Practice questions Salivary gland pathology
Practice questions
Salivary gland pathology
Updated: 02/21/2019
© Jun Wang, MD, PhD
1. A 67-year-old man
presents with pain and swelling of left neck for 2 days. He does not have
fever. He was diagnosed with squamous cell carcinoma of lung 3 years ago. Other
past medical history including diabetes and hypertension. He has a 45 pack year
history of cigarette smoking, and drinks wines 2 glasses a day for 30 years.
Physical examination reveals a 4 cm mobile firm lesion at his left
submandibular area. Sonographic examination reveals an enlarged submandibular
glands. Biopsy reveals mixed serous and mucinous glands with neutrophilic
infiltrate and focal abscess formation. No cytological atypia is noted. What is
the diagnosis?
A. Acute sialadenitis
B. Mucinous carcinoma
C. Mucoepidermoid carcinoma
D. Sjogren syndrome
E. Squamous cell carcinoma
2. Use this case for the next two questions. A 64-year-old man
presents with a slowly growing firm mass at his right upper neck for 3 months.
He has a history of oral cavity leukoplakia. He smokes one and a half pack of
cigarette per day for 40 years and drinks wine occasionally. Physical
examination reveals a firm mass at his right submandibular area. No lymph
adenopathy is noted. His oral mucosa is unremarkable, although he has poor oral
hygiene. His laboratory tests are unremarkable. Image studies reveals asymmetrically
enlarged right submandibular glands. Biopsy reveals diffuse fibrosis with focal
lymphoplasmacytic infiltrate. Scattered acini are seen. No atypia is noted.
What is the most likely the diagnosis?
A. Acute sialadenitis
B. IgG4 related dacryoadenitis and sialadenitis
C. Mucoepidermoid carcinoma
D. Sjogren syndrome
E. Squamous cell carcinoma
3. A 64-year-old man
presents with a slowly growing firm mass at his right upper neck for 3 months.
He has a history of oral cavity leukoplakia. He smokes one and a half pack of
cigarette per day for 40 years and drinks wine occasionally. Physical
examination reveals a firm mass at his right submandibular area. No lymph
adenopathy is noted. His oral mucosa is unremarkable, although he has poor oral
hygiene. His laboratory tests are unremarkable. Image studies reveals
asymmetrically enlarged right submandibular glands. Biopsy reveals diffuse
fibrosis with focal lymphoplasmacytic infiltrate. Scattered acini are seen. No
atypia is noted. What serum marker is likely to be elevated?
A. Anti-nuclear antibodies
B. Anti-SSA
C. IgG4
D. Monoclonal IgG
E. Rheumatoid factor
4. Use this case for the next two questions. A 34-year-old woman
presents with bilateral face swelling for 6 months. She has a history of dental
caries, oral candidiasis and dry eyes. She denies history of diabetes. She does
not drink alcohol nor smoke cigarette. Physical examination reveals mild
nontender swelling of both parotid. No lymphadenopathy is noted. Her oral
mucosa is unremarkable. Her conjunctiva has dilated vessels with reduced tear
production by Schirmer test. Laboratory tests, including glucose and IgG4, are
within normal range. Biopsy of the parotid reveals diffuse fibrosis, focal
lymphocytic infiltrate and reduced number of acini. What is most likely the
diagnosis?
A. Acute sialadenitis
B. IgG4 related dacryoadenitis and sialadenitis
C. Pleomorphic adenoma
D. Sjogren syndrome
E. Squamous cell carcinoma
5. A 34-year-old woman
presents with bilateral face swelling for 6 months. She has a history of dental
caries, oral candidiasis and dry eyes. She denies history of diabetes. She does
not drink alcohol nor smoke cigarette. Physical examination reveals mild
nontender swolling of both parotid. No lymphadenopathy is noted. Her oral
mucosa is unremarkable. Her conjunctiva has dilated vessels with reduced tear
production by Schirmer test. Laboratory tests, including glucose and IgG4, are
within normal range. Biopsy of the parotid reveals diffuse fibrosis, focal
lymphocytic infiltrate and reduced number of acini. What serum test is likely
to be abnormal?
