Pathology Quiz questions, Last year's exam, Case Examples with Differentials

Terms in this set (77)

Pleomorphic adenoma



-Most commonly seen in parotid gland - 50-77%
-Most commonly seen intraorally on the palate
Most common salivary gland neoplasm overall and in children?
Warthin Tumor
Second most common benign parotid tumor?
Warthin Tumor and Secretory Carcinoma
Two tumors with male predilection?
Mucoepidermoid carcinoma



-Also most common malignant salivary gland tumor in children
-Most common in parotid gland
-Most common salivary gland tumor in lower lip, floor of mouth, tongue, retromolar pad areas (but rare for patient to get it in these locations)
-Second most common location is minor salivary glands, especially on palate
Most common salivary gland malignancy?
Intraosseous mucoepidermoid carcinoma
Most common intraosseous salivary gland tumor?
Adenoid cystic carcinoma
Most common malignancy of submandibular gland?
Fibroma



-Buccal mucosa along occlusal plane is the most common location
Most common "tumor" of oral cavity?
Neurofibroma
Most common neoplasm of peripheral nerves?
Hemangioma of infancy
Most common tumor in infancy?
Rhabdomyosarcoma
Most common soft tissue sarcoma of childhood and adolescence?
Salivary gland aplasia
Differential Diagnosis:

Variant of normal
-Congenital?
Bacterial sialadenitis
Differential Diagnosis:

Reactive
-Infectious?
Necrotizing sialometaplasia
Differential Diagnosis:

Reactive
-Physical/Chemical injury?
Sjogren syndrome
Differential Diagnosis:

Reactive
-Immune-mediated?
Neonatal hemochromatosis
Differential Diagnosis:

Metabolic
-Developmental?
Pleomorphic adenoma
Differential Diagnosis:

Neoplastic
-Benign?
Mucoepidermoid carcinoma
Differential Diagnosis:

Neoplastic
-Malignant?
Mucoepidermoid carcinoma
This histopathological image is from the patient case in the assigned reading. What is the diagnosis?

A) Osteosarcoma
B) Pleomorphic adenoma
C) Fibroma
D) Mucoepidermoid carcinoma
Resection
Which of the following likely represents the most appropriate management once a diagnosis mucoepidermoid carcinoma has been established?

A) Incisional biopsy
B) Excisional biopsy
C) Resection
D) Clinical observation
Benign neoplastic entity
The pleomorphic adenoma represents a:

A) Reactive entity
B) Benign neoplastic entity
C) Malignant neoplastic entity
D) Infectious process
Canalicular adenoma
Pleomorphic adenoma
Mucoepidermoid carcinoma
Pleomorphic adenoma
49 year old male
Mass of upper lip, present 3 years

Differential Diagnosis?
Mucoepidermoid carcinoma
65 year old female
Asymptomatic swelling of soft palate, present a couple months

Differential Diagnosis?
Canalicular adenoma
53 year old male
Mass of palate, 3 years duration, recent onset slight discomfort

Differential Diagnosis?
Acinic Cell Carcinoma
50 year old male
Mass of upper lip, present 6 months

Differential Diagnosis?
100%
The five-year survival related to a diagnosis of appropriately-managed pleomorphic adenoma is most likely:

A) 10%
B) 30%
C) 50%
D) 70%
E) 100%
Mucoepidermoid carcinoma
Each of the following malignancies have a marked propensity for neural invasion, EXCEPT one. Which one is the EXCEPTION?

A) Polymorphous adenocarcinoma
B) Mucoepidermoid carcinoma
C) Adenoid cyst carcinoma
Mucoepidermoid carcinoma
The most common neoplastic salivary entity in this location is (a/the):

A) Pleomorphic adenoma
B) Canalicular adenoma
C) Mucoepidermoid carcinoma
D) Mucocele
S. aureus
Which organism is most commonly implicated in the development of acute sialadenitis?

A) S. pyogenes
B) F. nucleatum
C) A. israelii
D) S. aureus
E) L. acidophilus
Autoimmunity
Sjogren's syndrome is caused by:

A) S. Aureus
B) Trauma
C) Autoimmunity
D) Sialithiasis
Pyogenic granuloma
Epithelial
Fibroma
Hint: Right buccal mucosa
All of the above
1. Color: Erythematous
2. Surface Texture: Smooth
3. Lesion Type: Nodule
4. Size: 0.7 by 0.7
5. Location: Buccal gingiva

Three part differential diagnosis
Pyogenic granuloma
Peripheral giant cell granuloma
Peripheral ossifying fibroma


Extra diagnosis*
Parulis
Fibroma
Port wine stain
Papillary
Right Dorsal of the tongue
0.5 by 0.5
Normal mucosa color

Differential Diagnosis:
Giant Cell Fibroma
Fibroma
Neurofibroma
Granular cell tumor
Traumatic neuroma
Pyogenic granuloma
Diagnosis:

Neurofibromatosis 1
95% diagnosed ~10 years of age
Main Concern: Malignant peripheral nerve sheath tumor
Description:
1. Color: Yellow-White, Erythematous
2. Surface Texture: Smooth
3. Lesion Type: Nodule
4. Size: 1.5 by 1.0
5. Location: Upper right alveolar ridge


Differential Diagnosis:
Pyogenic granuloma
Peripheral Giant Cell granuloma
Peripheral Ossifying fibroma
Fibroma

