ETAS_MCQ_05 dermatopathology

Dermatopathology1) Both mesenchymal and epithelial elements may be found in this tumor:

A. Bednar tumor

B. Cylindroma

C. Chondroid syringomaCorrect Choice

D. Microcystic adnexal carcinoma

E. Folliculosebaceous cystic hamartoma

Cutaneous mixed tumor, also known as Chondroid syringoma, represents an acquired hamartoma with folliculosebaceous-apocrine differentiation that has been generally interpreted as a form of adnexal adenoma (neoplasm). It has both a mesenchymal and epithelial component

2) What is the diagnosis?

A. Papillary eccrine adenoma

B. SyringomaCorrect Choice

C. Adenoid cystic carcinoma

D. Trichoadenoma

E. Dermal duct tumor

This is a syringoma, in which there are small cords and strands of epithelial cells, some in a “tadpole” configuration. There are scattered lumens, often lined with clear cells, with a bluish substance within them. No horn cysts are present

3) The diagnosis is:Image Link 1Image Link 2Image Link 3Image Link 4

A. clear cell Bowen's disease

B. extramammary Paget'sCorrect Choice

C. epidermotropic sebaceous carcinoma

D. epidermotropic Merkel cell carcinoma

E. epidermotropic balloon-cell melanoma

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In extramammary Paget’s disease, there are epidermotropic, large cells with a bluish cytoplasm. At times these cells can form “nests”, but in general, there is usually a compressed basal layer beneath the “nests”.

4) This is a desmoplakin:

A. Plakophilin

B. Plakoglobin

C. BPAg1 Correct Choice

D. Beta-catenin

E. Desmocollin

Desmoplakins include desmoplakin 1, BPAg1, envoplakin, and periplakin

5) Histologically, adenoma sebaceum represent which of the following lesions?

A. Angiokeratomas

B. Angiofibromas Correct Choice

C. Collagenomas

D. Neurofibromas

E. Smooth muscle hamartomas

Adenoma sebaceum, fibrous papules and pearly penile papules all have similar features histologically, presenting as angiofibromas. Features include atrophic epidermis with patchy melanocytic hyperplasia and hyperkeratosis, vertically oriented collagen, increased fibroblasts and blood vessels

6) Lipomembranous change is seen in:

A. Sclerosing panniculitis Correct Choice

B. Sebaceous carcinoma

C. Cystic sebaceous adenoma

D. Hibernoma

E. Mucocele

Lipomembranous change is a non-specific histologic pattern that is most commonly seen in lipodermatosclerosis, which is also known as sclerosing panniculitis; this condition may be secondary to venous stasis

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7) The diagnosis is: Image Link 1Image Link 2

A. sarcoidosis

B. foreign body

C. lupus miliaris et disseminata

D. lichen nitidusCorrect Choice

E. lymphocytoma cutis


A. Pilomatrixoma

B. Metastatic carcinoma

C. Tattoo

D. Wood splinter

E. Calcinosis cutisCorrect Choice

This is calcinosis cutis, in which there is calcification (blue chunky material) in the dermis

9) The diagnosis is:

A. Neurilemmoma

B. Granular cell tumor

C. Xanthoma Correct Choice

D. Reticulohistiocytoma

E. Neuroma

NEEDS EXPLANATIONS


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A. spiradenoma

B. mastocytosis

C. hidradenoma

D. glomangiomaCorrect Choice

E. Kimura's

In glomangiomas, one sees multiple lumina lined by cells with pink cytoplasm and indisctinct borders with very round nuclei. Generally, the lumina are lined by one or two layers of glomus cells.

11) 62-year old female with history of acute myeloid leukemia presents with multiple edematous, erythematous papules after starting G-CSF.

A. Bowel bypass dermatosis

B. Leukocytoclastic vasculitis

C. Erythema multiforme

D. Polymorphous light eruption

E. Sweet's syndromeCorrect Choice

Sweet's syndrome, or acute febrile neutrophilic dermatoses, is often associated with AML and G-CSF. Histologically, there is marked dermal edema with a prominent infiltrate composed of neutrophils with leukocytoclasia. There is an absence of extensive vascular damage

12) Multiple such lesions are seen in this syndrome:Image Link 1Image Link 2Image Link 3

A. Nicolau and Balus'

B. Alagille's

C. Rubinstein-Taybi's

D. Schopf's

E. Brooke-SpieglerCorrect Choice

In Brooke-Spiegler syndrome, there are multiple trichoepitheliomas, cylindromas, and spiradenomas. Nicolau and Balus’ syndrome has multiple eruptive syringomas, milia, and atrophoderma vermiculata. Alagille’s syndrome is the association of arteriohepatic dsyplasia with nevus comdonicus. Schopf’s syndrome associates multiple hidrocystomas with hypodontia, palmoplantar hyperkeratosis, and onychodystrophy. In Rubinstein-Taybi’s syndrome, patients are short of stature with broad thumbs and multiple pilomatricomas

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13) This patient has multiple lesions showing the following histology. She has a family history of such lesions. You check her for:Image Link 1Image Link 2Image Link 3

A. fumarate hydrataseCorrect Choice

B. transglutaminase

C. epoxide hydrolase

D. sulfatase

E. urease

14) The diagnosis is::Image Link 1Image Link 2Image Link 3

A. incontinentia pigmentiCorrect Choice

B. pemphigus vulgaris

C. epidermal nevus

D. bullous pemphigoid

E. dermatitis herpetiformis

15) The diagnosis is:Image Link 1Image Link 2Image Link 3

A. adenoid cystic carcinomaCorrect Choice

B. trichoepithelioma

C. dermal duct tumor

D. syringoma

E. tubular apocrine adenoma

In adenoid cystic carcinoma, there are cords and tubules of basaloid cells, arranged in a cribiform pattern. The cystic spaces contain a bluish material. Perineural invasion is common. The cells stain positively for epithelial membrane antigen (EMA).

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A. adenoid cystic carcinomaCorrect Choice

B. trichoepithelioma

C. dermal duct tumor

D. syringoma

E. tubular apocrine adenoma

In adenoid cystic carcinoma, there are cords and tubules of basaloid cells, arranged in a cribiform pattern. The cystic spaces contain a bluish material. Perineural invasion is common. The cells stain positively for epithelial membrane antigen (EMA

16) For this patient, you request that the lab perform indirect immunofluorescence using what substrate?

A. Monkey esophagus

B. Mouse epithelium

C. Rat bladder

D. Guinea pig esophagusCorrect Choice

E. Hep-2 cells

This patient has pemphigus folicaceus, and indirect immunofluorescence works best on guinea pig esophagus

17) This patient may need blood tests to check her:

A. Renal function

B. White blood cell count

C. Liver function

D. ThyroidCorrect Choice

E. Glucose

Herpes gestationis is associated with an increased incidence of Graves’ disease.


