PART 20 - NEOPLASIA (EXAM TYPE) Flashcards
- A 44 year old male consulted because of a 1.5x1cm solitary brownish nodule with collarette scale on the right lower leg with a duration of 2 months. Blanching of the lesion when pressure is applied was noted. Excision biopsy revealed a sharply demarcated zone of pale staining epidermal keratinocytes with psoriasiform epidermal hyperplasia. WHAT IS THE MOST LIKELY DIAGNOSIS?
A. Basal cell carcinoma
B. Clear cell acanthoma
C. Squamous cell cancer
D. Merkel cell carcinoma
Answer: B
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- A 30 year old female consulted because of a waxy yellowish linear plaque on the scalp. The lesion appeared when she was 12 years old but she noticed increase in thickness and development of a verrucous surface over the past year. What is the most common benign neoplasm associated with this condition?
A. Sebaceoma
B. Syringocystadenoma papilliferum
C. Trichilemmoma
D. Trichoblastoma
Answer: D
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- What variant of epidermal nevi is associated with CHILD syndrome?
A. ILVEN
B. Keratinocytic epidermal nevi
C. Nevus comedonicus
D. Nevus sebaceous
Answer: A
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- What is the site of predilection of hidradenoma papilliferum?
A. Axilla
B. Breast
C. Scalp
D. Vulva
D
- Which statement is TRUE regarding appendage tumors?
A.Diagnosis is often clinical with no need for biopsy.
B.Immunohistochemistry is necessary to distinguish benign and malignant neoplasms.
C.They are solitary or multiple papule/s or nodule/s with minimal overlying epidermal changes.
D.They are very common and often serve as marker of genetic syndromes
Answer: C
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Biopsy with subsequent histopathology is usually required for diagnosis
Analysis of the architecture is often necessary in diagnosing appendage tumors, especially when distinguishing between benign and malignant neoplasms. Immunohistochemistry is used sparingly.
D. In general, with some exceptions, appendage tumors are relatively rare but certain appendage tumors can serve as markers for genetic diseases and syndromes
A 12 year old boy presents with sudden eruption of flat topped 1-3mm pink to tan papules in a linear manner following blaschko’s lines on the arms. What is the best diagnosis?
A. ILVEN
B. Lichen planus
C. Lichen striatus
D. Verruca vulgaris
Answer: C
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A 60 year old male presents with months history of tender nodule on the helix of the ear. Histology showed an ulcer with degenerative changes of dermal collagen. What is the most likely diagnosis?
A. Acaanthoma fissuratum
B. Basal Cell Carcinoma
C. Chondrodermatitis nodularis helicis
D. Keratoacanthoma
Answer: C
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Which of the following best describes the histologic features of nevus comedonicus?
A. Keratin-filled epidermal invaginations + atrophic pilosebacseous unit
B. Papillomatosis + coarse keratohyalin granules
C. Pseudohorn cysts + basaloid keratinocytes
D. Superficial sebaceous glands + vellus hair follicles
A.
A female patient presents with firm well circumscribed nodules on the scalp. Biopsy reveals an epithelial lined cyst with abundant fold and lobules of squamous epithelium without a granular layer. What is the most likely diagnosis?
A. Follicular cyst, infundibular type
B. Milia
C. Pilar Cyst
D. Proliferating trichilemmal cyst
D.
Milia
Milia are minute epidermoid cysts, lined by stratified squamous epithelium and filled with keratin. Occasionally, a connection to eccrine ducts or vellus hair follicles may be observed. Bacteria are not usually present.
Pilar Cyst (Trichilemmal Cyst)
Trichilemmal cysts arise from the outer root sheath of the hair follicle, and thus are characterized by the absence of a granular layer and eosinophilic keratin contents
Proliferating trichiemmal Cyst
If abundant folds and lobules of squamous epithelium are seen in the walls of the lesion, it is most likely a proliferating trichilemmal cyst. Extensive cellular atypia and invasion of the cyst lining into the surrounding tissue are indicative of a malignant proliferating pilar tumor.
Which of the following appendage tumors differentiates from the apocrine gland?
