Practice questions, skin tumors 1

Practice questions, skin tumors 1
© Jun Wang, MD, PhD

1. Use this image for the question. A 41-year-old woman presents with a slowly growing painless mass at her leg. She has a history of multiple skin warts. Physical examination reveals a light tan nodule with greasy scaly surface. A shave biopsy is performed and an image is shown. What is the diagnosis?

(Image: Ed Uthman from Houston, TX, USA [CC BY 2.0 (https://creativecommons.org/licenses/by/2.0)])
A. Actinic keratosis
B. Merkel cell carcinoma
C. Seborrheic keratosis
D. Squamous cell carcinoma
E. Verruca vulgaris

2. Use this case and this image for the next two questions. A 59-year-old man presents with suddenly appeared skin lesions on his back. He has had dysphagia and a 15 pound weight loss for the last three months. He has a history of Barrett’s esophagus. Pictures of the skin lesion and microscopic examination are shown. What is the diagnosis?

(Image: Nephron [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
(Image: James Heilman, MD [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
A. Guttate psoriasis
B. Leser-Trelat syndrome
C. Neurofibromatosis 1
D. Nevoid basal cell carcinoma syndrome
E. Sezary syndrome

3. A 59-year-old man presents with suddenly appeared skin lesions on his back. He has had dysphagia and a 15 pound weight loss for the last three months. He has a history of Barrett’s esophagus. Pictures of the skin lesion and microscopic examination are shown. What is likely associated with these skin lesions?
(Image: Nephron [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
(Image: James Heilman, MD [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
A. Abnormal keratinocyte turnover
B. Human papilloma virus infection
C. GI tract malignancy
D. NF 1 mutation
E. UV light


4. Use this image for the question. A 45-year-old woman presents with brownish skin changes of her left axilla. She is otherwise asymptomatic. She has a history of type 2 diabetes and obesity. She had ductal carcinoma in situ of her left breast 2 years ago and was treated with lumpectomy. Physical examination reveals a slightly thickened area as shown. No lymphadenopathy is noted. What is most likely associated with these changes?
(Image: Madhero88 [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
A. Acute bacterial infections
B. Fungal infection
C. Insulin resistance
D. Melanocytic proliferation
E. Metastatic breast cancer

5. Use this image for the question. A 35-year-man presents with approximately 15 painless polypoid growths at his face and neck. His past medical history and family history are unremarkable. The lesions are firm and up to 3 mm in greatest dimension. An image of the microscopic examination is shown. What is the diagnosis?

(Image: LWozniak&KWZielinski [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
A. Acrochordon
B. Dermatofibroma
C. Dermatofibrosarcoma protuberans
D. Neurofibroma
E. Schwannoma

6. Use this image for the question. A 25-year-old man presents with a 2.3 cm slowly growing soft lump at his left forearm. He has a history of type 1 diabetes. The mass is resected and grossly it has a cystic appearance with soft greasy yellowish contents. An image of the microscopic examination is shown. What is the diagnosis?

(Image: Nephron [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
A. Dermatophytosis
B. Epidermal cyst
C. Pilar cyst
D. Pilomatrixoma
E. Teratoma

7. Use this image for the question. A 39-year-old woman presents with a 1.5 cm firm painless lump at her left scalp. He has a history of type 1 diabetes. The mass is resected and grossly it has solid homogenous appearance. An image of the microscopic examination is shown. What is the diagnosis?

(Image: Nephron [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
A. Epidermal cyst
B. Pilar cyst
C. Pilomatrixoma
D. Squamous cell carcinoma
E. Teratoma

8. Use this image for the question. A 77-year-old woman presents with a 0.4 cm firm painless nodule at her left palm. She has history of multiple basal cell carcinoma and squamous cell carcinoma of skin. An image of the biopsy is shown. What is the diagnosis?
(Image: LWozniak&KWZielinski [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
A. Actinic keratosis
B. Basal cell carcinoma
C. Cylindroma
D. Eccrine poroma
E. Squamous cell carcinoma