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A. Wegener’s granulomatosis

B. Syphilis

C. Fixed drug reaction

D. Granuloma faciale Correct Choice

E. Angiolymphoid hyperplasia with eosinophilia

NEEDS EXPLANATIONS

19) Multiple clear cell acanthomas are associated with:

A. Immunosuppression

B. Ichthyosis Correct Choice

C. Gastrointestinal polyps

D. Breast cancer

E. Cowden’s

Clear cell acanthoma is associated with ichthyosis


A. metastatic carcinoma

B. Merkel cell carcinoma

C. pyogenic granuloma

D. bacillary angiomatous

E. glomus tumorCorrect Choice

In a glomus tumor, generally vascular spaces are not particularly prominent, and there are cords as well as solid areas of uniform cells with very monomorphous rounded nuclei


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A. Large cell acanthoma

B. Clear cell acanthomaCorrect Choice

C. Hidroacanthoma simplex

D. Poroma

E. White sponge nevus

In a clear cell acanthoma, there is regular acanthosis, often with some parakeratotic scale with neutrophils overlying it. The keratinocytes making up the thickened epidermis are often clear, or pale, due to an increased glycogen content secondary to a deficiency of phosphorylase. There is often a very abrupt demarcation at the margins of the acanthotic pale/clear cells and the normal epidermis

22) The gene defect:Image Link 1Image Link 2Image Link 3

A. DSG3

B. ATP2A2

C. ATP2C1Correct Choice

D. SERCA2

E. CHRNA9

In Hailey-Hailey disease, there is full-thickness acantholysis of the epidermis. The gene defect is in ATP2C1

23) This tumor is vimentin+ and cytokeratin+:

A. Neurothekeoma

B. Dermatofibroma

C. Angiosarcoma

D. Epithelioid sarcoma Correct Choice

E. Nodular fasciitis

Characteristic immunohistochemistry of epithelioid sarcoma is vimentin- and cytokeratin- positivity


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A. argyriaCorrect Choice

B. minocycline-induced pigmentation

C. hemochromatosis

D. ochronosis

E. gold effect

In argyria, the silver deposits (black particles) are often seen around eccrine glands.


A. traumatic neuroma

B. acral angiofibroma

C. accessory digit

D. Koenen's tumor

E. acquired digital fibrokeratomaCorrect Choice

This is an acquired digital fibrokeratoma, with a thickened stratum corneum indicating an acral location and an absence of nerves in the dermis. Collagen is increased in the dermis

26) With immunofluorescence, the most likely pattern would be:Image Link 1Image Link 2Image Link 3

A. granular IgG

B. granular IgACorrect Choice

C. linear IgG, IgM, C3, and IgA

D. tubular IgG

E. linear IgM

In dermatitis herpetiformis, there are characteristic clusters of neutrophils at the tips of dermal papillae. Immunofluorescence will show granular IgA in the dermal papillae. Neutrophils at the dermo-epidermal junction of a bulla can also be seen in bullous systemic lupus erythematosus, linear IgA disease, neutrophilic bullous pemphigoid, and inflammatory epidermolysis bullosa acquisita

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A. epidermal nevus

B. poromaCorrect Choice

C. bowenoid papulosis

D. large cell acanthoma

E. verruca

In a poroma, there is a down-growing epidermal proliferation composed of uniform cells, often with indistinct cytoplasmic borders that have rounded, monomorphous nuclei. Within this proliferation, there are often ducts lined by an eosinophilic cuticle

28) Which immunohistochemical stain would be positive in eosinophilic granuloma?

A. Congo red

B. Mucin

C. Cytokeratin 20

D. CD1aCorrect Choice

E. HMB-45

Eosinophilic granuloma is a form of Langerhans Cell Histocytosis (LCH), previously called Histiocytosis X. Eosinophilic granuloma is a localized, benign form which is more common in males and generally affects the bones. All forms of LCH are characterized by the infiltration of Langerhans cells on pathology, which staing for S-100, CD1a and contain cytoplasmic birbeck granules


A. Lichen nitidusCorrect Choice

B. Lupus

C. Lichen planus

D. Lichen planus-like keratosis

E. Lichen striatus

The histologic features shown are indicative of lichen nitidus. Lichen nitidus has a very characteristic "claw clutching ball" appearance where the rete ridges extend downward around a lichenoid infiltrate

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30) An increased number of miniaturized hairs are seen in:

A. Lichen planopilaris and alopecia areata

B. Alopecia areata Correct Choice

C. Trichotillomania

D. Lichen planopilaris

E. Telogen effluvium

In alopecia areata, especially early stages, increased miniaturized catagen hairs can be seen in addition to the finding of peribulbar lymphocytes resembling a “swarm of bees.” Lichen planopilaris is a scarring alopecia in which vertical tracts of fibrosis are seen in place of follicles. Trichotillomania displays follicular plugging, trichomalacia, pigmented casts, hemorrhage, and increased catagen hairs on biopsy. Telogen effluvium is characterized by an increased number of telogen hairs


A. Monsel's reaction

B. chrysiasis

C. amalgam tattoo

D. minocycline-induced pigmentation

E. ochronosisCorrect Choice

In ochronosis, there is slightly thickened banana-shaped collagen in the superficial dermis that appears yellow-brown in color

32) The diagnosis of this biopsy is:

A. Erythema nodosum

B. Polyarteritis nodosaCorrect Choice

C. Granuloma annulare

D. Leukocytoclstic vasculitis

E. Reumatoid nodule

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Polyarteritis nodosa is a necrotizing vasculitis of medium-sized arteries in the derma-subcutaneous junction. It is a septal panniculitis as a result of vasculitis. There is more fibrinous changes than in thrombophlebitis and less necrosis than erythema induratum

33) What is the pathologic diagnosis of this lesion?

A. Acanthosis nigricans

B. Verruca planaCorrect Choice

C. Seborrheic keratosis

D. Normal skin

E. Epidermal nevus

The histologic characteristics of verruca plana are presence of hyperkeratosis and acanthosis. Koilocytes appear in the upper one-third of the epidermis

34) Similar follicles can be seen on skin from the:Image Link 1Image Link 2

A. fiinger

B. glans penis

C. nose

D. labia majora

E. eyelidCorrect Choice

Vellus hair follicles are seen commonly in accessory tragic and eyelid skin


A. Bowen's disease

B. melanoma

C. sebaceous carcinoma

D. pagetoid reticulosis

E. Paget's diseaseCorrect Choice

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In Paget’s disease, there are epidermotropic cells in a variably acanthotic epidermis. The epidermotropic cells have abundant cytoplasm that is often blue-gray in color. The cells are single or in nests throughout the epidermis. There should be a compressed rim of basal cells beneath nests that are located near the dermoepidermal junction

36) The diagnosis is::Image Link 1Image Link 2Image Link 3

A. mixed tumor

B. follicular mucinosisCorrect Choice

C. alopecia areata

D. lichen planopilaris

E. pityrosporum folliculitis

37) Eosinophils are typically found in each of the following except:

A. Incontinentia pigmenti

B. PlasmacytomaCorrect Choice

C. Urticaria

D. Lichenoid drug reactions

E. Pemphigus vulgaris

Plasmacytomas are characterized by the presence of monoclonal plasma cells. Plasmacytomas may occur from primary cutaneous focus or secondarily from myeloma

38) The diagnosis is:Image Link 1Image Link 2Image Link 3Image Link 4Image Link 5

A. Merkel cell carcinomaCorrect Choice

B. neuroblastoma

C. plasmacytoma

D. Lymphoma

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E. melanoma

This is a Merkel cell carcinoma, in which there is a dense collection of small blue cells with scant cytoplasm in the dermis. The cells are sometimes arranged in trabeculae and other times in nodules. The cells appear very blue on low power, and on higher power have somewhat pale nuclei that have paler/darker foci within them in a salt-and-pepper pattern

39) Which of the following lesions demonstrates a pseudo-Darier’s sign?

