Benign Neoplasms

Question 1

A patient presents with a barnacle appearance- round, flat coin-like waxy plaques, some are pigmented. Under a microscope, this appears to be a well-circumscribed epidermal tumor that has proliferating squamous cells and are very orderly. What do you diagnose them with?

Answer 1

seborrheic keratoses

Question 2

What is the Leser-Trelat sign and which disease is it seen with?

Answer 2

sudden onset of numerous Seborrheic keratoses that may indicate an underlying visceral malignancy

Question 3

A histology sample appears as “monotonous squamous tumor with horn cysts and hyperkeratosis”. What is the diagnosis?

Answer 3

pigmented seborrheic keratosis

*lots of pigmentation= horn cyst

Question 4

a patient presents with a polyp around the neck. she relates wearing a chunky necklace all the time there that rubs her skin. what is this poly?

Answer 4

fibroepithelial polyp-acrochordon

Question 5

this epithelial cyst has a “central punctum” filled with keratin and emits a cheesy secretion when excised. what is this?

Answer 5

epidermoid cyst

Question 6

this cyst is found typically on the scalp and is derived from a deeper part of the hair follicle. what is it?

Answer 6

trichilemmal cyst

vs. epidermoid cyst which is derived from follicular infindubulum

Question 7

a child presents with a single subcutaneous nodule at birth on lateral aspect of upper eyelid. what is this?

Answer 7

dermoid cyst

Question 8

this results from an autosomal dominant mutation in Keratin 17 and you see sebaceous glands and a “keratin cuticle” under the microscope. what is it?

Answer 8

steatocystoma

Question 9

which tumor of the hair follicle is associated with Cowden’s disease? Under a microscope, it has a cleared cytoplasm and no horn cysts as see in SK.

Answer 9

trichilemmoma

Question 10

which tumor of the hair follicle presents as a solitary firm nodule on the cheek most commonly?

Answer 10

pilomatrixoma

Question 11

Birt-Hogg-Dube syndrome is seen in which tumors of the hair follicle?

Answer 11

fibrofolliculomas
trichodiscomas
acrochordons

Question 12

what is Muir-Torre syndrome?

Answer 12

inherited defect in a DNA mismatch repair gene (MMR)

-related to HNPCC + skin tumors

Question 13

what tumors of sebaceous glands are seen with Muir-Torre syndrome?

Answer 13

• sebaceous adenoma

- sebaceoma

Question 14

this is not a tumor but rather a benign aggregate of histiocytes with cytoplasmic lipid. which clinical type is the only one with normal serum lipid levels?

Answer 14

disseminated xanthomas

Question 15

“touton” giant cells which are surrounded by a ring of lipid are seen in which disease?

Answer 15

juvenile xanthogranuloma

Question 16

“ground glass histiocytes” are seen in what disease?

Answer 16

reticulohistiocytoma

*compared to JXG which does have lipids

Question 17

which is the most aggressive form of Langerhans Cell Histiocytosis?

Answer 17

Acute Generalized LCH (Letterer-Siwe disease)

Question 18

a 5y/o patient presents with a triad of lytic skull lesions, diabetes insipidus, and proptosis. what is this?

Answer 18

multifocal chronic LCH (Hand-schuller-christian disease)

Question 19

which is the most benign form of Langerhans cell histiocytosis?

Answer 19

eosinophilic granuloma

Question 20

on a slide, it appears to be CD1a+ and birbeck granules are seen. what is this?

Answer 20

langerhans cells histiocytosis

CD1a is specific for langerhans cells

Question 21

on a slide, it appears to be CD1a+ and birbeck granules are seen. what is this?

Answer 21

langerhans cells histiocytosis

CD1a is specific for langerhans cells

Question 22

this neoplasm appears as firm, tan to brown papules. Under the scope, you see “collagen trapping.” what is this?

Answer 22

dermatofibroma

Question 23

under the scope you see a well-circumscribed proliferation of glands and blood vessels. what is this?

Answer 23

hemangioma

Question 24

a patient presents with a painful fleshy nodule at the site of a first hallux amputation. what do you think she has?

Answer 24

traumatic neuroma

*all nerve components are involved: schwann cells, nerve fibers, perineural cells, fibroblasts

Question 25

a high powered businesswoman relates wearing heels to work everyday presents with pain in the region of metatarsal heads that is exacerbated by walking. you cannot palpate any lesion but you suspect what?

Answer 25

Morton’s neuroma

Question 26

a patient who has mucosal neuroma should be evaluated for what other disorder?

Answer 26

multiple endocrine neoplasia syndrome (MEN 2B)

Question 27

this solitary painless nodule that invovles a nerve commonly affects the face of middle-aged elderly.

Answer 27

palisaded encapsulated neuroma

Question 28

this encapsulated lesion has no association with neurofibromatosis and is painless and appears as a solitary subcutaneous mass. what is it? it has prominent blood vessels

Answer 28

schwannoma (aka neurilemmoma)

Question 29

What is Antoni A? Antoni B?

Answer 29

Antoni A- cellular with nuclear palisading Verocay bodies

Antoni B- hypocellular

Question 30

how do you tell the difference between a neurofibroma and a schwannoma?

Answer 30

neurofibroma- unencapsulated

schwannoma- encapsulated

Question 31

what is this: nodular poliferation of mononuclear cells in a fibrous background with giant cells everywhere?

Answer 31

giant cell tumor of tendon sheath