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Non-neoplastic Lesions

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Book cover Histopathology of the Salivary Glands

Abstract

Sialolithiasis is a common, possibly the most common, disease of salivary glands and may occur in any of the salivary glands and at almost any age, childhood included. The vast majority though occur in major salivary glands, the submandibular gland being the site in 80–90 % of cases. Less than 20 % are found in the parotid gland and only 1–2 % in the sublingual gland and minor salivary glands. The most common site in minor salivary glands is the anterior part of the mouth, especially close to the labial commissure of the upper lip. Although rare in minor salivary glands, more than 100 such cases have been described in the literature. Minor salivary gland calculi seldom exceed 5 mm. The long, tortuous, upward path of the submandibular duct and the thicker, mucoid secretions of the submandibular gland may be the reason for its greater tendency to form calculi. The size of salivary calculi can range from a few millimetres to so-called giant salivary gland calculi being larger than 15 mm. The giant calculi are rare and are most frequently encountered in the submandibular gland, and stones as large as 50 mm are reported. The aetiology of calculi is little known, and the exact mechanism of formation is unknown. Smoking appears to be unrelated to the formation of calculi. Microcalculi are however present in serous acinar cells, striated duct cells and lumina and interstitium of normal parotid and submandibular glands. They may form in autophagosomes in parenchymal cells and pass into the lumina to be expelled in the saliva. Their size is approximately 25 μm when intracellular and somewhat larger when located in the lumina. Microcalculi are hence found in normal glands and are unrelated to calculi. Microcalculi are related to the age of the patient, whereas calculi appear to be secondary to sialadenitis and related to the duration of symptoms. Calculi are predominantly composed of calcium phosphate (hydroxyapatite) with smaller amounts of ammonium, magnesium, potassium and iron. Deficit of crystallisation inhibitors such as myoinositol hexaphosphate (phytate) could be an important etiologic factor. Contrary to what may be a common view, residents of hard water areas are not at increased risk of developing salivary calculi. Multiple and also bilateral parotid sialoliths have been reported in patients with parotid MALT lymphoma and Sjögren’s syndrome. The first report of detection of ochronotic pigments in acinar cells and lumina in the submandibular gland, as well as the presence of a large calculus, in a patient with alkaptonuria (AKU). AKU is an autosomal recessive disease leading to widespread deposition of oxidised homogentisic acid polymer, primarily in the joints.

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  1. Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, Faro, Portugal

    Henrik Hellquist

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    Alena Skalova

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Hellquist, H., Skalova, A. (2014). Non-neoplastic Lesions. In: Histopathology of the Salivary Glands. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-46915-5_2

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