Question 1

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?

Accepted Answer

The uniform, round opacity in the floor of the maxillary sinus with intact normal landmarks and absence of symptoms or history of sinus problems is consistent with a maxillary sinus retention cyst. Variation of normal would be characterized by the absence of any abnormal findings. Necrotizing sialometaplasia and Sjögren's syndrome are not associated with sinus opacities. Carcinoma of the maxillary sinus would be an unlikely finding in a young patient without symptoms or clinical suspicion.

Question 2

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

Accepted Answer

Systemic drugs, such as medications used to treat high blood pressure, can often cause xerostomia in the elderly. This is because these drugs can decrease saliva production, leading to a dry mouth.

Question 3

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

Accepted Answer

Patients with Sjögren's syndrome have an increased risk for developing lymphoma, specifically non-Hodgkin's lymphoma. This increased risk is thought to be due to chronic B-cell activation and proliferation that occurs in the setting of the autoimmune disorder.

Question 4

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?

Accepted Answer

The fact that the patient indicates that the lesion developed after he bit his lip suggests a history of trauma, which would support the possibility of a mucocele. Mucoceles arise from the rupture of a salivary gland duct and subsequent leakage of mucus into surrounding soft tissues. They are typically not tender, but can be if they become infected. The other choices are less likely based on the given information.

Question 5

Trauma is the cause of which of the following?

Accepted Answer

Trauma is known to cause mucous extravasation phenomenon, which is the accumulation of mucin in the soft tissues due to rupture of minor salivary gland ducts. Static (Stafne) bone cysts are developmental cysts, MEN III-associated mucosal neuromas are associated with a genetic syndrome, and dermoid cysts are developmental abnormalities, therefore trauma is not the cause of these conditions.

Question 6

Necrotizing sialometaplasia:

Accepted Answer

Necrotizing sialometaplasia typically occurs in the palate and can be clinically and microscopically confused with carcinoma. It is also related to ischemic necrosis.

Question 7

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

Accepted Answer

This question describes the classic histological features of a pleomorphic adenoma (mixed tumor), which is the most common benign salivary gland neoplasm.

Question 8

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

Accepted Answer

Polymorphous low-grade adenocarcinoma is rarely seen in major salivary glands, as it typically arises from minor salivary glands in the oral cavity. The other options are all commonly seen in both minor and major salivary glands.

Question 9

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

Accepted Answer

Sialolithiasis is the formation of calculi (stones) within the salivary gland ducts. The submandibular glands are the most common site for sialolithiasis, accounting for approximately 80% of cases.

Question 10

Sialoliths are associated with which of the following?

Accepted Answer

Sialoliths are calcified masses that form within the salivary gland or its ducts. They can cause pain, duct obstruction, which can lead to swelling and infection, and mucous retention. Therefore, all of the above choices are associated with sialoliths.

Question 11

Basal cell adenoma:

Accepted Answer

The answer of Basal cell adenoma:
...

Question 12

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

Accepted Answer

- Primary Sjögren's syndrome: This disorder is associated with an increased risk for the development of lymphoma.
- Proliferative verrucous leukoplakia: This condition is considered a premalignant lesion and has a high rate of transformation into squamous cell carcinoma.
- Neurofibromatosis: This genetic disorder is associated with an increased risk of developing tumors of the nervous system, including malignant peripheral nerve sheath tumors.
- MEN III: Multiple Endocrine Neoplasia Type III is an autosomal dominant disorder that is characterized by the development of tumors in multiple endocrine tissues, including medullary thyroid carcinoma and pheochromocytoma. These tumors can be malignant.
Therefore, all of the above disorders place the patient at risk for the development of a malignancy.

Question 13

Mixed tumor of salivary glands:

Accepted Answer

Mixed tumors of salivary glands, also known as pleomorphic adenomas, are characterized by containing both epithelial and connective tissue components, which can sometimes resemble cartilage. They are not specifically caused by smoking, and while they can eventually become malignant, they do not frequently metastasize to local lymph nodes in their benign form.

Question 14

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

Accepted Answer

Mixed tumor of minor salivary gland usually presents as a firm submucosal mass. Other clinical presentations such as painful exudative lesion, ulcerative plaque, rapidly growing mass, and red plaque are less typical of this type of tumor.

Question 15

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

Accepted Answer

The replacement of normal parenchyma with granulomas suggests a chronic inflammatory process, which is most commonly seen in sarcoidosis. Necrotizing sialometaplasia would show necrotic changes in the glandular tissue, whereas salivary lymphoepithelial lesions would have lymphoid tissue infiltrating the glandular tissue. Mucous extravasation phenomenon and mucous retention cysts would show ductal dilatation and scarring, which is not present in this case.

Question 16

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

Accepted Answer

Ranula is a swelling that occurs on the floor of the mouth and is caused by the obstruction of the major salivary duct of the sublingual gland.

Question 17

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

Accepted Answer

Maxillary sinus retention cysts are usually asymptomatic and do not require treatment. Observation with follow-up radiographs is usually sufficient in most cases. Endodontic therapy of the adjacent teeth or antibiotic therapy is not indicated for maxillary sinus retention cysts. Surgical removal may be considered in rare cases where the cyst is causing significant symptoms or obstructing the sinus opening, but it is not typically necessary.

Question 18

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?

Accepted Answer

The presence of noncaseating granulomas in both the tongue and lungs is highly suggestive of sarcoidosis, a systemic granulomatous disease that commonly affects the lungs, lymph nodes, and other organs including the salivary glands. Benign lymphoepithelial lesions are usually found in the parotid gland, while lymphoma typically presents as a single mass rather than multiple nodular lesions. Necrotizing sialometaplasia is a benign self-limiting ulcerative lesion of the salivary glands, and mumps usually presents with parotid gland swelling.

Quiz 8: Salivary Gland Diseases