Diseases Of Salivary Glands Question And Answers

Diseases of Salivary Glands Question And Answers

Question 1. What is a gland?
Answer. A gland is a unit of structure and function, involved in the manufacture and discharge of a secretion.

Question 2. What are salivary glands?
Answer. These are exocrine glands, which continuously secrete saliva to keep the mouth moist and healthy.

Read And Learn More: Oral Pathology Short Notes Question And Answers

Question 3. What are the different types of salivary glands present?
Answer. Salivary glands are mainly of two types—major and minor glands.

Question 4. What are the major salivary glands?
Answer. There are three paired major glands namely—the parotids, the submandibular, and the sublingual glands.

Question 5. What are minor salivary glands?
Answer. Besides the major glands, there are numerous minor salivary glands (their number may be up to 300) present in almost every part of the oral cavity.

Question 6. Name the areas in the oral cavity, where there are no minor salivary glands present.
Answer. Gingiva and the anterior part of the hard palate.

Question 7. Name the extra-oral area where minor salivary glands are also present?
Answer. Paranasal sinuses.

Question 8. What are the different salivary gland diseases commonly seen?
Answer. Salivary gland diseases are broadly divided into two categories:

• Non-neoplastic diseases
• Neoplastic diseases.

Question 9. What are the common non-neoplastic disorders of the salivary gland seen?
Answer. The non-neoplastic disorders of the salivary gland include developmental, inflmmatory, immunological or metabolic types, etc.

Question 10. Name the common developmental disorders of salivary glands.
Answer.

• Aplasia (agenesis) of the salivary gland
• Hypoplasia
• Diseases of Salivary Glands 131
• Aberrant salivary gland
• Atresia (absence of duct in the gland)
• Accessory ducts
• Diverticuli
• Lingual mandibular salivary gland depression.

Question 11. Name the common reactive lesions of the salivary glands.
Answer.

• Mucus retention cyst
• Mucus extravasation cyst
• Sialolithiasis
• Post-radiation sialadenitis
• Chronic sclerosing sialometaplasia.

Salivary Glands Removal

Question 12. What are the common infective lesions of the salivary glands?
Answer.

• Bacterial sialadenitis
  • Acute
  • Chronic
  • Recurrant
• Viral sialadenitis
  • Mumps
  • Cytomegalic inclusion disease.

Question 13. Name the common immune-mediated disorders of salivary glands.
Answer. Immune-mediated disorders are:

• Mikulicz’s disease
• Sjogren’s syndrome.

Question 14. Name the miscellaneous disorders of salivary glands.
Answer.

• Heerfordt’s syndrome
• Sialosis
• Ptyalism and aptyalism
• HIV the associated salivary gland disease.

Question 15.What are the special investigations done for confimatory diagnosis of salivary gland disorders?
Answer. Biopsy, sialometry, sialography, sialochemistry, CT scan, scintigraphy and ultrasonography, etc.

Question 16. Name the benign epithelial tissue neoplasms of salivary glands.
Answer.

• Pleomorphic adenoma (mixed tumor)
• Monomorphic adenoma
• Adenolymphoma (Warthin’s tumor)
• Oxyphil adenoma.

Question 17. Name the malignant epithelial tissue neoplasms of salivary glands.
Answer.

• Mucoepidermoid tumor
• Acinic cell tumor
• Carcinomas
• Adenoid cystic carcinoma
• Adenocarcinoma
• Epidermoid carcinoma
• Undifferentiated carcinoma
• Carcinoma in pleomorphic adenoma (malignant mixed tumor).

Question 18. Name the benign mesenchymal tissue neoplasms of salivary glands.
Answer.

• Fibroma
• Fibrosarcoma
• Lipoma
• Neurilemmoma
• Hemangioma
• Lymphoma.

Question 18a. What is salivary gland aplasia?
Answer. Congenital absence of the salivary glands (both major and minor glands) due to complete failure of their development or genesis is called salivary gland aplasia.

Question 19. What is the effect of salivary gland aplasia in patients?
Answer. Aplasia of the major salivary gland commonly produces xerostomia (dryness of mouth) due to lack of production of saliva in the oral cavity.

Question 20. Name the conditions which may be associated with salivary gland aplasia.
Answer. Congenital aplasia of the salivary glands may be associated with the following diseases:

• Hereditary ectodermal dysplasia
• Mandibulofacial dysostosis
• Congenital aplasia of the lacrimal glands
• Hemi-facial microstomia.

Salivary Glands Removal

Question 21. What is hypoplasia of the salivary glands?
Answer. Relative underdevelopment of the salivary gland is known as salivary gland hypoplasia.

Question 22. Why hypoplasia of the salivary glands occur?
Answer. Hypoplasia of the salivary glands may occur either due to congenital absence of some part of the gland or due to atrophy of the gland secondary to lack of neuromuscular stimulations.

Question 23. Name one condition which may be associated with hypoplasia of the salivary glands.
Answer. Salivary gland hypoplasia is often associated with Melkersson-Rosenthal syndrome;which is characterized by cheilitis granulomatosa, facial paralysis and fisured tongue.

Question 24. What is ectopic salivary gland?
Answer. The occurrence of normal salivary gland tissue in anatomically unusual locations is known as salivary gland ectopia and such glands are known as ectopic salivary glands.

Question 25. Name the common locations where ectopic salivary glands are often found.
Answer.

• Mandibular body
• Gingiva
• Masseter muscle
• Upper portion of neck near the branchial cleft.

Question 26. What is gingival salivary gland choristoma (choristoma is a mass of histologically normal tissue in an abnormal location)?
Answer. Normally minor salivary glands are not present in gingiva. however sometimes ectopic salivary gland tissues may be found in gingiva, which produce a tumor-like mass called gingival salivary gland choristoma.

Question 27. What are the congenital defects seen in salivary gland ducts?
Answer.

• Atresia
• Absence of duct orifie
• Accessory ducts.

Question 28. What is salivary gland duct atresia?
Answer. Atresia is a rare congenital anomaly characterized by absence or narrowing of the duct system of salivary gland.

Question 29. What can be the possible effect of atresia?
Answer. It can cause xerostomia and development of retention cyst (mucoceles).

Question 30. Accessory ducts are often present in relation to which salivary gland?
Answer. These are present often in relation to the parotid gland (either above or below the normal Stensen’s duct).

Question 31. What are salivary gland diverticuli?
Answer. Diverticuli refer to the small pouches or out-pocketings in the ductal system of major salivary glands.

Question 32. Diverticuli are generally seen in relation to which gland?
Answer. These are predominantly found in relation to parotids.

Question 33. What problem diverticuli can cause?
Answer. Diverticuli may produce recurrent swellings and acute sialadenitis due to retention of saliva in those areas where the pouches are present along the course of the duct.

Question 34. How the salivary gland diverticuli can be detected?
Answer. Diverticuli can be diagnosed or detected by sialography. (Radiographic demonstration of the salivary ducts by means of the injection of substances opaque to X-rays).

Question 35. What is lingual mandibular salivary gland depression?
Answer. It is a developmental concavity in the lingual cortex of mandible usually in the third molar area; which forms around an accessory salivary gland.