9. Use this case and this image for the next two questions. A 33-year-old woman presents with multiple firm tumors up to 3.5 cm in greatest dimension at her left scalp. She has family history of similar growth. An image of the biopsy is shown. What is the diagnosis?
(Image: Nephron [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
A. Basal cell carcinoma
B. Cylindroma
C. Eccrine poroma
D. Squamous cell carcinoma
E. Syringoma

10. A 33-year-old woman presents with multiple firm tumors up to 3.5 cm in greatest dimension at her left scalp. She has family history of similar growth. An image of the biopsy is shown. Mutation of what gene is likely associated with these findings?
(Image: Nephron [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
A. Beta-catenin
B. BRAF
C. CYLD
D. MSH2
E. PTCH

11. Use this image for the question. A 47-year-old woman presents with multiple firm papules at her lower eyelids. The papules has light yellowish hue and are up to 3 mm in greatest dimension. She has a history of left invasive ductal carcinoma with axillary lymph node metastasis and was treated with lumpectomy, axillary lymph node dissection and local radiation therapy. An image of the biopsy is shown. What is the diagnosis?
(Image: Ed Uthman from Houston, TX, USA [CC BY 2.0 (https://creativecommons.org/licenses/by/2.0)])
A. Cylindroma
B. Eccrine poroma
C. Metastatic invasive ductal carcinoma
D. Sebaceous adenoma
E. Syringoma

12. Use this case and this image for the next two questions. A 65-year-old woman presents with a firm tumor at her left face. She has a history of hypertension and diabetes for 20 years. She had colectomy at age 35 due to well differentiated sigmoid colon adenocarcinoma. Her family history is positive for colorectal carcinoma and endometrial carcinoma. An image of the biopsy is shown. What is the diagnosis?
(Image: Nephron [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
A. Brooke-Spiegler syndrome
B. Cowden syndrome
C. Muir-Torre Syndrome
D. Neurofibromatosis 2
E. Nevoid basal cell carcinoma syndrome

13. A 65-year-old woman presents with a firm tumor at her left face. She has a history of hypertension and diabetes for 20 years. She had colectomy at age 35 due to well differentiated sigmoid colon adenocarcinoma. Her family history is positive for colorectal carcinoma and endometrial carcinoma. An image of the biopsy is shown. Mutation of what gene is likely associated with these findings?
(Image: Nephron [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
A. Beta-catenin
B. BRAF
C. CYLD
D. MSH2
E. PTCH

14. Use this image for the next question. A 5-year-old boy presents with a firm tumor at his left fact. He is otherwise healthy. An image of the biopsy is shown. What is the diagnosis?
(Image: Nephron [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
A. Cylindroma
B. Pilar cyst
C. Pilomatricoma
D. Sebaceous adenoma
E. Syringoma

15. Use this image for the next question. An 11-year-old boy presents with a slowly growing tumor at his forehead. He is otherwise healthy.  An image of the biopsy is shown. What is the diagnosis?
(Image: Nephron [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
A. Basal cell carcinoma
B. Cylindroma
C. Epidermal cyst
D. Pilomatricoma
E. Trichoepithelioma

16. Use this image for the next question. A 33-year-old woman presents with a slowly growing warty papule at her face. An image of the biopsy is shown. What is the diagnosis?
(Image: LWozniak&KWZielinski [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
A. Basal cell carcinoma
B. Cylindroma
C. Eccrine poroma
D. Trichoepithelioma
E. Tricholemmoma

17. Use this image for the next question. A 27-year-old woman presents with a slowly growing nodule at her left leg. Her past medical history is unremarkable. Physical examination reveals a 1.2 cm firm nodule with smooth unremarkable skin surface. An image of the biopsy is shown. Per immunohistochemistry studies, this lesion is positive for factor XIIIa and negative for cytokeratin, desmin, S100 and CD34. What is the diagnosis?
(Image: Ed Uthman from Houston, TX, USA [CC BY 2.0 (https://creativecommons.org/licenses/by/2.0)])
A. Dermatofibroma
B. Dermatofibrosarcoma protuberans
C. Leiomyoma
D. Melanoma
E. Neurofibroma

