoma
front 168 Perineural invasion. This is a highly characteristic feature of this tumor, probably corresponding to the common clinical finding of pain in these patients.	back 168 adenoid cystic carcinoma

front 169 What is the treatment and prognosis for adenoid cystic carcinoma?	back 169 surgical resection is usually the treatment of choice adjuvant radiation therapy may slightly improve patient survival prone to local recurrence and eventual distant metastasis 5-year survival 77% to 82%, 10-year 60% to 68%, 20-year 35% to 52% better survival of (a) females, (b) younger patients, (c) localized disease metastases (35%) most frequent to (1) lungs, (2) bone, and (3) brain
front 170 Clinical Features almost exclusive to minor glands peak in sixth to eighth decades two-thirds occur in females painless, slow growing mass may erode underlying bone Histopathologic Features tumor cells with deceptively uniform appearance polygonal in shape, with indistinct cell borders pale to eosinophilic cytoplasm nuclei may be round, ovoid, or spindled cells can exhibit different growth patterns ("polymorphous") solid pattern or cords, ducts, or larger cystic spaces peripheral cells are usually infiltrative ("single file" invasion) perineural invasion (mistaken for adenoid cystic carcinoma)	back 170 polymorphous low-grade adenocarcinoma
front 171 Slow-growing, firm mass of the right posterior lateral hard palate. This tumor occurs almost exclusively in minor salivary glands, and may be mistaken for adenoid cystic carcinoma, however, it is usually painless.	back 171 polymorphous low-grade adenocarcinoma
front 172 This medium-power view shows a cribriform arrangement of uniform tumor cells with pale-staining nuclei, resembling adenoid cystic carcinoma.	back 172 polymorphous low-grade adenocarcinoma

front 173 Pale-staining cells that infiltrate as single-file cords. Extension into underlying bone or skeletal muscle may be observed.	back 173 polymorphous low-grade adenocarcinoma
front 174 Perineural invasion. This may be cause the tumor to be mistaken for adenoid cystic carcinoma, however, distinction between these tumors is important because of their vastly differing prognoses.	back 174 polymorphous low-grade adenocarcinoma
front 175 What is the treatment and prognosis for polymorphous low-grade adenocarcinoma?	back 175 best treated by wide surgical excision distant metastasis is rare recurrent rate reported to be 9% to 29%
front 176 In spite of the wide variety of salivary gland malignancies that have been specifically identified and categorized, some tumors still defy the existing classification schemes. What are these designated as?	back 176 salivary adenocarcinomas, not otherwise specified (NOS)

front 177 Clinical Features represent such a diverse group of neoplasms most common in the parotid gland asymptomatic masses or may cause pain microscopic appearance is highly variable	back 177 salivary adenocarcinoma
front 178 “Clear cell” adenocarcinoma of the submandibular gland. As these tumors are studied more, it should be possible to classify some of them into separate, specific categories and allow more definitive analyses of their clinical and microscopic features.	back 178 salivary adenocarcinoma
front 179 Mass of the posterior lateral hard palate. As these tumors are studied more, it should be possible to classify some of them into separate, specific categories and allow more definitive analyses of their clinical and microscopic features.	back 179 salivary adenocarcinoma
front 180 What is the treatment and prognosis for salivary adenocarcinoma?	back 180 difficult to predict the prognosis early-stage, well-differentiated tumors have a better outcome 10-year survival rate parotid tumors ranges from 26% to 55% 10-year survival rate of 76% for intraoral tumors