Question 36. What are the other names given to lingual mandibular salivary gland depression?
Answer. The condition also has several other names such as Stafne’s bone cyst, static bone cyst or latent bone cyst, etc.

Question 37. What clinical symptom lingual mandibular salivary gland depression produces?
Answer. It is clinically asymptomatic.

Question 38. Describe the radiographic appearance of lingual mandibular salivary gland depression.
Answer. It radiographically presents a distinct, localized, deep concavity on the lingual aspect of mandible, in the third molar region in between the mandibular canal and the lower border of mandible.

Question 39. Name the lesion, which often creates confusion with lingual mandibular salivary gland depression?
Answer. Hemorrhagic bone cyst, this cyst almost always lies above the mandibular canal while the lingual mandibular salivary gland depression lies below the canal.

Question 40. What is sialolithiasis?
Answer. Sialolithiasis is a pathological condition characterized by the presence of one or more calcifid stones (sialoliths) within the salivary gland itself or within its duct.

Question 41. Sialoliths develop more often in relation to which gland?
Answer. Submandibular salivary gland (70–90 percent cases).

Question 42. Name the duct system of submandibular salivary gland.
Answer. Wharton’s duct.

Question 43. Why sialoliths develop more often in relation to submandibular gland?
Answer.

• Multiple sharp bends or curvatures in the Wharton’s duct
• More viscous nature of saliva of this gland
• Higher calcium levels in saliva of this gland
• Dependent position of the gland often increases the chance of stasis of saliva.

Question 44. Can sialoliths form in relation to minor salivary glands?
Answer. Yes.

Question 45. What are the symptoms of sialolithiasis?
Answer.

• Intermittent pain
• Discomfort
• Recurrent swelling of the affected gland.

Question 46. When actually the pain starts in sialolithiasis?
Answer. When size of the sialolith is large enough to cause occlusion of the salivary gland duct (resulting in retention of saliva), then only pain starts.

Salivary Glands Removal

Question 47. During what time, pain and discomfort become more severe in sialolithiasis?
Answer. Pain and discomfort become more severe during meals (as the taste and smell of food increase the rate and volume of salivary secretion). Moreover, the symptoms become severe particularly when the patient takes sour foods or beverages; or when direct stimulation of salivary secretion is done with a lemon drop candy.

Question 48. What will be the clinical feature of sialolithiasis in submandibular gland?
Answer. It will produce a unilateral swelling on the flor of mouth medial to the inferior border of the mandible; the swelling is often fim and tendered on palpation.

Question 49. What will be the clinical feature of sialolithiasis in parotid gland?
Answer. Sialolithiasis of the parotid often causes fim swelling over the ramus of the mandible; the swelling also increases during meals.

Question 50. Minor salivary gland sialolithiasis can often be seen in which areas of mouth?
Answer. Upper lip and buccal mucosa.

Question 51. Why xerostomia does not occur in sialolithiasis?
Answer. Sialoliths do not cause xerostomia since they involve only one or two glands.

Question 52. During clinical examination of sialolith, what type of palpation is done?
Answer. Bidigital palpation using both hands.

Question 53. Name different X-rays often advised for detection of sialoliths at different locations.
Answer.

Question 54. Name the situations where X-rays fail to detect the sialolith.
Answer.
In case of superimposition of sialolith with the mandibular bone
If the sialolith is not fully calcified.

Question 55. What is sialography?
Answer. Sialography is a method of detection of salivary stones within a gland or its duct by prior retrograde injection of a radiopaque dye within the duct system and subsequently obtaining a radiograph of the said gland or duct.

Question 56. What investigations are done in case the conventional imaging techniques fail to detect the sialolith?
Answer. Ultrasonography and CT scan.

Question 57. Describe the macroscopic appearance of sialolith.
Answer. Sialolith appears as a hard, round or oval, rough or smooth solid mass; often having yellowish or yellowish-white color.

Question 58. Describe the composition of a sialolith.
Answer.

Question 59. What is the histological appearance of a sialolith?
Answer. Microscopically the salivary stone is acellular and amorphous and when decalcifid it presents the following—

• Concentric laminations of amorphous basophilic matrix
• The outer margin may exhibit aggregates of microbial colonies
• The ductal lining surrounding the stone shows oncocytic, squamous and/or mucous metaplasia of varying degrees.

Question 60. Name the conditions which may simulate sialolithiasis.
Answer.

• Endemic parotitis
• Salivary gland neoplasm
• Mesenchymal neoplasms
• Hypervitaminosis-A
• Calcification of lymph node in chronic long-standing tuberculosis.

Question 61. Name the different treatment modalities for sialoliths.
Answer.

• Small stones in the distal parts of the duct—removal through the orifie by digital manipulation only.
• Surgical removal of the stone
• Lithotripsy
• Sialoadenectomy.

Question 62. What is lithotripsy?
Answer. It is a non-invasive technique for the treatment of a large sialolith, in which the large stone is fist disintegrated and then the powdered particles are carried out of the duct via saliva.

Question 63. What is sialoadenectomy?
Answer. It is the surgical removal of sialolith along with the involved gland.

Question 64. What is the indication of sialoadenectomy?
Answer. It is indicated in situations where conventional and conservative techniques for removal of sialolith fail; for example:

• Intraglandular stones
• Multiple stones in a single gland
• Diffuse glandular calcifiations.

Question 65. What is the common mistake made during the removal of a sialolith?
Answer. Due to improper handling at the time of surgery, the stone may be pushed from duct into the gland mass.

Question 66. What is the treatment of minor salivary stones?
Answer. Minor salivary gland stones are treated by simple surgical excision of the stone along with the surrounding minor salivary gland tissue.

Question 67. What is post radiation sialadenitis?
Answer. It the inflmmation of the salivary glands, which are damaged due to radiation therapy.

Question 68. What is chronic sclerosing sialadenitis?
Answer. Chronic sclerosing sialadenitis is the chronic inflammation of the salivary gland resulting in degeneration and subsequent replacement of acini by firous tissue.

Salivary Glands Removal

Question 69. What are the causes of chronic sclerosing sialadenitis?
Answer.

• Autoimmune disease
• Systemic and metabolic disorders
• Direct trauma
• Infection
• Occlusion of the duct by calculi
• Compression of the gland or duct by any neoplasm
• Salivary glands cysts
• Radiation therapy
• Medication and drugs.

Question 70. What are the clinical features of chronic sclerosing sialadenitis?
Answer. Nonspecific, firm, painless swelling of the gland; with occasional stagnation in the salivary flw.

Question 71. Describe the histological features of chronic sclerosing sialadenitis.
Answer.

• There will be progressive destruction of the salivary gland acinar cells with chronic inflmmatory cell infitration in the gland
• Once the acini are lost, the gland parenchyma undergoes progressive sclerosis or firosis
• Even after the gland acini are completely degenerated, the ductal elements often remain unaffected
• Sometimes there can be retrograde bacterial infection in the damaged gland.

Question 72. What is the treatment of chronic sclerosing sialadenitis?
Answer.

• Etiologic factors should be removed
• Sialoadenectomy in case of irreversible damage to the gland
• Use of artifiial saliva
• Administration of pilocarpine to stimulate salivary flw
• Use of electro-stimulatory aid to stimulate the salivary flw.

