Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Review Question - QID 109323

In scope icon M 1 D
QID 109323 (Type "109323" in App Search)
A 62-year-old female presents to her primary care provider complaining of a mass near her right jaw. She reports that the mass is painless and has grown very slowly over the past six months. She initially did not see a physician due to being very busy at her work as a lawyer. However, she reports that she noticed some right-sided facial weakness in the past week which prompted her to visit the physician. Her past medical history is notable for Hodgkins lymphoma as a child which required radiation therapy to the neck. She has a 20 pack-year smoking history and drinks alcohol socially. Her temperature is 98.6°F (37°C), blood pressure is 120/85 mmHg, pulse is 85/min, and respirations are 18/min. Physical examination reveals a painless firm mass at the angle of the right jaw. There is also a small palpable firm mass beneath the floor of the mouth. A right facial droop along with an inability to elevate her right eyebrow is noted. A biopsy of one of this lesion would most likely reveal which of the following?

Cystic configurations of anaplastic squamous and mucoid cells

29%

114/394

Non-infiltrative clusters of epithelial and mesenchymal cells

11%

42/394

Epithelial cells with dense lymphoid stroma and germinal centers

35%

138/394

Large basophilic binucleate cells

15%

60/394

Uniform spindle cells with scant cytoplasm and cigar-shaped nuclei

8%

32/394

Select Answer to see Preferred Response

bookmode logo Review TC In New Tab

The patient in this vignette presents with multiple painless firm masses arising from the parotid and submandibular glands with abnormal cranial nerve VII function. This presentation is suggestive of a malignant mucoepidermoid carcinoma which is characterized on histology by mucoid (muco) and squamous (epidermoid) cells.

Mucoepidermoid carcinomas are the most common malignant tumors and most common radiation-induced tumors of the salivary glands. They typically affect the parotid gland and therefore may involve the facial nerve (CN VII) which passes through the parotid gland. In this patient, signs of cranial nerve palsy and multi-glandular involvement suggest that the underlying process is likely malignant. Histologically, mucoepidermoid carcinoma is often infiltrative with bland nuclei.

Illustration A demonstrates the characteristic histologic appearance of mucoepidermoid carcinomas as seen on fine needle aspiration. Note the intermixed squamous and mucoid cells.

Incorrect Answers:
Answer 2: Pleomorphic adenoma is the most common benign salivary tumor and is characterized histologically by encapsulated clusters of epithelial and mesenchymal cells.

Answer 3: Warthin’s tumor arises from lymphoid tissue in the salivary glands and is therefore composed of epithelial cells and lymphoid tissue. It is the second most common benign salivary tumor after pleomorphic adenoma and is frequently bilateral.

Answer 4: Reed-Sternberg cells are large basophilic binucleate cells (owl’s eye appearance) that are pathognomonic for Hodgkin lymphoma. Despite the early history of Hodgkin lymphoma in this patient, the presentation of a mass at the angle of the jaw with cranial nerve involvement is more characteristic of a malignant salivary gland tumor.

Answer 5: Schwannomas are tumors arising from Schwann cells. They are characterized histologically by uniform spindle cells with scant cytoplasm.

Bullet Summary:
Mucoepidermoid carcinomas are the most common malignant tumors of the salivary gland that are characterized by biphasic populations of mucoid and squamous cells.

ILLUSTRATIONS:
Authors
Rating
Please Rate Question Quality

2.8

  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon

(4)

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options