Next Step:
Take a bio
Diagnosis:
Peripheral Giant Cell Granuloma
Description:
1. Color: Blue/Black
2. Surface Texture: Smooth
3. Lesion Type: Multi-Nodular Mass
4. Size: 2 by 4
5. Location: Anterior gingiva of the Mandible


Differential Diagnosis:
Melanoma
Karposi Sarcoma
Pyogenic granuloma
Peripheral Giant Cell granuloma
Peripheral ossifying fibroma

Next Step:
Biopsy
Male, 58 years

CC: I have a sore in my mouth.
Description:
1. Color: Mucosa colored
2. Surface Texture: Smooth
3. Lesion Type: Sessile Nodule
4. Size: 1.0 by 1.0
5. Location: Labial mucosa


Differential Diagnosis:
Mucocele
Fibroma
Lipoma
Mucoepidermoid Carcinoma

Next Step:
Biopsy
Squamous cell carcinoma
Which of the following do NOT belong on the differential diagnosis?

A) Mucocele
B) Pyogenic granuloma
C) Squamous cell carcinoma
D) Mucoepidermoid carcinoma
Description:
1. Color: Mucosa colored
2. Surface Texture: Smooth
3. Lesion Type: Sessile Papule
4. Size: 0.4 by 0.4
5. Location: Labial mucosa


Differential Diagnosis:
Fibroma
Lipoma
Mucocele

Next Step:
Biopsy
Buccal frenum
Carcinoma ex pleomorphic adenoma
Which of the following is the most common of the tumors classified as malignant mixed tumors?

A) Mucoepidermoid carcinoma
B) Carcinosarcoma
C) Metastasizing mixed tumor
D) Carcinoma ex pleomorphic adenoma
A and C only





A radiolucency at the apex of the nearest tooth

The nearest tooth is non-vital
Palate


Parotid is NOT considered as intraoral
Warthin tumor
Upper Lip
Mucoepidermoid carcinoma
Palate
Palate
Adenoid cystic carcinoma
Arteriovenous malformations
Mandible compared to the maxilla
Dermal capillary malformations
Scalp
Vascular tissues
Metabolic
Reactive
Neoplastic
C and D




Polymorphous adenocarcinoma

Adenoid cystic carcinoma
Which of the following tumors is/are likely to be associated with patient complaints of pain?

A) Low-grade mucoepidermoid carcinoma
B) Secretory carcinoma
C) Polymorphous adenocarcinoma
D) Adenoid cystic carcinoma
E) A and D
F) B and D
G) C and D
Carcinoma ex pleomorphic adenoma
Of the following tumors, which usually has the worst prognosis?

A) Polymorphous adenocarcinoma
B) Acinic cell carcinoma
C) Carcinoma ex pleomorphic adenoma
D) Secretory carcinoma
Canalicular adenoma
Which of the following would you be least likely to include on the differential diagnosis for a unilateral swelling of the parotid gland in a 60 year old female?

A) Warthin tumor
B) Mucoepidermoid carcinoma
C) Pleomorphic adenoma
D) Canalicular adenoma
Sialadenoma papilliferum
Which of the following is the most likely to clinically resemble a squamous papilloma?

A) Papillary cystadenoma
B) Sialadenoma papilliferum
C) Intraductal papilloma
D) Inverted ductal papilloma
A and B




There is a female predilection

Most cases affect the bilateral parotid glands
Which of the following is false regarding Warthin tumor?

A) There is a female predilection
B) Most cases affect the bilateral parotid glands
C) Linked with smoking
D) Presents clinically as a slow growing, painless mass
E) A and B
F) A and C
G) B and C
H) B and D
Both statements are true
Statement 1: the typical appearance of pleomorphic is a smooth-surfaced submucosal mass.

Statement 2: Myoepithelioma is considered to be on the spectrum of pleomorphic adenoma
Palate
Which intraoral site is most commonly affected by salivary gland tumors?

A) Buccal mucosa
B) Palate
C) Tongue
D) Upper lip
Parotid > Minor glands > Submandibular > Sublingual
For salivary gland tumors overall, which of the following correctly ranks the glands involved from most to least common?

A) Sublingual > Submandibular > Minor glands > Parotid
B) Parotid > Minor glands > Submandibular > Sublingual
C) Parotid > Submandibular > Minor glands > Sublingual
D) Parotid > Submandibular > Sublingual > Minor glands
There is variability in the histopathologic appearance
What do the terms, "pleomorphic adenoma" and "benign mixed tumor" imply about the lesion which they describe?

A) The presence of pleomorphic cells within the lesion
B) The lesion is derived from multiple germ layers
C) There is variability in the histopathologic appearance
D) The lesion tends to be locally aggressive
Acute sialadenitis
Which of the following conditions is associated with a purulent exudate?

A) Sialorrhea
B) Acute sialadenitis
C) Necrotizing sialometaplasia
D) Ranula
Lower lip is the most common site
Which of the following is true of a mucocele?

A) "Popping" the lesion is definitive treatment and recurrence is unlikely
B) Always look blue through the mucosa
C) Lower lip is the most common site
D) Uncommon in children
Muscular dystrophy
Which of the following is not associated with a true sialorrhea?

A) Heavy-metal poisoning
B) Rabies
C) Cholinergic medications to treat dementia or myasthenia gravis
D) Muscular dystrophy
Occurs most often on the palate
The histology report issued for a biopsy you submitted reads: "There is an increase in the number of normal acini expected in this region". Which of the following statements is true of the lesion this report describes?

A) Occurs most often on the palate
B) Occurs most often in the parotid gland
C) Presents as a "leafless tree" on sialography
D) Associated with eating disorders
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