Question 73. What is necrotizing sialometaplasia?
Answer. Necrotizing sialometaplasia is a spontaneous disease of unknown etiology, characterized by necrosis of minor salivary glands of the palate along with the surface epithelium and underlying connective tissue.

Question 74. What are the predisposing factors for necrotizing sialometaplasia?
Answer.

• Odontogenic infections
• Traumatic injury
• Ill-fiting dentures
• Tumor in the adjacent area
• Chronic throat infections.

Question 75. How the disease necrotizing sialometaplasia develops?
Answer. It occurs due to infraction of the tissue, although the underlying cause of the infraction is unknown (Infraction is the necrosis or damage of cells due to lack of oxygen).

Question 75a. Which glands are particularly affected in Necrotizing sialometaplasia?
Answer. It mostly affects the minor glands at the junction between hard and soft palate.

Question 76. How necrotizing sialometaplasia clinically appears?
Answer.

• Initially, there are one or two non-ulcerated swellings on the palate with pain and paresthesia
• Later on, deep-seated, punched-out, excavating ulcers develop.

Question 77. Necrotizing sialometaplasia is often confused with which diseases?
Answer. Many lesions of necrotizing sialometaplasia are clinically mistaken for malignant salivary gland neoplasms or epidermoid carcinomas.

Question 78. How necrotizing sialometaplasia is to be differentiated from malignant salivary gland neoplasms or epidermoid carcinomas?
Answer. In necrotizing sialometaplasia the ulcers do not have any raised or rolled borders.

Question 79. What is the histological appearance of necrotizing sialometaplasia?
Answer.

• Absence of surface epithelium in palate, which is replaced by necrotic debris and eosinophilic firinous materials
• Coagulation necrosis of the salivary gland tissue with absence of nuclei in acinar cells
• The acinar cells are distended and often appear pale and basophilic
• Glandular epithelium of salivary gland adjacent to the necrotic zone often exhibit squamous metaplasia.

Question 80. Name the common diseases which come under acute bacterial sialadenitis.
Answer. Acute parotitis or acute suppurative parotitis and occasional acute bacterial sialadenitis of submandibular salivary gland.

Question 81. Which organisms frequently cause acute parotitis?
Answer. Acute parotitis is mostly caused by Streptococcus pyogenes and Staphylococcus aureus.

Question 82. What are the clinical features of acute parotitis?
Answer.

• Sudden onset of unilateral or bilateral painful swelling in the pre-auricular region
• There may be constitutional symptoms, e.g. fever, malaise and redness of the skin overlying the parotid
• Many patients complain of trismus and diffiulty in swallowing
• Intra-orally parotid papilla may be inflmed with exudation of pus from the duct opening.

Question 83. What is chronic bacterial sialadenitis?
Answer. Chronic bacterial sialadenitis is a nonspecifi inflmmatory disease of the salivary gland.

Question 84. How chronic bacterial sialadenitis occurs?
Answer. Chronic bacterial sialadenitis occurs secondary to duct obstruction or low grade sustained ascending infection.

Question 85. Name the common investigations done in bacterial sialadenitis?
Answer.

• Sialography
• Radiography
• Bacterial culture from saliva or secretion of the gland
• Biopsy.

Question 86. What are the common causes of recurrent parotitis?
Answer.

• Salivary gland calculi
• Stricture of the ducts
• Abnormally low secretion of saliva due to any cause
• Congenital absence of the duct system
• Immunosuppression.

Question 87. Describe the clinical features of recurrent parotitis.
Answer. Recurrent painful swelling of the affected gland with discharge of pus from the duct orifie.

Salivary Glands Removal

Question 88. What are the common viral sialadenitis seen?
Answer. Mumps and cytomegalic inclusion disease.

Question 89. What is mumps?
Answer. Mumps is an acute contagious infection of the salivary gland caused by the Paramyxovirus.

Question 90. In mumps which gland is often affected?
Answer. Parotid gland is mostly affected

Question 90a. Name the indications of sialography.
Answer.

• Salivary ductal calculus
• Chronic parotitis
• Recurrent sialadenitis.

Question 90b. Name one contraindication of sialography.
Answer. Acute parotitis.

Question 91. In case of mumps how the virus is transmitted?
Answer. The virus is transmitted by direct contact with the infected saliva or by airborne droplets.

Question 92. Which age group is commonly affected in mumps?
Answer. It mostly occurs in children between 5 and 18 years of age.

Question 93. Describe the brief clinical features of mumps.
Answer. Rapid bilateral swelling of the parotid glands with acute pain during salivation; recurrent exudation from the duct orifie is also seen.

Question 94. Can any other body organs be affected in mumps besides parotid?
Answer. Sometimes other internal organs may also be affected by this virus, which include testes, central nervous system (CNS), ovaries and pancreas, etc.

Question 95. Cytomegalic inclusion disease of salivary gland is often caused by which virus?
Answer. Cytomegalic inclusion disease of salivary gland is a common infective disease caused by Cytomegalovirus.

Question 96. In cytomegalic inclusion disease which gland is often affected?
Answer. Parotid gland is mostly affected.

Question 97. Why it is called a cytomegalic inclusion disease?
Answer. Because histologically the affected salivary gland tissue exhibits the presence of large,doubly contoured, “owl-eye” shaped inclusion bodies within the nucleus or cytoplasm of the ductal epithelial cells.

Question 98. What is Mikulicz’s disease?
Answer. Mikulicz’s disease is a progressive autoimmune disease of the salivary gland, it is also called localized benign lymphoepithelial lesion.

Question 99. What is the basic pathologic characteristic of Mikulicz’s disease?
Answer. The disease is characterized by replacement of gland acini by dense infitrates of T lymphocytes along with squamous metaplasia of the ductal epithelium.

Question 100. Which glands are frequently affected in Mikulicz’s disease?
Answer. The disease frequently involves the parotid and lacrimal glands.

Question 101. Onset of Mikulicz’s disease is often marked with what symptoms?
Answer. The onset of the disease is often marked with fever, upper respiratory tract infection, and any other oral or orofacial infections, etc.

Question 102. What are the clinical features of Mikulicz’s disease?
Answer. There is often unilateral or bilateral, diffuse, soft, movable and painless swelling of the involved glands; in addition to that often there is presence of xerostomia.

Question 103. Are Mikulicz’s disease and Mikulicz’s syndrome same entities?
Answer. No, they are different things.

Question 104. Describe how Mikulicz’s disease and Mikulicz’s syndrome differ from one another.
Answer.

• Mikulicz’s disease: It is characterized by unilateral or bilateral, painless swelling of parotid and lacrimal glands; in association with xerostomia. It can be a manifestation of Sjogren’s syndrome or AIDS
• Mikulicz’s syndrome: It may represent some generalized specifi diseases, e.g. lymphomas or tuberculosis, etc and it exhibits parotid and lacrimal gland enlargements accompanied by the enlargement of lymph nodes.

Question 105. Describe the key histologic features of Mikulicz’s disease.
Answer. It is histologically characterized by replacement of gland acini by dense infitrates of T-lymphocytes along with squamous metaplasia of the ductal epithelium.

Salivary Glands Removal

Question 106. What is the treatment of Mikulicz’s disease?
Answer. Steroid therapy.

