Vascular Tumors and Malformations — MCQs
Which of the following statements about cavernous hemangioma is false?
Which of the following findings on colonoscopy is most consistent with angiodysplasia?
A 50-year-old HIV-positive patient presents with a painless, purple lesion on the skin. What is the most likely diagnosis?
The usual location of glomus jugulare tumor is -
What is the mechanism of action of Bevacizumab?
Which of the following statements is true regarding cystic hygroma?
A mother brought her child who has got a vascular plaque like lesion over the lateral aspect of forehead mainly involving ophthalmic and maxillary division of trigeminal nerve. Mother says that the lesion has remained unchanged since birth. Also mother gives a history that the child is on valproate for seizure disorder. What is the MOST probable diagnosis?
A 32-year-old lady presents with shoulder tip pain. She is diagnosed with Pancoast tumor and presents with miosis. What is the most likely associated diagnosis?
A 5-day-old infant is diagnosed with a non-communicating hydrocephalus. Which of the following is most likely to lead to such a condition?
A 52 year old female underwent MRM (Modified Radical Mastectomy). After few years, she developed lymphedema of the ipsilateral arm. Which of the following malignancies can develop in her arm?
Vascular Tumors and Malformations Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following statements about cavernous hemangioma is false?
- A. Not associated with VHL disease
- B. Less infiltrative than capillary hemangioma
- C. Intravascular thrombosis and dystrophic calcification are seen commonly
- D. Undergo spontaneous regression (Correct Answer)
Explanation: ***Undergo spontaneous regression*** - This statement is **false** because **cavernous hemangiomas** typically do not undergo spontaneous regression. They are persistent lesions. - Spontaneous regression is more characteristic of **capillary hemangiomas** (also known as infantile hemangiomas), especially those occurring in early childhood. *Less infiltrative than capillary hemangioma* - This statement is **true**. Cavernous hemangiomas are generally **well-circumscribed** and less infiltrative than capillary hemangiomas, which can sometimes spread more diffusely. - Their distinct, large vascular channels make them easier to delineate from surrounding tissue. *Intravascular thrombosis and dystrophic calcification are seen commonly* - This statement is **true**. The slow blood flow and large, irregular vascular spaces within cavernous hemangiomas predispose them to **thrombosis**. - Subsequent organization of thrombi and **fibrin deposition** often leads to **dystrophic calcification**, which can be visualized radiographically. *Not associated with VHL disease* - This statement is **true**. **Cavernous hemangiomas** are generally **not associated with von Hippel-Lindau (VHL) disease**. - VHL disease is primarily linked to **hemangioblastomas**, particularly in the CNS and retina, which are distinct from common cavernous hemangiomas.
Question 2: Which of the following findings on colonoscopy is most consistent with angiodysplasia?
- A. Inflamed diverticula
- B. Dilated submucosal veins (Correct Answer)
- C. Mucosal ulcers
- D. Mass lesion
Explanation: Dilated submucosal veins - **Angiodysplasia** is characterized by the presence of **dilated, tortuous submucosal venules and capillaries** that are prone to bleeding. - On colonoscopy, these lesions typically appear as small, flat, cherry-red spots or fern-like vascular patterns. *Inflamed diverticula* - **Diverticulitis** involves inflammation and infection of outpouchings in the colon wall, presenting with pain, fever, and leukocytosis. - Colonoscopy during acute diverticulitis is generally avoided due to the risk of perforation, and the findings would be localized inflammation, not dilated vessels indicative of angiodysplasia. *Mucosal ulcers* - **Mucosal ulcers** are breaks in the mucosal lining, often associated with inflammatory bowel disease, infections, or ischemia. - While ulcers can cause bleeding, they represent a different pathological process than the vascular malformations characteristic of angiodysplasia. *Mass lesion* - A **mass lesion** suggests a tumor, polyp, or other growth within the colon. - This finding is more indicative of a neoplastic process or a large inflammatory lesion, distinct from the small, flat vascular lesions of angiodysplasia.
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: The usual location of glomus jugulare tumor is -
- A. Mastoid air cells
- B. Epitympanum
- C. Internal auditory meatus
- D. Hypotympanum (Correct Answer)
Explanation: ***Hypotympanum*** - The **glomus jugulare tumor** originates from **chemoreceptor cells (glomus bodies)** located in the adventitia of the **jugular bulb**, which is situated in the hypotympanum. - This location accounts for the common presentation of these tumors within the **middle ear space**, often eroding upwards from the floor. *Mastoid air cells* - While glomus jugulare tumors can invade the **mastoid**, this is typically a secondary extension, not their primary site of origin. - Tumors primarily arising in the mastoid air cells are more commonly **cholesteatomas** or **primary mastoid malignancies**. *Epitympanum* - The **epitympanum** (attic) is the upper part of the middle ear and is more often associated with the origin of **cholesteatomas** or extensions of tympanic membrane perforations. - **Glomus jugulare tumors** are not typically found to originate here. *Internal auditory meatus* - The **internal auditory meatus** houses the facial nerve and vestibulocochlear nerve and is the common location for **vestibular schwannomas (acoustic neuromas)**. - **Glomus jugulare tumors** do not primarily originate in this location but can extend to involve the internal auditory meatus in advanced stages.
