In Viral sialadenitis, vacuolar changes are seen in the acini with lymphocytic and monocytic infiltrate found in the interstitium
Cytomegalovirus (CMV) sialadenitis may show no gross symptoms
Chronic sialadenitis (also known as lymphoepithelial sialadenitis (LESA)) presents with 50% of which are monoclonal by PCR while mucosa-associated lymphoid tissue (MALT) lymphoma has ducts surrounded by broad coronas of monocytoid cells, infiltration of interfollicular region by monocytoid cells or atypical plasma cells containing Dutcher bodies, monoclonality by immunohistochemistry or flow cytometry, and monocytoid infiltrates in regional lymph nodes.Histologically, chronic sialadenitis can appear from unremarkable to a firm tan with expansion or atrophy of the lobular structure depending on the degree of inflammation and chronicity. Salivary stones (Sialolith) may be evident with cystic dilation of the salivary ducts and periductal fibrosis. Mucus extravasation may also be observed. Common observations of chronic sialadenitis include chronic inflammatory infiltrate (lymphocytes, plasma cells and macrophages), fibrosis, acinar atrophy, mucous cell metaplasia of the ductal system is observed. In Sialoithiasis, concomitant squamous metaplasia may be observed in the salivary ducts with dark calcific stone fragments. Chronic sialadenitis
Chronic sclerosing sialadenitis has various degrees of inflammation which can include focal lymphocytic sialadenitis to widespread salivary gland cirrhosis with obliteration of acini. This can be a result of obstruction of salivary ducts by microliths (due to associated intercurrent infections), or a result of immune reaction with the formation of secondary lymph follicles. Chronic sclerosing sialadenitis is characterised by presence of three major criteria of dense lymphoplasmacytic infiltrate, storiform pattern of fibrosis and obliterative phlebitis.
Viola players are believed to be more predisposed to developing fiddlers neck than violinists because the viola is larger and heavier, but this has not been empirically confirmed.The development of fiddlers neck does not depend on preexisting skin problems, and Blum & Ritter find that only 23% of men and 14% of women in their study reported cutaneous disorders in other parts of the face (mainly acne and eczema) that were independent of playing the violin or viola. Fiddlers neck may exacerbate existing acne, but acne may also be limited solely to the lesion and not appear elsewhere. Nonetheless, musicians with underlying dermatologic diseases like acne and eczema are more endangered by fiddlers neck than others. Males may develop folliculitis or boils due to involvement of beard hair. References


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