A. Mastocytoma

B. Spitz nevus

C. Smooth muscle hamartomaCorrect Choice

D. Pilomatricoma

E. Bullous pemphigoid

Smooth muscle hamartomas are benign tumors which arise from smooth muscle of the dermis. Pseudo-Darier's sign may be elicited due to transient piloerection after rubbing. Histologically, red-orange bundles and fascicles are present with blunt-ended nuclei


A. apocrine adenoma

B. amyloidosis

C. Masson's tumorCorrect Choice

D. intravascular pyogenic granuloma

E. papillary digital adenocarcinoma

41) The most likely diagnosis for this painful neoplasm is:

A. Glomus tumor

B. Neurilemmoma

C. Cutaneous endometriosisCorrect Choice

D. Blue rubber bleb nevus

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E. Angiolipoma

Cutaneous endometriosis usually occurs after gynecologic surgery. The rich, cellular stroma with regularly shaped channels and glandular structures are typical. Hemorrhage may also be present in deeper sections

42) What infectious agent is most likely responsible for this reaction of fibrin and antibodies which help to prevent phagocytosis?

A. ActinomycosisCorrect Choice

B. Anthrax

C. Candida albicans

D. Ricketsii species

E. Nocardia

Hoeppli-Splendore reaction is characterized histologically by intensely eosinophilic material consisting of fibrin and antibodies. Causes of the phenomenon include Actinomycosis israelii, Staph aureus, Proteus, Pseudomonas and E. coli

43) Goblet cells are seen in:

A. Bronchogenic cyst Correct Choice

B. Steatocystoma

C. Cutaneous ciliated cyst

D. Dermoid cyst

E. Endometriosis

Bronchogenic cysts have a pseudostratified cuboidal or columnar lining that is ciliated; goblet cells are found in the lining as well


A. Metastatic carcinoma

B. Mixed tumor Correct Choice

C. Papillary eccrine adenoma

D. Nodular hidradenoma

E. Mucinous carcinoma

NEEDS EXPLANATIONS

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45) The most common cause of this in the U.S. is:Image Link 1Image Link 2Image Link 3

A. Microsporum distortum

B. Epidermophyton floccosum

C. Trichophyton rubrumCorrect Choice

D. Microsporum canis

E. Trichophyton mentagrophytes

Trichophyton rubrum is the most common cause of Majocchi’s granuloma, a type of folliculitis where the dermatophyte likely tracks down the follicle and creates a foreign-body-type inflammatory reaction in the dermis

46) This patient recently developed this rash. You decide to patch test her, but in the meanwhile you tell her to avoid:

A. Primin

B. Abietic acid

C. Benzocaine

D. CinnamonCorrect Choice

E. Chamomile

This patient likely has a fragrance allergy. Patients allergic to fragrances also need to avoid certain spices like cinnamon

47) Multiple such lesions may be seen associated with:Image Link 1Image Link 2Image Link 3

A. Cowden's

B. Wermer'sCorrect Choice

C. Cowper's

D. Werner's

E. Brooke's

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MEN type I (Wermer's Syndrome) is sometmes associated with multiple angiofibromas. Tuberous sclerosis is also associated with adenoma sebaceum (angiofibromas

48) Turk cells are found in what infection?

A. Rubeola

B. Mumps

C. Roseola

D. Syphilis

E. RubellaCorrect Choice

Turk cells are atypical lymphocytes found in rubella


A. Masson's

B. bacillary angiomatosis

C. hemangioendothelioma

D. fibrosing pyogenic granulomaCorrect Choice

E. apocrine adenoma

50) Which disease process best describes Texier's disease?

A. Deposition disorder

B. PanniculitisCorrect Choice

C. Granulomatous disease

D. Neutrophilic dermatosis

E. Infectious process

Texier's disease is a panniculitis secondary to vitamin K injections causing sclerotic lesions with lilac borders on the buttocks and thighs resembling a cowboy belt and holster

51) A patient with dystrophic nails and multiple lesions with this histologic finding may have what gene defect?

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A. Phosphorylase

B. Keratin 6b/17Correct Choice

C. Beta-catenin

D. Keratin 6a/16

E. Keratin 1/10

Pachonychia congenita type II (also known as Jackson-Lawler) is a autosomal dominant disorder characterized by natal teeth, steatocystoma multiplex, and pincer nails. Steatocystomas have cyst walls that are intricately folded or crenulated. Sebaceous glands are present within the cyst wall


A. Warty dyskeratoma

B. Molluscum contagiosumCorrect Choice

C. Trichilemmoma

D. Ecthyma contagiosum

E. Orf

This is a lesion of Molluscum contagiosum, in which there is a lobulated down-growth (cup-shaped) of keratinocytes; centrally towards the surface, the keratinocytes are enlarged with cytoplasmic pink inclusions (Henderson-Patterson bodies

53) Multiple such lesions can be associated with:Image Link 1Image Link 2Image Link 3

A. Gaucher's

B. Sipple's

C. fucosidosisCorrect Choice

D. Louis-Barr

E. Bourneville's

multiple angiokeratomas in a bathing trunk distribution may be associated with Fabry's disease (angiokeratoma corporis diffusum) or fucosidosis as well as some other storage diseases as well as possibly being a normal finding. There has been a recent report of angiokeratomas in a bathing trunk distribution in a woman with no other signs of a storage disorder


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A. Lipoid protinosis

B. Erythrpoietic protoporphyria

C. Lichen sclerosus et atrophicusCorrect Choice

D. Lichen amyolidosus

E. Morphea

This is lichen sclerosus et atrophicus in which there is hyperkeratosis overlying an atrophic epidermis. Underlying the epidermis is a layer of homogenized light pink collagen. Beneath that, there is a somewhat band-like inflammatory infiltrate of predominantly lymphocytes, but also histiocytes and plasma cells


A. Seborrheic keratosis

B. Hidroacanthoma simplex

C. Epidermal nevus

D. Fibroepithelioma of PinkusCorrect Choice

E. Nevus sebaceus

Fibroepithelioma of Pinkus is a form of basal cell carcinoma. Histology shows long, thin, anastomosing strans of basal cell embedded in fibrous stroma with many connections to the epidermis

56) A newborn infant presents with bullous lesions. Based upon the pathology, what is the most likely gene defect causing her skin condition?

A. Keratin 1 and 10

B. PAX3

C. NEMOCorrect Choice

D. Keratin 5 and 14

E. SPINK5

Incontinentia pigmenti is an X_linked dominant genodermatosis which presents in the newborn period with vesicles in a Blaschkoid distribution. A biopsy would show eosinophilic spongiosis with dyskeratotic keratinocytes and pigment incontinence. A gene defect in NEMO has been identified as the cause for the constellation of fingings

57) The most common location for this lesion would be:

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A. Upper lip

B. Sole of footCorrect Choice

C. Buttock

D. Finger

E. Groin

Eccrine poroma is a benign, solitary tumor arsing in the lower portion of the epidermis. It is characterized by small, uniformly cuboidal cells with deeply basophilic nuclei. The tumor mass is assembled in broad anastomosing bands and may have narrow ductal lumina lined by eosinophilic cuticle


A. microcystic adenexal carcinoma

B. breast carcinomaCorrect Choice

C. neuroendocrine carcinoma

D. tubular apocrine adenoma

E. infiltrative basal cell carcinoma

The diagnosis is metastatic breast carcinoma. In this example, there is a dense collection of cells throughout the ermis. On closer examination, tehre are strands/cords of cells as well as some cells arranged around lumina infiltrating through the dermis

59) Steatocystoma multiplex is associated with:

A. Jackson-Lawler Correct Choice

B. Jadassohn-Lewandowsky

C. Zinsser-Engman-Cole

D. Schaufer-Brunauer

E. Touraine-Solente-Gole

Jackson-Lawler (Jackson-Sertoli) is known as pachyonychia congenital type 2. Multiple steatocysts can be seen in this condition