A. Anti-SSA
B. IgG4
C. IgE
D. Immunofixation
E. Rapid plasma reagin
6. A 5-year-old boy presents
with a vesicle at his lower lip. His past medical history is unremarkable. Physical
examination reveals a 0.5 cm vesicle with clear fluid contents. Biopsy reveals
an intrastromal collection of mucin like material with neutrophilic
infiltrations. No cytological atypia is seen. What is the diagnosis?
A. Bullous pemphigoid
B. Dermatitis herpetiformis
C. Herpes
D. Lichen planus
E. Mucocele
7. Use this case for the next two questions. A 31-year-old woman
presents with left face mass for 1 year. The mass has been slowly growing. Her
past medical history is unremarkable. Physical examination reveals a lobulated
firm mass at the left face at the preauricular area. Neurological examination
is unremarkable. Image studies reveal a 3.5 cm well defined parotid mass. The
mass is resected. Microscopically, it has glandular components lined by short
cuboid cells. The stroma is predominantly fibrotic, with foci of cartilage and
bone formation. No cytological atypia nor necrosis is seen. What is the
diagnosis?
A. IgG4 related dacryoadenitis and sialadenitis
B. Mucoepidermoid carcinoma
C. Pleomorphic adenoma
D. Sjogren syndrome
E. Warthin’s tumor
8. A 31-year-old woman
presents with left face mass for 1 year. The mass has been slowly growing. Her
past medical history is unremarkable. Physical examination reveals a lobulated
firm mass at the left face at the preauricular area. Neurological examination
is unremarkable. Image studies reveal a 3.5 cm well defined parotid mass. The
mass is resected. Microscopically, it has glandular components lined by short
cuboid cells. The stroma is predominantly fibrotic, with foci of cartilage and
bone formation. No cytological atypia nor necrosis is seen. Mutation of what
gene is likely associated with these findings?
A. APC
B. CDH-1
C. P53
D. PLAG1
E. RET
9. A 65-year-old woman presents with left face mass for a month. She has difficulty closing her left eye since a week ago. She has a history of recurrent pleomorphic adenoma that was treated with surgery when she was 31, 39 and 45. Image studies reveal a 2 cm mass with irregular border. Biopsy reveals predominantly fibrous tissue with foci of lymphocytic infiltrate. A few cords of markedly atypical cells are seen. Per immunohistochemistry, these cells are positive for cytokeratin. What is the most likely diagnosis?
A. Adenoid cystic carcinoma
B. Carcinoma ex pleomorphic
adenoma
C. IgG4 related dacryoadenitis and sialadenitis
D. Recurrent pleomorphic
adenoma
E. Warthin tumor
10. A 56-year-old man
presents with slowly growing painless left face mass for 6 months. He does not
have fever or abnormal facial sense or movement. He has a history of Hodgkin
lymphoma 20 years ago, that was treated with radiation therapy and
chemotherapy. He has a 40 pack-year history of smoking cigarette, and has been
a social drinker for 30 years. Physical examination reveals a vaguely defined
mass of his left preauricular area. His oral cavity is unremarkable. No
lymphadenopathy is noted. Image studies reveal a 2.5 cm parotid mass. The mass
is removed. Grossly, it is a cystic lesion containing brown fluid.
Microscopically, it has finger-like projects convered by double layered
epithelial cells with eosinophilic granular cytoplasm. The stroma has dense
lymphoplasmacytic infiltrate with vague follicular architecture. No atypical cells are seen. What is the diagnosis?
A. Adenoid cystic carcinoma
B. IgG4 related dacryoadenitis and sialadenitis
C. Follicular lymphoma
D. Recurrent Hodgkin
lymphoma
E. Warthin tumor
11. Use this case for the next two questions. A 71-year-old man
presents with painless swelling of left preauricular area for a year. He has a
history of oral erythroplakia that was monitored and stage 1 colon
adenocarcinoma, that was treated with surgery. He smokes cigarette 1 pack a day
for 50 years, but not drink alcohol. Physical examination reveals a firm left
face mass with vague lobulated surface. No ulcer is noted. His oral mucosa has
an approximately 1.5 cm erythematous area at the left posterior hard palate.
