Chapter 07: Neoplasia

Ibsen: Oral Pathology for the Dental Hygienist, 7th Edition

Multiple Choice

1. Which choice represents a characteristic of malignant tumors?

a. Encapsulated b. Ability to spread to distant sites c. Benign d. Cells resemble normal cells

ANS: B

Malignant tumors have the ability to spread to distant sites. Cancer is synonymous with malignancy. Encapsulated is a characteristic of benign rather than malignant tumors. It means the tumor is walled off by surrounding fibrous connective tissue. Sometimes a benign tumor can invade adjacent structures, but it does not have the ability to spread to distant sites. The cells of benign tumors almost always resemble normal cells, whereas malignant tumors vary in their histologic appearance.

REF: Classification of Tumors, page 219

2. Anaplastic means the tumor a. is composed of cells that vary in size and shape. b. has cells with darker nuclei than those of normal cells.

OBJ: 2 c. has cells that exhibit an increased nuclear-to-cytoplasmic ratio. d. does not resemble the tissue from which it was derived.

ANS: D

Anaplastic means the tumor does not resemble the tissue from which it was derived. Pleomorphic means the tumor is composed of cells that vary in size and shape. The nuclei of malignant tumor cells are often hyperchromatic; that is, they are darker than those of normal cells. The nuclei of malignant tumor cells exhibit an increased nuclear-to-cytoplasmic ratio, but anaplastic means the tumor does not resemble the tissue from which it was derived.

REF: Classification of Tumors, page 220

3. A benign tumor of bone is called a(n) a. osteoma. b. osteogenic sarcoma. c. chondroma. d. carcinoma.

ANS: A

OBJ: 1

A benign tumor of bone is called an osteoma. The prefix of the name of a tumor is determined by the tissue or cell of origin. The suffix -oma is used to indicate a tumor. Malignant tumors of epithelium are called carcinomas, and malignant tumors of connective tissue are called sarcomas. Thus a malignant tumor of bone is an osteogenic sarcoma. A chondroma is a benign tumor of cartilage. A carcinoma is a malignant tumor of epithelium.

REF: Name of Tumors, page 220 OBJ: 5 a. benign; salivary gland b. malignant; squamous c. benign; squamous d. malignant; odontogenic

4. A papilloma is a _____ tumor derived from _____ epithelium.

ANS: C

A papilloma is a benign tumor derived from squamous epithelium. Three different types of epithelial tumors occur in the oral cavity: tumors derived from squamous epithelium, tumors derived from salivary gland epithelium, and tumors derived from odontogenic epithelium. A papilloma is a benign tumor derived from squamous rather than salivary gland epithelium. An adenoma is a benign tumor derived from salivary gland epithelium. A papilloma is a benign rather than malignant tumor derived from squamous epithelium. A squamous cell carcinoma is a malignant tumor derived from squamous epithelium. A papilloma is a benign tumor derived from squamous epithelium rather than a malignant tumor derived from odontogenic epithelium.

REF: Papilloma, page 221

OBJ: 5 a. Hard palate b. Buccal mucosa c. Soft palate or tongue d. Retromolar area

5. Where do most cases of papilloma occur?

ANS: C

Most cases of papilloma occur on the soft palate or tongue. The papilloma is a benign tumor that presents as a small, exophytic, pedunculated, or sessile growth. These tumors are composed of numerous papillary projections that may either be white or the color of normal mucosa. The more keratin, the whiter the lesion appears clinically. Most cases of papilloma occur on the soft palate or tongue rather than the hard palate. Most cases of papilloma occur on the soft palate or tongue rather than the buccal mucosa. Most cases of papilloma occur on the soft palate or tongue rather than the retromolar area.

REF: Papilloma, page 221 OBJ: 5

6. Idiopathic leukoplakia a. is a malignant lesion of the oral mucosa. b. can be rubbed off with gauze squares. c. is caused by direct irritation, as in tobacco pouch keratosis. d. does not have a specific known cause.

ANS: D

Idiopathic leukoplakia does not have a specific known cause. Idiopathic leukoplakia is considered a premalignant rather than malignant lesion. Leukoplakia cannot be rubbed off and cannot be diagnosed as a specific disease. Most leukoplakias are the result of hyperkeratosis or a combination of epithelial hyperplasia and hyperkeratosis. Idiopathic leukoplakia does not have a specific known cause.

REF: Leukoplakia, page 221 OBJ: 3

7. An intraoral mucosal lesion that shows a mixture of red and white areas is termed a. erythroplakia. b. speckled erythroplakia. c. speckled leukoplakia. d. leukoplakia.

ANS: C

An intraoral mucosal lesion that shows a mixture of red and white areas is generally called speckled leukoplakia. An intraoral mucosal lesion that shows a mixture of red and white areas is generally called speckled leukoplakia rather than erythroplakia. An intraoral mucosal lesion that shows a mixture of red and white areas is generally called speckled leukoplakia rather than speckled erythroplakia. An intraoral mucosal lesion that shows a mixture of red and white areas is generally called speckled leukoplakia rather than simply leukoplakia.

REF: Erythroplakia, page 223 OBJ: 3 a. Most cases of erythroplakia occur on the buccal mucosa and vestibule. b. Erythroplakia is more common than leukoplakia. c. When examined microscopically, 90% of cases of erythroplakia demonstrate epithelial dysplasia or squamous cell carcinoma. d. Erythroplakia is considered a less serious clinical finding than leukoplakia.

8. Which statement about erythroplakia is true?

ANS: C

When examined microscopically, 90% of cases of erythroplakia demonstrate epithelial dysplasia or squamous cell carcinoma. Most cases of erythroplakia occur in the floor of the mouth, tongue, and soft palate. Erythroplakia is much less common than leukoplakia. Erythroplakia is considered a more serious clinical finding than leukoplakia. A biopsy must be performed to establish a definitive diagnosis.

REF: Erythroplakia, page 223 OBJ: 3 a. It is considered a malignant condition. b. Unlike squamous cell carcinoma, cellular changes in epithelial dysplasia may revert to normal if the stimulus, such as tobacco smoking, is removed. c. It presents clinically as an erythematous lesion and not a white lesion (leukoplakia). d. Lesions often arise on the hard and soft palate.

9. Which statement about epithelial dysplasia is true?

ANS: B

Unlike squamous cell carcinoma, cellular changes in epithelial dysplasia may revert to normal if the stimulus, such as tobacco smoking, is removed. Epithelial dysplasia is considered a premalignant condition. Epithelial dysplasia may present clinically as an erythematous lesion, as a white lesion, or as a mixed erythematous and white lesion. Epithelial dysplasia lesions often arise in the floor of the mouth or tongue.

REF: Epithelial Dysplasia, page 223 OBJ: 2

10. Severe epithelial dysplasia involving the full thickness of the epithelium is termed a. anaplasia. b. squamous cell carcinoma. c. carcinoma in situ. d. metastasis.

ANS: C

Severe epithelial dysplasia involving the full thickness of the epithelium is called carcinoma in situ. Anaplasia is characterized by a loss of differentiation of cells and their orientation to one another. Squamous cell carcinoma is a malignant tumor of squamous epithelium. Metastasis means that neoplastic cells are transported to parts of the body remote from the primary tumor and that new tumors are established at those sites.

REF: Epithelial Dysplasia, page 223 OBJ: 2 a. Spleen b. Lungs c. Liver d. Lymph nodes

11. Squamous cell carcinoma of the oral epithelium usually metastasizes first to which site?

ANS: D

Squamous cell carcinoma of the oral epithelium usually metastasizes first to the lymph nodes of the neck. From there, it proceeds to more distant sites such as the lungs and liver. Squamous cell carcinoma of the oral epithelium usually metastasizes first to the lymph nodes of the neck rather than the spleen.

REF: Squamous Cell Carcinoma, page 223

12. “Keratin pearls” are a characteristic feature of a. squamous cell carcinoma. b. basal cell carcinoma. c. pleomorphic adenoma. d. monomorphic adenoma.

ANS: A

OBJ: 5

“Keratin pearls” are a characteristic feature of squamous cell carcinoma. Well-differentiated tumors show keratin formation because keratin is a product of squamous epithelium. The neoplastic cells contain large hyperchromatic nuclei and numerous mitotic figures. Some of the mitotic figures appear normal, whereas others are bizarre. “Keratin pearls” are a characteristic feature of squamous cell carcinoma and not basal cell carcinoma. “Keratin pearls” are a characteristic feature of squamous cell carcinoma and not pleomorphic adenoma. “Keratin pearls” are a characteristic feature of squamous cell carcinoma and not monomorphic adenoma.

