Soft Tissue Tumors — MCQs
A 7-year old boy presents with a right-sided hemangioma and left-sided focal seizures. The most likely diagnosis is:
A 22 year old woman comes with a non progressive mass in the left breast since 6 months. There are no associated symptoms. Examination shows a mobile mass not attached to the overlying skin or underlying tissue. The possible diagnosis is
A 50-year-old HIV-positive patient presents with a painless, purple lesion on the skin. What is the most likely diagnosis?
What is the investigation of choice for nasopharyngeal angiofibroma?
Café au lait spots are seen in which condition?
Which of the following is not associated with Carney's triad?
Which of the following malignant diseases of children has the best prognosis -
Most common benign tumour during infancy is:
All of the following statements are true for keloids EXCEPT:
For which malignancy, intensity modulated radiotherapy (IM) is the most suitable?
Soft Tissue Tumors Indian Medical PG Practice Questions and MCQs
Question 1: A 7-year old boy presents with a right-sided hemangioma and left-sided focal seizures. The most likely diagnosis is:
- A. Incontinentia pigmenti
- B. Sturge-Weber disease (Correct Answer)
- C. Neurofibromatosis
- D. Hypermelanosis of Ito
Explanation: ***Sturge-Weber disease*** - The classic presentation of a **facial hemangioma** (port-wine stain) and **focal seizures** on the contralateral side is highly characteristic of Sturge-Weber disease. - This neurocutaneous syndrome involves a **leptomeningeal angioma** on the same side as the facial hemangioma, leading to neurological symptoms. *Incontinentia pigmenti* - This X-linked dominant disorder primarily affects females and presents with **skin lesions** that evolve through vesicular, verrucous, and hyperpigmented stages, often in a **linear pattern**. - While it can cause neurological symptoms, a unilateral hemangioma and contralateral focal seizures are not typical. *Neurofibromatosis* - Neurofibromatosis Type 1 (NF1) is characterized by **café-au-lait spots**, **axillary/inguinal freckling**, and **neurofibromas**. - While seizures can occur, the combination of a unilateral hemangioma and contralateral focal seizures is not the hallmark presentation of neurofibromatosis. *Hypermelanosis of Ito* - This condition is characterized by **streaky or whorled hyperpigmentation** patterns on the skin, often following Blaschko's lines. - While neurological abnormalities can be associated, the primary cutaneous manifestation is diffuse hyperpigmentation, not a focal hemangioma.
Question 2: A 22 year old woman comes with a non progressive mass in the left breast since 6 months. There are no associated symptoms. Examination shows a mobile mass not attached to the overlying skin or underlying tissue. The possible diagnosis is
- A. Fibroadenoma (Correct Answer)
- B. Cystasarcoma Phylloides
- C. Scirrhous Carcinoma
- D. Fibroadenosis
Explanation: ***Fibroadenoma*** - This is the most common benign breast tumor in young women, typically presenting as a **mobile, non-tender, firm mass** with no attachment to surrounding tissues. - The history of a **non-progressive mass** over six months in a 22-year-old woman is highly characteristic of a fibroadenoma. *Cystasarcoma Phylloides* - While it can present as a mobile mass, phyllodes tumors tend to grow **rapidly** and can reach a large size, which contradicts the "non-progressive" nature of the mass described. - Phyllodes tumors often have a **leaf-like architectural pattern** histologically and can be benign, borderline, or malignant. *Scirrhous Carcinoma* - This is a type of invasive ductal carcinoma that typically presents as a **hard, irregular, fixed mass** that is often attached to the skin or underlying tissue, unlike the mobile mass described here. - It is common in older women and often associated with **skin dimpling** or nipple retraction. *Fibroadenosis* - This refers to a group of benign breast changes, often presenting with generalized **lumpiness, pain, or tenderness** that fluctuates with the menstrual cycle, rather than a discrete, solitary mass. - It usually presents as **multiple, diffuse nodules** rather than a single, well-defined mass.
Question 3: A 50-year-old HIV-positive patient presents with a painless, purple lesion on the skin. What is the most likely diagnosis?
- A. Kaposi's sarcoma (Correct Answer)
- B. Squamous cell carcinoma
- C. Malignant melanoma
- D. Basal cell carcinoma
Explanation: ***Kaposi's sarcoma*** - The presentation of **painless, purple skin lesions** in an **HIV-positive patient** is highly characteristic of Kaposi's sarcoma. - This is a vascular tumor caused by **Human Herpesvirus 8 (HHV-8)**, often seen in immunocompromised individuals. *Malignant melanoma* - Malignant melanoma typically presents as a **dark, irregularly shaped lesion** with varying colors and often exhibits change in size, shape, or color over time (**ABCDEs of melanoma**). - While it can be purple or dark, the multiple, widespread nature and association with HIV points away from typical melanoma. *Squamous cell carcinoma* - Squamous cell carcinoma usually presents as a **red, scaly patch, nodule, or an open sore** that doesn't heal, often found in sun-exposed areas. - It is not typically described as a painless purple lesion, and while HIV patients have increased risk, the lesion morphology is more consistent with Kaposi's. *Basal cell carcinoma* - Basal cell carcinoma commonly appears as a **pearly or waxy bump**, a **flat, flesh-colored lesion**, or a **brown, scar-like lesion**, often with a rolled border and telangiectasias. - Unlike the description, it is not typically purple and painless, and while common, the clinical picture with HIV is not classic for BCC.