60) Weibel-Palade bodies are seen in:

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A. Spitz Nevi

B. Endothelial cells Correct Choice

C. Cells infected with MCV

D. Plasmacytoid Cells

E. Malakoplakia

Weibel-Palade bodies are seen in endothelial cells and are therefore found in vascular lesions. Kamino bodies are found in Spitz nevi. Henderson Patterson bodies are seen in molluscum. Dutcher bodies are intranuclear inclusions seen in plasmacytoid cells. Michaelis Gutmann bodies are partially digested bacteria seen in malakoplakia

61) Eosinophilia-Myalgia syndrome is caused by:

A. Norwegian salt-petter

B. Unadultered Spanish grapeseed oil

C. Excessive anaerobic exercise

D. L-Tryptophan Correct Choice

E. Pb intoxication

The eosinophilia myalgia syndrome is characterized by marked peripheral eosinophilia with a clinical spectrum of signs and symptoms, including generalized myalgias, pneumonitis, myocarditis, neuropathy, encephalopathy and fibrosis. Many patients progress to a clinical picture clinically indistinguishable from eosinophilic fasciitis. The disease is caused by the ingestion of certain lots of L-tryptophan

62) Blue-gray pigmentation on the legs secondary to minocycline on biopsy stains with:

A. Fontana Masson and Perls Correct Choice

B. All of these answers are correct

C. Sudan black

D. Fontana Masson

E. Perls

There are three types of pigmentary change that are caused by minocycline. The blue-gray pigmentation on the legs and the blue pigment in scars is thought to be secondary to a drug-protein complex deposited in the dermis. The blue-gray pigment on the legs stains with Perls and Fontana-Masson. The blue in scars (often on the face) stains with Perls. The muddy-brown discoloration on sun-exposed areas shows increased basilar pigment and melanin incontinence on biopsy. It is likely secondary to phototoxicity.

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A. Artecoll reaction

B. goutCorrect Choice

C. mucinous carcinoma

D. Urbach-Wiethe's

E. Hunter's

In gout, there are characteristic amorphous light pink masses of material within which it is sometimes possible to see outlines of needle-like spaces. The urate crystals can only be seen if alcohol fixation is used. The amorphous material is generally surrounded by histiocytes and foreign-body giant cells

64) The histologic finding of "shoulder parakaratosis", parakeratosis with prediliection for the follicular ostia, is characteristic of pityriasis rubra pilaris as well as:

A. Stasis dermatitis

B. Atopic dermatitis

C. Seborrheic dermatitisCorrect Choice

D. Nummular dermatitis

E. Allergic contact dermatitis

Parakeratosis refers to pyknotic keratinocyte nuclei in the stratum corneum, where nuclei are not usually present. It is common in diseases with changes in the epidermis. Histologically seborrheic dermatitis can shows "shoulder parakeratosis" with epidermal spongiosis. Histologically atopic, nummular and contact dermatitis present with spongiosis with or without vesicles. Stasis dermatitis presents with more dilated papillary dermal small blood vessels and hemosiderin

65) The diagnosis is:Image Link 1Image Link 2Image Link 3Image Link 4Image Link 5Image Link 6

A. scleroderma, early

B. erythema induratum

C. sarcoidosis

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D. erythema nodosumCorrect Choice

E. subcutaneous granuloma annulare

In erythema nodoosum, one sees a predominantly septal panniculitis with some septal thickening and fibrosis and an inflammatory infiltrate within the septae composed of lymphocytes, histiocytes, eosinophils, and giant cells


A. Psoriasis

B. Bowen's disease

C. Clear cell acanthoma Correct Choice

D. Trichilemmoma

E. Poroma

NEEDS EXPLANATIONS

67) Which type of artifact is shown here?

A. Electrodessication

B. Dessication

C. Gel foamCorrect Choice

D. Microtome knife chatter

E. Freeze

The presence of deeply basophilic, wavy, angulated foreign material characteristic of gel foam artifact

68) This is associated with MEN IIa:

A. Malignant peripheral nerve sheath tumor

B. Macular amyloidosis Correct Choice

C. Mucocele

D. Neurothekeoma

E. Chondroid syringoma

Macular amyloidosis is associated with MEN IIa

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A. Lymphoma

B. Small cell melanoma

C. Glomus tumor

D. Merkel cell carcinoma Correct Choice

E. Rhabdomyosarcoma

NEEDS EXPLANATIONS


A. acrospiroma

B. reticulated seborrheic keratosis

C. fibroepithelioma of PinkusCorrect Choice

D. syringofibroadenoma

E. tumor of the follicular infundibulum

In fibroepithelioma of Pinkus, there is a reticulated network of basaloid cells coming off of the epidermis in a plate-like fashion. There is some peripheral palisading of cells. The cells are embedded in a fibrotic stroma

71) Paraproteinemia is associated with all except:

A. Plane xanthoma

B. Necrobiotic xanthogranuloma

C. Scleromyxedema

D. Sclerosing panniculitis Correct Choice

E. Scleredema

Sclerosing panniculitis (lipodermatosclerosis) displays characteristic changes in the fat (lipomembranous change); it is not associated with paraproteinemia. Generalized plane xanthomas, scleromyxedema, necrobiotic xanthogranuloma, scleredema, erythema elevatum diutinum, xanthoma disseminatum, and pyoderma gangrenosum have all been associated with a paraproteinemia

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A. Cylindroma

B. Trichoblastoma

C. Hidradenoma

D. Acrospiroma

E. Spiradenoma Correct Choice

NEEDS EXPLANATIONS

73) All of the following are true of reticulohistiocytoma except:

A. Trauma is precipitating factor

B. Rare occurrence in children

C. Association with arthritisCorrect Choice

D. Immunostaining is positive for OKM1

E. Giant cells with “ground-glass” cytoplasm

Reticulohistiocytomas, also called giant cell reticulohistiocytomas, occur almost exclusively in adults. They are generally solitary, and unlike the multicentric type, are not associated with mutilating arthritis or predisposition for malignancy


A. Spiradenoma

B. CylindromaCorrect Choice

C. Dermal duct tumor

D. Syringocystadenoma papilliferum

E. Trichoblastoma

This is a cylindroma, in which there is a jigsaw puzzle type arrangement of islands of basaloid cells with intervening fibrous, pink stroma. The basaloid cells are sometimes rimmed by a thick, pink basement membrane

75) Mulberry cells contain increased:

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A. Mitochondria Correct Choice

B. Phagolysosomes and mitochondria

C. Phagolysosomes

D. Golgi

E. Ribosomes

Hibernomas commonly arise in the neck, axillae, and posterior shoulder. The cells are multivacuolated and resemble mulberries; the cells are filled with mitochondria, as are the cells in normal brown fat

76) The endemic form of this disease may be transmited by:Image Link 1Image Link 2Image Link 3

A. Glossina

B. SimuliumCorrect Choice

C. Lutzomyia

D. Phlebotomus

E. Triatoma

Triatoma (reduviid bug) species transmit American trypanosomiasis. Glossina is the genus of tsetse flies that transmit African trypanosomiasis. Simulium is the genus of the black fly that can tranmit Onchocerciasis and possibly the endemic form of pemphigus foliceus (fogo selvagem). Phlebotomus and Lutzomyia are types of sandflies that can transmit Leishmaniasis, Carrion’s disease, and viral sandfly fever

77) Which of the following hitologic features would be most helpful in differentiating lichenoid drug eruption from lichen planus?

