Salivary Gland Diseases Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Salivary Gland Diseases. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Salivary Gland Diseases Indian Medical PG Question 1: Microscopically, epimyoepithelial islands are typically seen in:
- A. Epithelial-myoepithelial carcinoma
- B. Myoepithelioma
- C. Mucoepidermoid carcinoma
- D. Sjögren's syndrome (Correct Answer)
Salivary Gland Diseases Explanation: ***Sjögren's syndrome***
- **Epimyoepithelial islands** are a characteristic histopathological feature of **Sjögren's syndrome**, particularly in affected salivary glands. [1]
- These islands represent **benign lymphoepithelial lesions** where ducts are surrounded by lymphocytes, eventually forming true islands.
*Epithelial-myoepithelial carcinoma*
- This is a **malignant salivary gland tumor** with dual differentiation, but it typically presents as distinct inner epithelial and outer myoepithelial layers around ducts or cords, not as true "islands."
- While it involves both epithelial and myoepithelial cells, its arrangement and neoplastic nature differ from the benign epimyoepithelial islands of Sjögren's.
*Myoepithelioma*
- This is a **benign tumor composed predominantly of myoepithelial cells**, often appearing in various morphological patterns (spindle, plasmacytoid, epithelioid, clear cell).
- It does not typically form the well-defined **lymphoepithelial islands** seen in Sjögren's, as its characteristic is the proliferation of myoepithelial cells in a different architectural pattern.
*Mucoepidermoid carcinoma*
- This is a common **malignant salivary gland tumor** characterized by a mixture of mucin-producing cells, epidermoid cells, and intermediate cells.
- Its histological features are distinct and do not include the formation of **epimyoepithelial islands**, which are diagnostically specific to Sjögren's syndrome.
**References:**
[1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 235-236.
Salivary Gland Diseases Indian Medical PG Question 2: Most common parotid gland tumour is
- A. Monomorphic adenoma
- B. Primary lymphoma
- C. Pleomorphic adenoma (Correct Answer)
- D. Adenocarcinoma
Salivary Gland Diseases Explanation: ***Pleomorphic adenoma***
- This is the **most common benign tumor** of the salivary glands, accounting for approximately **60-70%** of all parotid gland tumors [1].
- It is characterized by its **mixed stromal and epithelial components**, giving it a pleomorphic (varied) appearance [1].
*Monomorphic adenoma*
- This is a **less common benign epithelial tumor** of the salivary glands compared to pleomorphic adenoma.
- It lacks the **stromal component** seen in pleomorphic adenoma and typically affects older individuals.
*Adeno adenocarcinoma*
- This is a type of **malignant epithelial tumor** of the salivary glands, which is much less common than benign pleomorphic adenoma [1].
- While it can occur in the parotid gland, it constitutes a **minority of parotid tumors**, typically presenting with more aggressive features.
*Primary lymphoma*
- **Lymphomas** can occur in the salivary glands but are **rare** as primary tumors of the parotid gland itself.
- They typically arise from **lymphoid tissue** within or adjacent to the gland, often presenting as firm, non-tender masses.
**References:**
[1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 751-755.
Salivary Gland Diseases Indian Medical PG Question 3: What is the most common oral cancer?
- A. Transition cell ca
- B. Mucoepidermoid
- C. Adenocarcinoma
- D. Squamous cell ca (Correct Answer)
Salivary Gland Diseases Explanation: ***Squamous cell ca***
- **Squamous cell carcinoma (SCC)** accounts for over **90% of all oral cancers**, making it the most prevalent type.
- It arises from the **stratified squamous epithelium** lining the oral cavity.
*Transition cell ca*
- This term is more commonly associated with tumors of the **urinary tract**, such as transitional cell carcinoma of the bladder.
- **Transitional cell carcinomas** are not typically found in the oral cavity.
*Mucoepidermoid*
- **Mucoepidermoid carcinoma** is the most common primary malignant tumor of **salivary glands**, not the oral cavity lining.
- While salivary glands are in the oral region, this type of cancer originates specifically from these glands.
*Adenocarcinoma*
- **Adenocarcinoma** originates from **glandular tissue** and represents a small percentage of oral cancers.
- It is much **less common** than squamous cell carcinoma in the oral cavity.
Salivary Gland Diseases Indian Medical PG Question 4: Which of the following statements is true about mumps?
- A. Mumps orchitis frequently leads to infertility
- B. The patient is not infectious prior to clinical parotid enlargement
- C. Salivary glands involvement is limited to parotid
- D. Meningoencephalitis can precede parotitis (Correct Answer)
Salivary Gland Diseases Explanation: ***Meningoencephalitis can precede parotitis***
- While **parotitis** is the most common manifestation of mumps, **meningoencephalitis** can occur as a complication and, in some cases, may appear before the onset of salivary gland swelling.
