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Pathology · Neoplasia: salivary gland tumours
Sample itemA 45-year-old woman had enucleation of a painless parotid mass that had grown slowly for five years. Histology showed epithelial and myoepithelial cells in a chondromyxoid stroma. Two years later she has multiple recurrent nodules in the operative bed. What is the best explanation?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
A. Tumour projections through an incomplete pseudocapsule were left behind
Pleomorphic adenoma is the commonest salivary gland tumour. Its capsule is thin or incomplete and tumour pseudopods extend beyond it, so enucleation leaves tumour and causes multinodular recurrence. Superficial parotidectomy with facial nerve preservation is the standard operation.
Option by option
A. Tumour projections through an incomplete pseudocapsule were left behind (correct)
Incomplete capsule with pseudopodia explains recurrence after enucleation of a pleomorphic adenoma.
B. Perineural spread typical of adenoid cystic carcinoma
Adenoid cystic carcinoma has a cribriform pattern and is a different tumour from the one described.
C. Multifocal origin from intraparotid lymph nodes
Intraparotid lymph node origin is associated with Warthin tumour, not pleomorphic adenoma.
D. Haematogenous seeding from a distant primary
Pleomorphic adenoma is a primary parotid neoplasm and is not a metastasis from elsewhere.
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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