REF: Squamous Cell Carcinoma, page 224

OBJ: 5

13. Squamous cell carcinomas on the vermilion border of the lips and skin of the face are a. associated with lack of exposure to the sun and vitamin D deficiency. b. more common in individuals with dark skin. c. associated with a poorer prognosis than that for squamous cell carcinoma of the oral mucosa. d. associated with color changes of the vermilion border from dark pink and uniform to mottled grayish pink.

ANS: D

Squamous cell carcinomas on the vermilion border of the lips and skin of the face are associated with color changes of the vermilion border from dark pink and uniform to mottled grayish-pink. Squamous cell carcinomas are associated with exposure to the sun. Squamous cell carcinomas tend to be more common in individuals with fair skin. Squamous cell carcinomas of the lips and skin are associated with a much better prognosis than that for squamous cell carcinomas of the oral mucosa.

REF: Squamous Cell Carcinoma, page 224

OBJ: 5 a. Cigar, pipe, and cigarette smoking b. Snuff dipping and tobacco chewing c. Consumption of alcohol d. Chronic irritation

14. Which choice is not regarded as an initiating factor in the development of oral cancer?

ANS: D

No evidence exists that chronic irritation is an initiating factor in the development of oral cancer. The most significant risk factor associated with the development of squamous cell carcinoma is tobacco use, including cigar, pipe, and cigarette smoking, snuff dipping, and tobacco chewing. Alcohol consumption appears to add to the risk of oral squamous cell carcinoma, especially in individuals who also use tobacco products.

REF: Squamous Cell Carcinoma, page 225

OBJ: 5 a. less than 2; ipsilateral; no distant b. 2 to 4; ipsilateral; no distant c. 2 to 4; contralateral; no distant d. 2 to 4; contralateral; distant

15. According to the TNM staging system for oral squamous carcinoma, T2, N1, M0 would mean tumor _____ cm in diameter, _____ palpable nodes, and _____ metastasis.

ANS: B

According to the TNM staging system for oral squamous carcinoma, T2, N1, M0 would mean tumor 2 to 4 cm in diameter, ipsilateral palpable nodes, and no distant metastasis. According to the TNM staging system for oral squamous carcinoma, T1, N1, M0 would mean tumor less than 2 cm in diameter, ipsilateral palpable nodes, and no distant metastasis. According to the TNM staging system for oral squamous carcinoma, T2, N2, M0 would mean tumor 2 to 4 cm in diameter, contralateral palpable nodes, and no distant metastasis. According to the TNM staging system for oral squamous carcinoma, T2, N2, M1 would mean tumor 2 to 4 cm in diameter, contralateral palpable nodes, and distant metastasis.

REF: Squamous Cell Carcinoma, Box 7.1, Table 7.3, page 226

16. Verrucous carcinoma

OBJ: 5 a. has a better prognosis than other forms of squamous cell carcinomas. b. appears clinically as a quick-growing exophytic tumor with a pebbly white surface. c. is characterized by poorly differentiated epithelium with atypical cells. d. shows invasion of tumor cells through the basement membrane.

ANS: A

Verrucous carcinoma has a better prognosis than other forms of squamous cell carcinomas. Verrucous carcinoma appears clinically as a slow-growing exophytic tumor with a pebbly white and red surface. Verrucous carcinoma is characterized by well-differentiated epithelium, does not contain atypical cells, and exhibits broad-based rete pegs that penetrate deeply into the connective tissue. The epithelial basement membrane is intact in cases of verrucous carcinoma, and the tumor does not show invasion of tumor cells through the basement membrane, as is seen in squamous cell carcinoma.

REF: Verrucous Carcinoma, page 226 OBJ: 5 a. posterior lateral border of the tongue of women over 40 b. floor of the mouth of women over 70 c. vestibule and buccal mucosa of men over 55 d. bone of the mandible of men over 20

17. Most cases of verrucous carcinoma occur in the _____ years old.

ANS: C

Most cases of verrucous carcinoma occur in the vestibule and buccal mucosa of men over 55 years old. Most cases of verrucous carcinoma occur in the vestibule and buccal mucosa of men over 55 years old rather than on the posterior lateral border of the tongue of women over 40 years old. Most cases of verrucous carcinoma occur in the vestibule and buccal mucosa of men over 55 years old rather than on the floor of the mouth of women over 70 years old. Most cases of verrucous carcinoma occur in the vestibule and buccal mucosa of men over 55 years old rather than in the bone of the mandible of men over 20 years old.

REF: Verrucous Carcinoma, page 226 OBJ: 5 a. benign; occurs b. malignant; occurs c. benign; does not occur d. malignant; does not occur

18. Basal cell carcinoma is a _____ tumor that _____ in the oral cavity.

ANS: D

Basal cell carcinoma is a malignant tumor that does not occur in the oral cavity. It is associated with excessive exposure to the sun. It frequently arises on the skin of the face and appears as a non healing ulcer with characteristic rolled borders. Basal cell carcinoma is a malignant tumor, not a benign tumor, and does not occur in the oral cavity.

REF: Basal Cell Carcinoma, page 227 OBJ: 5

19. As a general rule, a patient should be referred to an oral and maxillofacial surgeon or dermatologist to have a biopsy performed on any non healing ulcer of the skin or lips that has been present for more than a. 24 hours. b. 2 weeks. c. 3 months. d. 1 year.

ANS: B

As a general rule, a patient should be referred to an oral and maxillofacial surgeon or dermatologist to have a biopsy performed on any non healing ulcer of the skin or lips that has been present for more than 10 days. A biopsy should be performed on any non healing ulcer of the skin or lips that has been present for more than 10 days, not 24 hours. A biopsy should be performed on any non healing ulcer of the skin or lips that has been present for more than 10 days, not 3 months. A biopsy should be performed on any non healing ulcer of the skin or lips that has been present for more than 10 days, not 1 year.

REF: Basal Cell Carcinoma, page 227 OBJ: 2

20. Intraoral minor salivary gland tumors are most commonly located a. on the labial and buccal mucosa. b. at the junction of the hard and soft palate. c. on the retromolar area. d. on the floor of the mouth.

ANS: B

Intraoral minor salivary gland tumors are most commonly located at the junction of the hard and soft palate. They can also occur on the labial and buccal mucosa, the retromolar area, the floor of the mouth, and rarely the tongue. Tumors of minor salivary gland origin are much more common in the upper lip than in the lower lip.

REF: Salivary Gland Tumors, page 227 OBJ: 5

21. A benign tumor of salivary gland origin is termed a(n) a. leiomyoma. b. lipoma. c. adenoma. d. papilloma.

ANS: C

A benign tumor of salivary gland origin is called an adenoma. Although some malignant salivary gland tumors are called adenocarcinomas, most have more specific names such as adenoid cystic carcinoma and mucoepidermoid carcinoma. A leiomyoma is a benign tumor of smooth muscle. A lipoma is a benign tumor of mature fat cells. A papilloma is a benign tumor of squamous epithelium.

REF: Salivary Gland Tumors, page 227 OBJ: 5 a. Adenoid cystic carcinoma b. Mucoepidermoid carcinoma c. Pleomorphic adenoma d. Monomorphic adenoma

22. Which is the most common salivary gland neoplasm?

ANS: C

The pleomorphic adenoma is the most common salivary gland neoplasm. It accounts for about 90% of all benign salivary gland tumors. The pleomorphic adenoma rather than the adenoid cystic carcinoma is the most common salivary gland neoplasm. The pleomorphic adenoma rather than the mucoepidermoid carcinoma is the most common salivary gland neoplasm. The pleomorphic adenoma rather than the monomorphic adenoma is the most common salivary gland neoplasm.

REF: Pleomorphic Adenoma, page 227 OBJ: 5

23. The most common intraoral location for the pleomorphic adenoma is the a. parotid gland. b. submandibular gland. c. palate. d. floor of the mouth.

ANS: C

The most common intraoral location for the pleomorphic adenoma is the palate. The most common extraoral location is the parotid gland. However, these tumors can occur wherever salivary gland tissue is present. The most common extraoral location is the parotid gland. The most common intraoral location for the pleomorphic adenoma is the palate not the submandibular gland. The most common intraoral location for the pleomorphic adenoma is the palate not the floor of the mouth.

REF: Pleomorphic Adenoma, page 227 OBJ: 5

24. The pleomorphic adenoma a. is a malignant tumor. b. appears clinically as a painful dome-shaped mass. c. occurs most often in children. d. appears as a slowly enlarging, nonulcerated, painless, dome-shaped mass.

ANS: D

The pleomorphic adenoma appears as a slowly enlarging, nonulcerated, painless, domeshaped mass. The pleomorphic adenoma is a benign salivary gland tumor, although it has been known to undergo malignant transformation. This occurrence is known as a carcinoma arising in a pleomorphic adenoma. The pleomorphic adenoma appears as a slowly enlarging, nonulcerated, painless, dome-shaped mass. Most pleomorphic adenomas occur in individuals over 40 years of age, and a female predilection has been noted. Pleomorphic adenomas have also been reported in children.

