Vascular Tumors — MCQs
AIDS, secondary infection will be all except
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 statements about hypernephroma is true?
Which of the following statements about cavernous hemangioma is false?
In which part of the body are lesions of Kaposi sarcoma most commonly seen?
All are seen in malignant hypertension except?
Earliest symptom of glomus tumor is?
A 50-year-old HIV-positive patient presents with a painless, purple lesion on the skin. What is the most likely diagnosis?
Monckeberg's calcific sclerosis primarily affects which layer of the medium-sized muscular arteries?
A red soft to firm swelling on the sternum shows proliferation of endothelial cells forming vascular channels on biopsy. What is the most likely diagnosis?
Vascular Tumors Indian Medical PG Practice Questions and MCQs
Question 1: AIDS, secondary infection will be all except
- A. Candida
- B. Kaposi's sarcoma (Correct Answer)
- C. HSV
- D. Rubella
Explanation: ***Kaposi's sarcoma*** - Kaposi's sarcoma is a **cancer** caused by human herpesvirus 8 (HHV-8) [2] that is common in patients with AIDS, but it is a **malignancy**, not a secondary infection [2],[3]. - While it arises due to immune suppression, it represents abnormal cell proliferation rather than direct microbial invasion. *Candida* - **Candidiasis** (e.g., oral thrush, esophageal candidiasis) is a common opportunistic fungal infection in AIDS patients due to their **impaired cellular immunity** [1]. - It often presents as **white plaques** on mucous membranes and is a clear example of a secondary infection. *HSV* - **Herpes Simplex Virus (HSV)** infections, including oral and genital herpes, are common and often severe in AIDS patients. - Due to immunocompromise, these infections can be **more widespread**, chronic, or recur frequently, qualifying as secondary infections. *Rubella* - **Rubella (German measles)** is a viral infection that is generally mild and self-limiting in immunocompetent individuals. - It is **not considered an opportunistic infection** or a common secondary infection specifically associated with AIDS; rather, it is listed as a differential diagnosis for the primary HIV infection rash [1].
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 statements about hypernephroma is true?
- A. May present with rapidly developing varicocele
- B. Usually an adenocarcinoma
- C. Not radiosensitive (Correct Answer)
- D. Arises from the cortex, usually from a pre-existing adenoma
Explanation: ***Radiosensitive*** - Hypernephroma, or renal cell carcinoma, is typically resistant to **radiation therapy**, making this statement false. - It is generally treated with **surgery** and targeted therapies rather than radiation. *Usually adenocarcinoma* - Hypernephroma is indeed a type of **adenocarcinoma**, as it originates from the renal tubular epithelium [1]. - It is the most common form of **kidney cancer**, supporting this as a true statement. *May present with rapidly developing varicocele* - Rapidly developing **varicocele** can occur due to **renal vein obstruction** associated with renal tumors [2], so this statement is true. - Varicocele is a recognized clinical feature in renal cell carcinoma due to its anatomical relationships. *Arise from cortex usually from pre existing adenoma* - Hypernephroma does arise from the **renal cortex**, often from pre-existing renal adenomas or other lesions. - This establishes its origin, making the statement accurate. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 959-961. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 492-493.
Question 4: 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 5: In which part of the body are lesions of Kaposi sarcoma most commonly seen?
- A. Upper extremities
- B. Lower extremities (Correct Answer)
- C. Torso
- D. Head and neck
Explanation: ***Lower extremities*** - Kaposi sarcoma lesions most frequently appear on the **skin of the lower extremities**, especially the feet and ankles. - This predilection is thought to be due to increased **venous stasis** or other local factors. *Upper extremities* - While Kaposi sarcoma can affect the upper extremities, it is a **less common primary site** compared to the lower limbs. - Lesions here are more likely to appear as the disease **progresses or disseminates**. *Torso* - Kaposi sarcoma lesions can occur on the torso, particularly on the **trunk**, but it is not the most common initial presentation. - Visceral involvement of the **gastrointestinal tract** and lungs can often present without skin lesions on the torso. *Head and neck* - Lesions of Kaposi sarcoma can appear on the head and neck, especially on the **face and oral cavity**, particularly in classic Kaposi sarcoma or in individuals with advanced immunosuppression. - However, this is still **less frequent** than involvement of the lower extremities.
Question 6: All are seen in malignant hypertension except?