A. Squamatization of the basal layer

B. Band-like infiltrate with “Saw-tooth” rete ridges

C. Parakeratosis and eosinophilsCorrect Choice

D. Presence of pruritus

E. Civatte bodies

Lichenoid drug eruptions share clinical and histopathologic features with lichen planus. Sometimes differentiation is not possible; however, eosinophil, parakeratosis, and a deeper perivascular infiltrate is more suggestive of lichenoid drug. Implicated medications include captopril, penicillamine, and chloroquine

26




78) In this patient, this test will be helpful in making the diagnosis:

A. Direct immunofluorescenceCorrect Choice

B. Tissue culture

C. Fluorescent antibody test for herpes

D. Patch test

E. KOH exam

This patient has penicillamine-induced pemphigus foliaceus. Direct immunofluorescence testing will be very helpful as it should reveal intercellular antibodies within the epidermis

79) This patient says the rash is spreading and not controlled with topical therapy. You give him a course of oral treatment that lasts:

A. 1 week

B. 3 weeksCorrect Choice

C. 5 weeks

D. 4 weeks

E. 2 weeks

Generally, for poison ivy dermatitis, if patients are given a course of oral steroids, the course should be at least 3 weeks long, as if the duration is shorter, patients may develop a rapid rebound

80) Langerhans cells express or are characterized by all of the following except:

A. HLA-DR

B. ChromagraninCorrect Choice

C. Birbeck granules

D. CD1a

E. S-100

Chromagranin stain neuroendocrine cells, Merkel cellcarcinomas and eccrine glands. They do not stain Langerhans cells


27

A. Dermatomyofibroma

B. Leiomyosarcoma

C. Palisaded encapsulated neuromaCorrect Choice

D. Leiomyoma

E. Traumatic neuroma

This is a palisaded encapsulated neuroma, in which there are small bundles of cells that have wavy, thin (elongated) nuclei and pink cytoplasm. The cells are separated by artifactual clefting. The bundles are often located very superficially. Encapsulation is often incomplete/not obvious

82) This woman should have a workup for:

A. Nephrolithiasis

B. HemochromatosisCorrect Choice

C. Lymphoma

D. Thalassemia

E. Pancreatic cancer

Porphyria cutanea tarda has been shown to be associated with hemochromatosis. Patients with porphyria cutanea tarda have mutations in the HFE gene, and early detection of mutations can improve life expectancy for these patients


A. myxedema

B. digital mucous cystCorrect Choice

C. reticulated erythematous mucinosis

D. mucinous granuloma annulare

E. papular mucinosis

In a digital mucous cyst, one sees a collection of mucin in the dermis beneath acral skin. This entity is not a true cyst as there is no epithelial lining to the cyst. The mucin is largely composed of hyaluronic acid

84) The diagnosis is:Image Link 1Image Link 2

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Image Link 3Image Link 4Image Link 5

A. neurothkeoma

B. palisaded encapsualted neuromaCorrect Choice

C. amelanotic blue nevus

D. dermatofibroma

E. leiomyoma

In palisaded encapsulated neuroma, there are broad fascicles of spindle cells set in a clear matrix. The fascicles of spindle cells are sometimes clearly separated from the surrounding normal dermis by a capsule, but other times blend into the dermis. The spindle cells have elongated, thin/tapered nuclei. Palisading of nuclei is often not obvious


A. granuloma faciale

B. pigmented purpura

C. leukocytoclastic vasculitisCorrect Choice

D. mastocytosis

E. acrodermatitis of Mali

In leukocytoclastic vasculitis, on low power there is an inflammatory infiltrate generally clustered around the vessels (although sometimes more dense and interstitial). There is extravasation of erythrocytes around vessels with predominantly neutrophils around vessels and often within the walls of the vessels. There is fragmentation of neutrophilic nuclei (“nuclear dust”) with fibrin (pink amorphous material) within the walls of vessels and sometimes frank destruction of vessels

86) Which type of artifact is illustrated here?

A. ElectrodessicationCorrect Choice

B. Gel foam

C. Knife chatter

D. Dessication

E. Freeze

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The elogation of cells and spindling of nuclei with typical "string bean" appearance are characteristic of electrodessication artifact

87) This patient’s biopsy will likely show:

A. Mononuclear cells with abundant cytoplasm around superficial vessels

B. Eosinophils at the dermoepidermal junction

C. Leukocytoclasia around superficial vessels

D. Lymphocytes at the dermoepidermal junctionCorrect Choice

E. Neutrophils at the dermoepidermal junction

This patient has erythema multiforme, and biopsy should show a lichenoid infiltrate of lymphocytes at the dermoepidermal junction

88) The promontory sign is seen in:

A. Tufted angioma

B. Acroangiodermatitis of Mali

C. Kaposi’s sarcoma Correct Choice

D. Glomeruloid hemangioma

E. Spindle cell hemangioendothelioma

The promontory sign refers to the formation of new vessels around existing vessels and adnexal structures. This is seen in Kaposi’s


A. Lupus erythematosus

B. Mycosis fungoides

C. Poroma

D. Porokeratosis

E. PsoriasisCorrect Choice

This is psoriasis, in which there is parakeratosis with entrapped neutrophils overlying a regularly acanthotic epidermis. There is hypogranulosis of the epidermis with increased mitoses in the basal layer. There are thinned suprapapillary plates with dilated vessels in the superficial dermal papillae. There is a lympho-histiocytic infiltrate around superficial vessels. Occasionally, clusters of neutrophils can be seen in the stratum spinosum (spongiform pustules of Kogoj

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A. Melanoma

B. Extramammary Paget’sCorrect Choice

C. Sebaceous carcinoma

D. Bowen’s

E. Condyloma

This is an example of extramammary Paget’s, in which there are atypical cells singly and in groups within the epidermis. The cells have abundant bluish cytoplasm

91) This is secondary to:Image Link 1Image Link 2

A. paraproteinemia

B. a dull blade

C. silicone injections

D. gel foamCorrect Choice

E. metastatic carcinoma

Gel foam in tissue sections is a characteristic wavy material that stains bluish-gray

92) The predominant location of the cleft in transient neonatal pustular melanosis is:

A. Suprabasal

B. Basement membrane zone

C. Subcorneal/granularCorrect Choice

D. Dermal

E. Basal keratinocytes

Transient neonatal pustular melanosis is an idiopathic pustular eruption of newborns, mostly on the chest, that heals with hyperpigmentation. It is most common on pigmented individuals. Histologically it presents as subcorneal pustules with eosinophils and neutrophils


31



A. ChondrodermatitisCorrect Choice

B. Granular cell tumor

C. Bromoderma

D. Lichen simplex chronicus

E. Actinic keratosis

This is chondrodermatitis nodularis helices, in which there is hyperkeratosis and parakeratosis overlying an altered/thickened epidermis. Beneath that area, in the dermis, there is often fibrosis. Flanking the fibrosis on either side, there is a proliferation of vessels and inflammation (resembling granulation tissue

94) A lichenoid infiltrate that surrounds eccrine glands is seen in:

A. Lichen planus

B. Lichenoid purpura

C. Lichen striatusCorrect Choice

D. Lichenoid drug rection

E. Lichen planopilaris

Lichen striatus is an uncommon inflammatory dermatitis seen most commonly in children aged 5 to 15. It presents unilaterally along Blaschko's lines as raised, slightly scaly, erythematous papules, which are often pruritic. These lesions typically regress spontaneously within a year. The histopathologic features of lichen striatus include a superficial perivascular inflammatory lymphohistiocytic infiltrate with rare plasma cells and eosinophils. There is a focal lichenoid infiltrate in the papillary dermis with basilar vacuolar alteration and necrotic keratinocytes. Spongiosis with exocytosis of lymphocytes can be seen in the epidermis. A specific and distinctive feature of lichen striatus is the presence of an inflammatory infiltrate that surrounds hair follicles and eccrine glands

