Salivary glands

Inflammatory

Chronic sialadenitis / sialolithiasis


Editorial Board Member: Lisa Rooper, M.D.
Editor-in-Chief: Debra L. Zynger, M.D.
Kim A. Ely, M.D.

Topic Completed: 4 December 2020

Minor changes: 26 May 2021

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PubMed Search: Chronic sialadenitis / sialolithiasis pathology [TIAB]

Kim A. Ely, M.D.
Page views in 2020: 3,946
Page views in 2021 to date: 14,495
Cite this page: Ely KA. Chronic sialadenitis / sialolithiasis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/salivaryglandssialolithiasis.html. Accessed December 7th, 2021.
Definition / general
  • Repeated episodes of pain and inflammation due to impedance of salivary flow with stasis as a result of a stone
Essential features
  • Results from impedance of salivary flow with stasis as a result of obstruction from a sialolith
  • Affects the submandibular gland (80%) unilaterally without a side predilection
Terminology
  • Obstructive sialadenitis
ICD coding
  • ICD-10: K11.23 - chronic sialadenitis
  • ICD-10: K11.20 - sialadenitis, unspecified
Epidemiology
Sites
  • Obstructive sialadenitis due to stones mostly affects the submandibular gland (80%) unilaterally without a side predilection (Oral Surg Oral Med Oral Pathol 1972;33:2)
    • Alkaline pH, increased mucinous and mineral content of its saliva (elevated calcium and phosphate concentrations) predisposes to calculi
    • Wharton duct runs upward, making saliva flow against gravity and is narrow and tortuous, further contributing to salivary stasis (Mayo Clin Proc 2018;93:266)
  • Approximately 15% of salivary stones occur within the parotid gland
    • Sublingual and other minor salivary glands are rarely affected
Pathophysiology
  • Mechanism is unclear and may be due to:
Etiology
Clinical features
  • Intermittent, periprandial pain and swelling of a single salivary gland
  • Risk factors include reduced fluid intake, tobacco use, prolonged illness, diuretics and drugs that diminish saliva (Otolaryngol Head Neck Surg 2011;145:935)
Diagnosis
  • If inconclusive clinically, sialography is the gold standard for the diagnosis
Radiology images

Images hosted on other servers:

Hypoechoic mass

Case reports
Treatment
  • Treatment is conservative, with excision reserved for the minority of cases
Gross images

Images hosted on other servers:

Smooth mass

Sialolith

Microscopic (histologic) description
  • Varying degrees of acinar destruction, fibrosis and chronic inflammation, with lymphoid aggregates containing prominent germinal centers
  • Ducts may undergo squamous and mucous metaplasia
  • Lobular arrangement is maintained
  • May see microliths
  • Otolaryngol Clin North Am 2009;42:927
Microscopic (histologic) images

Contributed by James S. Lewis, M.D.

Preservation of lobular architecture

Intense chronic inflammation

Acinar destruction

Sample pathology report
  • Submandibular gland, left, excision:
    • Chronic sialadenitis (see comment)
    • Comment: There is a prominent periductal lymphoplasmacytic infiltrate containing lymphoid aggregates with prominent germinal centers. Some ducts appear ectatic and filled with debris suggestive of a microlith. Others are affected by squamous and mucinous metaplasia. These changes are associated with varying degrees of acinar atrophy and fibrosis.
Differential diagnosis
Board review style question #1

A 55 year old man presents with a history of intermittent pain and swelling of the submandibular gland after eating. A biopsy with immunostains for IgG4 and IgG was performed and demonstrated a positive plasma cell ratio of 20%. Which of the following is the most likely diagnosis?

  1. Chronic sialadenitis
  2. IgG4 related sialadenitis
  3. Lymphoepithelial sialadenitis
  4. Mucoepidermoid carcinoma
Board review style answer #1
A. Chronic sialadenitis

Comment Here

Reference: Chronic sialadenitis / sialolithiasis
Board review style question #2
Why is it thought that stones most commonly arise in the submandibular gland?

  1. Acid pH of its saliva predisposes to the precipitation of minerals
  2. Caliber of Wharton duct is wide, causing stasis of secretions
  3. Mucinous and viscous nature of its saliva results in a more stagnant flow of secretions
  4. Wharton duct descends precipitously leading to pooling of saliva
Board review style answer #2
C. Mucinous and viscous nature of its saliva results in a more stagnant flow of secretions

Comment Here

Reference: Chronic sialadenitis / sialolithiasis
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