Question 4: What is the investigation of choice for nasopharyngeal angiofibroma?
- A. Contrast-enhanced CT (Correct Answer)
- B. Plain CT
- C. X-ray
- D. MRI
Explanation: ***Contrast-enhanced CT*** - A **contrast-enhanced CT** scan is the investigation of choice for **nasopharyngeal angiofibroma** due to its ability to clearly delineate the extent of the tumor, its vascularity, and its bony involvement. - The contrast highlights the **highly vascular nature** of the angiofibroma, which is crucial for surgical planning and embolization. *X-ray* - **X-rays** provide limited detail of soft tissue structures and mass lesions in the complex anatomy of the nasopharynx. - They are generally not sensitive enough to characterize a tumor like **angiofibroma** or determine its exact extent. *Plain CT* - A **plain CT** (non-contrast CT) can show soft tissue masses and bony erosion but lacks the ability to assess the **vascularity** of the tumor. - Without contrast, it's difficult to differentiate the tumor from surrounding tissues or identify its blood supply, which is critical for **angiofibroma** management. *MRI* - While **MRI** offers excellent soft tissue contrast and is valuable for assessing intracranial extension or perineural spread, **contrast-enhanced CT** is generally preferred as the primary imaging modality for angiofibroma. - **CT with contrast** is superior for demonstrating **bony erosion** and the characteristic **vascularity** of this tumor.
Question 5: Café au lait spots are seen in which condition?
- A. Cockayne syndrome
- B. Down syndrome
- C. Neurofibromatosis (Correct Answer)
- D. Gardner's syndrome
Explanation: ***Neurofibromatosis*** - **Café au lait spots** (light brown macules) are a hallmark feature of **Neurofibromatosis type 1 (NF1)**, often appearing in childhood. - Diagnosis of NF1 usually requires having **six or more café au lait spots** larger than 5 mm in prepubertal children or 15 mm in postpubertal individuals. *Cockayne syndrome* - This is a rare genetic disorder characterized by **premature aging**, **photosensitivity**, and **neurological dysfunction**, but not café au lait spots. - Key features include **dwarfism**, a "bird-like" facial appearance, and **progressive neurological degeneration**. *Down syndrome* - Caused by trisomy of chromosome 21, **Down syndrome** presents with distinct facial features like an upward slant to the eyes and a single palmar crease. - While it can be associated with various medical conditions, **café au lait spots** are not a characteristic finding. *Gardner's syndrome* - This is a subtype of **familial adenomatous polyposis** characterized by numerous **colorectal polyps**, alongside extracolonic manifestations such as **osteomas** and **desmoid tumors**. - **Pigmented lesions** can occur, but these are typically **retinal pigmented epithelial hypertrophy** or epidermal cysts, rather than café au lait spots.
Question 6: Which of the following is not associated with Carney's triad?
- A. Atrial myxoma (Correct Answer)
- B. GIST
- C. Chondroma
- D. Paraganglioma
Explanation: ***Atrial myxoma*** - Atriomyxoma is not part of **Carney's triad**, which primarily includes **paraganglioma**, **chondroma**, and **gastrointestinal stromal tumors (GIST)**. - Carney's triad is a rare genetic condition associated with **multiple neoplasms**, and atrial myxomas are cardiac tumors, not part of this triad. *Paraganglioma* - Paragangliomas are tumors derived from **neuroendocrine cells**, and they are one of the key components of **Carney's triad**. - They typically arise in **chromaffin tissue**, which is involved in catecholamine secretion. *Chondroma* - Chondromas are benign tumors of **cartilage**, also recognized as a component of **Carney's triad**. - They are often found in the **bones** or soft tissues, but they are part of the neoplasms associated with this condition. *GIST* - Gastrointestinal stromal tumors (GISTs) are significant neoplasms linked to **Carney's triad**, arising from **interstitial cells of Cajal** in the GI tract. - They are characterized by specific mutations and can be a source of gastrointestinal symptoms in affected individuals.