Question 107. What is Sjogren’s syndrome?
Answer. Sjogren’s syndrome is a multisystem immune-mediated chronic inflmmatory disease of salivary and lacrimal glands.

Question 108. What is the basic pathologic characteristic of Sjogren’s syndrome?
Answer. The disease is characterized by lymphocytic infitration and acinar destruction of salivary and lacrimal glands.

Question 109. Is there any gender predilection in Sjogren’s syndrome?
Answer. Sjogren’s syndrome exhibits a marked predilection for women.

Question 110. How the disease Sjogren’s syndrome occurs?
Answer. Although exact etiopathogenesis of Sjogren’s syndrome is not known but it is strongly believed to be an autoimmune disorder.

Question 111. Why it is believed that Sjogren’s syndrome is an autoimmune disorder?
Answer. Because rheumatoid factors, which are associated with many autoimmune disorders are frequently present in Sjogren’s syndrome. Moreover presence of serum antinuclear antibodies (ANA), e.g. Anti-Sjogren’s syndrome-A (Anti-SS-A) and anti-Sjogren’s syndrome-B (Anti-SS-B) also further increase the probability of this disease.

Question 112. How many types of Sjogren’s syndrome may occur?
Answer. Sjogren’s syndrome are of two types:

• Primary Sjogren’s syndrome
• Secondary Sjogren’s syndrome.

Question 113. What is primary Sjogren’s syndrome?
Answer. If the disease affects only the salivary and lacrimal glands without any co-existing systemic autoimmune diseases, it is called primary Sjogren’s syndrome.

Question 114. What is the other name of primary Sjogren’s syndrome?
Answer. Primary Sjogren’s syndrome is also known as sicca syndrome.

Question 115. What are the characteristics of sicca syndrome?
Answer. It is often characterized by the occurrence of dry mouth (xerostomia) and dry eyes (xerophthalmia or keratoconjunctivits sicca).

Question 116. What is secondary Sjogren’s syndrome?
Answer. Secondary Sjogren’s syndrome characteristically has xerostomia, xerophthalmia and an associated autoimmune connective tissue disease, usually the rheumatoid arthritis.

Question 117. Name the other diseases which could be associated with secondary Sjogren’s syndrome?
Answer. Any of the following disease could be associated:

• Lupus erythematosus
• Systemic sclerosis
• Primary biliary cirrhosis
• Periarteritis nodosa
• Polymyositis
• Dermatomyositis
• Macroglobulinemia.

Question 117a. What is periarteritis nodosa?
Answer. It is an autoimmune disease characterized by spontaneous inflmmation of the external coats arteries and can affect any organ of the body. It can lead to inadequate blood supply and permanent damage to organs.

Question 118. What are common clinical features of secondary Sjogren’s syndrome?
Answer. The most common symptoms of secondary Sjogren’s syndrome are the xerostomia, xerophthalmia (dry eye) and arthralgia (pain in the joints).

Question 119. Which type of Sjogren’s syndrome produces more severe oral and ocular lesions?
Answer. The primary Sjogren’s syndromes produce more severe oral and ocular changes than the secondary Sjogren’s syndromes.

Question 120. What are the constitutional symptoms of Sjogren’s syndrome?
Answer. Severe tiredness and fatigue are the important features of the disease with depression in few cases; and most of the patients sleep for about 10 to15 hours in a day.

Question 121. Which salivary glands are predominantly affected in Sjogren’s syndrome?
Answer. About 88 percent cases exhibit decreased salivary flw of the submandibular and sublingual glands; parotid salivary flw decreases in about 55 percent cases.

Question 122. What are the typical salivary gland manifestations or changes in Sjogren’s syndrome?
Answer. There is often secondary acute bacterial sialadenitis with tendered swelling of the gland with erythema in the overlying skin and purulent discharge from the duct orifies.

Question 123. What is the appearance of oral mucosa in Sjogren’s syndrome?
Answer. Oral mucosa appears red, dry, tendered, smooth and glazed; this is often called a “parchment-like appearance” of the mucosa.

Question 124. What is keratoconjunctivitis sicca?
Answer. It is an extremely important manifestation of Sjogren’s syndrome; which often manifests as dryness of the eyes with conjunctivitis (occurs due to decreased secretion from the lacrimal glands).The ‘sicca syndrome’ also produces a gritty, burning sensation in the eye; patients may feel like there is a foreign body inside the eye, which is causing blurred vision and itching pain in the eye.

Question 125. What are the oral manifestations of Sjogren’s syndrome?
Answer.

• Xerostomia with frothy saliva
• Difficulty in eating, swallowing, and talking
• Red, dry, tendered, smooth, and glazed appearance of oral mucosa with a typical parchment-like appearance
• Disturbed taste sensation, oral candidiasis, and occasional angular chelitis
• Tongue exhibits red and atrophic mucosa with varying degrees of fisuring and lobulations on the surface (cobble-stone appearance)
• Rapidly progressing dental caries
• Patients often feel diffiulty in wearing artifiial dentures.

Question 126. Describe the histology of Sjogren’s syndrome.
Answer. Histologically the disease is characterized by lymphocytic infitration with atrophy of the salivary gland acini and proliferation of the ductal epithelial cells. Eventually there is acinar destruction of salivary and lacrimal glands. In the fully developed lesions, the entire glandular tissue is replaced by multiple myoepithelial islands.

Question 127. Name the common laboratory tests done in Sjogren’s syndrome.
Answer.

• Raised erythrocyte sedimentation rate (ESR)
• Diminished total salivary flw rate
• Hypergammaglobulinemia
• Positive serologic test for rheumatoid factors
• Immunohistochemistry: Detects the presence of antinuclear antibodies ANA (anti-SS-A and anti-SS-B) in the serum of large number of patients.

Question 128. Name the common antibacterial agent found in saliva, tears and egg-white.
Answer. Lysozyme.

Question 128a. How sialography appears in Sjogren’s syndrome?
Answer. In Sjogren’s syndrome, solography often produces a snow-storm or cherry tree in blossom like appearance.

Question 129. What is the use of rose Bengal dye in keratoconjunctivitis sicca?
Answer. The keratoconjunctivitis sicca is characterized by corneal kerototic lesions, which stain pink when “rose Bengal” dye is used.

Question 130. What is Schirmer’s test?
Answer. The reduced lacrimal flw rate in Sjogren’s syndrome is measured by this test. A strip of fiter paper is placed in between the eye and the eyelid to determine the degree of tearing, which should be measured in millimeter. When the flw is reduced to less than 5 mm in 5 minutes of sample period, the patient should be considered positive for Sjogren’s syndrome.

Question 131. Describe the treatment of Sjogren’s syndrome.
Answer.

• Use of artificial saliva
• Use of systemic steroids
• Antibiotic eye drops
• Anti-fungal drugs
• Maintenance of oral hygiene
• Avoidance of sweets and use of florides to control caries.

Question 132. What is Heerfordt’s syndrome?
Answer. The Heerfordt’s syndrome or uveoparotitis is a rare syndrome and is characterized by swelling of the parotid gland, fever and paralysis of the facial nerve.