REF: Pleomorphic Adenoma, page 227 OBJ: 5

25. The Warthin tumor a. is a unique type of pleomorphic adenoma. b. presents as a painless, soft mass, usually in the sublingual gland. c. often develops bilaterally in adult women. d. contains sheets of lymphocytes that surround the cystic structures.

ANS: D

The Warthin tumor contains sheets of lymphocytes that surround the cystic structures. In some cases the lymphoid component demonstrates germinal center formation. This tumor presents as a painless, soft, compressible or fluctuant mass, usually located in the parotid gland. It often develops bilaterally and occurs predominantly in adult men. The Warthin tumor is a type of monomorphic rather than pleomorphic adenoma. The Warthin tumor presents as a painless, soft, compressible or fluctuant mass, usually located in the parotid gland rather than the sublingual gland.

REF: Monomorphic Adenoma, page 228 OBJ: 5 a. Pleomorphic adenoma b. Monomorphic adenoma c. Adenoid cystic carcinoma d. Mucoepidermoid carcinoma

26. Which salivary gland tumor has a “Swiss cheese” appearance under the microscope?

ANS: C

The adenoid cystic carcinoma has a “Swiss cheese” appearance under the microscope. These round and oval islands represent cylinders of tumor. The adenoid cystic carcinoma rather than the pleomorphic adenoma has a “Swiss cheese” appearance under the microscope. The adenoid cystic carcinoma rather than the monomorphic adenoma has a “Swiss cheese” appearance under the microscope. The adenoid cystic carcinoma rather than the mucoepidermoid carcinoma has a “Swiss cheese” appearance under the microscope.

REF: Adenoid Cystic Carcinoma, page 229

27. The adenoid cystic carcinoma is a. a benign tumor of salivary gland origin.

OBJ: 5 b. well encapsulated and does not infiltrate surrounding tissue. c. most commonly seen intraorally on the palate. d. painless.

ANS: C

The adenoid cystic carcinoma is most commonly seen intraorally on the palate. The adenoid cystic carcinoma is a malignant tumor of salivary gland origin that can originate from either major or minor salivary gland tissue. The adenoid cystic carcinoma is unencapsulated and infiltrates surrounding tissue. Pain is often present with the adenoid cystic carcinoma because of the tendency for these tumors to surround nerves.

REF: Adenoid Cystic Carcinoma, page 229

OBJ: 5 a. Men b. Women of childbearing age c. Fifth and sixth decades of life d. Children

28. Adenoid cystic carcinoma is commonly seen in which demographic group?

ANS: C

Adenoid cystic carcinoma is most commonly diagnosed in the fifth and sixth decades of life. It is more common in women than in men. Adenoid cystic carcinoma is more common in women than in men. Adenoid cystic carcinoma is most commonly diagnosed in the fifth and sixth decades of life, after childbearing age. Adenoid cystic carcinoma is most commonly diagnosed in the fifth and sixth decades of life, not in children.

REF: Adenoid Cystic Carcinoma, page 229

OBJ: 5 a. Adenoid cystic carcinoma b. Mucoepidermoid carcinoma c. Monomorphic adenoma d. Pleomorphic adenoma

29. Which tumor is an unencapsulated, infiltrating tumor composed of a combination of mucous cells interspersed with squamous-like epithelial cells?

ANS: B

The mucoepidermoid carcinoma is an unencapsulated, infiltrating tumor composed of a combination of mucous cells interspersed with squamous-like epithelial cells called epidermoid cells. Adenoid cystic carcinoma is composed of small, deeply staining, uniform epithelial cells arranged in perforated round to oval islands. Monomorphic adenoma is composed of a uniform pattern of epithelial cells. These tumors do not have the connective tissue–like component seen in a pleomorphic adenoma. Pleomorphic adenoma is an unencapsulated tumor composed of tissue that appears to be a mixture of both epithelium and connective tissue.

REF: Mucoepidermoid Carcinoma, page 230

OBJ: 5

30. A central mucoepidermoid carcinoma is derived from either salivary gland tissue trapped within bone or a. a periapical abscess surrounding the apex of a nonvital tooth. b. the transformed epithelial lining of a dentigerous cyst. c. a lateral periodontal cyst. d. an incisive canal cyst.

ANS: B

A central mucoepidermoid carcinoma is derived from either salivary gland tissue trapped within bone or the transformed epithelial lining of a dentigerous cyst. A central mucoepidermoid carcinoma is derived from either salivary gland tissue trapped within bone or the transformed epithelial lining of a dentigerous cyst rather than from a periapical abscess surrounding the apex of a nonvital tooth. A central mucoepidermoid carcinoma is derived from either salivary gland tissue trapped within bone or the transformed epithelial lining of a dentigerous cyst rather than from a lateral periodontal cyst. A central mucoepidermoid carcinoma is derived from either salivary gland tissue trapped within bone or the transformed epithelial lining of a dentigerous cyst rather than from an incisive canal cyst.

REF: Mucoepidermoid Carcinoma, page 230

OBJ: 5 a. Adenoid cystic carcinoma b. Mucoepidermoid carcinoma c. Monomorphic adenoma d. Pleomorphic adenoma

31. Which is the most common malignant salivary gland tumor found in children?

ANS: B

The mucoepidermoid carcinoma is the most common malignant salivary gland tumor in children. The adenoid cystic carcinoma is also a malignant tumor; however, the mucoepidermoid carcinoma is the most common malignant salivary gland tumor in children. The mucoepidermoid carcinoma is the most common malignant salivary gland tumor in children. Both the monomorphic adenoma and pleomorphic adenoma are benign tumors, although pleomorphic adenomas have been known to undergo malignant transformation. The mucoepidermoid carcinoma is the most common malignant salivary gland tumor in children.

REF: Mucoepidermoid Carcinoma, page 230 OBJ: 5

32. The ameloblastoma a. occurs exclusively in the mandible. b. is a benign, encapsulated tumor. c. is commonly known as a Pindborg tumor. d. may cause expansion of bone.

ANS: D

The ameloblastoma may cause expansion of bone. It is a benign, slow-growing but locally aggressive epithelial odontogenic tumor that may arise in either the maxilla or mandible. The ameloblastoma may arise in either the maxilla or mandible. The ameloblastoma is a benign, unencapsulated tumor that infiltrates into surrounding tissue and can cause extensive destruction. The calcifying epithelial odontogenic tumor, rather than the ameloblastoma, is also known as a Pindborg tumor.

REF: Ameloblastoma, page 231 OBJ: 4 a. Calcifying epithelial odontogenic tumor b. Adenomatoid odontogenic tumor c. Calcifying odontogenic cyst d. Odontogenic myxoma

33. Which tumor most closely resembles an ameloblastoma with ameloblast-like epithelial cells surrounding areas that look like stellate reticulum?

ANS: C

The epithelium of the calcifying odontogenic cyst resembles that seen in an ameloblastoma, consisting of ameloblast-like cells and stellate reticulum-like areas. The epithelium of the calcifying odontogenic cyst, rather than the calcifying epithelial odontogenic tumor, resembles that seen in an ameloblastoma, consisting of ameloblast-like cells and stellate reticulum-like areas. The epithelium of the calcifying odontogenic cyst, rather than the adenomatoid odontogenic tumor, resembles that seen in an ameloblastoma, consisting of ameloblast-like cells and stellate reticulum-like areas. The epithelium of the calcifying odontogenic cyst, rather than the odontogenic myxoma, resembles that seen in an ameloblastoma, consisting of ameloblast-like cells and stellate reticulum-like areas.

REF: Calcifying Odontogenic Cyst, page 233 OBJ: 4 b. posterior maxilla. c. anterior mandible. d. posterior mandible.

34. Most ameloblastomas are located in the a. anterior maxilla.

ANS: D

Most ameloblastomas are located in the posterior mandible. Eighty percent of all ameloblastomas arise in the mandible, most often in the molar or ramus area. Most ameloblastomas are located in the posterior mandible rather than the anterior maxilla. Most ameloblastomas are located in the posterior mandible rather than the posterior maxilla. Most ameloblastomas are located in the posterior mandible rather than the anterior mandible.

REF: Ameloblastoma, page 231 OBJ: 4 a. Ameloblastoma b. Calcifying epithelial odontogenic tumor c. Adenomatoid odontogenic tumor d. Odontogenic myxoma

35. Which tumor occurs most frequently in the anterior part of the jaws?

ANS: C

Seventy percent of adenomatoid odontogenic tumors involve the anterior part of the jaws. In contrast, 80% of ameloblastomas arise in the mandible, most often in the molar and ramus area. Although the calcifying epithelial odontogenic tumor can occur anywhere in the maxilla or mandible, the bicuspid and molar areas are the most common locations. Most cases of odontogenic myxoma occur in the posterior mandible.