Question 7: Which of the following malignant diseases of children has the best prognosis -
- A. Primitive neuroectodermal tumor
- B. Wilms tumor (Correct Answer)
- C. Neuroblastoma
- D. Rhabdomyosarcoma
Explanation: ***Wilms tumor*** - **Wilms tumor**, also known as **nephroblastoma**, has one of the best prognoses among childhood malignancies, with a **survival rate exceeding 90%** for localized disease. - Its high curability is attributed to its **chemosensitivity**, surgical resectability, and advancements in multimodal therapy. *Primitive neuroectodermal tumor* - **Primitive neuroectodermal tumors (PNETs)** are highly aggressive and often associated with a **poor prognosis**, particularly when they are large or metastatic. - These tumors arise from neuroectoderm and can occur in the central nervous system (e.g., medulloblastoma) or peripherally, making treatment challenging due to their infiltrative nature. *Neuroblastoma* - **Neuroblastoma** is a common extracranial solid tumor in children, originating from neural crest cells, and its prognosis varies widely based on age, stage, and biological features, but it often has a **guarded prognosis**, especially in older children or with unfavorable genetic markers. - High-risk neuroblastomas frequently exhibit **amplification of the MYCN oncogene** and often require intensive, multi-modal treatment, still leading to significant mortality. *Rhabdomyosarcoma* - **Rhabdomyosarcoma** is a malignant tumor of mesenchymal origin with skeletal muscle differentiation, and its prognosis depends heavily on site, histology (e.g., alveolar vs. embryonal), and resectability, with **overall survival rates lower than Wilms tumor**, especially for unfavorable subtypes or metastatic disease. - Aggressive treatment including chemotherapy, radiation, and surgery is often necessary, but recurrence rates can be high.
Question 8: Most common benign tumour during infancy is:
- A. Hemangioma (Correct Answer)
- B. Lymphangioma
- C. Lipoma
- D. Cystic hygroma
Explanation: ***Hemangioma*** - **Hemangiomas** are the most common benign vascular tumors of infancy, characterized by a rapid proliferative phase followed by spontaneous involution. - They are typically present at birth or manifest within the first few weeks of life, growing rapidly during the first year. *Lymphangioma* - **Lymphangiomas** are congenital malformations of the lymphatic system, less common than hemangiomas. - They are typically present at birth and do not demonstrate the same rapid proliferative and involuting phases seen with hemangiomas. *Lipoma* - **Lipomas** are benign tumors composed of mature fat cells and are relatively rare in infancy. - They typically present as soft, movable subcutaneous masses and grow slowly, usually appearing in older children or adults. *Cystic hygroma* - **Cystic hygromas** (lymphatic malformations) are a type of lymphangioma, usually presenting as large, multiloculated cysts, often in the head and neck region. - While congenital, they are distinct from hemangiomas and involve the lymphatic system, not blood vessels, and do not show the same initial rapid growth followed by involution.
Question 9: All of the following statements are true for keloids EXCEPT:
- A. The maturation and stabilization of the collagen fibrils is inhibited
- B. It is rarely seen in white skinned persons and is more common over the sternum
- C. True keloid does not spread into surrounding tissue (Correct Answer)
- D. True keloid continues to become worse even after one year
Explanation: ***True keloid does not spread into surrounding tissue*** - This statement is **incorrect** as a defining characteristic of keloids is their tendency to **spread beyond the original wound boundaries**, invading surrounding healthy tissue. - This expansive growth differentiates keloids from hypertrophic scars, which remain confined to the site of injury. *The maturation and stabilization of the collagen fibrils is inhibited* - This statement is **true**. In keloids, there is an impairment in the normal maturation process of collagen, leading to an accumulation of **immature, disorganized collagen fibrils**. - This abnormal collagen synthesis and degradation contribute to the excessive and persistent fibrosis characteristic of keloids. *It is rarely seen in white skinned persons and is more common over the sternum* - This statement is **true**. Keloids are more prevalent in individuals with **skin of color (e.g., African, Hispanic, and Asian descent)** and are less common in Caucasians. - Common locations for keloids include the **sternum**, earlobes, shoulders, and upper back, areas under significant skin tension. *True keloid continues to become worse even after one year* - This statement is **true**. Unlike hypertrophic scars which may regress over time, keloids tend to be **persistent and progressive**, often continuing to grow and worsen in size and appearance even years after the initial injury. - They typically do not resolve spontaneously and may even recur after excision.
Question 10: For which malignancy, intensity modulated radiotherapy (IM) is the most suitable?
- A. Lung
- B. Leukemias
- C. Stomach
- D. Prostate (Correct Answer)
Explanation: ***Prostate*** - **IMRT** is highly suitable for prostate cancer due to its ability to precisely deliver high radiation doses to the prostate while sparing adjacent organs like the **rectum** and **bladder**. [1] - The use of multiple small beams of varying intensities allows for highly conformal dose distribution, minimizing toxicity to surrounding sensitive structures. *Lung* - While IMRT can be used for lung cancer, particularly for complex-shaped tumors or those near critical structures, **stereotactic body radiation therapy (SBRT)** is often preferred for early-stage lung cancer, due to its ability to deliver very high doses in fewer fractions. - The movement of the lungs during respiration presents a challenge for IMRT planning and delivery, often requiring motion management techniques. *Leukemias* - Radiation therapy for leukemias typically involves **total body irradiation (TBI)** as part of conditioning regimens for stem cell transplantation, rather than IMRT. - TBI aims to ablate the bone marrow and suppress the immune system, requiring a broad, uniform dose distribution, which is not the primary strength of IMRT's highly conformal approach. *Stomach* - For stomach cancer, radiation therapy is often used in conjunction with **chemotherapy** (chemoradiation) for locally advanced disease. - While IMRT can be used, the **mobility of the stomach** and intestines makes precise, repeatable targeting challenging, and there is a higher risk of gastrointestinal toxicity, usually requiring careful planning to manage.
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