Question 133. What is Sialosis?
Answer. Sialosis or sialadenosis is a condition characterized by bilateral, recurrent, noninflmmatory and non-neoplastic swelling of the salivary glands.

Question 134. What are the causes of sialosis?
Answer.

• Disturbance in the neuro-secretary control
• Hormonal disturbance e.g. thyroid insuffiiency
• Administration of certain sympathomimetic drugs
• Malnutrition
• Liver cirrhosis/chronic alcoholism
• Diabetes mellitus
• Bulimia
• Pregnancy
• Idiopathic.

Question 135. What is ptyalism?
Answer. Ptyalism is an abnormal condition characterized by increased secretion of salvia in the mouth; it is just opposite to xerostomia.

Question 136. Enumerate the causes of ptyalism.
Answer.

• Metal poisoning
• Abnormal neuro-secretary stimulation.
• Acute necrotizing ulcerative gingivitis (ANUG)
• General stomatitis
• Aphthous ulcer
• Psychological factor
• Following oral examination procedure
• Major surgery in the oral cavity
• Improper swallowing due to any cause
• Insertion of new prosthesis in the mouth
• Idiopathic.

Question 137. What is aptyalism?
Answer. Aptyalism is the pathological condition characterized by a decrease or complete cessation of secretion of saliva causing dryness of mouth. Lack of salivary secretion often leads to clinical phenomenon known as xerostomia.

Question 138. What are the causes of xerostomia?
Answer. There are two types of causes: temporary causes and permanent causes.

Question 139. What are the temporary causes of xerostomia?
Answer.

• Playing or outdoor activity for long time on a hot day
• Psychological disorders e.g. anxiety and depression
• Consumption of alcohol
• Sialadenitis
• Use of drugs e.g. atropine, antihistaminics, bronchodilators, diuretics, and antidepressants
• Dehydration due to diarrhea, vomiting and hemorrhage
• Lack of mastication
• Mouth breathing.

Question 140. What are the permanent causes of xerostomia?
Answer.

• Aplasia of salivary glands (e.g. hereditary ectodermal dysplasia)
• Artesia of salivary glands
• Radiotherapy in the head/neck region with destruction of gland acini
• Sjogren’s syndrome
• Diabetes mellitus and diabetes insipidus
• Vitamin deficiency (A and B complex)
• Sarcoidosis, HIV-associated salivary gland disease, amyloidosis
• Pernicious and iron deficiency anemia
• Parkinson’s disease
• Defective secretomotor stimulations and ageing.

Question 140a. Why dry mouth occurs during antidepressant therapy?
Answer. It occurs due to blockade of muscarinic acetylcholine receptors.

Question 141. Why various oral diseases develop due to xerostomia?
Answer. In xerostomia oral diseases often develop because of the following:

• Decreased oral pH with increased accumulations of plaque
• Increased trauma and irritation in mouth due to dryness (during otherwise normal oral functions)
• Decreased remineralization of enamel by saliva
• Increased periodontal diseases
• Increased susceptibility to opportunistic infections.

Question 142. Describe the clinical features of xerostomia.
Answer.

• General symptoms:
  • Soreness, burning or pain sensations in the mouth
  • Difficulty in taking foods (especially dry and crispy foods e.g. cereals and crackers) as they causes irritation and burning sensation.
• Changes in oral mucosa:
  • Erythematous changes in the oral mucosa
  • Cracking, fisuring and occasional ulceration of mucosa
  • Candidiasis
  • Red spots over the mucosal surfaces of tongue, hard and soft palate.
• Tongue problems:
  • Due to dry sticky oral mucosa, tongue always sticks to the palate
  • Atrophy of the tongue papilla with cracking, fisuring and occasional ulceration of the surface.
• Change in the lips:
  • ‘Lipstick sign’ is positive for women (lipstick always sticks to the upper front teeth)
  • Inflammation and fisuring of the lips (chelitis).
• Throat problems:
  • Constant sore throat and there is diffiulty in swallowing
  • Hoarseness of voice and speech diffiulty
• Change in saliva and salivary gland:
  • Parotid swelling with sialadenitis
  • Little or no pool of saliva in the flor of the mouth
  • Whatever saliva is present, it looks stringy, ropy or foamy
• Tooth and gum problems:
  • Increase in the incidence of dental caries due to lack of protective action of saliva
  • Increased incidences of periodontal disease with gum bleeding.
  • Early tooth loss in adults
  • Diffiulty in wearing artifiial prosthesis
• Miscellaneous problems:
  • Taste disorder (dysgeusia) and burning tongue (glossodynia)
  • Increased need to drink water especially at night
  • Diffiulty in maintaining proper oral hygiene and persistent halitosis
  • Dry nasal passage.

Question 143. What is Pleomorphic adenoma?
Answer. Pleomorphic adenoma or benign mixed tumor is the most common neoplasm of the salivary glands, which is histologically characterized by complex intermingling of epithelial components and the mesenchymal areas.

Question 144. Why it is called ‘pleomorphic’ adenoma (Pleomprphic—Occurrence of two or more structural forms in the same tumor)?
Answer. The neoplastic cells in this tumor exhibit differentiation of epithelial cells (luminal), myoepithelial cells (abluminal) as well as a very characteristic stromal tissue comprising of chondroid, myxoid, osseous and myxo-chondroid elements. This complexity and diversity of appearance of this neoplasm account for the term Pleomorphic.

Question 145. What is the origin of pleomorphic adenoma?
Answer. According to the multicellular theory, these tumors originate from intercalated duct cells and myoepithelial cells of the salivary glands.

Question 146. What is the distribution of pleomorphic adenoma in major salivary glands?
Answer. It accounts for 60%–65% of all neoplasms of the parotid, 50% of submandibular and 25% of sublingual gland.

Question 147. What is the distribution of pleomorphic adenoma in minor salivary glands?
Answer. Approximately 45% of minor gland tumors are pleomorphic adenomas.

Question 148. What is the commonest location of pleomorphic adenoma of minor salivary gland origin in mouth?
Answer. Palate (postero-lateral aspect) is the most frequent site for minor gland lesions (55%).

Question 149. Describe the clinical appearance of pleomorphic adenoma?
Answer. Pleomorphic adenoma usually produces the following features:

• A slow-growing, painless, well-delineated, nodular exophytic growth
• It may be solitary or occasionally multinodular
• The tumor often has a rubbery consistency
• The surface of the lesion is mostly non-ulcerated, smooth and lobulated
• There is generally no history of pain.

Question 150. What is the macroscopic appearance of an intact pleomorphic adenoma?
Answer. Macroscopically an intact pleomorphic adenoma appears as a well-circumscribed,lobulated, globular mass, which is surrounded by a capsule of variable thickness or completeness. On palpation, the lesion feels like a rubbery, resilient mass with bosselated (bosselated means showing many protuberances on the surface).

Question 151. How the cut surface of pleomorphic adenoma appears?
Answer. The cut surface shows a variegated appearance (having variety of colors) with presence of few hemorrhagic or cystic areas.

Question 152. What is the histological appearance of pleomorphic adenoma?
Answer.

