OTORRINO - SEMINAR 12 — SALIVARY GLAND TUMORS

[PRACTICE] — Major salivary glands and their ducts Which association between a major salivary gland and its duct is CORRECT? A. Parotid gland — Wharton's duct opening at the sublingual caruncle B. Submandibular gland — Stensen's duct opening opposite the upper second molar C. Parotid gland — Stensen's duct opening opposite the upper second molar D. Sublingual gland — Eustachian tube opening into the nasopharynx.

[PRACTICE] — Facial nerve and parotid anatomy Which statement about the facial nerve and parotid gland is CORRECT? A. The facial nerve does not pass through the parotid gland. B. The facial nerve traverses the parotid, separates its superficial and deep surgical compartments, and must be assessed before surgery. C. The facial nerve supplies the principal parasympathetic secretomotor innervation to the parotid gland. D. The optic nerve separates the superficial and deep lobes of the parotid.

[RECONSTRUCTED] — Greatest absolute number of malignant salivary tumors Which salivary gland accounts for the greatest absolute number of malignant salivary gland tumors? A. Sublingual gland B. Submandibular gland C. Parotid gland D. Minor salivary glands exclusively.

[PRACTICE] — Highest probability of malignancy Which salivary gland has the highest approximate proportion of malignant tumors according to the lecture? A. Parotid gland B. Sublingual gland C. Submandibular gland D. All glands have identical malignant proportions.

[RECONSTRUCTED] — Sialolithiasis and mealtime syndrome A patient develops recurrent painful swelling of a submandibular gland during eating. What is the most likely diagnosis? A. Sialolithiasis B. Pleomorphic adenoma C. Warthin tumor D. Salivary duct carcinoma.

[RECONSTRUCTED] — Ranula What is a ranula? A. A malignant tumor of the parotid gland B. A congenital thyroid remnant C. A mucus extravasation pseudocyst arising from the sublingual gland D. A peritonsillar abscess.

[PRACTICE] — Non-neoplastic salivary swelling Which combination correctly matches causes of salivary gland swelling with their typical manifestations? A. Sialolithiasis — mealtime swelling; bacterial sialadenitis — pain and possible purulent duct discharge; Sjögren disease — xerostomia and dry eyes B. Sialolithiasis — facial nerve paralysis in every patient; Sjögren disease — isolated otosclerosis C. IgG4-related disease — exclusively malignant parotid carcinoma; sialadenitis — always painless D. All persistent salivary swelling represents malignancy.

[RECONSTRUCTED] — Malignancy warning signs Which clinical finding is particularly suspicious for malignancy in a parotid mass? A. Stable size over several years B. Freely mobile painless nodule C. New ipsilateral facial nerve weakness D. Slowly enlarging mass without neurological symptoms.

RECONSTRUCTED] — Benign versus malignant clinical patterns Which finding is LEAST suggestive of parotid malignancy? A. Facial paralysis B. Rapid enlargement C. Fixed painful mass D. Long-standing slow growth without neurological symptoms.

[PRACTICE] — Complete clinical assessment Which combination represents the appropriate clinical examination of a patient with a persistent salivary gland mass? A. Assessment of mass size, mobility, skin, oral mucosa, facial nerve, cervical lymph nodes and previous cutaneous malignancies B. Audiometry alone C. Examination of the vocal folds only D. Assessment of blood pressure without head and neck examination.

[PRACTICE] — WHO versus Milan versus TNM Which classification is used to define the histological type of a salivary gland tumor? A. WHO classification B. Milan category alone C. Cervical lymph node level classification D. Glasgow Coma Scale.

[RECONSTRUCTED] — Most common parotid tumor Which is the most common neoplasm of the parotid gland? A. Adenoid cystic carcinoma B. Warthin tumor C. Pleomorphic adenoma D. Salivary duct carcinoma.

[RECONSTRUCTED] — Treatment of pleomorphic adenoma What is the preferred treatment for a fit patient with a confirmed pleomorphic adenoma of the parotid gland? A. Simple enucleation without surrounding tissue B. Appropriate complete surgical excision while preserving an uninvolved facial nerve C. Chemotherapy alone D. Observation in every patient.

[PRACTICE] — Warthin tumor Which benign salivary gland tumor is strongly associated with smoking and may be bilateral or multifocal? A. Pleomorphic adenoma B. Warthin tumor C. Neurofibroma D. Lipoma.

[PRACTICE] — Pleomorphic adenoma versus Warthin tumor Which statement correctly distinguishes pleomorphic adenoma from Warthin tumor? A. Pleomorphic adenoma is usually treated by simple enucleation, while Warthin tumor always requires radical parotidectomy. B. Pleomorphic adenoma often requires complete excision due to recurrence risk, whereas selected confidently diagnosed Warthin tumors may be monitored. C. Pleomorphic adenoma is strongly associated with smoking, while Warthin tumor never occurs in smokers. D. Warthin tumor always causes facial nerve paralysis.

[PRACTICE] — Mucoepidermoid carcinoma Which cell populations are characteristic of mucoepidermoid carcinoma? A. Mucous, epidermoid and intermediate cells B. Melanocytes and osteocytes C. Adipocytes exclusively D. Neurons and glial cells.

PRACTICE] — Adenoid cystic carcinoma Which salivary gland carcinoma is particularly associated with perineural invasion? A. Warthin tumor B. Pleomorphic adenoma C. Adenoid cystic carcinoma D. Oncocytoma.

