Surgery MCQs Q14

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SURGERY • HEAD & NECK

A 45-year-old woman presents with a slow-growing, painless swelling in the parotid region that has been present for several years. On examination, the mass is firm, mobile, and non-tender. Imaging suggests a well-circumscribed salivary gland tumor.

Which of the following statements regarding pleomorphic adenoma of the salivary gland is most accurate?

A It is more common in the submandibular gland than in the parotid gland

B It is the most common salivary gland tumor

C It is more common in males than in females

D In the parotid gland it most commonly arises medial to the facial nerve

Pleomorphic adenoma (benign mixed tumor) is the most common salivary gland tumor, representing about 60–70% of all cases. It occurs most frequently in the parotid gland, particularly in the superficial lobe.

Decoding Clue

1

CLUE "Painless swelling... present for several years"

TRANS Points toward a benign, slow-growing tumor rather than an inflammatory process or rapid malignancy.

2

CLUE "Parotid region"

TRANS Statistical likelihood: 80% of parotid tumors are benign, and of those, 80% are pleomorphic adenomas.

Option Analysis

A. Submandibular vs Parotid: Incorrect. The parotid gland is by far the most common site for pleomorphic adenoma.

C. Males vs Females: Incorrect. There is a slight female predominance (approximately 60:40).

D. Relation to Facial Nerve: Incorrect. It most commonly arises in the superficial lobe, which is lateral to the facial nerve.

High-yield

Pleomorphic Adenoma is the "Mixed Tumor" because it contains both epithelial and mesenchymal elements. It is the most common tumor of both major and minor salivary glands.

Relevant Clinical Challenges

Challenge #1: Malignant Change

What is the term for a malignancy arising from a long-standing pleomorphic adenoma?

Answer: Carcinoma ex pleomorphic adenoma.

Challenge #2: Minor Glands

Where is the most common site for pleomorphic adenoma of the minor salivary glands?

Answer: The Hard Palate.

Challenge #3: Surgical Management

What is the preferred surgical treatment for a pleomorphic adenoma of the superficial parotid lobe?

Answer: Superficial parotidectomy (with preservation of the facial nerve).

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