• The neoplasm often exhibits proliferation of glandular, basophilic epithelial cells in the form of diffuse sheets or clusters. (basophilic means- stained with basic dye)
• The neoplastic epithelial cells are polygonal, spindle or stellate-shaped and they have a tendency to form duct-like structures. (stellate means-star shaped)
• Each duct-like structure is often filed with either a clear or a brightly eosinophilic, PAS-positive material (epithelial mucin)
• The connective tissue stroma often characteristically exhibits metaplastic changes, which results in the formation of mucoid, myxoid, chondroid, myxo chondroid, and osseous tissues.

Question 153. Name the lesions often included in the differential diagnosis of pleomorphic adenoma.
Answer.

• Adenolymphoma
• Adenocarcinoma
• Fibroma
• Lipoma
• Chondroma
• Myxoma.

Question 154. What are the special investigations done in pleomorphic adenoma?
Answer.

• Fine needle aspiration cytology (FNAC)
• Magnetic resonance imaging (MRI)
• Special staining
• Immunohistochemistry.

Question 155. What is the treatment of pleomorphic adenoma?
Answer.

• Small lesion—complete surgical removal
• Larger lesion in parotid—surgical excision (lobectomy or gland extirpation).

Question 156. Name the common complications following surgical intervention in parotid gland for removal pleomorphic adenoma.
Answer. Facial nerve palsy and the auriculotemporal syndrome may be the common complications occurring following surgical intervention in the neoplasms of the parotid gland.

Question 157. What is a monomorphic adenoma (onomorphic means having only one morphologic form)?
Answer. Monomorphic adenomas are a group of rare benign salivary neoplasms; characterized by proliferation of a single epithelial cell type that has a distinctive architectural pattern.

Question 158. How does monomorphic adenoma differ from pleomorphic adenoma?
Answer. Monomorphic adenomas do not exhibit the wide cellular diversities, which are normally encountered in pleomorphic adenomas.

Question 159. Enumerate the different types of monomorphic adenomas.
Answer.

• Basal cell adenoma
• Canalicular adenoma
• Sebaceous adenoma
• Glycogen rich adenoma
• Clear cell adenoma.

Question 160. Among different types of monomorphic adenomas, which one is the most common?
Answer. Basal cell adenoma is the most common type.

Question 161. What is clinical appearance of monomorphic adenoma?
Answer. The monomorphic adenomas produce slow growing, encapsulated, fim, movable and painless lesions in the oral cavity.

Question 162. What is the histological appearance of basal cell adenoma?
Answer. Basal cell adenomas histologically present clusters of proliferating neoplastic glandular epithelial cells in the form of oval-shaped nests. The outermost layer of cells, which surround individual cell nests are cuboidal type, while the inner core of cells are uniform in size. As a whole, the tumor cells resemble basal cells of the stratifid squamous epithelium.

Question 163. What are the histological subtypes of basal cell adenoma?
Answer. On the basis of their microscopic appearance, basal cell adenomas are divided into four subtypes—

• Solid type
• Trabecular type
• Tubular type
• Membranous type.

Question 164. What is a myoepithelioma?
Answer. These are rare benign salivary gland neoplasms arising from the myoepithelial cells.

Question 165. What is the histological appearance of myoepithelioma?
Answer. Histologically the lesion shows proliferating spindle-shaped neoplastic cells having eosinophilic cytoplasms; which are often arranged in diffuse sheets or in interlacing fascicles.

Question 166. What are the different histological patterns of myoepitheliomas seen?
Answer. There are generally three patterns:

• Spindle cell pattern
• Plasmacytoid pattern
• Combination pattern.

Question 167. What is an oncocytoma?
Answer. Oncocytoma is a rare benign salivary gland neoplasm, which is composed of clusters of large eosinophilic granular cells (oncocytes).

Question 168. What is the other name of oncocytoma?
Answer. Oxyphilic adenoma.

Question 169. Oncocytoma predominantly affects which organ?
Answer. It primarily affects superfiial lobe of the parotid gland.

Question 170. What is the clinical appearance of oncocytoma?
Answer. Clinically the tumor produces slow enlarging, painless, uninodular or sometimes multinodular, movable swelling anterior to the ear or over the ramus of the mandible.

Question 171. Describe the histological appearance of oncocytoma.
Answer. Histologically oncocytoma exhibits proliferation of numerous polygonal or cuboidal oncocytes, showing prominent eosinophilic and granular cytoplasm with compact nuclei.

The neoplastic cells are often arranged in organoid or acinar pattern, which often form solid cords or doughnut-shaped cellular confiurations (Doughnut—a small cake of sweetened dough, often ring-shaped).

Question 172. What is differential diagnosis of oncocytoma?
Answer.

• Adenolymphoma
• Pleomorphic adenoma
• Enlarged parotid lymph node.

Question 173. What is the treatment of oncocytoma?
Answer. Surgical excision by lobectomy of the affected gland.

Question 174. What is an adenolymphoma?
Answer. Adenolymphoma is a benign salivary gland neoplasm, which is composed of many cystic spaces and abundant lymphoid tissue in the stroma.

Question 175. What is the other name of adenolymphoma?
Answer. Warthin’s tumor.

Question 176. Adenolymphoma primarily affects which gland?
Answer. It primarily affects the parotid gland.

Question 177. What are the different theories regarding the pathogenesis of adenolymphoma?
Answer.

• Some investigators propose that the tumor develops as a result of neoplastic proliferation of ectopic salivary gland tissues, situated within the intraparotid or paraparotid lymph nodes
• Other investigators believe that neoplastic proliferation of salivary gland epithelial cells initiates a secondary reactive response in the lymphoid tissue of the stroma
• However, many people consider adenolymphoma as a hamartomatous growth rather than a true neoplastic lesion. (hamartoma is a focal growth that results from abnormal proliferation of tissue native to the same region).

Question 178. What is the clinical appearance of adenolymphoma?
Answer. Adenolymphoma clinically presents a slow enlarging, well-circumscribed, soft and painless swelling with a typical doughy consistency. The tumor is movable and is consistently found over the angle of the mandible in the superfiial lobe of parotid.

Question 179. What is the macroscopic appearance of adenolymphoma?
Answer.

• Macroscopically the neoplasm exhibits multiple conflent cystic spaces and variable number of lymphoid follicles, being surrounded by a dense firous capsule.
• Cut section of a fresh specimen of adenolymphoma that exhibits exudation of watery or sometimes chocolate-colored flid from the tissue.

Question 180. Describe the microscopic appearance of adenolymphoma.
Answer.

• The tumor exhibits multiple cystic spaces lined by double-layered, pseudostratified tall columnar epithelial cells. (pseudostratified: Occurs in multilayered epithelium in which the nuclei of adjacent cells are at different levels)
• The epithelial cells have distinct eosinophilic cytoplasm (columnar oncocytes) and they cover many papillary folds which extend into the cystic spaces
• The papillary folds are supported by large amounts of lymphoid tissue with scattered germinal centers
• The cystic lumens are often filed with a homogeneous eosinophilic material.

Question 181. Name the lesions included in the differential diagnosis of adenolymphoma.
Answer.

• Pleomorphic adenoma
• Oncocytoma
• Enlarged parotid lymph node
• Mucoepidermoid tumor
• Mucous retention cyst
• Malignant lymphoma.

Question 182. What is the treatment of adenolymphoma?
Answer. Simple surgical enucleation.