Question 5: What is the mechanism of action of Bevacizumab?
- A. Anti VEGF antibody (Correct Answer)
- B. Histone deacetylase inhibitor
- C. HER2 neu inhibitor
- D. Proteasome inhibitor
Explanation: ***Anti VEGF antibody*** - **Bevacizumab** is a **monoclonal antibody** that specifically targets and binds to vascular endothelial growth factor (VEGF). - By inhibiting VEGF, bevacizumab prevents the formation of new blood vessels (**angiogenesis**) that tumors need to grow and metastasize. *Histone deacetylase inhibitor* - **Histone deacetylase (HDAC) inhibitors** influence gene expression by modifying chromatin structure, leading to cell cycle arrest and apoptosis in cancer cells. - They are used in certain hematologic malignancies and solid tumors but do not directly interfere with angiogenesis. *Proteasome inhibitor* - **Proteasome inhibitors** like bortezomib block the action of proteasomes, leading to an accumulation of ubiquitinated proteins and induction of apoptosis in cancer cells. - This mechanism is distinct from blocking new blood vessel formation. *HER2 neu inhibitor* - **HER2 neu inhibitors** (e.g., trastuzumab) specifically target the HER2/neu receptor, which is overexpressed in certain breast and gastric cancers. - Their action primarily involves blocking growth signals transmitted through this receptor, not inhibiting VEGF or angiogenesis.
Question 6: Which of the following statements is true regarding cystic hygroma?
- A. Non transilluminant
- B. Develops from jugular lymphatic sequestration (Correct Answer)
- C. Lined by endothelial cells
- D. All of the options
Explanation: ***Develops from jugular lymphatic sequestration*** - **Cystic hygromas** are congenital **lymphatic malformations** that primarily occur in the neck - They arise from the abnormal budding or sequestration of the **jugular lymph sacs** during embryonic development, leading to the formation of dilated lymphatic channels that fail to connect with the venous system - This is the **most specific and characteristic** feature of cystic hygroma pathogenesis *Non transilluminant* - This statement is **incorrect**; cystic hygromas are typically **transilluminant** because they are fluid-filled sacs - The cystic nature of the lesion allows light to pass through, which is a classic diagnostic feature on clinical examination *Lined by endothelial cells* - While this statement is technically true (lymphatic endothelial cells are a type of endothelial cell), it is **not the most specific answer** - This feature is shared with all vascular and lymphatic structures, making it less distinctive for cystic hygromas - The key distinguishing feature is their **embryological origin** from jugular lymphatic sequestration, not just their endothelial lining *All of the options* - This option is **incorrect** because not all statements are true or most appropriate - Only the statement about jugular lymphatic sequestration represents the most specific and correct answer
Question 7: A mother brought her child who has got a vascular plaque like lesion over the lateral aspect of forehead mainly involving ophthalmic and maxillary division of trigeminal nerve. Mother says that the lesion has remained unchanged since birth. Also mother gives a history that the child is on valproate for seizure disorder. What is the MOST probable diagnosis?
- A. Infantile hemangioma
- B. Tuberous sclerosis
- C. Sturge weber syndrome (Correct Answer)
- D. Incontinentia pigmenti
Explanation: ***Sturge weber syndrome*** - The classic presentation of a **vascular plaque-like lesion** (port-wine stain) in the distribution of the **trigeminal nerve** (ophthalmic and maxillary divisions) from birth, combined with a history of **seizure disorder**, strongly points to Sturge-Weber syndrome. - This neurocutaneous disorder is characterized by a **facial cutaneous angioma**, **leptomeningeal angioma** (leading to seizures), and often **ocular involvement** like glaucoma. *Infantile hemangioma* - While also a vascular lesion, **infantile hemangiomas** typically proliferate in the first few months of life and then involute, rather than being present as a stable "plaque" from birth. - They also don't typically follow a specific trigeminal nerve distribution and are not directly associated with a primary **seizure disorder** as a core feature. *Tuberous sclerosis* - Tuberous sclerosis presents with characteristic clinical features, including **facial angiofibromas** (adenoma sebaceum), **shagreen patches**, and **ash-leaf spots**, which are distinct from a flat vascular plaque. - Although seizures are common in tuberous sclerosis due to **cortical tubers**, the facial skin lesion described does not fit the typical dermatological manifestations of this condition. *Incontinentia pigmenti* - This condition presents with highly characteristic **skin lesions** that evolve through distinct stages, including vesicular, verrucous, and hyperpigmented (swirl-like patterns), which do not match the description of a vascular plaque. - While it can be associated with neurological issues like **seizures**, the dermatological findings are the primary differentiating factor here.