- A. Fibrinoid necrosis
- B. Necrotizing glomerulonephritis
- C. Hyaline arteriolosclerosis (Correct Answer)
- D. Hyperplastic arteriolosclerosis
Explanation: ***Hyaline aeriolosclerosis*** - **Hyaline aeriolosclerosis** is more commonly associated with chronic hypertension rather than malignant hypertension [5], which is characterized by **severe, acute elevations** in blood pressure. - Malignant hypertension typically leads to **end-organ damage**, particularly in the kidneys, through other mechanisms rather than the **hyaline changes** observed in chronic conditions [4]. *Necrotizing glomerulonephritis* - Often seen in malignant hypertension as it leads to **acute kidney injury** characterized by **glomerular capillary damage**. - Associated with **fibrinoid necrosis** in the renal vasculature due to heightened blood pressure adversely affecting renal tissues [1,3]. *Fibrinoid necrosis* - Is a key feature in malignant hypertension, appearing as **deposits of fibrin** in the vessel walls [1,3]. - Characterizes the **acute vascular damage** and is indicative of renal impairment during malignant hypertensive crises [2]. *Hyperplastic aeriolosclerosis* - This condition is linked with malignant hypertension, characterized by **onion skin fibrosis** around arterioles [1]. - It reflects the **severe vascular changes** and is a direct response to the acute elevation in blood pressure [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, p. 945. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 276-277. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 277-278. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 541-542. [5] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 943-945.
Question 7: Earliest symptom of glomus tumor is?
- A. Pulsatile otorrhoea
- B. Facial nerve palsy
- C. Pulsatile tinnitus (Correct Answer)
- D. Hearing Loss
Explanation: ***Pulsatile tinnitus*** - **Pulsatile tinnitus** is often the earliest and most characteristic symptom of a glomus tumor due to its highly vascular nature and close proximity to vascular structures. - Patients typically report hearing a **heartbeat-like sound** in their ear that corresponds to their pulse. *Pulsatile otorrhoea* - **Pulsatile otorrhoea** would indicate active discharge from the ear, often associated with a perforating membrane or advanced infection, which is not an early sign of an internal vascular tumor. - This symptom suggests a more advanced or complicated ear pathology rather than the primary presentation of a glomus tumor. *Facial nerve palsy* - **Facial nerve palsy** occurs when the glomus tumor has grown to a significant size and begins to compress or invade the facial nerve, indicating a more advanced stage of the disease. - Isolated facial nerve weakness is not typically the first symptom but rather a complication of tumor extension. *Hearing Loss* - While **hearing loss** can be a symptom of a glomus tumor, it is often not the earliest and is usually **conductive** due to obstruction of the middle ear rather than sensorineural. - Many other middle ear pathologies like otitis media or otosclerosis cause hearing loss earlier and more commonly.
Question 8: 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 9: Monckeberg's calcific sclerosis primarily affects which layer of the medium-sized muscular arteries?
- A. Intima
- B. Media (Correct Answer)
- C. Adventitia
- D. Intima and Media
Explanation: ***Media*** - Monckeberg's calcific sclerosis, also known as **medial calcinosis**, specifically involves the **tunica media** of medium-sized muscular arteries. - This condition is characterized by **calcific deposits** within the smooth muscle layer of the artery wall, without significant luminal narrowing. - Classic "**tram-track**" or "railroad track" appearance on imaging due to medial calcification. *Intima* - The **intima** is primarily affected in **atherosclerosis**, where plaque formation occurs within this innermost layer. - Monckeberg's sclerosis is distinct from atherosclerosis and does not involve significant intimal thickening or lipid deposition. *Adventitia* - The **adventitia** is the outermost layer of the arterial wall, providing structural support and containing nerves and vasa vasorum. - Monckeberg's calcification does not typically involve this layer. *Intima and Media* - While Monckeberg's sclerosis **exclusively affects the media**, this option incorrectly suggests intimal involvement. - The pathognomonic feature of Monckeberg's is its **restriction to the medial layer**, distinguishing it from atherosclerosis.
Question 10: A red soft to firm swelling on the sternum shows proliferation of endothelial cells forming vascular channels on biopsy. What is the most likely diagnosis?
- A. Hemangioma (Correct Answer)
- B. Osteochondroma
- C. Osteoid osteoma
- D. Paget disease
Explanation: ***Hemangioma*** - The soft to firm swelling and histological findings indicative of vascular spaces are characteristic of a **hemangioma**, often presenting as a benign vascular tumor [1][2]. - Commonly found in the **sternum**, it may show red or bluish discoloration and typically undergoes a **biopsy** revealing endothelial cell proliferation [2]. *Osteochondroma* - This is a **benign bone tumor** that arises from the growth plate but typically presents as a hard, bony mass rather than a soft swelling. - Histologically, it shows **cartilaginous cap** and is associated with bone rather than vascular structures. *Osteoid osteoma* - Usually presents as a **painful, small bone lesion** often found in the long bones, generally not in the sternum and characterized by a **nidus** of osteoid. - The biopsy would show a **central nidus** with osteoid and woven bone, not consistent with soft swellings. *Paget disease* - This chronic bone disorder involves excessive bone remodeling, leading to enlarged and deformed bones rather than a discrete swelling. - Histologically, it would show **disorganized bone** formation and is not associated with soft or firm masses like hemangiomas. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 481-482. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 523-524.
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