95) Similar follicles can be seen on skin from the:

A. EyelidCorrect Choice

B. Nose

C. Finger

D. Glans penis

E. Labia majora

Vellus hair follicles are seen commonly in accessory tragic and eyelid skin


32

A. Incontinentia pigmenti

B. Lichen striatus

C. Lichen simplex chronicus

D. Lichen planusCorrect Choice

E. Pityriasis lichenoides et varioliformis acuta

This is lichen planus, in which there is hyperkeratosis (and no parakeratosis), irregular acanthosis of the epidermis, hypergranulosis (often in wedge shapes), saw-toothing of the basal layer, and a band-like inflammatory infiltrate of predominantly lymphocytes (usually no eosinophils) at the dermoepidermal junction. Occasionally, artifactual clefting can be seen at the dermoepidermal junction (Max-Joseph space). Colloid bodies/Civatte bodies (amorphous pink material in globs) may also be seen near the dermoepidermal junction

97) This reaction is most likely secondary to: Image Link 1 Image Link 2

A. nicotinamide

B. tetracycline

C. mycophenolic acid

D. captoprilCorrect Choice

E. cyclosporine

Bullous pemphigoid can be drug-induced and a common inciting drug is captopril. Other causes include lasix, nalidixic acid, penicillamine, antibiotics (penicillin, amoxicillin, ampicillin), and PUVA

98) All have been associated with increased risk of breast cancer except:

A. Birt-Hogg-Dube Correct Choice

B. ataxia telangiectasia

C. Multicentric reticulohistiocytosis

D. Peutz-Jeghers

E. Cowden’s

Birt-Hogg-Dube is associated with renal cancer and thyroid cancer. Female carriers of a mutated ATM (homozygous mutations ATM cause ataxia telangiectasia) have an increased risk of breast cancer

99) The diagnosis is:Image Link 1

33


http://dermatology.etas-online.com/questionimages/bullous_pemphigoid_20x_orig.jpg

http://dermatology.etas-online.com/questionimages/bullous_pemphigoid_4x_orig.jpg

Image Link 2Image Link 3

A. microcystic adnexal carcinoma

B. mixed tumorCorrect Choice

C. syringofibroadenoma

D. mucinous carcinoma

E. papillary eccrine adenoma

Some authors separate mixed tumors into eccrine and apocrine types. In the eccrine mixed tumor (pictured here), there are cords, clusters, and strands of basaloid cells forming lumina, some lined by eosinophilic cuticles. These clusters of cells are embedded in a bluish myxoid/cartilaginous stroma

100) The predominant location of the cleft in acropustulosis of infancy is:

A. Dermal

B. Basment mebrane zone

C. Subcorneal/granularCorrect Choice

D. Suprabasal

E. Basal keratinocytes

Acropustulosis of infancy presents as idiopathic pustules on acral skin. Diagnosis is made only after other causes of pustules have been ruled out, and it usually resolves in a few years. The cleft in acropustulosis of infancy is subcorneal/granular with neutrophils

101) Cicatricial pemphigoid antibodies directed against this are associated with high frequency of malignancy:

A. Laminin 5 Correct Choice

B. Beta4-integrin

C. BPAg2

D. Laminin 6

E. All of these answers are correct

Anti-laminin 5 cicatricial pemphigoid (CP) is also known as anti-epiligrin CP. Anti-epiligrin CP is associated with an increased frequency of internal adenocarcinomas. Laminin 5 is composed of three chains (heterotrimer), alpha3, beta3, gamma2. Antibodies are frequently directed against the alpha3 chain, and so cross-reactivity can be observed with laminin 6, as laminin 6

34



(alpha3beta1gamma1) has the alpha3 chain as well. Beta4-integrin antibodies have been associated with ocular CP. BPAg2 antibodies are seen in CP patients that have mucosal as well as skin disease

102) This patient may have antibodies to:Image Link 1Image Link 2Image Link 3

A. metalloproteinase

B. transglutaminase

C. myeloperoxidaseCorrect Choice

D. proteinase-3

E. aminotransferase

The figures are consitent with polyarteritis nodosa. Patients with polyarteritis nodosa may have antibodies to p-ANCA or myeloperoxidase


A. malignant fibrous histiocytoma

B. nodular fascitisCorrect Choice

C. epithelioid sarcoma

D. neurofibroma

E. dermatofibrosarcoma protuberans

In nodular fasciitis, there is a ill-defined deep (often extending into fat) proliferation of plump spindle cells that on higher power resemble “tissue-culture fibroblasts” with elongated cytoplasm often set in a background of many small vessels and extravasated erythrocytes. The spindle cells are arranged haphazardly, and the stroma is often myxoid. Mitoses are common


A. Psoriasis

B. Granular parakeratosisCorrect Choice

C. Lichen nitidus

D. Dermatophyte

35








E. Lichen planus

Granular parakeratosis results from abnormal keratinization which generally occurs in the flexural areas. Histologically, the thick parakeratotic layer with retention of keratohyaline granules. In addition, the granular layer is preserved with relatively normal epidermis


A. Mastocytosis

B. Leprosy

C. Sarcoid

D. Lichenoid actinic keratosis

E. Lichen nitidusCorrect Choice

This is lichen nitidus, in which there is a “ball” of lymphocytes and histiocytes in the superficial dermis abutting the epidermis surrounded on both sides by “claws” of the epidermis (rete

106) Which of the following drugs has been known to cause pyogenic granuloma?

A. CapecitabineCorrect Choice

B. Paclitaxel

C. Isosfamide

D. Daunorubicin

E. Mithramycin

Systemic retinoids, indinavir and capecitabine have all been describe to cause pyogenic granulomas

107) Which of the following histologic features is seen in aging skin?

A. Increased sebum production

B. Increased number of terminal hairs

C. Thickened dermal-epidermal junction

D. Fewer Langerhans cellsCorrect Choice

E. Increased mast cells

Histologic features of aging epidermis include flattened dermo-epidermal junction, occasional nuclear atypia, decrease in the number of melanocytes and Langerhans cells. Changes that are present in the dermis include atrophy, decrease in fibroblasts, mast cells and blood vessels

36

108) In this patient, this test will be helpful in making the diagnosis:

A. Patch test

B. Fluorescent antibody test for herpesCorrect Choice

C. Tissue culture

D. KOH exam

E. Indirect immunofluorescence

This patient has herpes zoster. A direct fluorescent antibody test for the varicella zoster virus can be performed to confirm the diagnosis.

109) This patient also has anemia. He needs screening for::Image Link 1Image Link 2Image Link 3

A. malignancyCorrect Choice

B. liver cirrhosis

C. diabetes

D. pulmonary firbrosis

E. immunosuppression

The histology shows numerous neutrophils in the dermis with a lack of vasculitis, consistent with Sweet’s syndrome. In a patient with Sweet’s syndrome, the presence of anemia is associated with an internal malignancy.

110) Multiple such lesions are associated with::Image Link 1Image Link 2

A. Cowden'sCorrect Choice

B. Gorlin's

C. Werner's

D. Bloom's

E. Sipple's

Multiple sclerotic fibromas are seen in Cowden’s syndrome.


