Deck 8: Salivary Gland Diseases

Question 1

A patient presents with a chronic palatal ulcer. On biopsy there is evidence of salivary gland infarction and squamous metaplasia of salivary ducts. This is:

A)Benign lymphoepithelial lesion
B)Necrotizing sialometaplasia
C)Cytomegalic disease
D)Lymphoma
E)Mucous extravasation phenomenon

Answer 1

Necrotizing sialometaplasia

Question 2

A patient presents with a lump in the palate that is covered by normal epithelium. Microscopy shows that the mass is an infiltrative neoplasm composed of glandular epithelium. Tumor nests have a cribriform pattern and can be seen surrounding nerve. This describes which of the following?

A)Mixed tumor
B)Monomorphic adenoma
C)Mucocele
D)Adenoid cystic carcinoma
E)Mucoepidermoid carcinoma, low grade

Answer 2

Adenoid cystic carcinoma

Question 3

Which of the following benign lesions is known to have potential to undergo malignant transformation?

A)Traumatic fibroma
B)Ectopic lymphoid tissue
C)Denture-related papillary hyperplasia
D)Granular cell tumor
E)Mixed tumor

Answer 3

Mixed tumor

Question 4

A biopsy of the lower lip salivary glands showed replacement of parenchymal tissue by lymphocytes. The patient also had xerostomia and keratoconjunctivitis sicca. These findings suggest which of the following?

A)Lymphoma
B)Crohn's disease
C)Mumps
D)Sjögren's syndrome
E)None of the above

Question 5

A 24-year-old patient presents with a persistent firm asymptomatic submucosal mass (1 ´ 1 cm) in her lower lip. The mass fluctuates in size and occasionally drains a cloudy, sticky fluid. This would most likely be which of the following?

A)Mucous extravasation phenomenon
B)Necrotizing sialometaplasia
C)Traumatic fibroma
D)Soft tissue myxoma
E)Ectopic lymphoid tissue

Question 6

Mixed tumors of minor salivary glands present as asymptomatic lumps most commonly in which of the following locations?

A)Lower lip
B)Upper lip
C)Buccal mucosa
D)Tongue
E)Palate

Question 7

A 16-year-old patient complained of a 1 ´ 1 cm nontender mass in his upper lip. The lesion was nonulcerated and was composed of a dilated duct containing a sialolith. This would be which of the following?

A)Focal fibrous hyperplasias
B)Traumatic neuroma
C)Fibromatosis
D)Mucous extravasation phenomenon
E)None of the above

Question 8

Cells with bright pink cytoplasm that contain abundant mitochondria that are seen in aging salivary glands and in some salivary gland tumors are known as:

A)Myoepithelial cells
B)Acinar cells
C)Macrophages
D)Oncocytes
E)Basal keratinocytes

Question 9

An asymptomatic fluctuant mass in the floor of the mouth of a 25-year-old man was biopsied. Microscopically, it was a dilated duct containing mucin. This is a _____ cyst.

A)Dermoid
B)Lymphoepithelial
C)Branchial
D)Thyroglossal tract
E)Mucous retention

Question 10

A biopsy of the minor salivary gland of the lower lip was taken to evaluate for the salivary component of Sjögren's syndrome. The tissue showed a diffuse lymphocytic and plasma cell infiltrate in the gland parenchyma, extensive scarring of the gland with acinar atrophy, and ductal dilatation. This is most suggestive of which of the following?

A)Sarcoidosis
B)Adenoid cystic carcinoma
C)Pleomorphic adenoma
D)Chronic sialadenitis
E)Sjögren's syndrome

Question 11

A 15-year-old patient had a biopsy of a lower lip mass that was diagnosed as mucous extravasation phenomenon. This was probably related to which of the following?

A)A sialolith
B)Trauma
C)Bacterial infection
D)Viral infection
E)Congenital malformation

Question 12

A 45-year-old woman developed soft bilateral swelling of her parotids. Her salivary flow was reduced and she had keratoconjunctivitis sicca (dry eyes). She also recently developed painful joints. She should be evaluated for:

A)Chronic alcoholism
B)MEN III
C)Sjögren's syndrome
D)Neurofibromatosis
E)Diabetes

Question 13

The cell that replaces salivary and lacrimal gland parenchyma, resulting in dryness seen in association with Sjögren's syndrome, is the:

A)Macrophage
B)Lymphocyte
C)Langerhans cell
D)Neutrophil
E)Mast cell

Question 14

Although mucous extravasation phenomenon can potentially occur where salivary glands are present, it is most commonly seen in which of the following intraoral sites?

A)Buccal mucosa
B)Upper lip
C)Lower lip
D)Gingiva
E)Lateral tongue

Question 15

Minor salivary gland malignancies are most commonly seen in which of the following sites?

A)Lower lip
B)Upper lip
C)Palate
D)Tongue
E)Gingiva

Question 16

Which of the following salivary conditions occurs because of traumatic or surgical cutting of the excretory duct of a salivary gland?

A)Mixed tumor
B)Sialolithiasis
C)Mucous retention cyst
D)Mucous extravasation phenomenon
E)Ranula

Question 17

Mucosal neuroma, pheochromocytoma, and medullary carcinoma of the thyroid constitute which of the following syndromes?

A)Albright's syndrome
B)Sjögren's syndrome
C)von Recklinghausen's disease of skin
D)Peutz-Jeghers syndrome
E)None of the above

Question 18

The 5-year survival rate of one of the following salivary gland tumors is fair, but at 15 years it is very poor. Which of the following exhibits this slow, but unrelenting behavior?