- The mumps virus can directly infect the central nervous system, leading to neurological symptoms independent of or concurrent with glandular involvement [1].
*Mumps orchitis frequently leads to infertility*
- While mumps **orchitis** (inflammation of the testes) can occur, especially in adolescent and adult males, it **rarely** leads to complete infertility, and more commonly affects only **one testis** if it impacts fertility at all.
- The risk of bilateral testicular atrophy and subsequent infertility is low, occurring in a small percentage of affected individuals.
*The patient is not infectious prior to clinical parotid enlargement*
- Individuals infected with mumps are **infectious** typically **1-2 days before** the onset of parotid swelling and up to 5 days after, making transmission possible before clinical symptoms are apparent.
- The virus is shed in respiratory secretions during this **prodromal period** and early stages of parotitis.
*Salivary glands involvement is limited to parotid*
- While the **parotid glands** are most commonly affected in mumps, the **submandibular** and **sublingual glands** can also be involved, though less frequently.
- Mumps is a systemic viral infection that can affect various glandular tissues, not just the parotid.
Salivary Gland Diseases Indian Medical PG Question 5: Oophoritis, Orchitis, Chipmunk cheeks seen in:
- A. Sialadenosis.
- B. Mumps. (Correct Answer)
- C. Mucocele.
- D. Sialadenitis.
Salivary Gland Diseases Explanation: ***Mumps***
- **Mumps** is a viral infection that commonly presents with **bilateral parotid gland swelling**, leading to the characteristic "chipmunk cheeks" appearance.
- It can also cause complications such as **oophoritis** (inflammation of the ovaries) in females and **orchitis** (inflammation of the testes) in males, which are key features seen in this clinical description.
*Sialadenosis*
- **Sialadenosis** refers to a non-inflammatory, non-neoplastic enlargement of the salivary glands, often the parotid glands.
- While it can cause swollen glands, it is typically associated with systemic conditions like **diabetes** or **alcoholism** and does not cause oophoritis or orchitis.
*Mucocele*
- A **mucocele** is a common lesion of the oral mucosa that results from either rupture of a salivary gland duct and spillage of mucin into the surrounding soft tissues (extravasation type) or obstruction of a salivary gland duct (retention type).
- It usually presents as a benign, fluid-filled swelling, most commonly on the **lower lip**, and is not associated with systemic inflammation or widespread glandular involvement.
*Sialadenitis*
- **Sialadenitis** is an inflammation of a salivary gland, often due to bacterial infection or duct obstruction (e.g., by salivary stones).
- While it can cause painful swelling of the salivary glands, it typically affects only one gland and does not lead to complications like oophoritis or orchitis.
Salivary Gland Diseases Indian Medical PG Question 6: Frey's syndrome occurs due to aberrant regeneration of parasympathetic nerve fibers following parotid surgery, leading to gustatory sweating. The nerve directly involved in this aberrant reinnervation is:
- A. Trigeminal nerve
- B. Facial nerve
- C. GlossoPharyngeal nerve
- D. Auriculotemporal nerve (Correct Answer)
Salivary Gland Diseases Explanation: ***Auriculotemporal nerve***
- Frey's syndrome, or **gustatory sweating**, occurs due to damage to the **auriculotemporal nerve**, typically during parotidectomy.
- Aberrant regeneration leads to misdirection of parasympathetic fibers meant for the parotid gland to the sweat glands in the preauricular and temporal regions.
*Trigeminal nerve*
- The trigeminal nerve (CN V) is primarily responsible for **sensory innervation of the face** and **motor innervation of the muscles of mastication**.
- It does not directly provide secretomotor innervation to the parotid gland or sweat glands.
*Facial nerve*
- The facial nerve (CN VII) innervates the **muscles of facial expression** and provides taste sensation to the anterior two-thirds of the tongue, and secretomotor innervation to the submandibular and sublingual glands.
- While it passes through the parotid gland, it does not provide secretomotor innervation to the parotid gland itself.
*GlossoPharyngeal nerve*
- The glossopharyngeal nerve (CN IX) provides presynaptic parasympathetic fibers to the **otic ganglion**, which then synapse with postsynaptic fibers carried by the auriculotemporal nerve to the parotid gland.
- Although it is the origin of the parasympathetic innervation for the parotid, the direct aberrant reinnervation in Frey's syndrome involves the auriculotemporal nerve, not the glossopharyngeal nerve itself.
Salivary Gland Diseases Indian Medical PG Question 7: Following is true about the incidence of tumors of salivary glands except -
- A. Warthin's tumor - 5 - 10%
- B. Mucoepidermoid carcinoma - 15%
- C. Pleomorphic adenoma - 50%
- D. Oncocytoma - 5% (Correct Answer)
Salivary Gland Diseases Explanation: ***Oncocytoma - 5%***
- Oncocytomas are relatively rare, accounting for **less than 1%** of all salivary gland tumors, making 5% an overestimation.
