Granulomatous sialadenitis of the major salivary glands. A clinicopathological study of 57 cases

Abstract

Fifty-seven of 469 major salivary glands excised for various reasons were found to contain granulomas. The aetiologies were tuberculosis (eight parotid, one sublingual), sarcoidosis (two parotid), calculous duct obstruction (34 submandibular), carcinomatous duct obstruction (four submandibular, one sublingual) and undetermined (four submandibular, three parotid). The tuberculous glands showed caseation in the majority of cases but two cases consisted predominantly of discrete granulomas with minimal necrosis. The sarcoid granulomas were typically non-caseating but a few were centrally necrotic. The cases of calculous and carcinomatous duct obstruction contained single to multiple small granulomas which contained mucin and were related to ruptured ducts. It is suggested that the frequency of calculi and the mixture of serous and mucous acini in the submandibular gland account for the distribution of obstructive granulomas. This study establishes calculous sialadenopathy as a major cause of granulomatous sialadenitis.

HIV‐associated disseminated histoplasmosis in western French Guiana, 2002–2012

“…The diversity of organs with a positive biopsy led us to the conclusion that all suspected locations should be biopsied if possible. As in other systemic granulomatous diseases, minor salivary gland biopsy can be useful for diagnosis: it was done for two patients and showed granulomas with yeast for one of them.…”

Diagnostic problems of salivary gland tumors

“…At times branchial cyst in upper lateral neck may be mistaken for a salivary gland lesion. Many salivary gland neoplasms may undergo cystic change, namely, Warthin's tumor (WT), MEC, PA, intraductal papilloma, ACC, cystadenomaand adenocarcinoma . In case of low grade mucoepidermoid carcinoma, abundant stringy mucoid material containing foamy histiocytes and mucus secreting cells in the smears may be misinterpreted as benign mucus cyst.…”

“…Granulomatous sialadenitis usually shows epithelioid cell granulomas and large amount of reactive lymphoid cells. In Sarcoidosis, the granulomas are noncaseating while in tuberculosis, caseating granulomas are common . At times, it is very difficult to differentiate a low grade NHL from the lymphoepithelial lesions (Fig.…”

“…In these situations, immunochemistry on the cell block material and/or demonstration of light chain restriction and monoclonality with the help of Flow Cytometry may be helpful . The lymphocytic reaction found in association with neoplasms is referred as tumor‐associated‐lymphoid proliferation (TALP) and is reported in 30% of acinic cell carcinomas . Aspirates from Warthin's tumor and mucoepidermoid carcinoma also show lymphoid cells.…”