Biopsy of the mass reveals irregular glands, some are covered by cells with
abundant pale cytoplasm and basally located small round nuclei. Focally there
are nests of slightly atypical cells with eosinophilic cytoplasm and intercellular
bridges. What is the diagnosis?
A. Adenoid cystic carcinoma
B. Metastatic adenocarcinoma
of colon
C. Mucoepidermoid carcinoma
D. Squamous cell carcinoma
E. Warthin’s tumor
12. A 71-year-old man
presents with painless swelling of left preauricular area for a year. He has a
history of oral erythroplakia that was monitored and stage 1 colon
adenocarcinoma, that was treated with surgery. He smokes cigarette 1 pack a day
for 50 years, but not drink alcohol. Physical examination reveals a firm left face
mass with vague lobulated surface. No ulcer is noted. His oral mucosa has an
approximately 1.5 cm erythematous area at the left posterior hard palate.
Biopsy of the mass reveals irregular glands, some are covered by cells with
abundant pale cytoplasm and basally located small round nuclei. Focally there
are nests of slightly atypical cells with eosinophilic cytoplasm and
intercellular bridges. Abnormality of what gene is likely associated with these
findings?
A. APC
B. MECT1
C. PLAG1
D. RB1
E. RET
13. Use this case for the next three questions. A 52-year-old woman
presents with painless swelling of left posterior hard palate for a year. She
has a history of invasive lobular carcinoma of right breast with left axillary
lymph node metastasis 5 years ago, that was treated with surgery and
chemotherapy. She does not smoke cigarette, and is a social drinker. Physical
examination reveals a 2 cm reddish flat hard palate mass without ulceration.
Biopsy of the lesion reveals cords and nests of cells with eosinophilic
cytoplasm and moderately irregular nuclei. Focally there are scattered cells
with pale cytoplasm and basally located small nuclei. What is most likely the
diagnosis?
A. Adenoid cystic carcinoma
B. Metastatic lobular
carcinoma
C. Mucoepidermoid carcinoma
D. Squamous cell carcinoma
E. Warthin tumor
14. A 52-year-old woman
presents with painless swelling of left posterior hard palate for a year. She
has a history of invasive lobular carcinoma of right breast with left axillary
lymph node metastasis 5 years ago, that was treated with surgery and
chemotherapy. She does not smoke cigarette, and is a social drinker. Physical
examination reveals a 2 cm reddish flat hard palate mass without ulceration.
Biopsy of the lesion reveals cords and nests of cells with eosinophilic
cytoplasm and moderately irregular nuclei. Focally there are scattered cells
with pale cytoplasm and basally located small nuclei. What additional stain is
likely to be confirmative for the diagnosis?
A. E-cadherin
B. Estrogen receptor
C. Mucin
D. p16
E. Silver
15. A 52-year-old woman
presents with painless swelling of left posterior hard palate for a year. She
has a history of invasive lobular carcinoma of right breast with left axillary
lymph node metastasis 5 years ago, that was treated with surgery and
chemotherapy. She does not smoke cigarette, and is a social drinker. Physical
examination reveals a 2 cm reddish flat hard palate mass without ulceration.
Biopsy of the lesion reveals cords and nests of cells with eosinophilic
cytoplasm and moderately irregular nuclei. Focally there are scattered cells
with pale cytoplasm and basally located small nuclei. Abnormality of what gene
is likely associated with these findings?
A. APC
B. CDH-1
C. MECT1
D. PLAG1
E. RET
16. Use this case for the next three questions. A 42-year-old woman
presents with a slowly growing swelling of her left hard palate for 6 months.
She developed difficulty in mastication 2 weeks ago, but denies other symptoms.