Question 183. What is malignant pleomorphic adenoma?
Answer. Malignant pleomorphic adenoma (mixed tumor) is a relatively uncommon malignant tumor of salivary gland.

Question 184. How many types of malignant pleomorphic adenomas are seen?
Answer. Malignant mixed tumors or pleomorphic adenomas are broadly divided into two groups:

• Carcinoma ex-pleomorphic adenoma (developing from pre-existing benign mixed tumor)
• De-novo type (developing primarily as a malignant tumor).

Question 185. What is carcinosarcoma?
Answer.

Carcinosarcoma is a rare type of malignant neoplasm characterized by malignant transformation of both the epithelial and the connective tissue components of the involved tissue. These tumors sometimes occur in relation to salivary gland and they carry a much poorer prognosis than simple carcinomas or sarcomas.

Question 186. Name the symptoms which indicate malignant transformation in a pre-existing pleomorphic adenoma.
Answer.

• Very rapid growth in the recent times (within last 3 to 6 months)
• Severe pain and hemorrhage
• Anesthesia or paresthesia of the facial nerve
• Fixation of the tumor to the overlying skin or underlying muscle or bone
• Non-healing ulcer of the overlying skin and mucous membrane
• Regional lymphadenopathy
• Secondary candidal infection on the superfiial ulcerated surface.

Question 187. Benign pleomorphic adenomas undergo malignant transformation generally after how many years?
Answer. Malignant transformation in pre-existing benign pleomorphic adenomas generally occurs after 15 to 20 years.

Question 188. Malignant transformation in pre-existing benign pleomorphic adenomas may give rise to what type of tumors?
Answer. It can lead to the development of a variety of tumors e.g. adenocarcinoma, undifferentiated carcinoma or epidermoid carcinoma, etc.

Question 189. Describe the histological changes, which indicate suspected malignant transformation in a benign mixed tumor?
Answer.

• Destructive infitrative growth pattern
• Marked cytologic atypia with abnormal mitotic activity
• Cellular pleomorphism and nuclear hyperchromatism
• Areas of micronecrosis and hemorrhage
• Excessive hyalinization and dystrophic calcifiation in the tissue
• Vascular permeation or perineural invasion of tumor cells.

Question 190. How the prognosis of carcinoma ex-pleomorphic adenoma is determined?
Answer. If malignant cells remain within the confiement of pre-existing adenoma, its prognosis is good. If malignant cells have infiltrated into the surrounding normal tissue, its prognosis
is poor.

Question 191. Define adenoid cystic carcinoma.
Answer. Adenoid cystic carcinoma is a malignant neoplasm arising from the glandular epithelium of either major or minor salivary glands.

Question 192. What is the other name of adenoid cystic carcinoma?
Answer. Cylindroma.

Question 193. Name one important characteristic of adenoid cystic carcinoma.
Answer. It has a tendency to invade into the perineural lymphatic spaces.

Question 194. What are the common sites of adenoid cystic carcinoma?
Answer. Adenoid cystic carcinomas affect both major as well as the minor glands; however, these tumors affect minor glands more often than the major glands.

Question 195. What is the most common malignant neoplasm in submandibular salivary gland?
Answer. Adenoid cystic carcinoma.

Question 196. What is the usual intraoral site of adenoid cystic carcinoma?
Answer. The common sites for development of this lesion in minor glands are the palate and tongue.

Question 197. Besides the salivary glands, which other tissues can be affected by adenoid cystic carcinoma?
Answer. The lacrimal glands, breasts, prostate, uterine cervix, esophagus and glands of the paranasal sinuses, etc.

Question 198. Describe the general clinical manifestations of adenoid cystic carcinoma.
Answer.

• Slow enlarging growth in the affected gland with pain and frequent surface ulcerations
• Anesthesia, paresthesia or nerve palsy are very common as the tumor has a propensity to surround nerve trunk
• Often there is fiation and induration of the tumor to the underlying structures along with local invasion.

Question 199. How the parotid tumors of adenoid cystic carcinoma often appear?
Answer. Parotid tumors produce asymptomatic subcutaneous mass anterior to or below the external ear.

Question 200. Name the nerves which are often invaded by adenoid cystic carcinoma.
Answer. Adenoid cystic carcinoma of parotid gland often surrounds the facial nerve sheath.
Besides facial nerve, this tumor frequently invades the lingual and the hypoglossal nerves.

Question 201. Describe the clinical features of adenoid cystic carcinoma in palatal minor salivary glands.
Answer. Adenoid cystic carcinoma of the palatal minor salivary gland produces the following:

• A nodular growth, resembling an eccentric node with an ulcerated surface
• Pain in the adjoining teeth with mobility
• Delayed healing of the socket in case an adjoining maxillary tooth has been removed
• Palatal paresthesia may be present due to involvement of greater palatine nerve.

Question 202. Describe the histopathological features of adenoid cystic carcinoma.
Answer. In this tumor, numerous small, darkly staining, polygonal or cuboidal cells produce multiple typical duct-like structures. The duct-like structures contain an eosinophilic coagulum at the center and are surrounded by double layer of tumor cells and they often produce a classic swiss-cheese appearance.

Question 203. Why adenoid cystic carcinoma is also called cylindroma?
Answer. Because the stromal connective tissue of the tumor is hyalinized which surrounds the tumor cells by forming the structural pattern of many cylinders (from this the name cylindroma has evolved).

Question 204. Name the histological subtypes of adenoid cystic carcinoma?
Answer. Histologically adenoid cystic carcinomas have three subtypes or patterns:

• Cribriform pattern
• Solid pattern
• Tubular pattern.

Question 205. Describe the cribriform pattern of adenoid cystic carcinoma.
Answer. It is the most classic histological pattern of adenoid cystic carcinoma; here the small,uniform, polygonal, basophilic neoplasic epithelial cells proliferate as a cellular mass,being penetrated by numerous cylindrical spaces and thus the tumor produces a cribriform appearance.

Question 206. How does the solid pattern of adenoid cystic carcinoma appear?
Answer. In solid pattern, the tumor cells proliferate to form solid masses with areas of central necrosis.

Question 207. Describe the tubular pattern of adenoid cystic carcinoma.
Answer. In tubular pattern of adenoid cystic carcinoma, the tumor cells proliferate as small tubular units with a single central lumen. In this pattern, the tumor cells exhibit less stratifiation.

Question 208. What is neurotropism?
Answer. One of the most striking features of adenoid cystic carcinoma is the spread of the tumor cells via the perineural or intraneural spaces. This phenomenon is known as neurotropism of the tumor.

Question 208a. Perineural invasion is most commonly observed in which neoplasm?
Answer. Adenoid cystic carcinoma.

Question 209. How the tumor cells spread via perineural or intraneural spaces in adenoid cystic carcinoma?
Answer. In this tumor, concentric laminations of tumor cells wrap around the perineurium of nerve fiers and invade the perineural lymphatic vessels; through this path, tumor cells spread to the distant organiser.

Question 210. What is the other effect of neurotropism in adenoid cystic carcinoma, besides helping in the spread of tumor cells?
Answer. It increases the risk of recurrence of the tumor (recurrence means return of symptoms of a disease after treatment).