A. Basal cell carcinoma
B. Hidrocystoma
C. Pilomatricoma
D. Syringoma
B
Which of the following tumors originates from follicular infundibulum?
A. Pilar tumor
B. Trichofolliculoma
C. Trichoadenoma
D. Trichoblastoma
C.
A 32 year old male consulted because of 3 month history of erythematous papules on the glans penis. Biopsy showed histopathologic findings consistent with Bowenoid papulosis. Which statement is TRUE regarding the course and prognosis of this disease?
A. It is often responsive to topical therapy with no risk of recurrence
B. More than 60% of cases can lead to condyloma acuminata
C. Some lesions may have spontaneous regression
D. The risk of malignant transformation is high
C
A 15 year old male consulted because of pink flat topped papules and plaques on the knees, elbows, and trunk. Lesions started when he was 6 years old and gradually spread. Biopsy showed dyskeratosis and pyknosis. What is the most likely diagnosis?
A. Disseminated verruca plana
B. Epidermodysplasia verruciformis
C. Gorlin syndrome
D. Incontinentia pigmenti
B.
- Epidermodysplasia verruciformis (EV) is an inherited skin condition with a high local susceptibility to infection with human papillomavirus (HPV), most commonly with HPV types 5 and 8.
- Patients with EV develop skin lesions early in life as infection with HPV typically occurs during infancy.
- Skin findings comprise 2 different morphologies.
- First, numerous thin, pink, flat-topped papules and plaques that resemble flat warts (verrucae planae) may be seen. Therefore, these papules are sometimes referred to as EV-plane warts.
- Sites of predilection for these warts are knees, elbows, and trunk.
- Second, patients can present with widespread scaly, erythematous, or hypopigmented macules and flat papules that appear similar to tinea versicolor (Fig. 110-11).
- The mucosal membranes are usually not affected. Histopathologically, the
- EV-plane warts share features with plane warts not associated with EV.
- Dyskeratosis and pyknosis are observed more commonly in EV.
What subtypes of HPV are associated with epidermodysplasia verruciformis?
A. 2 and 3
B. 16 and 18
C. 31 and 33
D. 51 and 54
A.
What are the most important factors in the formation of actinic keratosis?
A. Advancing age, male sex
B. Fair skin, UV exposure
C. Infection with HPV and chemical exposure
D. Immunosuppression, genetic disorders
B.
Actinic Keratosis
Risk Factors:
- Skin phenotype
- Cumulative UV exposure- 2.5x risk ( farmers, construction workers, fishermen)
- Age - Number of sunburns during childhood
- Gender - More likely in Men
- Fitzpatrick 1 (fair skin, red/blonde hair, blue eyes - m/c
- Fitzpatrick 2-6 (brown eyes, dark hair) - less likely
Immunosuppression - increased risk, AKs earlier in life, more rapid malignant transformation
- Genetic Syndromes - Albinism, xeroderma pigmentosum
A 45 year old chronic smoker presents with a flat, white homogenous lesion that cannot be rubbed off on the inner cheek. Biopsy shows epithelial hyperplasia and dysplasia. What is the most likely diagnosis?
A. Candidiasis
B. Leukoplakia
C. Lichen Planus
D. Linea Alba
B
What drug is US FDA approved for the treatment of metastatic basal cell cancer ?
A. Imiquimod
B. Nicotinamide
C. Sonidigib
D. Vismodegib
D
Aside from odontogenic cysts of the jaw and Medulloblastoma or BCC, which of the following is considered a characteristic abnormality of basal cell nevus syndrome?
A. Macrocephaly
B. Ovarian Fibrosis
C. Palmoplantar pits
D. Syndactyly of the digits
C
What drug can decrease the risk of developing secondary post transplantation squamous cell cancer in kidney transplant patients?
A. Azathioprine
B. Cyclosporin
C. Erlotinib
D. Sirolimus
D
Which statement is true regarding the prognosis of Merkel cell carcinoma?
A. Adjuvant chemotherapy after surgery is recommended for better outcome
B. Less than 20% of patients with local or nodal disease recurred after treatment
C. There is less risk of recurrence for tumors less than 2cm
D. The risk of death is 2-3 times higher than melanoma
D