REF: Adenomatoid Odontogenic Tumor, page 231 OBJ: 5 a. It will not be associated with an impacted tooth. b. It extends beyond the cementoenamel junction and can involve 50% to 60% of the root. c. It will not form calcifications within the tumor, as does a dentigerous cyst. d. It will not form a well-circumscribed radiolucency.

36. How does an adenomatoid odontogenic tumor differ from a dentigerous cyst on radiographic images?

ANS: B

An adenomatoid odontogenic tumor will extend beyond the cementoenamel junction and can involve 50% to 60% of the root. Because of its frequent association with an impacted tooth, an adenomatoid odontogenic tumor often simulates a dentigerous cyst. Calcifications do form within the adenomatoid odontogenic tumor, and radiopaque areas of varying size will be visible on radiographs. An adenomatoid odontogenic tumor appears as a well-circumscribed radiolucency.

REF: Adenomatoid Odontogenic Tumor, page 232

OBJ: 5

37. The adenomatoid odontogenic tumor features ductlike structures that a. resemble those found in major salivary glands. b. resemble those found in minor salivary glands. c. are actually ameloblast-like cells that resemble ducts because of their circular arrangement. d. are actually odontoblast-like cells that resemble ducts because of their circular arrangement.

ANS: C

The adenomatoid odontogenic tumor features ductlike structures that are actually ameloblastlike cells that resemble ducts because of their circular arrangement. Eosinophilic material is seen in the center of these structures, and calcifications also form in this tumor.

REF: Adenomatoid Odontogenic Tumor, page 232 OBJ: 5 a. Calcifying odontogenic cyst b. Adenomatoid odontogenic tumor c. Calcifying epithelial odontogenic tumor d. Ameloblastoma

38. Ghost cells are characteristic of which lesion?

ANS: A

Ghost cells are characteristic of the calcifying odontogenic cyst. These cells exhibit a clear central area and are thought to represent degenerating epithelial cells. Ghost cells are characteristic of the calcifying odontogenic cyst and not an adenomatoid odontogenic tumor. Ghost cells are characteristic of the calcifying odontogenic cyst and not a calcifying epithelial odontogenic tumor. Ghost cells are characteristic of the calcifying odontogenic cyst and not an ameloblastoma.

REF: Calcifying Odontogenic Cyst, page 232 OBJ: 5 a. It occurs most often in people over 50. b. It exhibits a unilocular radiolucency with well-defined margins. c. The tumor may become quite large and cause displacement of teeth. d. Most cases arise in the posterior maxilla.

39. Which statement is true of the odontogenic myxoma?

ANS: C

The odontogenic myxoma may become quite large and cause displacement of teeth. The odontogenic myxoma occurs most often in young individuals between 10 and 29 years of age. No sex predilection is noted. The odontogenic myxoma exhibits a multilocular, honeycombed radiolucency with poorly defined margins. Most cases of odontogenic myxoma arise in the posterior mandible.

REF: Odontogenic Myxoma, page 234 OBJ: 5

40. The ameloblastic fibroma a. occurs most often in adults over 50. b. occurs more commonly in males than females. c. is most commonly located in the mandibular anterior region. d. is most commonly located in the maxillary anterior region.

ANS: B

The ameloblastic fibroma occurs more commonly in males than in females. The most common location for an ameloblastic fibroma is the mandibular bicuspid and molar region, not the mandibular anterior region. Most cases of ameloblastic fibroma occur in individuals younger than 20 years of age rather than in adults over 50. The most common location for an ameloblastic fibroma is the mandibular bicuspid and molar region, not the maxillary anterior region.

REF: Ameloblastic Fibroma, page 236 OBJ: 5

41. A compound odontoma a. consists of a mass of enamel, dentin, cementum, and pulp that does not resemble a normal tooth. b. usually occurs in the posterior mandible. c. appears on radiographs as a cluster of miniature teeth surrounded by a radiolucent halo. d. appears as a radiolucent mass surrounded by a thin radiopaque halo.

ANS: C

A compound odontoma appears on radiographs as a cluster of miniature teeth surrounded by a radiolucent halo. A complex odontoma consists of a mass of enamel, dentin, cementum, and pulp that does not resemble a normal tooth. The compound odontoma is usually located in the anterior maxilla, and the complex odontoma most commonly occurs in the posterior mandible. A complex odontoma appears as a radiopaque mass surrounded by a thin radiolucent halo.

REF: Odontoma, page 236 OBJ: 5 a. Ameloblasts b. Odontoblasts c. Osteoblasts d. Cells of the periodontal ligament

42. The central cemento ossifying fibroma is most likely derived from which cells?

ANS: D

The peripheral ossifying fibroma is most likely derived from cells of the periodontal ligament, not from ameloblasts. The peripheral ossifying fibroma is most likely derived from cells of the periodontal ligament, not from odontoblasts. The peripheral ossifying fibroma is most likely derived from cells of the periodontal ligament, not from osteoblasts. The peripheral ossifying fibroma is most likely derived from cells of the periodontal ligament. It is more common in females than in males and often occurs in young individuals.

REF: Central Cementifying Fibroma and Central Ossifying Fibroma, page 234 OBJ: 5

43. A lipoma a. is a tumor of peripheral nerve tissue. b. appears clinically as a yellowish mass surfaced by a thin layer of epithelium. c. is found most commonly intraorally on the tongue. d. occurs most often in men over 60.

ANS: B

A lipoma appears clinically as a yellowish mass surfaced by a thin layer of epithelium. A lipoma is a benign tumor of mature fat cells. The most common intraoral locations for lipomas are the buccal mucosa and the vestibule. The majority of lipomas occur in individuals over 40 years of age, and no sex predilection is noted.

REF: Lipoma, page 237 OBJ: 5

44. The most common intraoral location for a neurofibroma is the a. floor of the mouth. b. vestibule. c. tongue. d. tonsillar pillar.

ANS: C

The most common intraoral location for a neurofibroma is the tongue. Microscopic examination of a neurofibroma reveals a fairly well-delineated but unencapsulated proliferation of spindle-shaped Schwann cells and perineural fibroblasts. The most common intraoral location for a neurofibroma is the tongue and not the floor of the mouth. The most common intraoral location for a neurofibroma is the tongue and not the vestibule. The most common intraoral location for a neurofibroma is the tongue and not the tonsillar pillar.

REF: Neurofibroma and Schwannoma, page 237 OBJ: 5

45. The granular cell tumor a. most often occurs on the tongue followed by the buccal mucosa. b. appears as a painful, ulcerated nodule. c. occurs most commonly in children. d. occurs most often in men.

ANS: A

The granular cell tumor most often occurs on the tongue followed by the buccal mucosa. It most likely arises from a neural or primitive mesenchymal cell. The granular cell tumor appears as a painless, nonulcerated nodule. The majority of cases of granular cell tumor occur in adults. A female sex predilection is noted for the granular cell tumor.

REF: Granular Cell Tumor, page 238 OBJ: 5 a. benign; smooth b. malignant; smooth c. benign; striated d. malignant; striated

46. A rhabdomyosarcoma is a _____ tumor of _____ muscle.

ANS: D

A rhabdomyosarcoma is a malignant tumor of striated muscle. It is the most common malignant soft tissue tumor of the head and neck in children. A rhabdomyosarcoma is a malignant tumor of striated muscle, not a benign tumor of smooth muscle. A leiomyoma is a benign tumor of smooth muscle. A rhabdomyosarcoma is a malignant tumor of striated muscle, not a malignant tumor of smooth muscle. A leiomyosarcoma is a malignant tumor of smooth muscle. A rhabdomyosarcoma is a malignant tumor of striated muscle, not a benign tumor of striated muscle. A rhabdomyoma is a benign tumor of striated muscle.

REF: Tumors of Muscles, page 239 OBJ: 5 a. The gingiva is the most common intraoral location. b. They are more common in boys than in girls. c. They appear as variably sized, deep red or blue lesions that do not blanch when pressure is applied. d. They may occur in adults as a response to trauma and represent an abnormal proliferation of blood vessels during the healing process.

47. Which statement about hemangiomas is true?

ANS: D

Hemangiomas may occur in adults as a response to trauma and represent an abnormal proliferation of blood vessels during the healing process. The tongue is the most common intraoral location for a hemangioma. Hemangiomas are more common in girls than in boys. Hemangiomas appear as variably sized, deep red or blue lesions that frequently blanch when pressure is applied.

