Submandibular Gland Carcinoma — ORE Part 1 MCQ

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HardOral MedicineSubmandibular Gland CarcinomaORE Part 1

An adult has a unilateral submandibular-gland mass that has enlarged over 6 weeks. It is hard and fixed on palpation. There is reduced sensation in the ipsilateral lingual-nerve distribution. Which diagnosis is most likely?

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Correct answer: E — Adenoid cystic carcinoma

The best answer is **adenoid cystic carcinoma**. A hard, fixed and progressively enlarging gland mass is concerning for invasive malignancy. The decisive feature is ipsilateral lingual-nerve sensory loss, which suggests perineural tumour invasion; adenoid cystic carcinoma has a particularly strong propensity for perineural spread and is the commonest malignant tumour of the submandibular gland. Obstructive sialolithiasis usually causes intermittent meal-related pain and swelling, rather than a fixed mass with neuropathy. Acute bacterial sialadenitis is typically tender, inflammatory and may produce purulent discharge. Pleomorphic adenoma is generally a slow-growing, painless, mobile benign mass without neurological deficit. Reactive lymphadenopathy does not explain a fixed submandibular-gland mass with lingual paraesthesia. In UK practice, a persistent unexplained neck mass merits suspected-cancer-pathway referral.

Reference: da Silva LP, Serpa MS, Viveiros SK et al. Clinicopathological characteristics and perineural invasion in adenoid cystic carcinoma: a systematic review. Brazilian Journal of Otorhinolaryngology. 2015. https://pubmed.ncbi.nlm.nih.gov/25962319/