Parotid Stem#2

Question 1

Stem: A 55-year- old female with mastectomy done 5 years back and
parotidectomy for a pleomorphic adenoma.
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Q1: What’s the relation between breast cancer and pleomorphic adenoma?

Answer 1

Breast and pleomorphic adenoma both have tubular acinar gland – share same morphological chch. Both express BSE (Breast cancer and salivary gland expression gene) gene and BRCA 1/2
Genetic relation and some common features btw brst ca and some salivary tumors

Question 2

Q2: How would you investigate a clinically suspected pleomorphic adenoma?

Answer 2

FNAC / Tru-Cut biopsy

Question 3

Q3: What are the advantages of FNAC over a True-Cut biopsy?

Answer 3

FNAC; quick – cost-effective – easy / Disadv; operator dependent and less accurate

Question 4

Q4: What tests can be done in FNAC? When cytology is to be considered inconclusive? When FNAC sample is considered adequte?

Answer 4

IHC and receptor status
- Sample is inadequate / mislabeling / no definitive results / poor technique
- contains minimum 3 well preserved cells groups and no artifact in smear

Question 5

Q5: What’s the meaning of pleomorphic? Describe pleomorphic adenoma apperance?

Answer 5

Variety of hist features reflect stromal and epithelial elements
Ductal and myoepithelial features

Question 6

Q6: Could pleomorphic adenoma turn malignant?

Answer 6

Yes Carcinoma ex pleomorphic adenoma

Question 7

Q7: After 10 years from resection, patient developed a neck swelling, what’s your D.D .?

Answer 7

Recureence / Carotid body tumor / Lymphoma

Question 8

Q8: If the metastasis erodes the carotid artery, why it would not stop bleeding?

Answer 8

Due to direct vessel injury and high pressure of it
Carotid Blowout syndrome rare life threat emregnecy occurring in pt treated for head and neck malignancy. It’s due to art adventitial ischemia which is multifactorial due to weaking of advent due to stipping during surgery or following radiotherapy or direct tumor invasion

Question 9

Q9: Can you define a metastasis?

Answer 9

Survival of cell far away form its primary site

Question 10

Q10: Can you list 5 steps by which metastasis occurs?

Answer 10

1. Tumor cells growing without limits
2. Invading surrounding bld vess and Lymp vess
3. Travels through circulation
4. Arrest in capillary beds
5. Grows in the new site

Question 11

Q11: What are the main routs of spread of malignancy?

Answer 11

Direct / Hematogenous / Lymphatic / Tran celomic

Question 12

Q12: How does lymphatic spread occur?

Answer 12

Permeation and embolization

Question 13

What are the mechanisms by which cancer cells promote lymphatic spread?

Answer 13

Release immunomodulator like Exosomes (reduce immunity) / VEGFs which promotes formation of new vessels