Thursday, April 27, 2017

Salivary Gland Tumors

Different types of tumor may occur in the salivary gland and may be benign or malignant. A brief discription of the common tumors occuring in the salivary gland is given here:

1. Pleomorphic Adenoma
The pleomorphic adenoma- mixed salivary gland tumor- is a benign tumor, and the commonest salivary gland tumor. It is most commonly seen in the parotid gland and typically forms a mass in the lateral lobe, which slowly enlarges over many years, women in their forties are most often being affected.

Clinical Features
On palpation the tumor is firm, non tender and smooth or lobulated in texture. initially spherical and encapsulated, it may eventually spread more deeply, with the result that recurrence after resection is common. On oral examination the deep part of the gland may have pushed the tonsil and pillar of the fauces towards the midline.

Histology:
Histologically, it is highly variable in appearance, even within individual tumors. Classically it is biphasic and is characterized by an admixture of polygonal epithelial and spindle-shaped myoepithelial elements in a variable background stroma that may be mucoid, myxoid, cartilaginous or hyaline. Epithelial elements may be arranged in duct-like structures, sheets, clumps and/or interlacing strands and consist of polygonal, spindle or stellate-shaped cells (hence pleiomorphism). Areas of squamous metaplasia and epithelial pearls may be present. The tumor is not enveloped, but it is surrounded by a fibrous pseudocapsule of varying thickness. The tumor extends through normal glandular parenchyma in the form of finger-like pseudopodia, but this is not a sign of malignant transformation.
Pleomorphic adenoma consists of mixed epithelial (left) and mesenchymal cell components (right). The latter often exhibits myxofibrous appearance and in some instances shows chondromatous differentiation.
2. Adenolymphoma (Warthin’s Tumor)
It is a bening tumor and the second most common salivary tumor and is found exclusively in the parotid gland. It usually affects males in their fifties, forming a slow growing, painless swelling over the angle of the jaw, there is a high incidence of bilateral disease.

Infections Causes By Herpes Simplex Virus

Herpes Simplex virus infection may be caused by type I or type II virus and the infection may be primary or recurrent.

Primary Infection
The manifestations of primary Infection includes:

1. Systemic infection: e.g fever, sore throat and lymphadenopathy that may pass unnoticed. If the patient is immunocompromised, then the disease may become life threatening with fever, lymphadenopathy, pneumonitis and hepatitis.

2. Gingivostomatitis: Ulcers filled with yellow slough appear in the mouth.

3. Herpetic Whitlow: A breach in the skin that may be due to any minor trauma allows the virus to enter the finger, causing a vesicle to form. Often this condition is seen in children nurses.



4. Traumatic Herpes: Also known as Herpes gladiatorum. In this condition vesicles develop at any site where herpes simplex virus have been inoculated on the skin by brute force.

5. Eczema Herpeticum: HSV infection superimposed on eczematous skin. Usually seen in children.

Episcleritis - A Brief Introduction



Introduction: Episcleritis is a common and benign inflammation of the episclera, typically affecting young and middle-aged adults. Seventy percent of cases occur in females.

The episclera lies just beneath the bulbar conjunctiva. Its vessels are large, run in a radial direction,
and can be seen beneath the overlying conjunctiva. Episcleral and conjunctival vessels blanch with the use of topical 5% phenylephrine drops, unlike deep episcleral vessels.

Clinical Features: 

  • Patients may complain of foreign body sensation, mild tenderness, irritation, mild photophobia, and excessive lacrimation.
  • Pain is unusual but can occur, particularly in chroniccases. 
  • One-half of cases are bilateral. 
  • Eye findings are notable for a localized pink or bright red conjunctival injection, with involvement of the vessels in the superficial episcleral vascular plexus. 
  • Visual acuity is normal.

Associated  Conditions: Episcleritis is usually an isolated condition, though it may be associated with a number of systemic diseases, including rheumatoid arthritis, inflammatory bowel disease, lupus, and vasculitis.

Skin Manifestations Of Non Malignant Systemic Diseases

The skin functions as a barrier against potentially harmful physical and chemical agents as well as against different microorganisms. Sometimes different features may be seen that help to differentiate different systemic diseases. 
A brief list of the skin manifestations of non malignant systemic diseases is given here:

1. Erythema
  • Collagen disease
  • Carcinoid
  • Mitral valve disease
  • Polycythemia
  • Superior vena caval obstruction
  • Liver disease
  • Hyperviscosity syndrome
                                                  Facies in Primary Polycythemia vera. 

2. Erythema Multiforme
  • Fever
  • Inflammatory bowel disease
  • Rheumatoid arthritis
  • Thyrotoxicosis
  • Viral Infections
                                               Erythema Multiforme (target skin lesions) 

3. Urtricaria
  • Collagen disorders
  • Xanthomatoses
  • Hereditary angioneurotic edema
  • Urtricaria pigmentosa
  • Henoch-Schonlein purpura
  • Cold aglutinins

A Brief Introduction To Sabaceous Cyst



Definition

Sabaceous cyst which is also known as an epidermoid cyst is derived from hair follicles and it is a closed sac under the skin that is filled with a cheese like or oily material. It may be felt as small lumps or bumps under the skin.

Incidence
Sabaceous cyst represent one of the commonest skin lesions, occurring at any age after childhood. They are often multiple and occur in any hair bearing site on the body most commonly on the trunk, face and neck and particularly on the scalp and scrotum. They do not occur on the palms and soles.

Clinical Features
The main symptom is usually a small, non-painful lump beneath the skin.

If the lump becomes infected or inflamed, other symptoms may include:
  • Skin redness
  • Tender or sore skin
  • Warm skin in the affected area
Grayish-white, cheesy, foul-smelling material may drain from the cyst.

The lesions are well defined and hemi spherical, growing slowly from 1-2 cm across. they lie in the subcutaneous tissue but are tethered to the skin by blocked duct, there being a pit on the surface at the site of hair follicle. gentle squeezing of the skin over the cyst demonstrates this point of tethering though the punctum is sometimes difficult to demonstrate, particularly over the scalp; when present it is diagnostic.

Scleritis

Definition: Scleritis is defined as inflammation of the sclera ( which is the white outer coating of the eye).Scleritis is painful, destructive, and potentially blinding condition of the eye.

Clinical features: The pain is constant and boring and may radiate to the face and periorbital
region. Associated features include tearing, photophobia, globe tenderness to palpation, and painful ocular movement.
The conjunctival vessels are injected. The eye itself may be intensely red with a violaceous or purple hue secondary to engorgement of the deep vessels of the episclera and scleral thinning. These deep vessels do not move when the overlying conjunctiva is moved with a cotton-tipped applicator, nor do
they blanch with topical phenylephrine.

On slit-lamp microscopy, the episcleral vessels are displaced outward by scleral edema.

Corneal involvement, iritis (with cells and flare in the anterior chamber), and decreased visual acuity may accompany scleritis.

Scleritis. A 55-year-old female with scleritis of the left eye associated with rheumatoid arthritis. Note dilation of the deep conjunctival and episcleral vessels and blue hue suggesting thinning of the sclera temporally

Etiology: An associated scleritis may occur with severe infectious keratitis. Primary infectious