A)Mucoepidermoid carcinoma
B)Mixed tumor
C)Adenoid cystic carcinoma
D)Monomorphic adenoma
E)Polymorphous low-grade adenocarcinoma

Question 19

Biopsy of minor salivary gland of the lip shows a lymphocytic infiltrate that has replaced salivary gland parenchyma without evidence of scar. The patient is 58 years old and has dry eyes and rheumatoid arthritis. She very likely has which of the following?

A)Sarcoidosis
B)Adenoid cystic carcinoma
C)Sjögren's syndrome
D)Chronic sialadenitis
E)Gorlin-Goltz syndrome

Question 20

A 33-year-old patient presents with an asymptomatic swelling of her right submandibular space. Which of the following should be considered in a clinical differential diagnosis?

A)Chronic lymphadenitis
B)Salivary gland tumor
C)Lymphoepithelial cyst
D)Lymphoma
E)All the above

Question 21

On routine panographic examination, a uniform round opacity measuring 1.5 cm in diameter was noted in the floor of the maxillary sinus of a 24-year-old man. All normal landmarks in the maxilla appeared intact. The patient had no symptoms and no history of sinus problems. This lesion most likely represents which of the following?

A)Variation of normal
B)Necrotizing sialometaplasia
C)Sjögren's syndrome
D)Maxillary sinus retention cyst
E)Carcinoma of the maxillary sinus

Question 22

Which of the following is a common cause of xerostomia in the elderly?

A)Bacterial infection
B)Mumps
C)Systemic drugs
D)Allergic reactions
E)None of the above

Question 23

Patients with Sjögren's syndrome have increased risk for developing which of the following?

A)Oral cancer (squamous cell carcinoma)
B)Lymphoma
C)Mixed tumors
D)Melanoma
E)Anemia

Question 24

An adult patient complained of a 1 ´ 1 cm slightly tender nonulcerated mass in his lower lip. The patient believes that the lesion developed after he bit his lip several weeks ago. This would most likely be which of the following?

A)Traumatic fibroma
B)Granular cell tumor
C)Squamous cell carcinoma
D)Mucocele
E)Traumatic granuloma

Question 25

Trauma is the cause of which of the following?

A)Static (Stafne) bone cyst
B)MEN III-associated mucosal neuroma
C)Mucous extravasation phenomenon
D)Dermoid cyst
E)None of the above

Question 26

Necrotizing sialometaplasia:

A)Occurs in the palate
B)May be confused with carcinoma clinically
C)May be confused with carcinoma microscopically
D)Is related to ischemic necrosis
E)All the above

Question 27

The circumscribed salivary gland tumor that is composed of a benign mixture of neoplastic ductal epithelium and myoepithelium-derived connective tissue is known as:

A)Pleomorphic adenoma (mixed tumor)
B)Monomorphic adenoma
C)Mucoepidermoid carcinoma
D)Adenoid cystic carcinoma
E)Polymorphous low-grade adenocarcinoma

Question 28

All the following may develop in minor salivary gland tissue. However, one is rarely seen in major glands. It is:

A)Mixed tumor
B)Mucoepidermoid carcinoma
C)Adenoid cystic carcinoma
D)Polymorphous low-grade adenocarcinoma
E)Monomorphic adenoma

Question 29

Sialolithiasis is a phenomenon that most likely would be associated with which of the following glands?

A)Parotids
B)Submandibular glands
C)Sublingual glands
D)Minor salivary glands
E)None of the above

Question 30

Sialoliths are associated with which of the following?

A)Pain
B)Duct obstruction
C)Secondary gland infection
D)Mucous retention
E)All the above

Question 31

Basal cell adenoma:

A)Is an aggressive neoplasm
B)Is more common in the upper lip than in the lower lip
C)Often transforms into adenocarcinoma
D)Has a relatively high recurrence potential
E)None of the above

Question 32

Which of the following disorders places the patient at risk for the appearance or development of a malignancy?

A)Primary Sjögren's syndrome
B)Proliferative verrucous leukoplakia
C)Neurofibromatosis
D)MEN III
E)All the above

Question 33

Mixed tumor of salivary glands:

A)Is caused by smoking
B)Contains epithelial elements plus connective tissue of varied appearance, sometimes resembling cartilage
C)Frequently metastasizes to local lymph nodes
D)All the above
E)B and C only

Question 34

Which of the following is the most likely clinical presentation of mixed tumor of minor salivary gland?

A)Painful exudative lesion
B)Ulcerative plaque
C)Rapidly growing mass
D)Red plaque
E)Firm submucosal mass

Question 35

A labial salivary gland biopsy showed the replacement of normal parenchyma with granulomas. There was no scarring and no ductal dilatation. This biopsy suggests:

A)Necrotizing sialometaplasia
B)Salivary lymphoepithelial lesion
C)Mucous extravasation phenomenon
D)Mucous retention cyst
E)Sarcoidosis

Question 36

Ranula is the clinical designation of a salivary gland lesion that occurs in which of the following locations?

A)Parotid
B)Lower lip
C)Buccal mucosa
D)Floor of mouth
E)Ventral tongue

Question 37

The management of maxillary sinus retention cysts that are typically discovered during routine panoramic radiographic examinations is:

A)Endodontic therapy of the adjacent teeth
B)Antibiotic therapy
C)Surgical removal
D)Observation
E)None of the above

Question 38

A biopsy of a nodular lesion of the tongue showed several noncaseating granulomas. The patient was found to have similar lesions in the hilar regions of his lungs. He most likely has which of the following?

A)Benign lymphoepithelial lesion
B)Sarcoidosis
C)Lymphoma
D)Necrotizing sialometaplasia
E)Mumps