Pathology Flashcards
Which of the following statements regarding melanoma is true?
A. The incidence in the white population has decreased significantly over the past 2 decades.
B. Melanoma commonly occurs in patients who demonstrate pale skin, red hair, freckles, and the
tendency to burn while in the sun.
C. Nodular melanoma is more common than the superficial spreading variety.
D. The acral lentiginous melanoma is most common in the oral cavity.
Answer: B
Rationale:
The incidence of melanoma continues to grow in the white population with the highest rate being in northern Australia. Of this population, melanoma is seen most commonly in people with red or blond hair, fair skin, large numbers of freckles, and the potential to burn easily when in the sun. The superficial spreading melanoma is the most common variety being seen almost twice as often as the nodular type. The acral lentiginous melanoma as the name denotes is a tumor of the palmar, plantar, and subbing skin.
Which of the following is not a sun-induced skin lesion?
A. Actinic Keratosis
B. Bowen’s Disease of Skin
C. Erythroplasia of Queyrat
D. Morpheaform variant of basal cell carcinoma
Answer C
Rationale:
Even though histologically very similar to Bowen’s Disease, Erythroplasia of Queyrat is a dysplastic lesion of the penis in uncircumcised males. It usually arises on the inner surface of the prepuce. Actinic keratosis, Bowen’s disease of skin (carcinoma in situ) and the morpheaform (sclerosing) variant of basal cell carcinoma are all well accepted examples of sun induced skin disease.
Which of the following statements regarding the basal cell carcinoma (BCC) is true?
A. The BCC is the least common malignant skin tumor.
B. The majority of BCC’s are found in the trunk.
C. The BCC is often associated with Xeroderma Pigmentosum.
D. The multifocal superficial variant is the most common type of BCC.
Answer: C
Rationale:
80% of BCC’s are in the head and neck region. The BCC as well as the squamous cell carcinoma are both seen in cases of Xeroderma Pigmentosum. The most common variant of the BCC is the solid type, which represents approximately 70% of all cases.
Which of the following is true regarding Nevoid Basal Cell Carcinoma Syndrome (Gorlin-Goltz Syndrome)?
A. Inheritance is Autosomal Dominant with a variable and complete penetrance.
B. The basal cell carcinoma is only seen on non sun-exposed skin.
C. The basal cell carcinomas in this syndrome appear at a much later age than the more typical basal
cell carcinoma.
D. Rib abnormalities are seen in approximately 90% of the patients.
Answer: A
Rationale:
Inheritance is autosomal dominant with complete penetrance and variable expressability. The basal cell carcinomas seen in Basal Cell Nevus Syndrome are typically seen on sun-exposed and non sun-exposed skin, they occur at an earlier age than the classic basal cell carcinoma, and rib abnormalities (bifid rib) are seen in about 60% of patients with this syndrome.
Which of the following is true regarding the keratoacanthoma (KA)?
A. It is a quickly growing lesion of the skin.
B. It is often multiple when seen in the head and neck region.
C. It is a skin tumor of older females.
D. It is just as common on non-exposed skin as on skin exposed to the sun.
Answer: A
Rationale:
The classic presentation of a KA is a solitary lesion of the facial sun-exposed skin in an older male. It is typically a fast growing lesion, reaching its maximal size within approximately 6 weeks. This is a feature that helps to distinguish it from squamous cell carcinoma of the skin.
The primary identifying histologic feature of the odontogenic keratocyst (OKC) is: A. orthokeratin. B. daughter cysts. C. parakeratin. D. rete peg formation.
Answer: C
Rationale:
Parakeratin is the defining histologic feature of the OKC. Orthokeratin is found in other odontogenic cysts particularly the dentigerous cyst. Daughter cysts are not an exclusive feature of OKC’s either although their presence contributes to the high recurrence rate potential. Rete peg formation is not a histological feature of the OKC due to such a thin epithelial lining of 6 – 10 cells.
Which of the following represents the unique differentiating histologic pattern of the calcifying odontogenic cyst (COC)?
A. Cuboidal to columnar epithelial pattern
B. Multinucleated giant cells near the basal cell layer
C. Daughter cyst
D. Anuclear cell keratinization
Answer: D
Rationale:
The most prominent and unique characteristic of the Gorlin cyst (COC) is “ghost cell” keratinization. These cells are anuclear and retain the cell outline. There is a dystrophic mineralization process that occurs here. Cuboidal to columnar epithelial pattern does exist here but is not the unique differentiating histologic feature. Daughter cysts are more prominent in OKC
Which of the following represents the major differentiating characteristic of an anterior maxillary dentigerous cyst versus adenomatoid odontogenic tumor (AOT)?
A. AOT is always a mixed radio-opaque radiolucent lesion.
B. Age and sex distribution pattern.
C. Attachment of the dentigerous cyst to the cemento-enamel junction of the involved tooth.
D. AOT is confined to the anterior maxilla.
Answer: C
Rationale:
The AOT can be either a mixed radio-opaque/ radiolucent or a radiolucent lesion. The radiographic characteristic of the AOT vs. dentigerous cyst is the complete encompassing of the involved tooth by the cyst lining in the AOT vs. CEJ attachment in the dentigerous cyst. Age and sex distribution patterns are not defining characteristics in differentiating the two. AOT is not confined to the anterior maxilla.
Which of the following represents the major distinguishing characteristic accounting for the high recurrence rate of odontogenic keratocysts in the basal cell nevus (Gorlin-Goltz) syndrome patient?