REF: Vascular Tumors, page 239 OBJ: 5

48. Kaposi sarcoma is a. caused by a human herpesvirus. b. seen only in association with HIV infection. c. most often seen intraorally on the tongue. d. a malignant striated muscle tumor.

ANS: A

Kaposi sarcoma is caused by a human herpesvirus (HHV) that is called both human herpesvirus type 8 (HHV-8) and Kaposi sarcoma–associated herpesvirus (KSAH). Kaposi sarcoma may occur in patients with other forms of immunodeficiency in addition to HIV, specifically patients who have received immunosuppressive drug therapy as a result of organ transplantation. The hard palate and gingiva are the most common intraoral sites of Kaposi sarcoma. Kaposi sarcoma is a malignant vascular tumor.

REF: Malignant Vascular Tumors, page 240 OBJ: 5

49. Malignant melanoma usually presents as a(n) a. slowly enlarging white mass. b. rapidly enlarging blue-to-black mass. c. slowly enlarging papule. d. exophytic, wartlike lesion.

ANS: B

Malignant melanoma usually presents as a rapidly enlarging blue-to-black mass. It is a very aggressive tumor that exhibits unpredictable behavior and early metastasis. Malignant melanoma usually presents as a rapidly enlarging blue-to-black mass rather than as a slowly enlarging white mass. Malignant melanoma usually presents as a rapidly enlarging blue-toblack mass rather than as a slowly enlarging papule. Malignant melanoma usually presents as a rapidly enlarging blue-to-black mass rather than as an exophytic, wartlike lesion.

REF: Melanoma, page 241 OBJ: 5 a. It has a benign counterpart known as the benign melanoma. b. Most malignant melanomas arise on the skin as a result of prolonged exposure to chemicals such as benzene. c. Primary malignant melanoma of the oral cavity is rare. d. The most common intraoral location is the tongue.

50. Which statement about malignant melanoma is true?

ANS: C

Primary malignant melanoma of the oral cavity is rare. All melanomas are malignant; there is no benign counterpart. Most malignant melanomas arise on the skin as a result of prolonged exposure to sunlight. The most common intraoral locations are the palate and maxillary gingiva.

REF: Melanoma, page 241 OBJ: 5

51. A “sunburst” pattern is associated with a. Kaposi sarcoma. b. osteoma. c. osteosarcoma. d. multiple myeloma.

ANS: C

A “sunburst” pattern is associated with osteosarcoma. It is a malignant tumor of bone-forming tissue. It is the most common primary malignant tumor of bone in patients under 40 years of age. Patients may experience a diffuse swelling or mass that is often painful. A “sunburst” pattern is associated with osteosarcoma, not Kaposi sarcoma. A “sunburst” pattern is associated with osteosarcoma, not osteoma. A “sunburst” pattern is associated with osteosarcoma, not multiple myeloma.

REF: Osteosarcoma, page 242 OBJ: 5 a. immature white blood b. mature white blood c. immature plasma d. mature plasma

52. Acute leukemia is characterized by a proliferation of _____ cells.

ANS: A

Acute leukemia is characterized by a proliferation of immature white blood cells. It is most common in children and young adults. Leukemia occurs more often in males than in females. Acute leukemia is characterized by a proliferation of immature white blood cells rather than mature white blood cells. Acute leukemia is characterized by a proliferation of immature white blood cells rather than immature plasma cells. Acute leukemia is characterized by a proliferation of immature white blood cells rather than mature plasma cells.

REF: Leukemia, page 242 OBJ: 5

53. The most common location for an intraoral lymphoma is the a. floor of the mouth. b. posterior lateral border of the tongue. c. tonsillar area. d. vestibule.

ANS: C

The most common location for an intraoral lymphoma is the tonsillar area. Rarely, a lymphoma may present as a primary lesion in the oral soft tissues or bone. Most lymphomas involve either lymph nodes or aggregates of lymphoid tissue that are located in the digestive tract from the oral cavity to the anus. The most common location for an intraoral lymphoma is the tonsillar area, not the floor of the mouth. The most common location for an intraoral lymphoma is the tonsillar area, not the posterior lateral border of the tongue. The most common location for an intraoral lymphoma is the tonsillar area, not the vestibule.

REF: Lymphoma (Non-Hodgkin Lymphoma), page 242 OBJ: 5

54. Bence Jones proteins are associated with a. osteosarcoma. b. leukemia. c. lymphoma. d. multiple myeloma.

ANS: D

Bence Jones proteins are associated with multiple myeloma. Bence Jones proteins are associated with multiple myeloma, not osteosarcoma. Bence Jones proteins are associated with multiple myeloma, not leukemia. Bence Jones proteins are associated with multiple myeloma, not lymphoma.

REF: Multiple Myeloma, page 244 OBJ: 5

55. Multiple myeloma is a systemic, malignant proliferation of a. red blood cells. b. plasma cells. c. eosinophils. d. basophils.

ANS: B

Multiple myeloma is a systemic, malignant proliferation of plasma cells. It causes destructive lesions in bone. Patients usually experience bone pain and swelling. Pathologic fracture of an involved bone is common and typically occurs in bones weakened as a result of their destruction by the proliferation of neoplastic plasma cells. Multiple myeloma is a systemic, malignant proliferation of plasma cells rather than red blood cells. Multiple myeloma is a systemic, malignant proliferation of plasma cells rather than eosinophils. Multiple myeloma is a systemic, malignant proliferation of plasma cells rather than basophils.

REF: Multiple Myeloma, page 242 OBJ: 5 a. Nares b. Maxilla c. Mandible d. Zygoma

56. Where is the most frequent intraoral site for metastatic tumors of the jaws?

ANS: C

The most frequent intraoral site for metastatic tumors of the jaws is the mandible. The most frequent intraoral site for metastatic tumors of the jaws is the mandible, not the nares. The most frequent intraoral site for metastatic tumors of the jaws is the mandible, not the maxilla.

The most frequent intraoral site for metastatic tumors of the jaws is the mandible, not the zygoma.

REF: Metastatic Tumors, page 244 OBJ: 5

57. The benign oral pathologic lesion that occurs frequently in the head and neck area and is classified as capillary or cavernous is termed a. hematoma. b. lipoma. c. adenoma. d. hemangioma.

ANS: D

The hemangioma is a benign proliferation of capillaries containing numerous small capillaries called capillary hemangiomas or, if containing larger blood vessels, cavernous hemangiomas. A hematoma is a lesion that results from the accumulation of blood within tissue as a result of trauma. A lipoma is a benign tumor of adipose tissue. An adenoma is a benign tumor of the salivary glands.

REF: Vascular Tumors, page 239 OBJ: 5 a. Leukoplakia b. Bleeding c. Erythroplakia d. Pigmentation

58. All are common warning signs of malignant neoplasms except one. Which is the exception?

ANS: B

Bleeding is not a classic warning sign of malignancy. Leukoplakia, erythroplakia, pigmentation, and a mass are all common warning signs of malignant neoplasms.

REF: Melanocytic Nevus, page 241 | Leukoplakia, page 221 | Erythroplakia, page 223 OBJ: 2 a. Inability to spread to distant sites b. Nonencapsulated c. Undifferentiated and pleomorphic d. No resemblance to surrounding cells

59. Which is a common characteristic of benign neoplasms?

ANS: A

A benign neoplasm does not have the ability to spread to distant sites. A benign neoplasm is more commonly encapsulated than nonencapsulated. Benign neoplasms are commonly well differentiated and not pleomorphic. Benign neoplasms commonly resemble normal and surrounding cells.

REF: Classification of Tumors, page 219 OBJ: 2

60. A common location of the oral neurofibroma is the a. tongue. b. palate. c. gingiva. d. buccal mucosa.

ANS: A

The tongue is the most common location of the oral neurofibroma. The palate is not a common location of the oral neurofibroma. The gingiva is not a common location of the oral neurofibroma. The buccal mucosa is not a common location of the oral neurofibroma.

REF: Neurofibroma and Schwannoma, page 237 OBJ: 5 a. Well circumscribed b. Radiopaque c. Attached to root d. Multilocular

61. A benign cementoblastoma has all these radiographic characteristics except one. Which is the exception?

ANS: D

The benign cementoblastoma does not appear as multilocular on a radiograph. The benign cementoblastoma is a cementum-producing lesion that is fused to the root(s) and radiographically appears as a well-defined radiopaque mass with a surrounding radiolucent halo.

REF: Cementoblastoma, page 235 OBJ: 5

62. The diagnosis of oral osteosarcoma is dependent on a. clinical examination. b. palpation. c. radiographic interpretation. d. patient symptoms.