Her past medical history is unremarkable. She has a 15 pack-year history of
cigarette smoking, and has been chewing betel nuts since 18. Physical
examination reveals a 1.5 flat firm raised area at the left palate. This lesion
has a reddish surface without ulceration. Biopsy of the lesion reveals cords
and nests of epithelioid cells with round nuclei and scant cytoplasm. Focally
there are round spaces between these cells. Per immunohistochemistry studies,
these cells are positive for cytokeratin and negative for CD45 and CD56. Mucin
stain is negative. What is the diagnosis?
A. Adenoid cystic carcinoma
B. Mucoepidermoid carcinoma
C. Small cell carcinoma
D. Small lymphocytic
lymphoma
E. Squamous cell carcinoma
17. A 42-year-old woman
presents with a slowly growing swelling of her left hard palate for 6 months.
She developed difficulty in mastication 2 weeks ago, but denies other symptoms.
Her past medical history is unremarkable. She has a 15 pack-year history of cigarette
smoking, and has been chewing betel nuts since 18. Physical examination reveals
a 1.5 flat firm raised area at the left palate. This lesion has a reddish
surface without ulceration. No lymphadenopathy is noted. Biopsy of the lesion
reveals cords and nests of epithelioid cells with round nuclei and scant
cytoplasm. Focally there are round spaces between these cells. Per
immunohistochemistry studies, these cells are positive for cytokeratin and
negative for CD45 and CD56. Mucin stain is negative. What is most likely
causing her difficulty in mastication?
A. Mandibular damage
B. Masseter inflammation
C. Paraneoplastic syndrome
D. Perineural invasion
E. Temporomandibular joint
damage
18. Use this case for the next three questions. A 56-year-old man
presents with a painless right preauricular mass for 3 months. His past medical
history is unremarkable. He has a 30 pack-year history of cigarette smoking and
alcohol abuse. He is currently seeing counseling for his alcohol addiction. Physical
examination reveals a vague firm mass in his right face. Image studies reveals
a 2.1 cm well defined parotid mass. A 0.5 cm lymph node is noted at the right
inferior parotid edge. Biopsy of the parotid mass reveals sheets of cells with
basophilic granular cytoplasm and small round nuclei. Per immunohistochemistry
studies, these cells are positive for cytokeratin and alpha amylase, but
negative for CD56. Mucin stain is negative. What is most likely the diagnosis?
A. Acinic cell carcinoma
B. Adenoid cystic carcinoma
C. Carcinoid
D. Mucoepidermoidl carcinoma
E. Small cell carcinoma
19. A 56-year-old man
presents with a painless right preauricular mass for 3 months. His past medical
history is unremarkable. He has a 30 pack-year history of cigarette smoking and
alcohol abuse. He is currently seeing counseling for his alcohol addiction.
Physical examination reveals a vague firm mass in his right face. Image studies
reveals a 2.1 cm well defined parotid mass. A 0.5 cm lymph node is noted at the
right inferior parotid edge. Biopsy of the parotid mass reveals sheets of cells
with basophilic granular cytoplasm and small round nuclei. Per
immunohistochemistry studies, these cells are positive for cytokeratin and
alpha amylase, but negative for CD56. Mucin stain is negative. What additional
marker is likely to be positive for these cells?
A. Alpha-1-antichymotrypsin
B. Chromogranin
C. CD20
D. IgG4
E. P53
20. A 13-year-old boy
presents with a nodular mass on his lower lip for 6 months. He denies other
symptoms. His past medical history is unremarkable. Physical examination
reveals a dark red firm mass at the left lower lip. The surface mucosa appear
to be normal. No lymphadenopathy is noted. Image studies reveals a 0.9 cm well
defined mass. The mass is removed. Microscopically it has sheets of cells with
abundant basophilic granular cytoplasm. Focally there small round spaces
between these cells. Per immunohistochemistry, these cells are positive for
alpha-1-antichymotrypsin and cytokeratin. What is most likely the diagnosis?
A. Acinic cell carcinoma
B. Adenoid cystic carcinoma
C. Mucoepidermoid carcinoma
D. Ranula
E. Small cell carcinoma
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