Malignant Tumors of Conjunctiva — MCQs
Cobblestone appearance of the conjunctiva is typically seen in which of the following conditions?
What could be the most appropriate provisional diagnosis for multiple nodular exophytic reddish lesions of oral mucosa in an AIDS patient?
Which of the following is NOT a feature of Peutz-Jeghers syndrome?
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 cells with large, pleomorphic, hyperchromatic nuclei. What is the most likely diagnosis?
Lesions of Nevus of Ota commonly involve which cranial nerve?
Retinoblastoma is associated with:
A farmer presented with a black mole on the cheek. It increased in size, more than 6mm with irregular borders and a central black lesion, what could be the diagnosis?
Most common malignant tumour of eyelid is ?
What is the most common type of non-Hodgkin's lymphoma found in the orbit?
Patient diagnosed with squamous cell intraepithelial lesion, which of the following has the highest risk for progression to carcinoma?
Malignant Tumors of Conjunctiva Indian Medical PG Practice Questions and MCQs
Question 1: Cobblestone appearance of the conjunctiva is typically seen in which of the following conditions?
- A. Allergic conjunctivitis
- B. Chlamydial conjunctivitis
- C. Giant papillary conjunctivitis
- D. Vernal keratoconjunctivitis (Correct Answer)
Explanation: ***Vernal keratoconjunctivitis*** - This condition is characterized by **large, flattened papillae** on the upper tarsal conjunctiva, which give it a classic **cobblestone appearance**. - It is a severe, chronic form of **allergic conjunctivitis**, often seen in children and young adults, associated with severe itching and seasonal recurrence. *Allergic conjunctivitis* - While it involves allergic reactions and sometimes papillae, the term **"cobblestone appearance"** specifically refers to the **large, flat papillae seen in Vernal Keratoconjunctivitis**, not general allergic conjunctivitis. - General allergic conjunctivitis often presents with **diffuse papillary hypertrophy** but not typically the characteristic cobblestoning unless it progresses to the chronic, severe form. *Chlamydial conjunctivitis* - This is primarily associated with **follicles** on the conjunctiva, particularly in the lower fornix, rather than a cobblestone appearance. - It is an **infectious condition**, often linked to sexually transmitted infections, and its conjunctival findings are distinct from allergic forms. *Giant papillary conjunctivitis* - While it features **giant papillae** (similar to those causing the cobblestone appearance), it is typically caused by mechanical irritation from **contact lenses** or ocular prostheses, not a primary allergic etiology like VKC. - It often affects the **upper tarsal conjunctiva** but is usually unilateral or asymmetrical and directly related to a foreign body.
Question 2: What could be the most appropriate provisional diagnosis for multiple nodular exophytic reddish lesions of oral mucosa in an AIDS patient?
- A. Acute pseudo-membranous candidiasis
- B. Hemangioma
- C. Kaposi's sarcoma (Correct Answer)
- D. Focal epithelial hyperplasia
Explanation: ***Kaposi's sarcoma*** - **Kaposi's sarcoma (KS)** is a common malignancy in AIDS patients, often presenting with **reddish-purple to brown nodular lesions** on the skin and **mucous membranes**, including the oral cavity. - The description of **multiple nodular exophytic reddish lesions** of the oral mucosa in an AIDS patient is highly suggestive of KS. *Acute pseudo-membranous candidiasis* - This typically presents as **white, removable pseudomembranes** that, when scraped off, reveal an erythematous or bleeding surface. - It does not present as **reddish nodular exophytic lesions**. *Hemangioma* - While hemangiomas are benign vascular lesions that can be reddish, they are typically **solitary or develop earlier in life** and are not specifically associated with HIV/AIDS in this widespread, nodular form. - The presence of **multiple, exophytic nodular lesions** in an immunocompromised patient points to a more aggressive or opportunistic pathology. *Focal epithelial hyperplasia* - Also known as **Heck's disease**, this presents as **multiple, soft, flattened or rounded papules** that are usually the color of the normal mucosa or slightly paler. - It is caused by certain strains of **human papillomavirus (HPV)** and is not typically reddish or exophytic in the manner described.