[PRACTICE] — Carcinoma ex pleomorphic adenoma A patient has had a painless parotid mass for several years. During the last two months, the mass has enlarged rapidly and is now associated with pain and ipsilateral facial weakness. Which diagnosis is particularly concerning? A. Stable Warthin tumor B. Carcinoma ex pleomorphic adenoma C. Normal parotid tissue D. Uncomplicated otosclerosis.

[PRACTICE] — Secretory carcinoma and molecular pathology Which molecular alteration is characteristically associated with salivary secretory carcinoma? A. BCR::ABL1 B. PML::RARA C. ETV6::NTRK3 D. JAK2 V617F.

[PRACTICE] — Primary versus secondary parotid malignancy A patient with a history of cutaneous squamous cell carcinoma of the face develops a new parotid mass. Which diagnosis must be considered? A. Metastasis to an intraparotid lymph node B. Benign sialolithiasis in every case C. Normal enlargement of the gland with age D. Otosclerosis.

[PRACTICE] — First-line imaging Which is commonly the first imaging examination for a superficial parotid mass? A. Ultrasound B. Electroencephalography C. Pure-tone audiometry D. Spirometry.

[PRACTICE] — MRI versus CT Which imaging method is particularly useful for evaluating suspected perineural spread of salivary carcinoma? A. Tympanometry B. MRI C. Pure-tone audiometry D. Standard chest radiography alone.

[PRACTICE] — Fine-needle aspiration and core biopsy Which statement about tissue sampling of salivary gland masses is CORRECT? A. An inadequate FNA specimen establishes a benign diagnosis. B. Image-guided FNA is commonly used initially; core needle biopsy may be useful when more tissue is needed. C. Open parotid biopsy is always the preferred first investigation. D. FNA replaces all imaging and always establishes the definitive histological grade.

[PRACTICE] — Milan category I What does Milan category I indicate? A. Benign pleomorphic adenoma B. Non-diagnostic cytology C. Confirmed malignant carcinoma D. Regional lymph node metastasis.

[PRACTICE] — Milan IVb and the significance of SUMP Which Milan category indicates a salivary gland neoplasm of uncertain malignant potential (SUMP)? A. II B. III C. IVa D. IVb.

[PRACTICE] — Primary tumor staging According to the simplified TNM9 system in the lecture, a 3 cm major salivary gland carcinoma without gross extraparenchymal extension corresponds to: A. T1 B. T2 C. T3 D. T4b.

[PRACTICE] — N staging, distant metastases and stage groups According to the simplified TNM9 tables in the seminar, which statement is CORRECT? A. N0 indicates more than three metastatic lymph nodes. B. N1 indicates one to three involved nodes without extranodal extension; M1 indicates distant metastasis. C. M0 indicates confirmed distant metastasis. D. Stage IV is assigned to every T1 N0 M0 tumor.

[PRACTICE] — Slowly growing parotid lump A 42-year-old patient has a mobile, painless parotid mass that has slowly enlarged over 18 months. Facial nerve function is normal and no suspicious cervical lymph nodes are palpable. What is the most appropriate next step? A. Assume it is benign and discharge without investigation. B. Perform total parotidectomy immediately without diagnostic assessment. C. Document facial nerve function, perform ultrasound and consider image-guided FNA. D. Begin chemotherapy without obtaining a tissue diagnosis.

[PRACTICE] — Rapidly changing parotid mass A 68-year-old patient has had a parotid mass for several years. It enlarges rapidly over two months, becomes painful and causes new facial weakness. Which management is most appropriate? A. Reassure the patient because long-standing parotid masses cannot become malignant. B. Urgent specialist assessment, MRI when nerve involvement is suspected, tissue diagnosis and oncological staging. C. Treat solely with salivary gland massage. D. Delay investigation until the facial weakness becomes bilateral.

[RECONSTRUCTED] — Extent of parotid surgery Which statement regarding parotid tumor surgery is CORRECT? A. Every parotid tumor requires complete removal of the gland and facial nerve. B. All parotid tumors can be simply enucleated. C. The extent of resection depends on tumor histology, size, location and facial nerve involvement. D. Parotid surgery never risks facial paralysis.

[PRACTICE] — ESGS anatomical classification In the European Salivary Gland Society (ESGS) classification, which levels correspond to the superficial parotid compartment? A. I–II B. III–IV C. IV–V D. III–V.

[PRACTICE] — Oncological treatment principles Which statement best reflects the surgical treatment principles for malignant salivary gland tumors? A. Every malignant tumor requires facial nerve sacrifice, regardless of nerve involvement. B. Surgical management aims for clear margins, preservation of uninvolved facial nerve tissue where feasible, and appropriate treatment of involved cervical lymph nodes. C. Cervical lymph nodes are irrelevant to salivary carcinoma treatment. D. A positive surgical margin is always acceptable because salivary carcinomas never recur.

[PRACTICE] — Indications for postoperative radiotherapy Which histopathological finding may support postoperative radiotherapy after surgery for salivary carcinoma? A. High-grade malignancy B. Positive surgical margins C. Perineural invasion D. All of the above.

[PRACTICE] — Frey syndrome What is Frey syndrome after parotid surgery? A. Permanent anosmia B. Gustatory sweating and flushing over the parotid region C. Bilateral vocal-fold paralysis D. Inner-ear vertigo.

[PRACTICE] — Long-term follow-up and recurrence Which statement about follow-up after treatment of salivary gland tumors is CORRECT? A. Follow-up is unnecessary after histological diagnosis. B. Pleomorphic adenoma can never recur after incomplete excision. C. Adenoid cystic carcinoma cannot produce distant metastases after several years. D. Long-term monitoring should consider tumor histology, surgical margins, facial nerve function, wound healing and the risk of late recurrence.