- While benign, they are much less common than other benign salivary gland neoplasms such as pleomorphic adenoma and Warthin's tumor.
*Warthin's tumor - 5 - 10%*
- Warthin's tumor is the **second most common benign salivary gland tumor** and typically accounts for 5-10% of all salivary gland neoplasms.
- This incidence rate is generally considered accurate in various epidemiological studies.
*Mucoepidermoid carcinoma - 15%*
- **Mucoepidermoid carcinoma** is the most common malignant salivary gland tumor, representing approximately 10-15% of all salivary gland tumors [1].
- This percentage falls within the expected range for its incidence.
*Pleomorphic adenoma - 50%*
- **Pleomorphic adenoma** is the most common benign salivary gland tumor, accounting for approximately 50-60% of all salivary gland tumors [1].
- The stated incidence of 50% is well within the accepted range for this type of tumor [1].
**References:**
[1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 751-753.
Salivary Gland Diseases Indian Medical PG Question 8: What investigation uses dye to find out stones in the salivary gland?
- A. MR angiography
- B. USG
- C. Breast imaging
- D. Sialography (Correct Answer)
Salivary Gland Diseases Explanation: ***Sialography***
- **Sialography** is an imaging technique that involves injecting a **radiopaque dye** into the salivary ducts to visualize the internal structure and identify obstructions like stones (**sialoliths**).
- This method allows for detailed imaging of the ductal system, revealing the exact location and size of stones or strictures.
*Breast imaging*
- **Breast imaging**, such as mammography or ultrasound of the breast, is used to detect abnormalities within the **breast tissue**.
- It is completely unrelated to the diagnosis of salivary gland stones.
*MR angiography*
- **MR angiography (MRA)** is a type of MRI that specifically visualizes **blood vessels** and blood flow throughout the body.
- It is used to detect vascular diseases, not obstructions in salivary glands.
*USG*
- **Ultrasound (USG)** can visualize salivary gland stones, but it does not typically involve the use of an injected dye for this purpose.
- While useful for initial screening, **sialography** provides a more detailed view of the ductal system, especially smaller or more complex stones.
Salivary Gland Diseases Indian Medical PG Question 9: All are true for pleomorphic adenoma except:
- A. May turn into malignant
- B. Minor salivary gland can be affected
- C. Arises from parotid
- D. Always remains benign (Correct Answer)
Salivary Gland Diseases Explanation: ***Always remains benign***
- This statement is incorrect because **pleomorphic adenomas** have a recognized potential for **malignant transformation** into carcinoma ex pleomorphic adenoma. [1]
- The risk of malignancy increases with the duration of the tumor and its size. [1]
*May turn into malignant*
- This is true; **pleomorphic adenomas** can undergo malignant transformation, leading to a more aggressive tumor known as **carcinoma ex pleomorphic adenoma**. [1]
- The rate of malignant transformation is generally low but is a significant concern in the long-term management of these tumors. [1]
*Minor salivary gland can be affected*
- This is true; while often found in the parotid gland, **pleomorphic adenomas** can also arise in **minor salivary glands**, particularly those in the palate.
- Tumors in minor salivary glands tend to have a higher malignant transformation rate and can present as asymptomatic masses.
*Arises from parotid*
- This is true; the **parotid gland** is the most common site for **pleomorphic adenomas**, accounting for approximately 80% of all cases. [1]
- They typically present as a slow-growing, painless mass in the parotid region. [1]
**References:**
[1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 751-753.
Salivary Gland Diseases Indian Medical PG Question 10: Pleomorphic adenomas arising from the minor salivary glands can be treated with
- A. Chemotherapy
- B. Local excision with 2mm margin
- C. Local excision with 5mm margin (Correct Answer)
- D. Radiotherapy
Salivary Gland Diseases Explanation: ***Local excision with 5mm margin***
- **Pleomorphic adenomas** are **benign tumors**, but they have a tendency for recurrence if not adequately excised due to their irregular, often lobulated shape and microscopic extensions.
- A **5mm margin** is generally recommended for complete removal and to minimize the risk of recurrence, especially for tumors arising from minor salivary glands.
*Chemotherapy*
- **Chemotherapy** is generally reserved for **malignant tumors** and systemic diseases, not for benign lesions like pleomorphic adenomas.
- It carries significant side effects and is unnecessary for a localized, benign tumor that can be surgically removed.
*Local excision with 2mm margin*
- While local excision is the correct approach, a **2mm margin** may be insufficient for pleomorphic adenomas.
- Such a small margin increases the risk of leaving behind microscopic tumor extensions, leading to a higher chance of **local recurrence**.
*Radiotherapy*
- **Radiotherapy** is primarily used for **malignant tumors** or in cases where surgery is not an option, or as an adjuvant therapy.
- It is not the standard primary treatment for **benign pleomorphic adenomas** due to potential side effects and the efficacy of surgical excision.
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