Practice question I Tumor of vessels answers

Practice question I answers

Tumor of vessels

© Jun Wang, MD, PhD

1. C. Proliferation of capillaries without cytological atypia is most likely capillary hemangioma. Angiosarcoma is characterized anastomosing vessels with endothelial atypia. Bacillary angiomatosis has neutrophilic infiltrate, and Gram negative rods can be identified by special stains. Hemangioblastoma is usually found in central nervous system, and is composed of proliferation of vessels with stromal cell atypia. Kaposi sarcoma is spindle cell tumor with slit spaces and red blood cell extravasation, usually seen in immunocompromised patients.

2. D. This is a capillary hemangioma that commonly regress with aging. There is no risk of metastasis or invasion. Malignant transformation or sepsis due to local ulceration of benign hemangioma is very rare.

3. C. Tumor with largely dilated vessels without atypia is most likely cavernous hemangioma. Angiosarcoma is characterized anastomosing vessels with endothelial atypia. Capillary hemangioma.is characterized by proliferation of capillaries without cytological atypia. Hepatocellular carcinoma do not have large spaces, and is negative for CD31. Kaposi sarcoma is spindle cell tumor with slit spaces and red blood cell extravasation, usually seen in immunocompromised patients.

4. D. Central nervous system vascular tumor with stromal cell atypia is most likely hemangioblastoma. Angiosarcoma is characterized anastomosing vessels with endothelial atypia. Capillary hemangioma.is characterized by proliferation of capillaries without cytological atypia. Glioblastoma has marked cytological atypia and necrosis, and has infiltrating pattern, not well demarcated. Oligodendroglioma is characterized by small to intermediate sized cells with “fried egg” appearance but not vascular proliferation.

5. E. Hemangioblastoma is associated with von Hippel-Lindau syndrome, a condition associated with VHL mutation. APC mutation is seen in familial adenomatous polyposis. NF1 mutation is seen in neurofibromatosis I. PRKAR1A mutation is seen in Carney complex. TSC mutation is seen in Tuberous sclerosis.

6. E. Patients with von Hippel-Lindau syndrome has increased risk of renal cell carcinoma, adrenal pheochromocytoma, pancreatic neuroendocrine tumor, hemangioblastoma, etc. Acute pancreatitis is associated with biliary tract disease or alcohol. End stage renal disease is seen in diabetic nephropathy, autosomal dominant (adult) polycystic kidney disease, nephronophthisis, etc, but is not a major concern for von Hippel-Lindau syndrome.

7. E. Pyogenic granuloma is characterized by lobular proliferation of capillaries separated by fine fibrous tissue without significant cytological atypia. It may be associated with previous trauma. Angiosarcoma is characterized anastomosing vessels with endothelial atypia. Aphthous ulcer is seen in oral mucosa and is very shallow without nodular appearance. Bacillary angiomatosis is usually seen in immunocompromised patients, has capillary proliferation, neutrophilic infiltrate, and Gram negative rods identified by special stains. Kaposi sarcoma is spindle cell tumor with slit spaces and red blood cell extravasation, usually seen in immunocompromised patients.

8. C. Painful tumor composed of monotonous tumor cells with round nuclei and moderate amount of cytoplasm, and positive reactivity to smooth muscle actin and CD34 is most likely Glomus tumor. Bacillary angiomatosis is usually seen in immunocompromised patients, has capillary proliferation, neutrophilic infiltrate, and Gram negative rods identified by special stains. Diffuse large B cell lymphoma is characterized by sheets of markedly atypical large lymphoid cells with positive reactivity to CD45 and CD20. Pyogenic granuloma is characterized by lobular proliferation of capillaries separated by fine fibrous tissue without significant cytological atypia. Tumor cells of chronic lymphocytic leukemia/Small lymphocytic lymphoma have small round nuclei and scant cytoplasm, and are positive for CD45 and CD20.

9. C. Kaposi sarcoma is spindle cell tumor with slit spaces and red blood cell extravasation, usually seen in immunocompromised patients. This is an AIDS patient with cutaneous and pulmonary Kaposi sarcoma. Angiosarcoma is characterized anastomosing vessels with endothelial atypia. Interstitial pneumonitis has fibrosis and inflammation, but not proliferation of atypical spindle cells. Pneumocystis jirovici pneumonia is characterized by foamy intraalveolar exudates. The fungi can be seen with silver stains. Sarcomatoid carcinoma is positive for cytokeratin.  

10. D. Kaposi sarcoma is associated with HHV8 infection. Alcohol combined with cigarette smoking is associated with squamous cell carcinoma of larynx. Cigarette smoking is a high risk factor for many cancers, especially malignant neoplasms of lung. EB virus is associated with various tumors, including nasopharyngeal carcinoma, Burkitt lymphoma, and Hodgkin lymphoma. Human papillomavirus is associated with various tumors, such as squamous papilloma, upper respiratory squamous cell carcinoma, sinonasal papilloma, and cervical/anal squamous cell carcinoma and adenocarcinoma.

11. D. Kaposi sarcoma is spindle cell tumor with slit spaces and red blood cell extravasation, usually seen in immunocompromised patients. This is an AIDS patient with cutaneous and pulmonary Kaposi sarcoma. Angiosarcoma is characterized anastomosing vessels with endothelial atypia. Dermatophytosis is characterized by neutrophilic infiltration with fungal hyphae in epidermis and dermis, but not spindle cell proliferation. Hemangioma has vascular proliferation without atypia. Squamous cell carcinoma, regardless of location, has squamous differentiation characterized by intercellular bridges and/or squamous pearls.

12. E. Radial array of dilated subcutaneous arteries or arterioles around a central core is most likely spider telangiectasia, commonly associated with hyperestrinism as seen in cirrhosis. Other conditions do not have this radiating pattern of vessels.

13. C. See discussion of question 12. Bartonella infection is seen in bacillary angiomatosis. Human herpes virus 8 is associated with various tumors, including Kaposi sarcoma and Primary effusion lymphoma. Portal hypertension is seen in cirrhosis, and associated with varicose of esophageal and veins. Pyogenic granuloma may be associated with previous trauma.

14. B. Bacillary angiomatosis is usually seen in immunocompromised patients, has capillary proliferation, neutrophilic infiltrate, and Gram negative rods identified by special stains. Angiosarcoma is characterized anastomosing vessels with endothelial atypia. Kaposi sarcoma is spindle cell tumor with slit spaces and red blood cell extravasation. Pyogenic granuloma is characterized by lobular proliferation of capillaries separated by fine fibrous tissue without significant cytological atypia. Burkitt lymphoma has sheets of intermediated sized round cells with scant cytoplasm, brisk mitosis and may macrophages forming a “starry sky” appearance.

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