ANS: C

Osteosarcoma is a malignant tumor of bone-forming tissue and is diagnosed through the use of radiographs. The diagnosis of osteosarcoma is not dependent on clinical examination but is dependent on radiographic interpretation. The diagnosis of osteosarcoma is not dependent on palpation but is dependent on radiographic interpretation. The diagnosis of osteosarcoma is not dependent on patient symptoms but is dependent on radiographic interpretation.

REF: Osteosarcoma, page 242 OBJ: 5 a. Adenoid cystic b. Basal cell c. Verrucous d. Squamous cell

63. All carcinomas are malignant tumors that originate from squamous epithelium except one. Which is the exception?

ANS: A

Adenoid cystic carcinoma originates from either major or minor salivary gland tissue. Basal cell carcinoma originates from stratified squamous epithelium. Verrucous carcinoma originates from squamous epithelium. Squamous cell carcinoma originates from squamous epithelium.

REF: Salivary Gland Tumors, page 227 OBJ: 5

64. The distinction between dangerous and innocuous leukoplakia is best determined by the a. clinical appearance of the lesion. b. identification of predisposing factors. c. patient’s previous experience. d. biopsy of the lesion.

ANS: D

The microscopic appearance of leukoplakia varies; therefore, a biopsy is essential to establish a definitive diagnosis between dangerous and innocuous leukoplakia. The clinical appearance of dangerous and innocuous leukoplakia can be identical. Predisposing factors are similar between dangerous and innocuous leukoplakia. A patient’s previous experience has no direct correlation between dangerous and innocuous leukoplakia.

REF: Leukoplakia, page 221 OBJ: 3

65. The name of the benign tumor that is slow growing but locally aggressive and derived in association with an impacted tooth and dentigerous cyst is termed a. calcifying odontogenic cyst. b. odontogenic myxoma. c. compound odontoma. d. ameloblastoma.

ANS: D

Ameloblastomas are slow growing but locally aggressive and can be associated with an impacted tooth and dentigerous cyst. Calcifying odontogenic cysts appear radiographically as a well-defined unilocular or multilocular radiolucency with radiopaque calcifications. Odontogenic myxoma is a benign mesenchymal odontogenic tumor that exhibits a multilocular, honeycombed radiolucency with poorly defined margins. Compound odontomas appear radiographically as a cluster of numerous miniature teeth surrounded by a radiolucent halo.

REF: Ameloblastoma, page 231 OBJ: 3 a. Both statements are true. b. Both statements are false c. The first statement is true; the second is false. d. The first statement is false; the second is true.

66. Epithelial dysplasia is a microscopy-based diagnosis; it indicates disordered growth and is considered a premalignant condition.

ANS: A

Both statements are true. Epithelial dysplasia is a microscopic diagnosis that indicates disordered growth and is considered a premalignant condition. Both statements are true.

REF: Epithelial Dysplasia, page 223 OBJ: 2 a. Both statements are true b. Both statements are false c. The first statement is true; the second is false. d. The first statement is false; the second is true.

67. The multiple myeloma is a benign proliferation of plasma cells that produce large amounts of immunoglobulin. Patients usually experience bone pain and swelling.

ANS: D

The first statement is false; the second is true. Multiple myeloma is a malignant proliferation of plasma cells.

REF: Multiple Myeloma, pages 242, 244 OBJ: 5

68. This benign tumor of fat cells that clinically appears as a yellowish mass surfaced by a thin layer of epithelium is referred to as a a. chondroma. b. rhabdomyosarcoma. c. lipoma. d. lymphoma.

ANS: C

A lipoma is a benign tumor of fat cells that clinically appears as a yellowish mass surfaced by a thin layer of epithelium. Chondroma is a benign tumor of the cartilage. A rhabdomyosarcoma is a malignant tumor of striated muscle. Lymphoma is a malignant tumor of lymphoid tissue.

REF: Lipoma, page 237 OBJ: 5

69. Squamous cell carcinoma of the oral epithelium usually metastasizes first to the lymph nodes of the neck. Common distant sites include a. kidneys and spleen. b. lungs and liver. c. breast and lungs. d. liver and spleen.

ANS: B

Squamous cell carcinoma of the oral epithelium usually metastasizes first to the lymph nodes of the neck and then to more distant sites such as the lungs and liver. Squamous cell carcinoma of the oral epithelium does not usually metastasize to the kidneys and spleen. It usually metastasizes first to the lymph nodes of the neck and then to more distant sites such as the lungs and liver. Squamous cell carcinoma of the oral epithelium does not usually metastasize to the breast and lungs. It usually metastasizes first to the lymph nodes of the neck. From there, it proceeds to more distant sites such as the lungs and liver. Squamous cell carcinoma of the oral epithelium does not usually metastasize to the liver and spleen. It usually metastasizes first to the lymph nodes of the neck. From there, it proceeds to more distant sites such as the lungs and liver.

REF: Squamous Cell Carcinoma, page 223 OBJ: 5

70. A benign tumor of cartilage is termed a(n) a. osteoma. b. lipoma. c. chondroma. d. carcinoma.

ANS: C

A chondroma is a benign tumor of cartilage. A benign tumor of bone is called an osteoma. A lipoma is a benign tumor of fat cells. A carcinoma is a malignant tumor of epithelium.

REF: Tumors of Cartilage, page 242 OBJ: 5 a. less than; ipsilateral; no distant b. is 2 to 4; ipsilateral; no distant c. greater than 4; no; no distant d. greater than 4; contralateral; distant

71. According to the TNM staging system for oral squamous carcinoma, T3, N0, M0 would mean tumor _____ cm in diameter, _____ palpable nodes, and _____ metastasis.

ANS: C

According to the TNM staging system for oral squamous carcinoma, T3, N0, M0 would mean the tumor is greater than 4 cm in diameter, no palpable nodes, and no distant metastasis.

According to the TNM staging system for oral squamous carcinoma, T1, N1, M0 would mean tumor less than 2 cm in diameter, ipsilateral palpable nodes, and no distant metastasis.

According to the TNM staging system for oral squamous carcinoma, T2, N1, M0 would mean tumor 2 to 4 cm in diameter, ipsilateral palpable nodes, and no distant metastasis. According to the TNM staging system for oral squamous carcinoma, T3, N2, M1 would mean the tumor is greater than 4 cm in diameter, contralateral palpable nodes, and distant metastasis.

REF: Box 7.1, page 226 a. Metastasis b. Neoplasia c. Hypertrophy d. Hyperplasia

72. _____ means new growth.

ANS: B

OBJ: 5

Neoplasia means new growth. It is a process in which cells exhibit uncontrolled proliferation. A neoplasm is a mass of such cells. Although the word tumor means swelling, it is commonly used as a synonym for neoplasm. Metastasis is transport of neoplastic cells to parts of the body remote from the primary tumor and the establishment of new tumors at those sites. Hypertrophy means the cells have increased in size. Hyperplasia is an abnormal increase in the number of cells in an organ or tissue.

REF: Description of Neoplasia, page 219

OBJ: 1 a. benign tumor b. malignant tumor c. hypertrophy d. hyperplasia

73. A _____ both invades and destroys surrounding tissue and has the ability to spread throughout the body.

ANS: B

A malignant tumor both invades and destroys surrounding tissue and has the ability to spread throughout the body. A benign tumor or neoplasm remains localized. Hypertrophy is an increase in the size of cells in an organ or tissue. Hyperplasia is an increase in the number of cells in an organ or tissue.

REF: Classification of Tumors, page 219 OBJ: 1 a. 10 times more b. 3 times more c. 3 times less d. 10 times less

74. Sarcomas are _____ common than carcinomas.

ANS: D

Sarcomas are about 10 times less common than carcinomas. Sarcomas are malignant tumors of connective tissue, and carcinomas are malignant tumors of connective tissue. Sarcomas are about 10 times less common, rather than 10 times more common, than carcinomas. Sarcomas are about 10 times less common, rather than 3 times more common, than carcinomas. Sarcomas are about 10 times less common, rather than 3 times less common, than carcinomas.

REF: Name of Tumors, page 220 OBJ: 2 a. 1 to 2 b. 5 to 25 c. 50 to 60 d. 90

75. Approximately _____% of leukoplakias examined microscopically demonstrate epithelial dysplasia.

ANS: B

Approximately 5% to 25% of leukoplakias examined microscopically demonstrate epithelial dysplasia. When examined microscopically, a leukoplakia may show epithelial dysplasia, a premalignant condition, or even squamous cell carcinoma, a malignant tumor of squamous epithelium. Approximately 5% to 25%, not 1% to 2%, of leukoplakias examined microscopically demonstrate epithelial dysplasia. Approximately 5% to 25%, not 50% to 60%, of leukoplakias examined microscopically demonstrate epithelial dysplasia. Approximately 5% to 25%, not 90%, of leukoplakias examined microscopically demonstrate epithelial dysplasia.