Question 3: Which of the following is NOT a feature of Peutz-Jeghers syndrome?
- A. Mucocutaneous pigmentation
- B. Autosomal recessive inheritance (Correct Answer)
- C. Autosomal dominant
- D. Hamartomatous polyp
Explanation: ***High risk of malignancy*** - Peutz-Jeghers syndrome is primarily associated with **benign hamartomatous polyps**, not a **high risk of malignancy**, which distinguishes it from other syndromes. - Although patients may develop cancers [1], the syndrome itself does not inherently denote a high malignancy risk like other syndromes such as familial adenomatous polyposis. *Autosomal dominant* - This syndrome is indeed **autosomal dominant**, caused by mutations in the STK11 gene. - Families with this condition typically show **vertical transmission**, characteristic of autosomal dominant inheritance. *Hamartomatous polyp* - Individuals with Peutz-Jeghers syndrome develop **hamartomatous polyps**, which are a hallmark feature of the condition [1]. - These polyps can occur in the gastrointestinal tract and are benign lesions rather than adenomatous type seen in other syndromes [1]. *Mucocutaneous pigmentation* - Mucocutaneous pigmentation, such as **freckling around the lips and buccal mucosa**, is a key clinical feature of Peutz-Jeghers syndrome. - This pigmentation usually appears in childhood and is often a distinguishing sign of the syndrome.
Question 4: 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 cells with large, pleomorphic, hyperchromatic nuclei. What is the most likely diagnosis?
- A. Dermal nevus
- B. Actinic keratosis (Correct Answer)
- C. Junctional nevus
- D. Compound nevus
Explanation: ***Actinic keratosis*** - This diagnosis aligns with the description of a **red, scaly plaque** with a **rough texture** and **irregular margins**, which are classic clinical features of actinic keratosis. - The biopsy findings of epidermal and dermal cells with **large, pleomorphic, hyperchromatic nuclei** are consistent with **atypical keratinocytes**, a hallmark of actinic keratosis, indicating **premalignant change**. *Dermal nevus* - A dermal nevus is a **benign melanocytic lesion** that typically presents as a smooth, flesh-colored to light brown papule or nodule, not a scaly or rough plaque. - Histologically, it would show nests of nevus cells primarily in the **dermis** without the significant cellular atypia described. *Junctional nevus* - A junctional nevus is a **benign melanocytic lesion** characterized by nests of nevus cells located at the **dermoepidermal junction**. - Clinically, it appears as a flat or slightly raised, well-demarcated macule or papule, usually uniform in color, lacking the scaly, rough, and irregular features of the presented lesion. *Compound nevus* - A compound nevus is a **benign melanocytic lesion** with nevus cell nests present at both the **dermoepidermal junction** and within the dermis. - It typically presents as a raised, pigmented papule or nodule with a smooth or slightly warty surface, not a scaly plaque with irregular margins.
Question 5: Lesions of Nevus of Ota commonly involve which cranial nerve?
- A. Oculomotor nerve (Cranial Nerve III)
- B. Trigeminal nerve (Cranial Nerve V) (Correct Answer)
- C. Spinal accessory nerve (Cranial Nerve XI)
- D. Facial nerve (Cranial Nerve VII)
Explanation: ***Trigeminal nerve (Cranial Nerve V)*** - Nevus of Ota is a **dermal melanocytosis** typically presenting as bluish-gray patches on the face, specifically within the distribution of the **ophthalmic (V1)** and **maxillary (V2) divisions** of the trigeminal nerve. - The lesions often involve the **periorbital region**, forehead, and cheek, corresponding to the sensory innervation fields of these trigeminal nerve branches. *Oculomotor nerve (Cranial Nerve III)* - The oculomotor nerve primarily controls **eye movements** and **pupil constriction**. - While Nevus of Ota can occasionally involve the eye itself (e.g., episcleral melanocytosis), its cutaneous lesions are not distributed along the oculomotor nerve's innervation pattern. *Spinal accessory nerve (Cranial Nerve XI)* - The spinal accessory nerve is a **motor nerve** responsible for controlling the **sternocleidomastoid** and **trapezius muscles**. - It has no sensory or cutaneous distribution relevant to the facial lesions seen in Nevus of Ota. *Facial nerve (Cranial Nerve VII)* - The facial nerve primarily controls **facial expressions** and taste sensation from the anterior two-thirds of the tongue. - Although it innervates facial muscles, its cutaneous sensory distribution is minimal, and the characteristic skin lesions of Nevus of Ota do not follow its pattern.