18. Use this case and this image for the next two questions. A 65-year-old man presents with a firm tumor at his back. His past medical history is unremarkable. Physical Examination reveals a 5.5 cm firm irregular mass at his left upper back. The skin covering has erythematous changes, but no ulceration is noted. An image of the biopsy is shown. Per immunohistochemistry studies, this lesion is positive for CD34 and negative for cytokeratin, desmin, S100 and factor XIIIa. What is the diagnosis?
(Image: LWozniak&KWZielinski [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
A. Dermatofibroma
B. Dermatofibrosarcoma protuberans
C. Leiomyoma
D. Melanoma
E. Neurofibroma

19. A 65-year-old man presents with a firm tumor at his back. His past medical history is unremarkable. Physical Examination reveals a 5.5 cm firm irregular mass at his left upper back. The skin covering has erythematous changes, but no ulceration is noted. An image of the biopsy is shown. Per immunohistochemistry studies, this lesion is positive for CD34 and negative for cytokeratin, desmin, S100 and factor XIIIa. Abnormality of what gene is most likely seen?
(Image: LWozniak&KWZielinski [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
A. Beta-catenin
B. BRAF
C. CYLD
D. PDGFB
E. PTCH

20. Use this case and these images for the next two questions. A 44-year-old man presents with multiple pedunculated skin polyps on his back. His past medical history is unremarkable. Physical Examination reveals numerous rubbery polypoid growth on his back. The skin covering is unremarkable. In addition, 3 irregular slight brown macules are seen on his right shoulder, and left abdomen. Images of his eye and biopsy of the skin lesions are shown. Per immunohistochemistry studies, this lesion is positive for S100 and negative for cytokeratin, desmin, CD34 and factor XIIIa. What is the diagnosis of the skin lesion?
(Image: Dimitrios Malamos [CC BY 4.0 (https://creativecommons.org/licenses/by/4.0)], and Calicut Medical College [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)])
A. Dermatofibroma
B. Dermatofibrosarcoma protuberans
C. Leiomyoma
D. Neurofibroma
E. Skin tags

21. A 44-year-old man presents with multiple pedunculated skin polyps on his back. His past medical history is unremarkable. Physical Examination reveals numerous rubbery polypoid growth on his back. The skin covering is unremarkable. In addition, 3 irregular slight brown macules are seen on his right shoulder, and left abdomen. Images of his eye and biopsy of the skin lesions are shown. Per immunohistochemistry studies, this lesion is positive for S100 and negative for cytokeratin, desmin, CD34 and factor XIIIa. Mutation of what gene is likely associated with these findings?
(Image: Dimitrios Malamos [CC BY 4.0 (https://creativecommons.org/licenses/by/4.0)], and Calicut Medical College [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)])
A. BRAF
B. Merlin
C. Neurofibromin
D. PDGFB
E. PTCH


22. Use this case and these images for the next two questions. A 51-year-old man presents with progressive headache for 6 months. His past medical history is unremarkable. Physical Examination reveals an irregular slight brown macule at his right chest. Head CT reveals a 2.5 cm mass near his pons. Images of his skin macule and biopsy of the brain lesion are shown. What is the diagnosis of the brain lesion?
(Image: Accrochoc at fr.wikipedia [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0/)], and jensflorian [CC BY-SA 3.0 de (https://creativecommons.org/licenses/by-sa/3.0/de/deed.en)])
A. Fibrosarcoma
B. Leiomyoma
C. Meningioma
D. Neurofibroma
E. Schwannoma

23. A 51-year-old man presents with progressive headache for 6 months. His past medical history is unremarkable. Physical Examination reveals an irregular slight brown macule at his right chest. Head CT reveals a 2.5 cm mass near his pons. Images of his skin macule and biopsy of the brain lesion are shown. Mutation of what gene is likely associated with these findings?
(Image: Accrochoc at fr.wikipedia [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0/)], and jensflorian [CC BY-SA 3.0 de (https://creativecommons.org/licenses/by-sa/3.0/de/deed.en)])
A. BRAF
B. Merlin
C. Neurofibromin
D. PDGFB
E. PTCH




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