Benign Epithelial Tumors — MCQs
Focal epithelial hyperplasia caused by HPV13 and 32 is also termed as:
Skin biopsy shows psoriasiform hyperplasia with neutrophilic microabscesses in stratum corneum. Most likely diagnosis?
Psoriasis has the following features except
A patient presents with a gradually progressive, painless mass persisting for 10 years. The mass is firm to nodular and shows variable consistency within different areas of the swelling. What is the most probable diagnosis?
A male patient presented with a 0.3 cm nodule on the left nasolabial fold. A pathological examination revealed a basaloid appearance with peripheral palisading. What is the most likely diagnosis?
A 16-year-old female presents with primary amenorrhea and raised FSH. On examination, her height was 58 inches. What would be the histopathological finding in the ovary?
Which of the following soft-tissue lesions has a biphasic histologic pattern and consists of cuboidal epithelial and spindle-shaped mesenchymal cells?
A patient consults a dermatologist about a skin lesion on her neck. Examination reveals a 1-cm diameter, red, scaly plaque with a rough texture and irregular margins. Biopsy demonstrates epidermal and dermal cells with large, pleomorphic, hyperchromatic nuclei. Which of the following conditions would most likely predispose this patient to the development of this lesion?
For the treatment of basal cell carcinoma, what is the popular surgery that is carried out?
A woman on Pap smear shows disorganized growth of cells with hyperchromatic nuclei. Which phenomenon is occurring here?
Benign Epithelial Tumors Indian Medical PG Practice Questions and MCQs
Question 1: Focal epithelial hyperplasia caused by HPV13 and 32 is also termed as:
- A. Cowden syndrome.
- B. Heck's disease. (Correct Answer)
- C. Acanthosis nigricans
- D. Keratoacanthoma.
Explanation: ***Heck's disease*** - **Focal epithelial hyperplasia (FEH)**, caused by **HPV 13 and 32**, is pathognomonically known as Heck's disease. - This condition presents as multiple, discrete, flattened or dome-shaped papules on the **oral mucosa**, often seen in children and young adults. *Cowden syndrome* - This is a rare **autosomal dominant disorder** characterized by multiple hamartomas and an increased risk of specific cancers (e.g., breast, thyroid). - It is caused by mutations in the **PTEN gene** and does not involve HPV 13 or 32 as an etiology. *Acanthosis nigricans* - Characterized by **darkening and thickening of the skin**, particularly in body folds (e.g., neck, axilla). - It is often associated with insulin resistance, obesity, or underlying malignancies, and is not caused by HPV. *Keratoacanthoma* - This is a rapidly growing, dome-shaped skin lesion with a **central keratin plug**, typically found on sun-exposed skin. - While it can resemble squamous cell carcinoma, it is generally considered a benign or low-grade malignancy and is not linked to HPV 13 or 32.
Question 2: Skin biopsy shows psoriasiform hyperplasia with neutrophilic microabscesses in stratum corneum. Most likely diagnosis?
- A. Psoriasis (Correct Answer)
- B. Seborrheic dermatitis
- C. Pityriasis rosea
- D. Lichen planus
Explanation: ***Psoriasis*** - **Psoriasiform hyperplasia**, characterized by regular epidermal acanthosis and elongated rete ridges, is a classic histological feature of psoriasis. - The presence of **neutrophilic microabscesses (Munro microabscesses)** in the stratum corneum is a pathognomonic finding for psoriasis. *Seborrheic dermatitis* - Histologically, seborrheic dermatitis typically shows **irregular acanthosis** with parakeratosis and a **perivascular lymphocytic infiltrate**, but not regular psoriasiform hyperplasia or Munro microabscesses. - There may be *spongiosis* and neutrophils in the stratum corneum, but not the distinct microabscesses seen in psoriasis. *Pityriasis rosea* - Pityriasis rosea histology often reveals **focal parakeratosis**, **spongiosis**, and a **perivascular lymphocytic infiltrate** with extravasated red blood cells. - It does not demonstrate the characteristic regular psoriasiform hyperplasia or neutrophilic microabscesses of psoriasis. *Lichen planus* - Lichen planus is characterized by a **"sawtooth" rete ridge pattern**, a **band-like lymphocytic infiltrate** at the dermo-epidermal junction, and **colloid bodies (Civatte bodies)**. - It does not exhibit psoriasiform hyperplasia or neutrophilic microabscesses in the stratum corneum.
