Salivary glands
Cytopathology competency / milestone assessment
4. Diseases of the salivary gland

Authors: Michelle R. Pramick, M.D., Zubair W. Baloch, M.D., Ph.D. (see Authors page)

Revised: 9 March 2018, last major update December 2013

Copyright: (c) 2002-2018, PathologyOutlines.com, Inc.

PubMed Search: Diseases of the salivary gland[TI] cytopathology[mh]

Cite this page: Pramick, M.R., Baloch, Z.W. Cytopathology competency - 4. diseases of the salivary gland. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/salivaryglandscompdiseases.html. Accessed July 21st, 2018.
Sialadenosis
Medical knowledge:
  1. Understand the clinical characteristics, presentation, pathogenesis and prognosis of sialadenosis
  2. Recognize that sialadenosis is usually caused by a metabolic derangement (malnutrition, alcoholism, endocrine disease) or medications (antihypertensive and sympathomimetic drugs)
  3. Recognize the architectural arrangement, cellular components and key nuclear and cytoplasmic features of sialadenosis in an aspirate biopsy
  4. Know the differential diagnosis of bilateral salivary gland enlargement and the key features to differentiate these entities

Practice based learning:
  1. Understand that fine needle aspiration of sialadenosis can be painful for the patient
Cysts
Medical knowledge:
  1. Understand that salivary gland neoplasms are frequently cystic
  2. Know that any salivary gland can develop a cyst and that they can occur at any age

Practice based learning:
  1. Know that the general principles of the aspiration of cystic masses
    • Drain the cyst
    • Reaspirate any residual mass
    • Excise the lesion if it recurs more than once
  2. Understand that correct classification of a cystic lesion can be difficult due to low cellularity of the aspirate
  3. Understand that a cytologic report of a poorly cellular fluid does not exclude the presence of a neoplasm, clinical correlation is critical
  4. Know that appropriate followup for a patient diagnosed with a nonneoplastic cyst should be reexamined in 2 to 4 weeks to confirm that the cyst has receded
Nonneoplastic cysts
Medical knowledge:
  1. Know the most common types of nonneoplastic cysts
  2. Know the most common locations of nonneoplastic cysts
  3. Know the pathogenesis of retention cysts
  4. Recognize the cellular and noncellular components present in an aspirate biopsy of a nonneoplastic cyst
  5. Understand the causes for the possibility of a false positive or false negative diagnosis
  6. Understand the differential diagnosis of macrophages with mucin (with possible reactive atypia) is low grade mucoepidermoid carcinoma
Neoplastic cysts
Medical knowledge:
  1. Know the various neoplasms that can give rise to cystic masses
Sialadenitis
Medical knowledge:
  1. Understand the clinical characteristics and presentation of sialadenitis (acute versus chronic)
  2. Know that sialadenitis occurs more commonly in children

Practice based learning:
  1. Understand that a patient with a classic clinical history of sialadenitis is probably not a good candidate for fine needle aspiration biopsy (painful, usually yields little diagnostic information)
  2. Know that a portion of the aspirated material should be sent for culture if an aspiration is performed on acute sialadenitis

Acute sialadenitis:
  1. Know that acute sialadenitis in not an indication for fine needle aspiration biopsy (although occasionally viral changes or bacteria can be seen)
  2. Know the causes of acute viral sialadenitis
  3. Know the most common bacteria associated with acute purulent sialadenitis
  4. Understand the pathogenesis and clinical associations of acute sialadenitis
  5. Recognize the cellular and non-cellular components seen in an aspirate biopsy of acute sialadenitis
Chronic sialadenitis
Medical knowledge:
  1. Understand the clinical characteristics, presentation, pathogenesis and prognosis of chronic sialadenitis
  2. Recognize that chronic sialadenitis is usually associated with duct obstruction and can be patchy in distribution
  3. Recognize the cellular components of chronic sialadenitis in an aspirate biopsy
  4. Know the differential diagnosis of salivary gland lesions with lymphocytes and the key features to differentiate these entities
Radiation sialadenitis
Medical knowledge:
  1. Recognize chronic radiation change in an aspirate biopsy
  2. Understand that a scant specimen with cohesive clusters favors a benign process (in contrast to a highly cellular specimen with single atypical cells favoring a malignancy)
Granulomatous sialadenitis
Medical knowledge:
  1. Recognize a granuloma in an aspirate biopsy
  2. Know that differential diagnosis of granulomatous sialadenitis and the key features to differentiate these entities

Practice based learning:
  1. Understand that a vigorous biopsy technique may be required to obtain adequate material in a fine needle aspiration biopsy (due to reticulin fibrosis)
  2. Know that if enough material is obtained for diagnosis of granulomatous inflammation, a portion of the biopsy should be sent for culture
Necrotizing sialometaplasia
Medical knowledge:
  1. Know that necrotizing sialometaplasia is a benign process that mimics malignancy
  2. Know the most common distribution of necrotizing sialometaplasia
  3. Understand the clinical settings in which necrotizing sialometaplasia usually occurs
  4. Recognize the cellular components and key nuclear and cytoplasmic features of necrotizing sialometaplasia in an aspirate biopsy
Adenomatoid hyperplasia
Medical knowledge:
  1. Understand the clinical characteristics and presentation of adenomatoid hyperplasia
  2. Recognize the cellular and noncellular components of adenomatoid hyperplasia in an aspirate biopsy
Autoimmune sialadenitis
Medical knowledge:
  1. Know that two forms of autoimmune sialadenitis are recognized:
    • Mikulicz disease
    • Sjögren syndrome
  2. Understand the clinical characteristics, presentation and prognosis of each of these entities
  3. Understand that Sjögren syndrome refers to the presence of Sicca syndrome and a systemic autoimmune connective tissue disease

Practice based learning:
  1. Know that patients with Sjögren syndrome have an increased risk of lymphoma and poorly differentiated squamous cell carcinoma
Benign lymphoepithelial lesion
Medical knowledge:
  1. Understand the clinical characteristics and presentation of benign lymphoepithelial lesion
  2. Know that it benign lymphoepithelial lesion is also known as myoepithelial sialadenitis
  3. Know the disease entities that are associated with benign lymphoepithelial lesion
  4. Recognize the architectural arrangement, cellular components and key nuclear and cytoplasmic features of benign lymphoepithelial lesion in an aspirate biopsy
  5. Know the differential diagnosis of benign epithelial lesion and the key features to differentiate these lesions
Benign lymphoepithelial cyst
Medical knowledge:
  1. Recognize the clinical setting in which benign epithelial cysts arise
  2. Recognize the cellular and noncellular components of benign lymphoepithelial cyst in an aspirate biopsy
  3. Know the differential diagnosis of benign lymphoepithelial cyst and the key features to differentiate these entities
Parotid gland in HIV infection
Medical knowledge:
  1. Understand the clinical features and presentation of HIV associated salivary gland disease
  2. Recognize that parotid cysts or lymphadenopathy may be the presenting symptom of HIV