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Salivary glands

Inflammation

Sialadenitis


Reviewers: Fatima Aly, M.D., National Cancer Institute (see Reviewers page)
Revised: 7 October 2011, last major update August 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

General
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● Bacterial, viral or autoimmune

Bacterial sialadenitis
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● Rare, usually due to ascending infection of ductal system by Staph aureus, Staph viridans or gram negative bacteria
● Predisposing factors include obstructive lesions such as sialolithiasis, dehydration, malnutrition or immunosuppression
● Usually presents with unilateral painful enlargement of salivary gland
● May cause abscess requiring surgical drainage

Chronic sialadenitis
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● Also called lymphoepithelial sialadenitis (LESA)
● Relatively common
● Chronic lymphocytic inflammation, often without symptoms
● Associated with obstruction (with atrophy and fibrosis), rheumatoid arthritis (older women), Sjogren’s syndrome, sialolithiasis, mumps
● 50% are monoclonal by PCR, but MALT lymphoma has ducts surrounded by broad coronas of monocytoid cells, infiltration of interfollicular region by monocytoid cells or atypical plasma cells containing Dutcher bodies, monoclonality by immunohistochemistry or flow cytometry, monocytoid infiltrates in regional lymph nodes (Mod Pathol 2002;15:255)
● Micro description: markedly hyperplastic lymphoid infiltrates with loss of salivary gland acini; ducts are surrounded by and infiltrated by lymphoid cells

Chronic sclerosing sialadenitis
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● Included in the spectrum of IgG4-related sclerosing diseases
● Either localized or systemic with bilateral involvement of submandibular glands
● May be associated with sclerosing cholangitis, retroperitoneal fibrosis or sclerosing pancreatitis
● Presents as stony hard Kuttner’s tumor if involves the submandibular gland
● Micro description: dilated ducts filled with inspissated secretions, lymphoplasmacytic infiltrate with variable germinal centers; late fibrosis and acinar atrophy; sialoliths in 50-80%

   
Lymphocytic infiltrate and fibrosis with ductal atrophy

Granulomatous sialadenitis
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● Due to tuberculosis, sarcoidosis, fungal infections, duct obstruction (may contain mucin pools)

Sclerosing polycystic adenosis
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● Discrete mass, usually in parotid gland, formed by fibrous stroma overlying dilated and hyperplastic ductal and acinar structures
● May have apocrine metaplasia and transluminal bridges with cribriform growth
● May have prominent atypia

Viral sialadenitis
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● Often due to mumps (paramyxovirus), usually affects parotids, also pancreas, testes
● Also Epstein-Barr virus, coxsackievirus, influenza A, parainfluenza


Viral sialadenitis

End of Salivary Glands > Inflammation > Sialadenitis


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