Question 3: Psoriasis has the following features except
- A. Granular cell layer is thinned or almost absent.
- B. Munro abscesses in the parakeratotic layer
- C. Acanthosis with thickened lower portion
- D. Suprapapillary thinning of epidermis
- E. Prominent granular cell layer (Correct Answer)
Explanation: ***Prominent granular cell layer*** - Psoriatic skin lesions are characterized by a **thinned or absent granular cell layer (stratum granulosum)**, not a prominent one. - This observation is often used histopathologically to differentiate psoriasis from other skin conditions. *Granular cell layer is thinned or almost absent* - This statement accurately describes a key histological feature of psoriasis, where the **stratum granulosum** is significantly reduced or missing. - The absence of this layer is linked to the rapid epidermal turnover seen in psoriatic plaques. *Munro abscesses in the parakeratotic layer* - **Munro microabscesses** are collections of neutrophils found within the **parakeratotic stratum corneum** in psoriatic lesions [1]. - These microabscesses are a characteristic histopathological finding that helps in the diagnosis of psoriasis. *Suprapapillary thinning of epidermis* - There is a characteristic **thinning of the suprapapillary epidermis** (the epidermis directly above the dermal papillae) [1]. - This thinning, combined with dilated capillaries in the dermal papillae, contributes to the **Auspitz sign**, where pinpoint bleeding occurs after scratching the surface of a psoriatic plaque [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Disorders Involving Inflammatory And Haemopoietic Cells, pp. 636-641.
Question 4: A patient presents with a gradually progressive, painless mass persisting for 10 years. The mass is firm to nodular and shows variable consistency within different areas of the swelling. What is the most probable diagnosis?
- A. Dermoid cyst
- B. Malignancy
- C. Sebaceous cyst
- D. Pleomorphic adenoma (Correct Answer)
Explanation: ***Pleomorphic adenoma*** - A **gradually progressive**, **painless mass** that has been present for 10 years, with a **firm to nodular** consistency and variability at different sites, is highly characteristic of a pleomorphic adenoma. - This benign tumor of salivary glands is known for its **slow growth** and **variable histological composition**, leading to its characteristic consistency. *Dermoid cyst* - Dermoid cysts are typically **present from birth** or early childhood and tend to be **soft and doughy** in consistency, rather than firm or nodular with variable consistency. - While painless, their growth pattern and texture differ from the described mass. *Malignancy* - A mass that has been present for **10 years** and is still described as **gradually progressive** but painless is less likely to be a malignancy, as most malignant tumors tend to grow more rapidly and often present with pain or other symptoms over such a long period. - Malignancies usually demonstrate a more infiltrative and aggressive growth pattern. *Sebaceous cyst* - A sebaceous cyst (epidermoid cyst) typically presents as a **smooth, movable, dome-shaped lump** and contains a cheesy, malodorous material, which is not consistent with a firm to nodular mass with varying consistency. - While they can be long-standing and painless, their characteristic feel and contents are different.
Question 5: A male patient presented with a 0.3 cm nodule on the left nasolabial fold. A pathological examination revealed a basaloid appearance with peripheral palisading. What is the most likely diagnosis?
- A. Basal cell carcinoma (Correct Answer)
- B. Melanoma
- C. Squamous cell carcinoma
- D. Nevus
Explanation: ***Basal cell carcinoma*** - The description of a **basaloid appearance with peripheral palisading** on pathological examination is a classic histological feature of basal cell carcinoma (BCC). - BCC commonly presents as a nodule on sun-exposed areas like the **nasolabial fold** and is the most common skin cancer. *Melanoma* - Melanoma is characterized by the **malignant proliferation of melanocytes** and histologically shows atypical melanocytes with pagetoid spread or nest formation. - While it can appear as a nodule, the described **basaloid appearance with peripheral palisading** is not characteristic of melanoma. *Squamous cell carcinoma* - Squamous cell carcinoma typically shows **atypical keratinocytes** with keratinization, intercellular bridges, and sometimes desmoplasia. - It usually presents as an **erythematous, scaly patch** or nodule, often with ulceration, and the described histology does not match. *Nevus* - A nevus (mole) is a benign proliferation of melanocytes, showing **uniform nests of melanocytes** with maturation as they descend into the dermis. - The term **basaloid appearance** refers to cells resembling basal keratinocytes, which is not typical for a nevus.
