Sialadenosis Diagnosis — ORE Part 1 MCQ

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ModerateOral PathologySialadenosis DiagnosisORE Part 1

A 55-year-old man has progressive, painless bilateral enlargement of the submandibular glands. He has alcohol dependence. Serum amylase is raised, with no other relevant blood-test abnormality. A biopsy shows acinar hypertrophy and fatty stromal change, without inflammation or neoplasia. What is the most likely diagnosis?

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Correct answer: D — Alcohol-related sialadenosis

Alcohol-related sialadenosis is correct. Sialadenosis is a non-neoplastic, non-inflammatory enlargement of major salivary glands, typically painless and bilateral, with acinar hypertrophy. Alcohol dependence is a recognised association, and the absence of inflammation or tumour architecture is decisive. Chronic obstructive sialadenitis would usually show inflammatory and obstructive changes, often with episodic painful swelling. Sjögren syndrome would show focal lymphocytic sialadenitis and is more commonly associated with xerostomia and sicca symptoms. IgG4-related sialadenitis requires a characteristic lymphoplasmacytic infiltrate, typically with fibrosis. Bilateral neoplasia would not produce diffuse acinar hypertrophy without neoplastic histology.

Reference: Wilson KF, Meier JD, Ward PD. Submandibular Sialadenitis and Sialadenosis. StatPearls, updated 2026. https://pubmed.ncbi.nlm.nih.gov/32965882/