37






A. Dermatofibrosarcoma

B. Angiolipoma Correct Choice

C. Epithelioid sarcoma

D. Nodular fasciitis

E. Liposarcoma

NEEDS EXPLANATIONS

112) Cellular neurothekeoma stains with:

A. Low molecular weight keratin

B. Stromelysin-3

C. Desmin

D. PGP-9.5 Correct Choice

E. S-100

PGP-9.5 and S100-a6 stains cellular neurothekeoma. Stromelysin-3 is positive in dermatofibromas and negative in dermatofibrosarcoma protuberans. Desmin stains rhabdomyosarcoma. S-100 stains neural tumors and melanocytic tumors among other things, but cellular neurothekeomas are generally S100-negative

113) What stain may be used to differentiate this entity from metastatic oat cell carcinoma of the lung?

A. HMB 45

B. CEA

C. PAS

D. Cytokeratin 20Correct Choice

E. S-100

Merkel cell carcinoma is a neuroendocrine cancer, usually of the head and neck. The tumor stain with cytokeratin 20 which is expressed in a paranuclear dot-like pattern. This stain helps to differentiate Merkel cell carcinoma from metastatic oat cell carinoma of the lung.


38




A. Epithelioid sarcoma

B. Angiosarcoma

C. Epithelioid hemangioendothelioma

D. Kaposi's sarcomaCorrect Choice

E. Aneurismal dermatofibroma

In nodular Kaposi’s sarcoma, one sees a proliferation of spindle cells, often arranged in nodules separated by fibrous bands. On higher power examination of the spindle cells, numerous extravasated erythrocytes can be seen between the cells. Often, hemosiderin-filled macrophages and plasma cells can be seen as well. The spindle cells are packed closely together and often will have intracytoplasmic pink inclusions (erythrophagolysosomes


A. Psoriasis

B. Pityriasis rubra pilarisCorrect Choice

C. Inflammatory linear verrucous epidermal nevus

D. Prurigo nodularis

E. Ichthyosis

NEEDS EXPLANATION


A. Dilated poreCorrect Choice

B. Fibrofolliculoma

C. Pilar sheath acanthoma

D. Keratosis pilaris

E. Trichoadenoma

This is a dilated pore, in which there is an invagination lined by epidermis that is slightly acanthotic

117) These cells should stain with:Image Link 1Image Link 2Image Link 3

A. S100

39




B. factor XIIIa

C. cytokeratin

D. CD34

E. actinCorrect Choice

This is a dermatomyofibroma. Dermatomyofibromas are often found over the scapula of women. The spindle cells are oriented parallel to the epidermis, and stain with vimentin and non-specific muscle actin. The spinde cells do not stain with desmin, S100, CD34, or Factor XIIIa


A. Impetigo

B. Bullous pemphigoidCorrect Choice

C. Subcutaneous lupus erythematosus

D. Dermatitis herpetiformis

E. Polymorphous light eruption

This is bullous pemphigoid, in which a subepidermal bullae/vesicle displays numerous eosinophils lining up at the dermo-epidermal junction

119) This developed in a patient with a history of breast cancer s/p surgical excision/radiation. Her diagnosis is:Image Link 1Image Link 2Image Link 3

A. Horner's

B. Stewart-TrevesCorrect Choice

C. Parkes-Weber

D. Kettle's

E. Klippel-Trenaunay

Angiosarcoma can develop in a lymphedematous extremity. When it develops in the upper extremity after surgical treatment of breast cancer, it is referred to as Stewart-Treves syndrome. When it develops in the lower extremity after lymph node dissection for a melanoma, it is referred to as Kettle's syndrome


40




A. Trichofolliculoma

B. Spiradenoma

C. Trichilemmoma

D. Mixed tumor

E. TrichoepithliomaCorrect Choice

This is a trichoepithelioma, in which there are islands of basaloid cells in a somewhat fibrous stroma with no retraction between the islands and the stroma. Often horn cysts are seen (not shown).

121) The inclusions in infantile digital fibromatosis stain for trichrome and:

A. Thioflavin T

B. Pentahydroxy flavanol

C. Osmium tetroxide

D. Phosphotungstic acid hematoxylin Correct Choice

E. Bodian

Osmium tetroxide stains fat. Thioflavin T stains amyloid. The Bodian stain is for nerves. Pentahydroxy flavanol is a fluorescent stain for calcium


A. myofibromatosis

B. schwannoma

C. Kaposi's sarcoma

D. neurofibromaCorrect Choice

E. leiomyoma

This is a plexiform neurofibroma. There are discrete nodules of spindle cells within the dermis. On higher power, the cells have wavy nuclei with pink cytoplasm


A. Carbon tattooCorrect Choice

41





B. Monsel’s reaction

C. Blue nevus

D. Postinflammatory hyperpigmentation

E. Minocycline-induced hyperpigmentation

This is a carbon tattoo, in which there are extracellular and intracellular particles of black material in the superficial dermis


A. Deep penetrating nevus

B. Recurrent nevus

C. Congenital nevusCorrect Choice

D. Epithelioid blue nevus

E. Nevoid melanoma

This is a congenital nevus, in which there are nests of nevomelanocytic cells at the dermoepidermal junction and extending deep into the dermis. In the deeper dermis, the cells infiltrate through collagen bundles and extend around adnexal structures. There is hyperkeratosis, acanthosis, and papillomatosis of the surface epidermis

125) The green color in chloroma is secondary to:

A. Stromelysin

B. Myeloperoxidase Correct Choice

C. Fumarase

D. Chloracetate

E. Alkaline phosphatase

Chloromas are greenish tumor grossly secondary to involvement of the skin in acute granulocytic leukemia. The green color is secondary to myeloperoxidase

126) Supporting evidence for the diagnosis of mycosis fungoides is CD4+ lymphocytes with loss of CD7 as well as loss of

A. CD20

B. CD2

42

C. CD30

D. CD5 Correct Choice

E. CD3

CD5 as well as CD7 are sometimes lost on the surface of epidermotropic T cells in mycosis fungoides. CD2, CD3, and CD5 are T cell markers. CD20 is a B cell marker. CD30 is positive in anaplastic large cell lymphoma cells, Hodgkin’s lymphoma, and lymphomatoid papulosis. Reactive infiltrates can also have some CD30-positive cells

127) Clinically, a nondescript hyperkeratotic papule on the ulnar side of the base of the fifth finger is most likely:

A. Cutaneous horn

B. Accessory digit Correct Choice

C. Digital fibromatosis

D. Acquired digital fibrokeratoma

E. Glomus tumor

Accessory digits (supernumerary digits) are usually found at the base of the fifth finger, often bilaterally

128) Multiple trichoepitheliomas are seen in all except:

A. Brooke-Fordyce syndrome

B. Rombo syndrome

C. Gorlin's syndrome Correct Choice

D. Brooke-Spiegler syndrome

E. Bazex's syndrome

Gorlin's syndrome is nevoid basal cell carcinoma syndrome; multiple trichoepitheliomas are not seen. Several syndromes have been associated with multiple trichoepitheliomas: Basex, Brooke-Fordyce, Brooke-Spiegler, Rombo, and possibly Rasmussen. (Rasmussen described one family in 1975 with autosomal dominant inheritance of multiple trichoepitheliomas, milia, and cylindromas.) Basex syndrome (follicular atrophoderma, hypotrichosis, occasional trichoepitheliomas, basal cell carcinomas, and localized or generalized hypohidrosis) is inherited in an X-linked dominant manner. Brooke and Fordyce both described multiple trichoepitheliomas concurrently in 1892, and therefore multiple familial trichoepitheliomas are sometimes called “Brooke-Fordyce” sydrome. Spiegler described patients with multiple cylindromas in 1899 and also noted that many of these patients had mutiple trichoepitheliomas; more recently it has been noted that multiple spiradenomas may be seen in patients with multiple trichoepitheliomas and cylinidromas; this co-occurrence of tumors has been referred to as “Brooke-Spiegler” syndrome. (Brooke-Fordyce and Brooke-Spiegler are likely the same syndrome.) Rombo syndrome is characterized by vermiculate atrophoderma, multiple BCCs, multiple trichoepitheliomas, cyanosis and peripheral vasodilation