Question 6: A 16-year-old female presents with primary amenorrhea and raised FSH. On examination, her height was 58 inches. What would be the histopathological finding in the ovary?
- A. Hemorrhagic Corpus Luteum
- B. Mucinous cystadenoma
- C. Absence of oocytes in the ovaries (streak ovaries) (Correct Answer)
- D. Psammoma bodies
Explanation: ***Absence of oocytes in the ovaries (streak ovaries)*** - The presentation of **primary amenorrhea** with **raised FSH** and short stature strongly suggests **Turner syndrome (45, XO)**. - In Turner syndrome, the ovaries typically fail to develop properly, resulting in **streak gonads** that lack functional oocytes and follicular structures. *Hemorrhagic Corpus Luteum* - A hemorrhagic corpus luteum is a normal physiological finding in a cycling ovary, usually associated with menstruation or early pregnancy. - It is inconsistent with primary amenorrhea and elevated FSH, which indicates ovarian failure rather than ovulation. *Mucinous cystadenoma* - A mucinous cystadenoma is a benign ovarian neoplasm that would typically present as an ovarian mass, potentially causing symptoms like abdominal pain or bloating. - It does not explain primary amenorrhea or elevated FSH, which reflect a lack of ovarian function, not a structural tumor. *Psammoma bodies* - **Psammoma bodies** are concentric calcifications found in various tumors, most notably **serous ovarian carcinomas** and papillary thyroid carcinoma. - Their presence would indicate a malignant or benign epithelial tumor, which is not suggested by the clinical picture of primary amenorrhea and ovarian failure.
Question 7: Which of the following soft-tissue lesions has a biphasic histologic pattern and consists of cuboidal epithelial and spindle-shaped mesenchymal cells?
- A. Synovial sarcoma (Correct Answer)
- B. Nodular fasciitis
- C. Liposarcoma
- D. Malignant fibrous histiocytoma
Explanation: *Liposarcoma* - Typically presents with **lipoblasts** and does not exhibit a **biphasic histologic pattern**. - Usually lacks **cuboidal epithelial** cells, focusing instead on adipose tissue differentiation. *Nodular fasciitis* [2] - This is a reactive benign lesion characterized by **plump fibroblasts** and **myofibroblasts**, not a malignant neoplasm. - The histological pattern is **monophonic** and does not feature **epithelial components**. *Synovial sarcoma* [1] - Though it can present with a biphasic pattern, it is characterized by **monomorphic spindle cells** and does not consistently show **epithelial components** like cuboidal cells. - Typically associated with **SS18-SSX fusion** genes, which is not an indication of just any malignant neoplasm. *Malignant fibrous histiocytoma* - Characterized by **histiocytic and spindle cell** components but lacks the **epithelial features** that define a biphasic pattern. - Primarily composed of **malignant fibrous histiocytoma**, which does not indicate a specific malignancy associated with epithelial differentiation. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1225-1226. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1223-1224.
Question 8: A patient consults a dermatologist about a skin lesion on her neck. Examination reveals a 1-cm diameter, red, scaly plaque with a rough texture and irregular margins. Biopsy demonstrates epidermal and dermal cells with large, pleomorphic, hyperchromatic nuclei. Which of the following conditions would most likely predispose this patient to the development of this lesion?