A. The fragile lining of the cyst
B. The presence of daughter cysts
C. Benign neoplastic biologic behavior
D. Incomplete removal of the original cyst lining
Answer: C
Rationale:
Although all of the above are plausible sswers, in the basal cell nevus syndrome the biologic behavior of the OKC more closely resembles a benign neoplasm. According to Toller, the aggressive nature of the OKC in this syndrome relates to remnants of the dental lamina as precursors to new cyst formation. This characteristically resembles odontogenic tumors.
Osteosarcoma occurs in which of the following patterns?
A. Less frequently in the mandible than maxilla
B. More frequently in the mandible than maxilla
C. With about the same frequency in the maxilla and mandible
D. With increasing frequency according to age
Answer: B
Rationale:
“Mandibular osteosarcomas are more frequent than those in the maxilla (60% vs 40%).” In general terms, osteosarcoma of the facial skeleton occurs in a younger age group, with declining frequency in older patients.
Which of the following represents the best treatment strategy for osteosarcoma of the jaws?
A. Chemotherapy followed by resective surgery followed by more chemotherapy
B. Chemotherapy followed by resective surgery with neck dissection
C. Radiotherapy to shrink followed by resective surgery
D. Ablative surgery alone
Answer: A
Rationale:
Osteosarcomas of the jaws are ideally treated with initial (neoadjuvant) chemotherapy of about five cycles, followed by surgery, which is followed by two or three additional doses of chemotherapy (adjuvant). Radical neck dissection has no role to play in the management of osteosarcoma, as lymphatic dissemination is almost non-existent, while hematogenous dissemination is the rule. Some osteosarcomas of the facial skeleton may be treated by ablative surgery alone, however, this is not considered the best treatment.
Rhabdomyosarcoma is best treated by which of the following treatment protocols? A. Surgery B. Surgery and radiation C. Surgery and chemotherapy D. Surgery, radiation and chemotherapy
Answer: D
Rationale:
For rhabdomyosarcoma, chemotherapy added to surgery and radiation therapy has been reported to improve 5-year survival compared with that seen with surgery and/or radiation therapy alone.
Low-grade mucoepidermoid carcinoma of the posterior mandible with no perforation of the bone and no adenopathy is best treated by which of the following protocols?
A. Resective surgery and post-surgical radiation
B. Resective surgery and post-surgical chemotherapy
C. Resective surgery alone
D. Radiation followed by chemotherapy
Answer: C
Rationale:
Treatment (of LG mucoepidermoid CA) is normally mandibular resection; postoperative radiation therapy is often not required, particularly for low-grade tumors, making mandibular reconstruction a simpler proposition.
Osteoradionecrosis can be characterized as which of the following? A. An osteomyelitic process B. Impaired wound healing C. Vitalized irradiated bone exposure D. Peripheral vasculitis
Answer: B
Rationale:
Osteoradionecrosis can be characterized as impaired wound healing due to the nature of radiation induced vasculitis and subsequent radiation fibrosis which severely compromises or even eliminates the microvasculature of the periosteum as well as endosteal tissue vascular channels while challenging and disabling the overlying integumental vascular plexus as well. There is a certain amount of intranuclear destruction that does occur in all cells present in the radiated field rendering some cell death through DNA disruption; however, the majority of injury occurs to the endothelial vascular lining via superoxide radicals.
Calcified and soft tissue radiation injury is generally caused by which of the following? A. Direct DNA injury B. Superoxide radical generation C. Endothelial fibrosis D. Mucositis and xerostomia
Answer: B
Rationale:
Calcified and soft tissue radiation injury in general is caused by superoxide radical generation as the enzymatic protective pathways against superoxides are by and large severely compromised by the sustained radiation exposure. This directly affects the calcified tissue by severely limiting its vascular metabolic support.
Tooth removal induced osteoradionecrosis is more likely to occur in which of the following scenarios?
A. Immediately after radiation therapy
B. 6-12 months post treatment
C. With the presence of a coexisting metabolic disorder
D. Following salivary gland atrophy
Answer: B
Rationale:
Tooth removal induced radiation necrosis is more likely to occur six to twelve months post treatment as radiation vasculitis and fibrosis are a progressive entity from radiation therapy induction to the completion and progressing factor in a compounding fashion. Initially, there is hyperemia of the insulted tissues with the vascularity remaining intact to the greater degree but with slow progression towards cell death and fibrosis over time which enhances the opportunity for other tissue necrosis such as bone.
Brodie’s abscess is commonly associated with infection of which of the following? A. Bone B. Teeth C. Tonsils D. Sutures
Answer: A
Rationale:
Brodie’s abscess is commonly associated with infection of a bone. It was identified anatomically and classically many years ago in orthopedic literature relative to axial or long bone osteomyelitis where there appeared to be a very well organized infectious process that walled itself off from the host immune response and any other therapeutic modalities save for surgical intervention. This same phenomenon has been appreciated in the mandible as it is commonly seen with the inflammatory response of the periosteum and the walling effect that can occur in terms of limiting the wound from a vascular penetrance.
The presence of purulence in an osteomyelitic wound specifically characterizes the infection as which of the following? A. Acute B. Chronic C. Immunologically responsive D. Vascularly compromisedal
Answer: C
Rationale:
The presence of gross purulence in an osteomyelitic wound characterizes as infection as immunologically responsive due to the actual composition of the purulence being made up by white blood cells or granulocytes, phagocytizing foreign body under the chemotactic influence of an inflammatory/immune cascade. The presence of pus in an osteomyelitic wound will not permit the distinction between acute and chronic osteomyelitis.