REF: Leukoplakia, page 221 OBJ: 3 a. oral mucosa b. striated muscle c. salivary gland d. tooth

76. Patients who have undergone radiation therapy for malignant tumors of the head and neck often experience severe xerostomia as a result of radiation damage to _____ tissue.

ANS: C

Patients who have undergone radiation therapy for malignant tumors of the head and neck often experience severe xerostomia as a result of radiation damage to salivary gland tissue. These patients require preventive dental care consisting of nutritional counseling, application of topical fluoride, and meticulous home care. Patients who have undergone radiation therapy for malignant tumors of the head and neck often experience severe xerostomia as a result of radiation damage to salivary gland tissue rather than oral mucosa tissue. Patients who have undergone radiation therapy for malignant tumors of the head and neck often experience severe xerostomia as a result of radiation damage to salivary gland tissue rather than striated muscle tissue. Patients who have undergone radiation therapy for malignant tumors of the head and neck often experience severe xerostomia as a result of radiation damage to salivary gland tissue rather than tooth tissue.

REF: Squamous Cell Carcinoma, Treatment and Prognosis, page 226

OBJ: 5 a. never b. rarely c. often d. always

77. A basal cell carcinoma will _____ metastasize.

ANS: B

A basal cell carcinoma will rarely metastasize. It is a locally invasive tumor that can become quite large and disfiguring if it is not removed. Surgical excision is the treatment of choice, and radiation therapy may be used to treat large lesions. A basal cell carcinoma will rarely rather than never metastasize. A basal cell carcinoma will rarely rather than often metastasize. A basal cell carcinoma will rarely rather than always metastasize.

REF: Basal Cell Carcinoma, page 227 OBJ: 5 a. verrucous carcinoma b. mucoepidermoid carcinoma c. cylindroma d. papillary cystadenoma lymphomatosum

78. The _____ is a unique type of monomorphic adenoma.

ANS: D

The papillary cystadenoma lymphomatosum is a unique type of monomorphic adenoma. Microscopic examination of this variant demonstrates an encapsulated tumor composed of two types of tissue: epithelial and lymphoid. The epithelial component is neoplastic. The papillary cystadenoma lymphomatosum is a unique type of monomorphic adenoma. Verrucous carcinoma is an epithelial tumor rather than a salivary gland tumor. The papillary cystadenoma lymphomatosum is a unique type of monomorphic adenoma. Mucoepidermoid carcinoma is an epithelial tumor rather than a salivary gland tumor. The papillary cystadenoma lymphomatosum is a unique type of monomorphic adenoma. Cylindroma or adenoid cystic carcinoma is an epithelial tumor rather than a salivary gland tumor.

REF: Monomorphic Adenoma, page 228 OBJ: 5 a. maxillary anterior b. maxillary posterior c. mandibular anterior d. mandibular posterior

79. When a mucoepidermoid carcinoma arises within bone, it will usually be found in the _____ region.

ANS: D

When a mucoepidermoid carcinoma arises within bone, it will usually be in the mandibular posterior region. In this location, it appears either as a unilocular or multilocular radiolucency. When a mucoepidermoid carcinoma arises within bone, it will usually be in the mandibular posterior region rather than the maxillary anterior region. When a mucoepidermoid carcinoma arises within bone, it will usually be in the mandibular posterior region rather than the maxillary posterior region. When a mucoepidermoid carcinoma arises within bone, it will usually be in the mandibular posterior region rather than the mandibular anterior region.

REF: Mucoepidermoid Carcinoma, page 230 OBJ: 5 a. unilocular radiolucency b. multilocular opacity c. unilocular or multilocular radiolucency d. unilocular or multilocular radiopacity

80. An ameloblastoma may appear as a _____ on radiographic images.

ANS: C

An ameloblastoma may appear as a unilocular or multilocular radiolucency on radiographic images. The classic radiographic appearance of an ameloblastoma is a multilocular soapbubble or honeycombed radiolucency. In smaller tumors the radiolucency may be unilocular.

REF: Ameloblastoma, page 231 OBJ: 4 a. adenomatoid odontogenic tumor b. calcifying epithelial odontogenic tumor c. ameloblastoma d. mucoepidermoid carcinoma

81. A(n) _____ is composed of islands and sheets of polyhedral epithelial cells with deposits of amyloid-like material that is thought to represent a form of abnormal enamel protein.

ANS: B

A calcifying epithelial odontogenic tumor is composed of islands and sheets of polyhedral epithelial cells with deposits of amyloid-like material that is thought to represent a form of abnormal enamel protein. A calcifying epithelial odontogenic tumor, not an adenomatoid odontogenic tumor, is composed of islands and sheets of polyhedral epithelial cells. A calcifying epithelial odontogenic tumor, not an ameloblastoma, is composed of islands and sheets of polyhedral epithelial cells. A calcifying epithelial odontogenic tumor, not a mucoepidermoid carcinoma, is composed of islands and sheets of polyhedral epithelial cells.

REF: Calcifying Epithelial Odontogenic Tumor, page 231 OBJ: 5 a. females over 40 b. males over 40 c. females under 20 d. males under 20

82. The majority of adenomatoid odontogenic tumors occur in _____ years of age.

ANS: C

The majority (70%) of adenomatoid odontogenic tumors occur in females under 20 years of age. The maxilla is more commonly involved than the mandible. Many adenomatoid odontogenic tumors are associated with impacted teeth. The majority of adenomatoid odontogenic tumors occur in females under 20 years of age rather than females over 40. The majority of adenomatoid odontogenic tumors occur in females under 20 years of age rather than males over 40. The majority of adenomatoid odontogenic tumors occur in females under 20 years of age rather than males under 20.

REF: Adenomatoid Odontogenic Tumor, page 231 OBJ: 5 a. hematoma b. hemangioma c. hamartoma d. lymphangioma

83. A _____ is a benign proliferation of capillaries.

ANS: B

A hemangioma is a benign proliferation of capillaries. It is a common vascular lesion considered by many to represent a developmental lesion rather than a tumor because hemangiomas do not generally exhibit an unlimited growth potential. A hemangioma rather than a hematoma is a benign proliferation of capillaries. A hemangioma rather than a hamartoma is a benign proliferation of capillaries. A hemangioma rather than a lymphangioma is a benign proliferation of capillaries.

REF: Vascular Tumors, page 239 OBJ: 5 a. maxilla; males b. maxilla; females c. mandible; males d. mandible; females

84. Osteosarcoma occurs more often in the _____ and more often in _____.

ANS: C

Osteosarcoma occurs more often in the mandible than the maxilla and more often in males than in females. Osteosarcoma occurs more often in the mandible than the maxilla. Osteosarcoma occurs more often in males than in females.

REF: Osteosarcoma, page 242 OBJ: 5 a. 10 b. 30 c. 50 d. 70

85. Approximately _____% of patients with chondrosarcoma involving the jaws survive 5 years after the diagnosis.

ANS: B

Approximately 30% of patients with chondrosarcoma involving the jaws survive 5 years after the diagnosis. Chondrosarcomas are treated with wide surgical excision. Radiation therapy and chemotherapy are not effective. The prognosis is poor. Approximately 30% rather than 10% of patients with chondrosarcoma involving the jaws survive 5 years after the diagnosis. Approximately 30% rather than 50% of patients with chondrosarcoma involving the jaws survive 5 years after the diagnosis. Approximately 30% rather than 70% of patients with chondrosarcoma involving the jaws survive 5 years after the diagnosis.

REF: Tumors of Cartilage, page 242 OBJ: 5 a. Invasive b. Encapsulated c. Cancer d. Metastasis

86. All terms are associated with malignancy except one. Which is the exception?

ANS: B

Encapsulated signifies a growth surrounded by a capsule of fibrous connective tissue. This type of growth better describes a benign lesion. Invasive refers to the infiltration and active destruction of surrounding tissues, as seen with a malignant growth. Another term for cancer is malignancy. Metastasis is the transport of neoplastic cells to parts of the body remote from the primary tumor and the establishment of new tumors in those sites.

REF: Classification of Tumors, pages 219-220 OBJ: 1 a. Osteosarcoma b. Osteoma c. Lipoma d. Carcinoma

87. What is the term to describe a malignant tumor in bone?

ANS: A

An osteosarcoma is a malignant tumor of bone. An osteoma is a benign tumor of bone. A lipoma is a benign tumor of fat. A carcinoma is a malignant tumor of epithelium.

