Parotid Carcinoma — ORE Part 1 MCQ

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HardOral MedicineParotid CarcinomaORE Part 1

A 55-year-old man presents with a unilateral parotid swelling that has enlarged rapidly over several weeks. On examination, it is hard and fixed to deep tissues. He has weakness of the facial muscles on the same side. What is the most likely diagnosis?

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Correct answer: D — Parotid carcinoma

Explanation lettering: E = shown as A · A = shown as D · D = shown as E

A is correct. Rapid enlargement, deep fixation and facial nerve weakness are highly suspicious features of a malignant parotid tumour. Facial weakness implies involvement of the nerve within or adjacent to the gland and is particularly concerning for invasive carcinoma. Pleomorphic adenoma is usually a slow-growing, mobile, painless benign mass; a long-standing lesion can undergo malignant transformation, but the diagnosis in this stem is carcinoma rather than the benign precursor. Warthin tumour is also typically benign and mobile, without facial palsy. A parotid abscess would usually cause acute pain, tenderness, systemic upset or purulent salivary discharge. Lymphoepithelial lesions are generally associated with benign inflammatory or autoimmune disease and do not characteristically cause this malignant red-flag triad.

Reference: Wong DSY, Li GKH. Signs and symptoms of malignant parotid tumours: an objective assessment. Hong Kong Medical Journal. 2001. https://pubmed.ncbi.nlm.nih.gov/11329749/