43

129) The diagnosis is::Image Link 1Image Link 2Image Link 3Image Link 4

A. hypertrophic scarCorrect Choice

B. leiomyoma

C. dermatomyofibroma

D. neurofibroma

E. dermatofibroma


A. Adenoid cystic carcinoma

B. Trichoblastoma

C. Microcystic adnexal carcinoma

D. Trichodiscoma

E. Morpheaform basal cell carcinomaCorrect Choice

This is a morpheaform basal cell carcinoma, in which there are very infiltrative islands of basaloid cells, extending deep into the dermis. Around some of the basaloid islands, there is new, pink collagen. The basaloid proliferation off of the surface of the epidermis is more typical of a superficial multicentric basal cell carcinoma and aids in the diagnosis

131) This patient should be examined for::Image Link 1Image Link 2Image Link 3Image Link 4

A. photosensitivity

B. keratoacanthomasCorrect Choice

C. pigmentary anomalies

D. odontogenic cysts

E. arsenical keratoses

44









The figures show a sebaceous adenoma. Sebaceous adenomas are associated with Muir-Torre syndrome, in which patients can have an internal malignancy and multiple keratoacanthomas

132) The most likely diagnosis for this lesion would be:

A. Verruca

B. Acrochordon

C. Acquired digital fibrokeratomaCorrect Choice

D. Amputation neuroma

E. Supernumery digit

The diagnosis of this acral lesion is an acquired digital fibrokeratoma which shows a small, exophytic circumscribed lesions. Collagen bundles are oriented perpendicularly to the skin surface. The lesion lacks nerve twigs and bone, which may be present in supernumery digit or amputation neuroma

133) Clear cell syringomas are associated with:

A. Sarcoidosis

B. Malignancy

C. Diabetes Correct Choice

D. Lichen myxedematosis

E. Argyria

Clear cell syringomas are associated with diabetes. Syringomas are associated with Down’s syndrome


A. tubular apocrine adenoma

B. dermal duct tumor

C. syringoma

D. trichoepithelioma

E. adenoid cystic carcinomaCorrect Choice

45




In adenoid cystic carcinoma, there are cords and tubules of basaloid cells, arranged in a cribiform pattern. The cystic spaces contain a bluish material. Perineural invasion is common. The cells stain positively for epithelial membrane antigen (EMA).

135) What is the cause of this pigmentary condition?

A. Hemochromatosis

B. Post-inflammatory hyperpigmetation

C. Minocycline ingestion

D. ArgyriaCorrect Choice

E. Chrysiasis

The characteristic feature of argyria is the presence of black granules in the eccrine glands. It differentiates this condition from other pigmentary disorders


A. Erythropoietic protoporphyria

B. Lipoid proteinosis

C. Radiation dermatitis

D. Colloid milium

E. Lichen sclerosus et atrophicusCorrect Choice

In lichen sclerosus et atrophicus, there is often an atrophic epidermis with overlying orthokeratosis that is thicker than the stratum spinosum, with some follicular plugging. There is sometimes a subepidermal separation. The upper dermis is homogenized and pink/pale. Sometimes underlying the homogenized zone, there is a band-like infiltrate (not seen here

137) A patient with a blue-red discoloration of the nail plate reports that the same finger becomes very tender when exposed to the cold. You suspect a:

A. Pyogenic granuloma

B. Glomus tumorCorrect Choice

C. Periungual verruca

D. Mucous cyst

46





E. Pterygium

Glomus tumors are tumors of the arterio-venous anastamosis of the digital dermis. They occur most frequently in the nail bed. The commonly have a bluish-red discoloration and may be tender or painful with exposure to heat or cold

138) Verruciform xanthoma is seen most commonly on:

A. Distal extremities

B. Mucosal surfaces and trunk/proximal extremities

C. Oral mucosae and genital areas Correct Choice

D. Nail bed and periungual areas

E. Head and neck

NEEDS EXPLANATION

139) This patient developed an acute vesicular rash after eating a mango. She has returned for a routine follow-up. She needs to be careful of exposure to:

A. All of these answers are correct

B. Ginkgo fruitCorrect Choice

C. Croton

D. Ragweed

E. Tea tree oil

Patients allergic to the peel of a mango can also be allergic to other plants/products of the Anacardiaceae family. Cross-reactions can occur with exposure to any plants of the genus Toxicodendron, to the oil from the cashew nut shell, to the Brazilian pepper tree, to lacquer from the Japanese lacquer tree, to ink from the Indian marking nut, and to the fruit pulp of the ginkgo tree, and others


A. Blastomycosis

B. Cryptococcosis

C. Histoplasmosis

47





D. Toxoplasmosis

E. LeishmaniaisisCorrect Choice

The diagnosis is Leishmaniasis. In this condition, the epidermis is often ulcerated (not seen in this case) with a dense infiltrate is seen within the dermis. There are numerous macrophages (Leishman-Donovan bodies) within the infiltrate that have intracellular amastigotes within them. On close examination of the parasites, a kinetoplast is evident. In contrast to histoplasmosis, a discrete halo is not seen around the amastigotes

141) Caterpillar bodies are seen in:

A. Dyskeratosis congenital

B. Porphyria cutanea tarda Correct Choice

C. Amyloidosis

D. Lipoid proteinosis

E. Mucocele

Caterpillar bodies are thought to be type IV collagen

142) A healthy 6 month old girl has a subcutaneous nodule above her right eyebrow. A skin biopsy demonstrates a cystic lesion with adnexal structures in the wall. Your diagnosis is:

A. Nevus sebaceous

B. Epidermal inclusion cyst

C. Steatocystoma

D. Pilar cyst

E. Dermoid cystCorrect Choice

Dermoid cysts present along lines of embryonic closure. The are most commonly found on the head (around the eyes) and the neck. They are lined by an epidermis that contains various epidermal appendages that are usually fully matured


A. basaloid squamous cell carcinoma

B. malignant acrospiroma

48




C. poroid squamous cell carcinoma

D. porocarcinoma

E. basosquamous carcinomaCorrect Choice

In basosquamous carcinomas, there are areas that appear typical of basal cell carcinoma (with basaloid cells coming off the epidermis in buds with peripheral palisading) as well as areas typical of squamous cell carcinoma (with atypical keratinocytes that are more pink and angular than basaloid cells). Often, ulcerated basal cell carcinomas have squamous differentiation at the base of the ulcer and this is not to be confused with a basosquamous carcinoma, in which there are areas of both basal cell carcinoma and squamous cell carcinoma


A. Dermatofibroma Correct Choice

B. Dermatomyofibroma

C. Neurofibroma

D. Plexiform fibrohistiocytic tumor

E. Infantile digital fibromatosis

NEEDS EXPLANATIONS

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Health & Medicine

ETAS_MCQ_05 dermatopathology