Sialadenitis

Sialadenitis 

Updated: 07/24/2023

© Jun Wang, MD, PhD

General features
  • Infection/inflammation of salivary glands
Etiology
  • Variable etiology including infection, autoimmune reaction or trauma
Bacterial sialadenitis
  • Rare
  • Usually due to ascending bacterial infection of ductal system
  • Unilateral painful enlargement of salivary gland
  • Usually clinical diagnosis
  • May cause abscess requiring surgical drainage
Viral sialadenitis
  • Mumps is the most common type
  • Other associated viruses: cytomegalovirus, coxsackievirus, herpes, etc
  • Tender enlargement of affected salivary gland 
  • Usually clinical diagnosis
  • Supported by serology or RT-PCR testing
  • Mumps 
    • Most common in pts < 15 years
    • Commonly bilateral parotid glands
    • May cause epididymo-orchitis
Chronic sialadenitis and sialolithiasis
  • AKA obstructive sialadenitis
  • Due to impedance of saliva flow resulted from stone formation
  • More common in male
  • More common in submandibular gland
  • May be associated with increased calcium content in secretions
  • Presentation: Intermittent periprandial pain, single gland swelling
  • Diagnosis: clinical or sialography
Lymphoepithelial sialadenitis
  • Heterogeneous group
  • Predominantly involving parotid, followed by submandibular gland
  • Swelling of affected glands, with or without pain
  • May be associated with obstruction (with atrophy and fibrosis), rheumatoid arthritis (older women), Sjogren syndrome, sialolithiasis, mumps
  • Pathological features
Marked lymphoid infiltrates
Loss of salivary gland acini
IgG4 related dacryoadenitis and sialadenitis
  • Old term: Mikulicz disease/syndrome
  • Spectrum of IgG4 related sclerosing diseases, including autoimmune pancreatitis
  • Involving lacrimal and salivary glands
  • More common in submandibular glands
  • Usually present as a mass (Küttner tumor or sclerosing sialadenitis if submandibular)
  • Serum IgG4 concentration elevated, but may be normal
  • Diagnosis based on histologic feature, elevated IgG4/IgG ratio
  • Three major pathological features
Dense lymphoplasmacytic infiltrate with IgG4+ plasma cells and CD4+ cytotoxic T cells
Storiform pattern of fibrosis
Obliterative phlebitis
IgG4 positive plasma cells


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