- A. Compound nevus
- B. Dermal nevus
- C. Junctional nevus
- D. Actinic keratosis (Correct Answer)
Explanation: ***Actinic keratosis*** - The skin lesion described (red, scaly plaque with a rough texture and irregular margins) along with the biopsy findings of **pleomorphic, hyperchromatic nuclei** are consistent with **squamous cell carcinoma in situ** or **Bowen's disease**, which often arises from **actinic keratosis**. - **Actinic keratosis** is a premalignant lesion caused by chronic exposure to **ultraviolet (UV) radiation**, leading to atypical keratinocytes. It is a direct precursor to invasive **squamous cell carcinoma**. *Compound nevus* - A **compound nevus** is a benign mole characterized by nests of melanocytes located at both the **dermoepidermal junction** and within the **dermis**. - It typically appears as a raised, pigmented lesion with a smooth surface and does not show the scaly, rough texture or the severe cellular atypia described. *Dermal nevus* - A **dermal nevus** is a benign mole where the melanocytes are exclusively located within the **dermis**. - These lesions are often dome-shaped, flesh-colored or lightly pigmented, and can appear warty or pedunculated, lacking the scaly, irregular features of the described lesion. *Junctional nevus* - A **junctional nevus** is a benign mole characterized by nests of melanocytes located at the **dermoepidermal junction**. - They are typically flat, well-demarcated, and uniformly pigmented, and do not present with the scaly texture, irregular margins, or the severe cellular atypia seen in the biopsy.
Question 9: For the treatment of basal cell carcinoma, what is the popular surgery that is carried out?
- A. Mohs surgery (Correct Answer)
- B. Superficial laser surgery
- C. Curettage and electrodesiccation
- D. Wide local excision
Explanation: ***Mohs surgery*** - **Mohs micrographic surgery** is the most popular and highly effective procedure specifically designed for **basal cell carcinoma (BCC)**, especially on the face and other cosmetically sensitive areas. - It involves the **progressive removal** of thin layers of skin, which are immediately examined under a microscope, allowing for complete tumor removal while preserving maximum healthy tissue. - Mohs surgery has the **highest cure rate** (95-99%) for BCC and is particularly preferred for high-risk locations, recurrent tumors, and poorly defined borders. *Superficial laser surgery* - While lasers can sometimes be used for very superficial skin lesions, **superficial laser surgery** is generally not the primary treatment for established **BCC** due to the risk of incomplete removal and recurrence. - It lacks the **histological margin control** provided by Mohs surgery, which is crucial for ensuring complete eradication of BCC. *Curettage and electrodesiccation* - **Curettage and electrodesiccation** is an alternative surgical treatment for small, low-risk BCCs in non-critical areas. - However, it has **lower cure rates** (85-95%) compared to Mohs surgery and does not provide histological margin assessment. - It is less preferred for facial BCCs where cosmetic outcome and complete removal are critical. *Wide local excision* - **Wide local excision** is a standard surgical approach that removes the tumor with predetermined margins (typically 4-5 mm for BCC). - While effective, it requires **larger tissue removal** compared to Mohs surgery and lacks the real-time microscopic margin control. - Mohs surgery remains more popular due to its tissue-sparing nature and higher cure rates, especially in cosmetically sensitive areas.
Question 10: A woman on Pap smear shows disorganized growth of cells with hyperchromatic nuclei. Which phenomenon is occurring here?
- A. Metaplasia
- B. Hypertrophy
- C. Carcinoma
- D. Dysplasia (Correct Answer)
Explanation: ***Dysplasia*** - **Dysplasia** refers to disordered growth and maturation of cells, often characterized by **cellular pleomorphism**, **loss of architectural orientation**, **nuclear hyperchromatism**, and increased mitotic activity [1]. - In a Pap smear, these features are indicative of **precancerous changes** in the cervical epithelium, requiring further investigation [2]. *Metaplasia* - **Metaplasia** is the reversible replacement of one differentiated cell type with another, often in response to chronic irritation [2]. - While it can be a precursor to dysplasia, metaplasia itself involves mature, well-differentiated cells, not the **disorganized growth** and **hyperchromatic nuclei** described. *Hypertrophy* - **Hypertrophy** is an increase in the size of cells, leading to an increase in the size of the organ. - This process involves mature cells and does not include the characteristic **disorganized growth** or nuclear abnormalities seen in the question. *Carcinoma* - **Carcinoma** is a malignant tumor derived from epithelial cells, characterized by uncontrolled growth and invasion. - While the described changes could progress to carcinoma, the term carcinoma implies **frank malignancy** with invasive potential, whereas dysplasia refers to **precancerous changes** (CIN I, II, III) [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1007-1010. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 467-468.
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