Question 211. What are the other routes of tumor cells metastasis in adenoid cystic carcinoma,besides the perineural route?
Answer. The tumor cells also make intravascular or perivascular invasions in the surrounding tissue and cause distal metastasis via the vascular route.

Question 212. Name the lesions which appear in the differential diagnosis of adenoid cystic carcinoma.
Answer.

• Pleomorphic adenoma
• Monomorphic adenoma
• Mucoepidermoid carcinoma
• Adenocarcinoma
• Acinic cell tumor
• Basal cell carcinoma.

Question 213. What is the treatment of adenoid cystic carcinoma?
Answer. Treatment is done by wide surgical excision followed by radiotherapy.

Question 214. What is the prognosis in adenoid cystic carcinoma?
Answer. Short-term prognosis is good, but long-term prognosis is grave.
Mucoepidermoid tumor is an unusual type of malignant salivary gland neoplasm with varying degree of severity and aggressiveness.

Question 216. What is the cell of origin in mucoepidermoid tumor?
Answer. According to the multicellular theory, the mucoepidermoid tumor arises from the excretory duct cells of the salivary gland.

Question 217. What is the age and sex prevalence in mucoepidermoid tumor?
Answer. The tumor usually occurs at the age of 30 to 50 years (sometimes in children also) and there is a slight female predilection.

Question 218. Name the common sites of involvement of mucoepidermoid tumor.
Answer. The tumor frequently involves the parotid as well as the minor salivary glands of the palate, lips, buccal mucosa, tongue and retromolar areas, etc.

Question 219. What are the clinical appearances of mucoepidermoid tumor?
Answer. The tumor mostly produces a slow-growing, painless swelling that often has a cystic feeling. Such tumors often clinically resemble pleomorphic adenomas; however in many cases, rapid growth of the tumor with pain, hemorrhage, ulceration and paresthesia, etc.

Question 220. What are the chances of development of intraosseous mucoepidermoid tumors?
Answer. Mucoepidermoid tumors may also develop as central jaw lesions especially in relation to mandible and such intraosseous lesions may develop either from the ectopic intrabony salivary gland tissue or from the metaplastic lining epithelium of the intra-osseous odontogenic cysts.

Question 221. In mucoepidermoid tumor how can the low-grade and the high-grade lesions be distinguished clinically?
Answer. Low-grade tumors are often flctuant in nature while the high-grade tumors are fim and are fied to the adjacent tissues.

Question 222. Describe the typical clinical appearance of low-grade mucoepidermoid tumors?
Answer. Low-grade tumors clinically appear as non-ulcerated, flctuant growths with a slight bluish color, these tumors contain several cystic structures and are often confused with mucoceles.

Question 223. Microscopically what are the different cells present in mucoepidermoid tumor?
Answer. The tumor consists of three distinct cell types:

• Large pale mucous-secreting cells
• Epidermoid cells
• Intermediate type of cells (these cells are capable of differentiating into two other cell types).

Question 224. How many histological types of mucoepidermoid tumors are usually seen?
Answer. There are two main types:

• Well-differentiated or low-grade tumors
• Poorly differentiated or high-grade tumors.

Question 225. Describe the histological appearance of well-differentiated or low-grade mucoepidermoid tumors.
Answer. These tumors consist mainly of mucous-secreting cells and epidermoid cells; and in a given tumor, single cell type often predominates:

• If the mucous cells predominate, the tumor tends to become cystic in nature
• If the epidermoid cells predominate then the tumor becomes solid type
• The mucous cells frequently line many cyst-like spaces within the tumor in epidermoid carcinoma in single or double layers
• The epidermoid cells either line the cysts or they form solid sheets or strands.

Question 226. How the poorly differentiated or high-grade mucoepidermoid tumors appear histologically?
Answer. The Poorly differentiated or high-grade tumor consists mainly of solid proliferations of epidermoid and intermediate cells. The epidermoid cells often exhibit cellular pleomorphism, nuclear hyperchromatism and infitrative growth into the surrounding tissue and the lymph nodes.

Question 227. Describe the solid type of mucoepidermoid tumor.
Answer. In this type of tumor, the epidermoid cells predominate over the mucous cells, the epidermoid cells either line the cystic spaces within the tumor or they form solid sheets or strands. The solid type of tumor often gives an impression of an epidermoid carcinoma,although the keratinization is minimum.

Question 228. How their biologic nature varies between solid and cystic types of mucoepidermoid tumors?
Answer. The solid tumors are often more aggressive in nature than the cystic type.

Question 229. Which lesions must considered during the differential diagnosis of mucoepidermoid tumors?
Answer.

• Pleomorphic adenoma
• Adenocarcinoma
• Squamous cell carcinoma
• Metastatic carcinoma.

Question 230. Name the common treatment outline in mucoepidermoid tumor.
Answer. Surgical excision and radiotherapy.

Question 231. What is an acinic cell tumor?
Answer. Acinic cell tumors are uncommon neoplasms of the salivary gland and are often composed of cells that resemble the serous cells of the salivary gland.

Question 232. From which cells acinic cell tumor originates?
Answer. According to the multicellular theory, these tumors originate from the cells of the salivary gland acini.

Question 233. What is the most common site of occurrence of acinic cell tumors?
Answer. Parotid is the most frequently affected site (acinic cell tumor is the second most common malignant tumor of parotid after mucoepidermoid tumor) and it is rarely seen in intraoral
sites.

Question 234. Describe the clinical features of acinic cell tumor.
Answer. The lesion often presents a well-defied, slow-growing, painless, fim, well-demarcated,movable swelling (about 3 cm in diameter) that often resembles pleomorphic adenoma.

Question 235. Describe the histopathological features of acinic cell tumor.
Answer. Histologically the tumor consists of either serous or mucous acinar cells which are large, round or polyhedral in shape and have granular basophilic cytoplasm and dark eccentrically placed nuclei. These cells are often arranged in acinus-like clusters and they often resemble the serous acinar cells of the salivary gland.

Question 236. Defie adenocarcinoma.
Answer. Adenocarcinoma is a malignant neoplasm of the salivary glands which occurs more often in relation to intraoral minor salivary glands and only occasionally in the parotid.
Moreover some adenocarcinomas may develop from the pre-existing pleomorphic adenomas.

Question 237. What is the age and gender prevalence for adenocarcinomas of salivary gland?
Answer. The majority of the patients are in their sixth decade of life and females are more likely to suffer.

Question 238. Describe the clinical features of adenocarcinoma.
Answer. Initially the tumor presents a slow-growing, fim, painless mass with no surface ulceration; later on the tumor develops a fast enlarging, painful swelling with ulceration and paresthesia, etc.
The palatal lesions are often fied to the adjacent tissues and they usually measure about 3 cm in diameter.

Question 239. Describe the histopathological features of adenocarcinoma.
Answer.

• Microscopically the tumor reveals numerous proliferating malignant ductal epithelial cells with areas of hemorrhage and necrosis
• At the periphery of the lesion, the tumor cells are arranged in parallel arrays of elongated tubular formations and thereby produce an onion-skin appearance
• Some tumors produce many cyst-like spaces, containing large quantity of mucus;and in few cases, papillary ingrowths into the cystic sp