Head and neck tumours: recurrent pleomorphic adenoma: practice question

A ENT question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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ENT · Head and neck tumours: recurrent pleomorphic adenoma

Sample item

A 40-year-old has several separate firm nodules in the parotid bed eight years after enucleation of a parotid lump. Facial function is normal. What best explains the recurrence?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Capsule defects with pseudopod-like extensions left or spilled

The capsule of a pleomorphic adenoma is often incomplete and the tumour sends pseudopod-like extensions through it. Enucleation leaves tumour behind or spills it, producing multinodular recurrence years later. The standard operation is superficial parotidectomy with a cuff of normal tissue. Malignant transformation would cause rapid growth and facial weakness.

Option by option

  • A. Capsule defects with pseudopod-like extensions left or spilled (correct)

    Correct. Capsular defects and pseudopods explain multinodular recurrence after enucleation.

  • B. Regrowth of normal serous acini after surgery

    Normal acini do not regrow into nodules.

  • C. Malignant change to a carcinoma ex pleomorphic adenoma

    Malignant change gives rapid growth, pain or facial palsy rather than slow multiple nodules.

  • D. Reactive enlargement of intraparotid lymph nodes

    Reactive nodes would not give multiple recurrent nodules years after surgery.

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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Questions about this ENT question

What is the answer to this ENT question?

The best answer is A, Capsule defects with pseudopod-like extensions left or spilled. The capsule of a pleomorphic adenoma is often incomplete and the tumour sends pseudopod-like extensions through it.

Why is "Regrowth of normal serous acini after surgery" not the answer?

Normal acini do not regrow into nodules.

Why is "Malignant change to a carcinoma ex pleomorphic adenoma" not the answer?

Malignant change gives rapid growth, pain or facial palsy rather than slow multiple nodules.

Why is "Reactive enlargement of intraparotid lymph nodes" not the answer?

Reactive nodes would not give multiple recurrent nodules years after surgery.

What concept does this question test?

It tests Head and neck tumours: recurrent pleomorphic adenoma in ENT. Enucleation leaves tumour behind or spills it, producing multinodular recurrence years later. The standard operation is superficial parotidectomy with a cuff of normal tissue. Malignant transformation would cause rapid growth and facial weakness.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Head and neck tumours: recurrent pleomorphic adenoma?

Learn tuning fork results and audiogram patterns by sketching them. Then use the flashcards and the other ENT questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.