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ENT · Salivary glands: carcinoma ex pleomorphic adenoma
Sample itemA 65-year-old woman who has had a slow-growing parotid lump for 30 years notices rapid enlargement, pain and facial weakness. What is the likely explanation?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. Malignant transformation to carcinoma ex pleomorphic adenoma
Long-standing pleomorphic adenomas carry a risk of malignant change, about 1.5 percent in 5 years and 10 percent by 15 years. A sudden growth spurt, pain or facial nerve weakness suggests carcinoma ex pleomorphic adenoma. Treatment is radical parotidectomy with neck dissection and radiotherapy.
Option by option
A. Simple cyst
A cyst does not cause nerve weakness.
B. Acute parotitis
Parotitis presents acutely with fever.
C. Warthin tumour
Warthin tumours do not usually cause facial palsy.
D. Malignant transformation to carcinoma ex pleomorphic adenoma (correct)
Correct. Malignant change is likely after many years.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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