Question 6: Retinoblastoma is associated with:
- A. Osteosarcoma (Correct Answer)
- B. Hepatocellular carcinoma
- C. Squamous cell carcinoma
- D. Giant cell tumor
Explanation: ***Osteosarcoma*** - Retinoblastoma is associated with **increased risk** of secondary malignancies, particularly **osteosarcoma**. - The relationship is due to **genetic predisposition** via alterations in the RB1 gene [1]. *Hepatocellular* - Hepatocellular carcinoma is primarily linked to **risk factors** like hepatitis infection and is not directly associated with retinoblastoma. - It does not share a **common genetic pathway** with retinoblastoma, making this option incorrect. *Osteoclastoma* - Osteoclastoma (giant cell tumor of bone) typically occurs in the **metaphysis of long bones** and does not relate to retinoblastoma. - There are no documented links between **genetic mutations** in retinoblastoma and osteoclastoma development. *SCC* - Squamous cell carcinoma (SCC) is more associated with **sun exposure** and certain viral infections, rather than retinoblastoma. - It lacks any **genetic relationship** or increased incidence linked to retinoblastoma, ruling this option out. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 298-300.
Question 7: A farmer presented with a black mole on the cheek. It increased in size, more than 6mm with irregular borders and a central black lesion, what could be the diagnosis?
- A. Superficial spreading melanoma (Correct Answer)
- B. Acral lentigo melanoma
- C. Lentigo maligna melanoma
- D. Nodular melanoma
Explanation: ***Superficial spreading melanoma*** - This is the most common type of melanoma and often presents as a **mole with irregular borders**, varying colors, and a diameter greater than 6mm, consistent with the description. - The lesion typically grows **radially** across the skin surface before beginning vertical growth, indicated by the increase in size. *Acral lentigo melanoma* - This type of melanoma primarily affects the **palms, soles, and nail beds**, which is inconsistent with a lesion on the cheek. - It often appears as a **dark brown or black patch** that slowly enlarges, but its location is characteristic. *Lentigo maligna melanoma* - This melanoma typically occurs in **chronically sun-damaged skin** of the elderly, often on the head and neck, but usually presents as a **flat, irregularly shaped, tan or brown patch** with varying shades, which may not fit the description of a central black lesion within a larger mole. - It has a dominant **radial growth phase** and progresses slowly over many years before developing a nodular component. *Nodular melanoma* - This type is characterized by its **rapid vertical growth** and appearance as a **raised, dark, often dome-shaped lesion** from the outset. - While it can be black, the description of an "increased in size" mole with irregular borders and a central black lesion points more towards a spreading type rather than a rapidly growing nodule from the beginning.
Question 8: Most common malignant tumour of eyelid is ?