REF: Name of Tumors, page 220 OBJ: 2 a. Benign mixed tumor b. Leukoplakia c. Epithelial dysplasia d. Verruca vulgaris

88. Which lesion most closely resembles a papilloma?

ANS: D

The papilloma presents as a small, exophytic, pedunculated growth composed of numerous papillary projections, similar to verruca vulgaris (common wart). A benign mixed tumor is a benign salivary gland tumor. Leukoplakia is a white plaque-like lesion that cannot be rubbed off and cannot be diagnosed clinically as a specific disease. Epithelial dysplasia may present as a red, white, or mixed red and white lesion.

REF: Tumors of Squamous Epithelium, page 221 OBJ: 6 a. Squamous cell carcinoma b. Hemangioma c. Epithelial dysplasia d. Premalignant condition

89. Leukoplakia cannot be diagnosed clinically as a specific disease; therefore, it must often be examined in a laboratory setting. When examined microscopically, leukoplakia may reveal the following except one. Which is the exception?

ANS: B

A hemangioma is a benign proliferation of capillaries. Early tumors of squamous cell carcinoma may reveal a leukoplakia appearance. When examined microscopically, a leukoplakia may show epithelial dysplasia in approximately 5% to 25% of cases. The laboratory results of a leukoplakia biopsy may also reveal a premalignant condition.

REF: Leukoplakia, page 221 OBJ: 6 a. Papilloma b. Fibroma c. Adenoma d. rhabdomyosarcoma

90. Surgery, chemotherapy, radiation therapy, or a combination of all three may be used to treat which lesion?

ANS: D

The rhabdomyosarcoma is an aggressive malignant tumor that is best treated by a combination of multidrug chemotherapy, radiation therapy, and surgery.

REF: p. 239 OBJ: 6 a. Keratin b. Exudate c. Granulation tissue d. Macrophages

91. The papilloma will appear whiter clinically because of additional amounts of what substance?

ANS: A

The color of the papilloma depends on the amount of surface keratin. The more keratin, the whiter the lesion will appear. Exudate is fluid with a high protein content and consists of white blood cells, fibrin and other protein molecules. Granulation tissue is the initial connective tissue formed in healing. The macrophage is the second type of white blood cell to arrive at the site of injury.

REF: Tumors of Squamous Epithelium, page 221 OBJ: 6 a. Sarcoma b. Papilloma c. Erythroplakia d. Leukoplakia

92. Which intraoral lesion appears as a smooth red patch or a granular red and velvety patch?

ANS: C

Erythroplakia is a term to describe an intraoral lesion that appears as a smooth red patch or a granular red and velvety patch. A sarcoma is a malignant tumor of connective tissue. A papilloma appears as a white exophytic pedunculated growth. Leukoplakia appears as a white patch or plaque.

REF: Erythroplakia, page 223

OBJ: 6 a. Floor of the mouth b. Gingiva c. Retromolar pad d. Midline of the hard palate

93. Squamous cell carcinoma may appear anywhere in the oral cavity; where is the most common site?

ANS: A

Squamous cell carcinomas may occur anywhere in the oral cavity, but the most sites of involvement include the floor of the mouth. The gingiva is not a common site for squamous cell carcinoma. The retromolar pad is not a common site for squamous cell carcinoma. The midline of the hard palate is not a common site for squamous cell carcinoma, although it may appear on the soft palate.

REF: Squamous Cell Carcinoma, page 224

OBJ: 6 a. Sun exposure b. Tobacco use c. Age d. Chronic irritant

94. Which is the most significant factor for the development of squamous cell carcinoma?

ANS: B

The most significant risk factor for the development of squamous cell carcinoma is tobacco, including cigar, pipe, and cigarette smoking. Sun exposure is a risk factor for the development of basal cell carcinoma. The majority of cases occur in patients over the age of 40, which is a young population. Chronic irritants, such as an ill-fitting denture, are not initiating factors in the development of squamous cell carcinoma.

REF: Squamous Cell Carcinoma, page 225 a. It often occurs in white adults with fair complexions. b. It appears as a non healing ulcer with rolled borders. c. It is usually seen on the skin of the face. d. It occurs intraorally.

95. Which is the false statement about basal cell carcinoma?

ANS: D

OBJ: 6

Basal cell carcinoma does not occur in the oral cavity. Basal cell carcinoma does occur in fairskinned persons. Basal cell carcinoma appears as a non healing ulcer with characteristic rolled borders. Basal cell carcinoma frequently arises on the skin of the face.

REF: Basal Cell Carcinoma, page 227 OBJ: 6 a. Tongue b. Junction of the hard and soft palate c. Interdental papilla d. Floor of the mouth

96. Where is the most common intraoral location for the development of minor salivary gland tumors?

ANS: B

Intraorally, minor salivary gland tumors are located most commonly at the junction of the hard and soft palates. Minor salivary gland tumors rarely occur on the tongue. Minor salivary glands are not found in the interdental papilla. Minor salivary glands are found in the floor of the mouth, but this is not the most common location.

REF: Salivary Gland Tumors, page 227 OBJ: 6

97. Because the origin of these tumors is glandular epithelium, benign tumors of salivary gland origin are termed a. adenomas b. nevi c. chondromas d. lipomas

ANS: A

An adenoma is a benign tumor that originates from glandular epithelium. Nevi are tumors of melanocytes. A chondroma is a benign tumor of cartilage. A lipoma is a benign tumor of fat.

REF: Salivary Gland Tumors, page 227 OBJ: 6 a. Nonulcerated lesion b. Painless c. Quickly enlarging d. Dome-shaped mass

98. Clinical signs and symptoms of a pleomorphic adenoma include the following except one. Which is the exception?

ANS: C

The pleomorphic adenoma is a slowly enlarging mass. Clinically, the pleomorphic adenoma appears as a nonulcerated mass. The pleomorphic adenoma is a painless lesion. Clinically, the pleomorphic adenoma is typically dome-shaped.

REF: Pleomorphic Adenoma (Benign Mixed Tumor), page 227

OBJ: 6 a. Multilocular, soap-bubble radiolucency b. Associated with the crown of an unerupted tooth c. Unilocular or multilocular radiolucency with radiopaque areas within d. Multilocular lesions with poorly defined borders, causing tooth displacement

99. What is the classic radiographic appearance of the ameloblastoma?

ANS: A

The classic radiographic appearance of an ameloblastoma is a multilocular soap bubble-like or honeycombed radiolucency. The adenomatoid odontogenic tumor appears as a well-defined radiolucency usually associated with an impacted tooth. The calcifying odontogenic cyst appears as a unilocular or multilocular radiolucency with calcifications within. Multilocular lesions with poorly defined borders that can cause tooth displacement may be seen with the odontogenic myxoma.

REF: Ameloblastoma, page 231 OBJ: 6 a. No treatment needed b. Surgical excision and drainage c. Enucleation of tumor and tooth extraction d. Surgery and radiation therapy follow-up

100. What is the treatment for a benign cementoblastoma?

ANS: C

Treatment of the benign cementoblastoma consists of enucleation of the tumor and removal of the involved tooth. Treatment is required for the benign cementoblastoma. Surgical excision and drainage is not the correct treatment protocol. Surgery and radiation therapy is not required for the benign cementoblastoma.

REF: Cementoblastoma, page 235 OBJ: 6

Matching

For each neoplasm description below, select the corresponding type of neoplasm from the list provided.

a. Benign b. Malignant

1. Cells closely resemble their cells of origin.

2. Mitosis is uncontrolled with rapid division.

3. Growth expands by invasion and replaces normal tissue.

4. The majority of these neoplasms are encapsulated.

5. Recurrence of the tumor is not common.

6. In naming the neoplasm, the word sarcoma or carcinoma is used.

7. Cells are poorly differentiated.

1. ANS: A REF: Classification of Tumors, page 220 OBJ: 2

2. ANS: B REF: Classification of Tumors, page 220 OBJ: 2

3. ANS: B REF: Classification of Tumors, page 220

OBJ: 2

4. ANS: A REF: Classification of Tumors, page 219 OBJ: 2

5. ANS: A REF: Classification of Tumors, page 219

OBJ: 2

6. ANS: B REF: Name of Tumors, page 220 OBJ: 2

7. ANS: B REF: Classification of Tumors, page 220 a. Complete surgical removal without cutting into the lesion b. Deviating from the usual or natural type c. Confined to the site of origin without an invasion of neighboring tissues d. Tooth forming e. Occurring within bone f. Occurring in various forms g. Microscopic staining that is more intense than normal 8.

For each vocabulary word below, select the corresponding definition from the list provided.

1 9. ANS: D REF: Vocabulary, page 219

8. ANS: E REF: Vocabulary, page 218

1 10. ANS: C REF: Vocabulary, page 219

11. ANS: G REF: Vocabulary, page 219

12. ANS: F REF: Vocabulary, page 219

13. ANS: B REF: Vocabulary, page 218

14. ANS: A REF: Vocabulary, page 218

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