Pathology consultation. Sialadenosis

Management Options for Sialadenosis

Sialadenosis (sialosis) is a chronic, noninflammatory, nonneoplastic, bilateral, often painless enlargement of the salivary glands, most frequently affecting the parotid glands. Approximately 50% of cases are associated with an underlying disease process. The pathogenesis of sialadenosis is unknown but likely results from an autonomic neuropathy. The key to management is diagnosis and management of any poorly controlled underlying medical process.

Sialadenosis in dogs

OBJECTIVE

To determine clinical findings, cytologic and histologic characteristics of salivary glands, and response to treatment with phenobarbital in dogs with clinical signs typical of sialadenosis.

DESIGN

Prospective study.

ANIMALS

13 dogs with enlarged salivary glands.

PROCEDURE

Data were collected from dogs with clinical signs attributable to enlarged salivary glands. Salivary gland biopsy and cytologic specimens were examined. Dogs were treated with phenobarbital and monitored for response to treatment.

RESULTS

Clinical signs commonly associated with sialadenosis included retching and gulping. Substantial cellular changes were not detected by histologic or cytologic examination of enlarged salivary glands. Response to treatment with phenobarbital was rapid, although most dogs required continuous treatment to prevent recurrence of clinical signs.

CONCLUSIONS AND CLINICAL RELEVANCE

Sialadenosis is a condition of unknown cause that may have been underdiagnosed in dogs. Criteria for diagnosis include typical clinical signs, enlarged salivary glands, and lack of substantial microscopic lesions. Response to treatment with phenobarbital is rapid.

[Sialadenosis in a patient with alcoholic fatty liver developing after heavy alcohol drinking]

Sialadenosis is a unique form of non-inflammatory, non-neoplastic bilateral salivary gland disorder characterized by recurrent painless swelling which usually occurs in parotid glands. Alcoholism is one of the main causes of sialadenosis along with diabetes, bulimia, and other idiopathic causes. The prognosis is verified according to the degree of liver function. We present a case of a 46 year-old man who had alcoholic fatty liver disease diagnosed as alcoholic sialadenosis based on clinical points of recurrent bilateral parotid swelling after heavy alcohol drinking, computed tomography, and fine-needle aspiration biopsy. After stopping alcohol drinking and treated with conservative treatment, he got improved without specific sequela.

Salivary gland parameters and clinical data related to the underlying disorder in patients with persisting xerostomia

This study assessed salivary gland parameters and clinical data in patients referred to our clinic because of persisting xerostomia of unknown origin, in order to facilitate early diagnosis and recognition of the underlying disorder. Most patients were referred for diagnostic analysis of a possible Sjögren's syndrome (SS). A complete diagnostic work-up was available in all patients (n = 176), including data on salivary gland function, saliva composition, sialography, salivary gland swelling, pattern of complaints, general health, and medication. Patients were diagnosed with SS (n = 62), sialosis (n = 45), sodium retention syndrome (n = 30), or medication-induced xerostomia (n = 9). In 30 patients no disease related to salivary gland pathology was found. Unstimulated whole salivary flow was decreased in all patients, except in patients with sodium retention syndrome and in patients without salivary gland pathology. Submandibular/sublingual salivary flow was lowest in SS patients. SS and sialosis patients had increased salivary potassium concentrations, whereas only SS patients had increased sodium concentrations. About half of the sialosis patients mainly complained of persistent parotid gland swelling. Xerostomia-inducing medication was used by most patients. It was concluded that gland-specific sialometry and sialochemistry is useful in discriminating between the various disorders causing persisting xerostomia.

Measuring change in parotid gland size: test-retest reliability of a novel method

BACKGROUND

There is currently no convenient method for measuring parotid gland hypertrophy, a common condition among patients with bulimia nervosa (BN) and anorexia nervosa (AN).

OBJECTIVE

To develop a technique for reliably estimating change in parotid gland size.

METHODS

A method for measuring facial width as a surrogate marker of parotid gland size was developed using calipers to measure between defined reference points located on the parotid gland region. The method was tested for reliability when performed by a single operator and used to determine face width measurements of 15 control subjects.

RESULTS

Face width measurements were reliable when performed by a single operator. Face width measurements of control subjects ranged from 9.1 cm to 15.3 cm.

DISCUSSION

The caliper method of measuring changes in parotid size is a novel method of measurement of parotid hypertrophy. It is quick, non-invasive and inexpensive and is highly reliable in the hands of a single operator.

Presumptive sialadenosis in a cat

A cat was presented with signs associated with enlargement of the mandibular salivary glands. Histological findings were normal, consistent with a diagnosis of sialadenosis, and the cat responded to symptomatic treatment with oral phenobarbitone.

Idiopathic salivary gland enlargement (sialadenosis) in dogs: a microscopic study

A histological, histochemical and morphometric study was performed on submandibular salivary glands from 13 dogs which had presented with a submandibular mass or swelling that proved to be a portion of non-inflammatory and non-neoplastic submandibular salivary gland. There were no consistent changes in lectin-binding histochemistry or immunohistochemical expression of various cell markers, and, in most cases, there was no measurable difference in acinar size in the affected gland. The possible explanation for the clinical salivary gland enlargement is therefore unclear.

Sialadenosis: a presenting sign in bulimia

BACKGROUND

Sialadenosis refers to noninflammatory, often recurrent, enlargement of the salivary glands, most frequently the parotids, which is almost always associated with an underlying systemic disorder. These include diabetes, alcoholism, malnutrition, anorexia nervosa, and bulimia. It is thought that the various causes of sialadenosis all result in a common pathogenetic effect in that they produce a peripheral autonomic neuropathy which is responsible for disordered metabolism and secretion, resulting in acinar enlargement.

METHODS

This paper reports a case of sialadenosis as a presenting sign in bulimia and studies the histologic and electron microscopic features of this disease.

RESULTS

Light microscopy showed acini which appeared to be larger than normal and which were composed of plump pyramidal cells containing prominent zymogen granules. There was less interstitial fat, and the ducts were widely dispersed. Electron microscopy showed the acinar cells to be packed with membrane-limited, dark secretory granules some of which showed moulding of their outlines. Cellular organelles and nuclei were inconspicuous.

CONCLUSIONS

Management of sialadenosis depends upon identification of the underlying cause, which must then be corrected. In bulimia, the swellings may be refractory to standard treatment modalities, and parotidectomy may be considered as a last resort to improve the unacceptable aesthetics.

Alcoholic parotid sialadenosis

Alcoholism is a primary cause of sialadenosis, which is an asymptomatic, bilateral enlargement of the parotid glands. The authors outline the pathogenesis, symptoms and testing involved in diagnosing sialadenosis. Recognizing sialadenosis is important because it may point to the unsuspected presence of underlying systemic disease. Therefore, dental practitioners need to be able to differentiate sialadenosis from an inflammatory or neoplastic process to prevent unnecessary treatment.

Sialadenosis of the parotid gland: report of four cases diagnosed by fine-needle aspiration cytology

Four patients presented with a history of recurrent bilateral swellings of parotid glands. Fine-needle aspiration (FNA) specimens showed highly cellular smears containing clusters of enlarged acini and numerous naked nuclei. A diagnosis consistent with sialadenosis was made considering the distinct morphologic appearance: micrometric measurements in all cases, in addition to histology and electron microscopy in two cases confirmed this hypothesis. A review of clinical histories revealed hormonal, nutritional and neurogenic disorders, which are known to be associated with sialadenosis. In the work-up of salivary gland swellings, it is important to recognize cytologically this underestimated entity, which does not necessarily require surgical treatment.