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:

Accepted Answer

The combination of salivary gland infarction and squamous metaplasia of the ducts is strongly suggestive of necrotizing sialometaplasia, a self-limiting inflammatory condition of the salivary glands. The chronic palatal ulcer seen in this case is a common clinical presentation of this lesion. Benign lymphoepithelial lesions may also present with palatal ulcers but do not typically show salivary gland infarction or squamous metaplasia of the ducts. Cytomegalic disease and lymphoma would be unlikely to present as a chronic palatal ulcer. Mucous extravasation phenomenon would not show salivary gland infarction or squamous metaplasia of the ducts.

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?

Accepted Answer

The infiltrative neoplasm combined with glandular epithelium, cribriform pattern and nerve involvement suggest adenoid cystic carcinoma, which is a malignant salivary gland tumor. The other options, such as mixed tumor, monomorphic adenoma, mucocele, and mucoepidermoid carcinoma, low grade, may have different histological features and less likely to show nerve involvement.

Question 3

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

Accepted Answer

Mixed tumors, also known as pleomorphic adenomas, have the potential to undergo malignant transformation into carcinoma ex pleomorphic adenoma. The other options listed are benign lesions that do not typically have the potential for malignant transformation.

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?

Accepted Answer

The replacement of salivary gland parenchymal tissue by lymphocytes, along with xerostomia (dry mouth) and keratoconjunctivitis sicca (dry eyes) are characteristic features of Sjögren's syndrome, an autoimmune disorder that affects the exocrine glands. Lymphoma may also involve lymphocyte infiltration of salivary glands, but it is not typically associated with dry eyes and mouth. Crohn's disease and mumps are not related to the observed findings.

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?

Accepted Answer

The presentation of a persistent submucosal mass in the lower lip that fluctuates in size and occasionally drains a cloudy, sticky fluid is consistent with a mucous extravasation phenomenon. This lesion is caused by trauma to minor salivary glands, leading to the leakage of mucin into surrounding tissues and the formation of a soft, fluctuant mass. The lesion may have a bluish tint and is typically asymptomatic, although it may become painful if it becomes inflamed or infected. Treatment of mucous extravasation phenomenon typically involves surgical excision if the lesion becomes symptomatic or cosmetically bothersome.

Question 6

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

Accepted Answer

Mixed tumors of minor salivary glands commonly present as asymptomatic lumps in the palate. They can also occur in the other locations listed but are most common in the 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?

Accepted Answer

The answer of A 16-year-old patient complained of a 1...

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:

Accepted Answer

The cells described are called oncocytes, which are also known as Hürthle cells. They have a bright pink cytoplasm due to an abundance of mitochondria and are commonly seen in aging salivary glands and in some salivary gland tumors.

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.

Accepted Answer

The description of a fluctuant mass in the floor of the mouth containing mucin corresponds to a mucous retention cyst. Dermoid, lymphoepithelial, branchial, and thyroglossal tract cysts would have different histologic findings.

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?

Accepted Answer

The answer of A biopsy of the minor salivary gland...

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?

Accepted Answer

Mucous extravasation phenomenon is a common lesion caused by trauma to a minor salivary gland duct, which results in the spillage of mucin into adjacent soft tissues. It typically presents as a painless, soft, dome-shaped nodule on the lower lip. Sialoliths are calcified masses that form within the salivary gland ducts and are not associated with mucous extravasation phenomenon. Bacterial and viral infections, as well as congenital malformations, are not known to cause mucous extravasation phenomenon.

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:

Accepted Answer

The symptoms described, including bilateral parotid swelling, reduced salivary flow, keratoconjunctivitis sicca, and joint pain, are classic features of Sjögren's syndrome, an autoimmune disorder that affects the exocrine glands. Chronic alcoholism, MEN III, and neurofibromatosis are not associated with these symptoms. While diabetes can cause dry eye syndrome, it would not explain the parotid swelling or joint pain.

Question 13

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

Accepted Answer

Sjögren's syndrome is an autoimmune disorder in which lymphocytes infiltrate and destroy the glands that produce tears and saliva, leading to dryness. Therefore, the cell that replaces salivary and lacrimal gland parenchyma in association with Sjögren's syndrome is the lymphocyte.

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?

Accepted Answer

The mucous extravasation phenomenon, also known as a mucocele, is most commonly seen in the lower lip due to trauma or disruption to the salivary gland ducts in this area.

Question 15

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

Accepted Answer

Palate is the most commonly affected site for minor salivary gland malignancies. They can also occur in other locations such as the lips, tongue, gingiva, and floor of the mouth, but at a much lower frequency.

Question 16

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

Accepted Answer

The mucous extravasation phenomenon occurs when there is a rupture or cutting of the excretory duct of a salivary gland, leading to the spillage of mucin into the surrounding tissues. This creates a swelling filled with mucin, but not lined by epithelium, distinguishing it from a true cyst.

Question 17

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

Accepted Answer

The combination of mucosal neuroma, pheochromocytoma, and medullary carcinoma of the thyroid is characteristic of Multiple Endocrine Neoplasia type 2B (MEN 2B), which is not listed among the provided options.

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?

Accepted Answer

Adenoid cystic carcinoma exhibits slow, but unrelenting behavior with a fair 5-year survival rate, but a very poor survival rate at 15 years.

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?

Accepted Answer

The lymphocytic infiltrate replacing the salivary gland parenchyma without evidence of scar is characteristic of Sjögren's syndrome, an autoimmune disorder commonly associated with dry eyes and dry mouth. The other options are not consistent with the biopsy findings or the patient's clinical presentation.

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?

Accepted Answer

All the given conditions, i.e., chronic lymphadenitis, salivary gland tumor, lymphoepithelial cyst, and lymphoma should be considered in the differential diagnosis of an asymptomatic swelling in the submandibular space. A thorough evaluation is necessary with the help of imaging studies and biopsy to arrive at a definitive diagnosis.

Quiz 8: Salivary Gland Diseases