- A. Basal cell carcinoma (Correct Answer)
- B. Malignant melanoma
- C. Squamous cell carcinoma
- D. Sebaceous gland carcinoma
Explanation: ***Basal cell carcinoma*** - **Basal cell carcinoma (BCC)** accounts for approximately 85-95% of all eyelid malignancies, making it the most common type. - It often presents as a **pearly nodule** with telangiectatic vessels, frequently affecting the lower eyelid. *Squamous cell carcinoma* - **Squamous cell carcinoma (SCC)** is the second most common eyelid malignancy, but it is significantly less frequent (5-10%) than BCC. - SCC has a **higher metastatic potential** compared to BCC. *Malignant melanoma* - **Malignant melanoma** is a rare but highly aggressive eyelid tumor, accounting for less than 1% of all eyelid malignancies. - It is characterized by its **pigmented appearance** and rapid growth pattern. *Sebaceous gland carcinoma* - **Sebaceous gland carcinoma** is a relatively uncommon, but aggressive, tumor of the eyelid, comprising about 1-5% of cases. - It often mimics benign lesions like a **chalazion** or chronic blepharitis, leading to delayed diagnosis.
Question 9: What is the most common type of non-Hodgkin's lymphoma found in the orbit?
- A. B-cell (Correct Answer)
- B. T-cell
- C. NK-cell
- D. Plasma cell
Explanation: ***B-cell*** - The most common type of non-Hodgkin's lymphoma in the orbit is **B-cell lymphoma**, which typically presents as a **painless mass** [1]. - **B-cell lymphomas** are more frequently associated with systemic lymphoproliferative disorders and have a higher incidence in this region. *NK-cell* - NK-cell lymphomas are rare compared to B-cell and usually present with more aggressive features. - They are less common in the orbit and are often associated with other systemic diseases like **HIV**. *Plasma cell* - Plasma cell neoplasms, such as **multiple myeloma**, are more related to bone marrow involvement rather than orbit-specific lymphomas. - These do not typically arise in the orbit and are less frequently classified under non-Hodgkin's lymphomas. *T-cell* - T-cell lymphomas are less prevalent compared to B-cell lymphomas and have different clinical presentations. - They can be aggressive and may occur in the orbit, but not as commonly as B-cell types. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Eye, pp. 1341-1342.
Question 10: Patient diagnosed with squamous cell intraepithelial lesion, which of the following has the highest risk for progression to carcinoma?
- A. Low grade squamous intraepithelial neoplasia
- B. High grade squamous intraepithelial neoplasia (Correct Answer)
- C. Squamous intraepithelial neoplasia associated with HIV
- D. Squamous intraepithelial neoplasia associated with HPV 16
Explanation: ***High grade squamous intraepithelial neoplasia*** - **High-grade squamous intraepithelial neoplasia (HSIL)** represents more severe dysplastic changes, involving a greater thickness of the epithelium, and thus carries a **significantly higher risk of progression to invasive carcinoma** compared to low-grade lesions [1]. - These lesions reflect persistent infection and dysregulation of cell growth and differentiation, often requiring more aggressive management [1]. *Low grade squamous intraepithelial neoplasia* - **Low-grade squamous intraepithelial neoplasia (LSIL)** involves only milder dysplastic changes, typically limited to the lower third of the epithelium [1]. - LSIL lesions have a **high rate of spontaneous regression** and a much lower risk of progressing to invasive carcinoma compared to HSIL [1]. *Squamous intraepithelial neoplasia associated with HIV* - While HIV infection is a risk factor for more persistent and progressive HPV infections and squamous intraepithelial lesions due to **immunosuppression**, the specific grade of the lesion (e.g., HSIL) is a more direct indicator of immediate progression risk than HIV status alone. - HIV-positive individuals frequently have **multifocal or recurrent lesions**, but the *cellular changes themselves* (high-grade vs. low-grade) are the primary determinant of progression risk. *Squamous intraepithelial neoplasia associated with HPV 16* - **HPV 16** is a **high-risk HPV type** strongly associated with squamous intraepithelial lesions and cervical cancer [1]. However, the *grade* of the lesion (HSIL vs. LSIL) indicates the extent of cellular transformation already present. - While HPV 16 is a major etiologic factor, the morphological classification of the lesion (HSIL) directly reflects the present cellular atypia and thus the immediate risk of progression to carcinoma, regardless of whether it's HPV 16-positive or not [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1006-1010.
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