Surgery MCQs Q14

FreeMedSite

ENT • SURGERY • PATHOLOGY

A 42-year-old woman presents with a slow-growing, painless swelling in the region of the parotid gland. The mass is firm, mobile, and has been increasing gradually over several years. Imaging shows a well-defined lesion in the superficial lobe of the parotid gland.

Which of the following statements regarding this tumor is correct?

A More common in submandibular gland than parotid

B Most common salivary gland tumor

C More common in males than females

D In parotid, commonly arises medial to facial nerve

B. Most common salivary gland tumor. The clinical description matches a Pleomorphic Adenoma (Benign Mixed Tumor), which is the most frequent tumor of both the parotid gland and salivary glands in general.

Decoding the Stem

1

CLUE "Slow-growing, painless, firm, mobile"

TRANS Suggests a benign neoplasm rather than an inflammatory process or malignancy.

2

CLUE "Superficial lobe of parotid"

TRANS Points to Pleomorphic Adenoma, the most common parotid tumor (80% occur here).

Explanation

B. Most common salivary gland tumor: Correct. Pleomorphic adenoma accounts for approximately 60-70% of all salivary gland tumors and 80% of parotid tumors.

A. Submandibular vs Parotid: Incorrect. Salivary tumors follow the "80% rule": 80% are in the parotid, 80% of those are pleomorphic adenomas, and 80% are benign.

C. Males vs Females: Incorrect. There is a slight female predominance (approx 2:1 or 3:2).

D. Relation to Facial Nerve: Incorrect. Most parotid tumors arise in the superficial lobe, which is lateral to the facial nerve. The nerve is the landmark separating the lobes.

🧠 High-Yield Pearls

Feature	Description	Key Fact
Histology	"Mixed Tumor"	Epithelial + Myxoid/Chondroid stroma
Transformation	Carcinoma ex-PA	Risk of malignancy in long-standing cases
Treatment	Superficial Parotidectomy	Enucleation leads to high recurrence

Integrated Clinical Questions

1. Most common malignant salivary gland tumor?

Answer: Mucoepidermoid carcinoma.

2. What nerve is at risk in parotid surgery?

Answer: The Facial Nerve (CN VII) and its five terminal branches.

3. Why is pleomorphic adenoma called “mixed tumor”?

Answer: It contains both epithelial components and mesenchymal-like stroma (chondroid or myxoid).

4. Complication of long-standing untreated tumor?

Answer: Malignant transformation into "Carcinoma ex Pleomorphic Adenoma" (sudden rapid growth).

⚡ Exam Pearls

• Parotid is the most common site for salivary tumors (~80%).
• Slow + Painless + Mobile = Benign.
• Rapid growth + Pain + Nerve Palsy = Malignant.
• Warthin tumor is the 2nd most common benign tumor (usually in males, smokers, often bilateral).

← Previous Question Next Question →

FreeMedSite • Open Medical Education