Salivary Gland Disease

Question 1

A 55 year old woman presents with a painless, unilateral mass, 3cm in diameter, located at the posteior lateral surface of the hard palate. She had a history of NPC and received radiotherapy 10 years ago. Histological findings shows predominantly mucous cells. Which of the following is the most likely diagnosis?

Adenoid carcinoma
Whartin’s tumour
Low grade mucoepidermoid carcinoma
High grade mucoepidermoid carcinoma

Answer 1

Low grade mucoepidermoid carcinoma

Question 2

On which of the following sites in the oral cavity a mucocele will not be found?

Posterior region of the hard palate
Ventral surface of anterior tongue
Incisive papilla
Midpalatine raphe

Answer 2

Midpalatine raphe

Question 3

A 7 year old girl presents with a single, sessile, circumscribed soft tissue lesion on her lower lip. The lesion is asymptomatic and soft to palpation. Her mother mentions that the lesion swells up and ruptures periodically. What could this lesion be?

Mucocele
Ranula
Pleomorphic adenoma
Papillary cystadenoma lymphomatosum

Answer 3

Mucocele

Question 4

Which of the following is characteristic of a ranula?

Caused by the Paramyxovirus genus, Rubulavirus
Firm on palpatiom
Found at the parotid gland duct
“Frog belly”

Answer 4

“Frog belly”

Question 5

A 33 year old female presents with a firm sessile soft tissue mass on her palate that is slow growing. The lesion does not blanch on pressure and is well circumscribed. What is the most likely diagnosis?

Pleomorphic Adenoma
Papillary Cystadenoma Lymphomatosum
Adenoid Cystic Carcinoma
Salivary Duct Cyst

Answer 5

Pleomorphic Adenoma

Question 6

A 35 year old female patient presents with a firm, nodular mass on her palate. She is unsure when it started as she only noticed the mass recently when it got bigger, and is otherwise asymptomatic. A histological slide of the mass was obtained. What is the most likely diagnosis and corresponding histological findings?

Pleomorphic adenoma- Ductal epithelium with multiple papillary infoldings surrounded by lymphoid stromae
Pleomorphic adenoma- Well-defined fibrous capsule containing diverse cell types including ductal, squamous, chondroid, osseous and spindle cell
Warthin’s tumour- Well-defined fibrous capsule containing diverse cell types including ductal, squamous, chondroid, osseous and spindle cell
Warthin’s tumour- Cribiform “swiss cheese” pattern containing lobules and islands of tumour cells, multiple small pseudoducts surrounded by myoepithelial cells

Answer 6

Pleomorphic adenoma- Well-defined fibrous capsule containing diverse cell types including ductal, squamous, chondroid, osseous and spindle cell

Question 7

Which of the following is an autoimmune disease characterised by T cell destruction of the salivary glands?

Mumps/Endemic parotitis
Adenoid Cystic Carcinoma
Sjögren’s syndrome
Pleomorphic Adenoma

Answer 7

Sjögren’s syndrome

Question 8

Which of the following is not a clinical feature of benign salivary gland neoplasms?

solitary and circumscribed mass that is often immobile, might also be encapsulated
normal overlying mucosa unless traumatised
asymptomatic, with slow growth and persistent mass
most common site is the hard palate

Answer 8

solitary and circumscribed mass that is often immobile, might also be encapsulated

Question 9

Which of the following describes the microscopic features of adenoid cystic carcinomas?

Cribriform pattern made up of lobules and islands of tumour cells with multiple small pseudoducts / true ducts, surrounded by myoepithelial cells
Ductal epithelium with 2 layers of cells and multiple papillary infolding into cystic spaces
Presence of diverse cell types within a well defined capsule
Presence of hyalinised stroma

Answer 9

Cribriform pattern made up of lobules and islands of tumour cells with multiple small pseudoducts / true ducts, surrounded by myoepithelial cells

Question 10

Which of the following is incorrect?

Mucocele lacks epithelial lining, so it is not a true cyst
Salivary duct cyst is a true cyst lined by epithelium
Ranula may rupture and release their mucin contents, only to re-form
Ranula is a mucocele that arises from submandibular gland

Answer 10

Ranula is a mucocele that arises from submandibular gland

Question 11

Which of the following is the most common site for benign salivary gland neoplasms to form?

Buccal mucosa
Hard palate
Floor of mouth
Lateral borders of the tongue

Answer 11

Hard palate

Question 12

Which of the following salivary gland tumours is a HIGH GRADE malignant tumour?

Papillary cystadenoma lymphomatosum
Adenoid cystic carcinoma
Acinic cell adenocarcinoma
Basal cell adenocarcinoma

Answer 12

Adenoid cystic carcinoma

Question 13

Which of the following are NOT clinical features of mumps?

Headache
Pain on chewing
Pus-filled blister formation
Swelling of the parotid gland

Answer 13

Pus-filled blister formation

Question 14

Which of the following statements on salivary gland tumours are false

a) Pleomorphic adenoma is a benign tumour
b) Pleomorphic adenoma has malignant transformation potential
c) Mucoepidermoid carcinoma is the most common malignant salivary gland tumour
d) Warthin’s tumour is a malignant parotid tumour

Answer 14

d) Warthin’s tumour is a malignant parotid tumour

Question 15

What is the second most common benign parotid tumour?

a) Myoepithelioma
b) Papillary Cystadenoma Lymphotosum (Warthin Tumor)
c) Pleomorphic adenoma
d) Onocytoma

Answer 15

b) Papillary Cystadenoma Lymphotosum (Warthin Tumor)

Question 16

Which of the following are not clinical features of pleomorphic adenoma?