Question 8: A 32-year-old lady presents with shoulder tip pain. She is diagnosed with Pancoast tumor and presents with miosis. What is the most likely associated diagnosis?
- A. Upper trunk of brachial plexus injury
- B. Thoracic outlet syndrome
- C. Horner syndrome (Correct Answer)
- D. Aberrant right subclavian artery
Explanation: Horner syndrome - The presence of miosis (constricted pupil) in a patient with a Pancoast tumor is a classic sign of Horner syndrome. - Pancoast tumors are apical lung tumors that can invade the sympathetic chain, leading to the triad of ptosis, miosis, and anhidrosis. Upper trunk of brachial plexus injury - While Pancoast tumors can involve the brachial plexus, an injury to the upper trunk (C5-C6) typically causes symptoms like weakness in shoulder abduction and external rotation, and sensory loss over the lateral arm. - It does not directly explain miosis unless the sympathetic chain is also involved, which is characteristic of Horner syndrome. Thoracic outlet syndrome - This syndrome involves compression of the neurovascular structures as they exit the thoracic outlet, often causing pain, paresthesias, and weakness in the arm and hand. - It does not directly account for the symptom of miosis, which points to sympathetic nerve involvement. Aberrant right subclavian artery - An aberrant right subclavian artery is a congenital anomaly where the right subclavian artery arises from the distal aortic arch, often causing dysphagia lusoria or being asymptomatic. - It has no direct association with Pancoast tumors or the development of miosis.
Question 9: A 5-day-old infant is diagnosed with a non-communicating hydrocephalus. Which of the following is most likely to lead to such a condition?
- A. Disturbances in the resorption of cerebrospinal fluid
- B. Excess production of cerebrospinal fluid
- C. Obstruction in the circulation of the cerebrospinal fluid (Correct Answer)
- D. Increased size of the head
Explanation: ***Obstruction in the circulation of the cerebrospinal fluid*** - **Non-communicating hydrocephalus**, by definition, is caused by an **obstruction within the ventricular system** that prevents CSF from reaching the subarachnoid space. - In a newborn, common causes of such obstruction include **aqueductal stenosis** or malformations like **Dandy-Walker syndrome**. *Disturbances in the resorption of cerebrospinal fluid* - This typically leads to **communicating hydrocephalus**, where CSF can flow freely within the ventricles but is not adequately absorbed into the venous system. - Examples include **arachnoid granulations** dysfunction or **post-meningitic scarring**. *Excess production of cerebrospinal fluid* - This is a very rare cause of hydrocephalus, usually associated with conditions like a **choroid plexus papilloma**. - This would lead to a **communicating hydrocephalus** as the obstruction is not within the ventricular system itself. *Increased size of the head* - An **increased head size (macrocephaly)** is a *symptom* or *sign* of hydrocephalus in an infant, not a cause. - The elevated intracranial pressure from the accumulated CSF leads to the expansion of the skull bones before the sutures fuse.
Question 10: A 52 year old female underwent MRM (Modified Radical Mastectomy). After few years, she developed lymphedema of the ipsilateral arm. Which of the following malignancies can develop in her arm?
- A. Malignant Melanoma
- B. Lymphangiosarcoma (Correct Answer)
- C. Lymphoma
- D. Malignant fibrous histiocytoma
Explanation: ***Lymphangiosarcoma*** - This is a rare, aggressive **vascular tumor** that can develop in chronically lymphedematous limbs, particularly after **mastectomy** for breast cancer. - The chronic lymphatic obstruction and inflammation are thought to be predisposing factors, leading to the condition known as **Stewart-Treves syndrome**. *Malignant Melanoma* - This cancer arises from **melanocytes** in the skin and is primarily associated with UV radiation exposure or existing nevi, not chronic lymphedema. - While it can occur anywhere on the body, there is no direct causal link between modified radical mastectomy and the development of melanoma in the arm. *Lymphoma* - Lymphoma is a cancer of the **lymphocytes** within the lymphatic system, typically presenting as swollen lymph nodes or B-symptoms. - Although lymphedema involves the lymphatic system, it generally predisposes to angiosarcoma rather than lymphoma in this specific clinical context. *Malignant fibrous histiocytoma* - This is a type of **soft tissue sarcoma** that can occur in various locations, but it is not specifically linked to chronic lymphedema following mastectomy. - While its etiology can be complex, it does not have the well-established association with chronic lymphedema that lymphangiosarcoma does.
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