Salivary Gland Diseases — MCQs
Microscopically, epimyoepithelial islands are typically seen in:
Most common parotid gland tumour is
What is the most common oral cancer?
Which of the following statements is true about mumps?
Oophoritis, Orchitis, Chipmunk cheeks seen in:
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:
Following is true about the incidence of tumors of salivary glands except -
What investigation uses dye to find out stones in the salivary gland?
All are true for pleomorphic adenoma except:
Pleomorphic adenomas arising from the minor salivary glands can be treated with
Salivary Gland Diseases Indian Medical PG Practice Questions and MCQs
Question 1: Microscopically, epimyoepithelial islands are typically seen in:
- A. Epithelial-myoepithelial carcinoma
- B. Myoepithelioma
- C. Mucoepidermoid carcinoma
- D. Sjögren's syndrome (Correct Answer)
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.
Question 2: Most common parotid gland tumour is
- A. Monomorphic adenoma
- B. Primary lymphoma
- C. Pleomorphic adenoma (Correct Answer)
- D. Adenocarcinoma
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.
Question 3: What is the most common oral cancer?
- A. Transition cell ca
- B. Mucoepidermoid
- C. Adenocarcinoma
- D. Squamous cell ca (Correct Answer)
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.
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)
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.
Question 5: Oophoritis, Orchitis, Chipmunk cheeks seen in:
- A. Sialadenosis.
- B. Mumps. (Correct Answer)
- C. Mucocele.
- D. Sialadenitis.
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.
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)
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.
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)
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.
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)
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.
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)
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.
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
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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