Firm, nodular swelling
Rapid growth
Commonly found on the palate
Asymptomatic

Answer 16

Rapid growth

Question 17

Which salivary gland tumour is characterized by a mixture of epithelial and myoepithelial cells, often showing ductal structures and cellular atypia under the microscope?

Pleomorphic Adenoma
Mucoepidermoid Carcinoma
Adenoid Cystic Carcinoma
Acinic Cell Carcinoma

Answer 17

Pleomorphic Adenoma

Question 18

Which of the following clinical presentations is most likely to make you suspect malignancy?

Swelling
Paresthesia
Growth over time
Satellite cells

Answer 18

Paresthesia

Question 19

Which of the following statements comparing a pleomorphic adenoma and a Warthin’s tumour is true?

Pleomorphic adenomas can occur in both major and minor salivary glands while Warthin’s tumour almost exclusively occur in submandibular gland.
Pleomorphic adenomas have a high rate of malignant transformation while Warthin’s tumours have a low rate of malignant transformation.
Pleomorphic adenomas normally occur in males while Warthin’s tumours normally occur in females.
Pleomorphic adenomas normally present in older adults while Warthin’s tumour normally present in young adults.

Answer 19

Pleomorphic adenomas have a high rate of malignant transformation while Warthin’s tumours have a low rate of malignant transformation.

Question 20

A 65 year old man walks into your dental clinic for a routine SAP. You notice bilateral masses near the patient’s angle of the mandible. He says that it is painless and that the masses formed at different timings. When histological tests were performed, there was a mixture of ductal epithelium and lymphoid stroma. What type of disease is this?

Acinic Cell Carcinoma
Mumps
Sjoren’s Syndrome
Warthin’s Tumour

Answer 20

Warthin’s Tumour

Question 21

Sialolithiasis most commonly occur in which of the following ducts?

Bartholin’s duct
Ducts of Rivinus
Stenson’s duct
Wharton’s duct

Answer 21

Wharton’s duct

Question 22

A 40 year old male presents with a painless lump below his tongue. A biopsy was done, showing a cribriform pattern. The biopsy also revealed that the tumour has invade surrounding structures and nerves and blood vessels. Which of the following would be the most likely diagnosis of the patient’s condition?

Adenoid Cystic Carcinoma
Adenosquamous Carcinoma
Mucoepidermoid Carcinoma
Salivary Duct Carcinoma

Answer 22

Adenoid Cystic Carcinoma

Question 23

Which of the following statements is FALSE about mucoepidermoid carcinoma?

Low grade tumour mimics benign neoplasm, treated by surgery with good prognosis.
5 year survival of patient with high grade tumour is 20- 40 %
Most common salivary gland malignancy
It represents 10% of all minor gland tumours

Answer 23

It represents 10% of all minor gland tumours

Question 24

Which of the following most accurately reflects malignant salivary gland neoplasms?

Highest incidence in parotid gland
Lesions are soft and movable
Presence of asymptomatic swelling
Fast tumour growth rate

Answer 24

Fast tumour growth rate

Question 25

Patient presents with a sessile, single, circumscribed soft tissue nodule on the lower lip after accidentally biting it. The size of the nodule fluctuates - it is biggest during mealtimes and smallest when sleeping/just waking up. Patient does not complain of any symptoms. Which of the following is the most likely differential diagnosis?

Mucocele
Ranula
Pleomorphic adenoma
Mucoepidermoid Carcinoma

Answer 25

Mucocele?

Question 26

patient comes in with an obstructive salivary cyst, upon investigation, clinician deduced it was a ranula. which feature could be observed?

epithelial lining
most commonly found on lower lip
arising from sublingual gland
rare recurrence without surgical excision of involved gland

Answer 26

arising from sublingual gland

Question 27

Which of the following is true about salivary cysts?

Mucoceles are true cyst that have an epithelium-lined cavity arising from salivary gland tissue.
Mucoceles are one of the rarer soft tissue enlargements of oral mucosa presenting more commonly in children and young adults.
Mucous Retention Cysts arise due to a distal gland duct obstruction and are usually painful.
Ranulas are commonly found in the floor of mouth and arise due to traumatisation of the submandibular or sublingual gland ducts.

Answer 27

Ranulas are commonly found in the floor of mouth and arise due to traumatisation of the submandibular or sublingual gland ducts.

Question 28

Which of the following is false about pleomorphic adenoma?

Most common salivary gland neoplasm
Malignant neoplasm
Most common i/o site is the palate
Well-defined capsule

Answer 28

Malignant neoplasm

Question 29

A 35-year old female patient comes to the clinic presenting with a tumour on her palate. The tumour has a well-defined capsule and it is firm on palpation. When questioned about the tumour, the patient recounted that it has been there for a few years and it is not painful. Which of the following is a possible diagnosis?

adenoid cystic carcinoma
necrotizing sialometaplasia
pleomorphic adenoma
salivary extravasation phenomenon

Answer 29

pleomorphic adenoma

Question 29

60 year-old woman noticed an enlarging ‘bump’ beneath her tongue for the past year. She does not consume alcohol, does not smoke. On physical examination, there is a movable, 2.5cm submucosa mass, arising in her minor salivary glands on the buccal mucosa beneath the tongue. After histologic examination, the excised mass is confirmed to be malignant, and locally invasive. Within 1 year, the tumour recurs. What is the most likely diagnosis?

Mucoepidermoid carcinoma
Non-Hodgkin lymphoma
Pleomorphic adenoma
Squamous cell carcinoma

Answer 29

Mucoepidermoid carcinoma

Question 30

What is an appropriate managment for a patient presenting with Sjogren’s syndrome?

CHX mouthrinse 2x daily
Monitor for development of lymphoma
Radiotherapy of salivary glands
Systemic corticosteroids

Answer 30

Monitor for development of lymphoma