Block 15 Step Pathology Prt 2

16 Questions | By Chachelly | Updated: Mar 20, 2022 | Attempts: 122

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1.

You have just diagnosed a 40-year-old woman patient of yours as having endonnetrial polyps. When she originally presented, one symptom alerted you to this possibility, and based on your follow up you were able to arrive at your conclusion. With what symptom did your patient likely present?
- A.
  
  Pelvic pain
- B.
  
  Pelvic pressure
- C.
  
  Abnormal vaginal discharge
- D.
  
  Abnormal vaginal bleeding
- E.
  
  Abnormal contractions
2.

A 29-year-old woman visits her obstetrician/gynecologist. She and her husband have been trying unsuccessfully to have a child. She also notes weight gain, increased facial hair, and lack of menses. A pelvic examination reveals normal external genitalia but palpation reveals that both ovaries are enlarged. Her blood chemistry shows elevated LH, decreased FSH, and abnormal steroid levels. The most likely diagnosis is Stein- Leventhal syndrome. The ovarian enlargement is most likely due to multiple bilateral cysts. If untreated, the woman would be MOST at risk for development of which of the following?
- A.
  
  Hypertension
- B.
  
  Baldness
- C.
  
  Endometrial carcinoma
- D.
  
  Breast cancer
- E.
  
  Renal failure
3.

A 40-year-old nullipara patient complains of longstanding painful periods she describes as dull pain in the lower abdomen that she feels for a week or 2 before menstruation. She also has cramps during menstruation. Recently she started feeling a pain during sexual intercourse and has recurrent episodes of hematuria. Urinary tract conditions causing hematuria were excluded. Pelvic examination, ultrasonography, and laparoscopy findings are consistent with endometriosis. She wishes to become pregnant. What treatment option will you consider in this woman?
- A.
  
  GnRH analogs
- B.
  
  Estrogen
- C.
  
  Meglitinide
- D.
  
  Human chorionic gonadotropin
- E.
  
  Prostaglandin
4.

An 18-year-old male presents with a gradually enlarging mass in the scrotum. On examination, the left testis shows a mass measuring 5 cms in diameter. The cut surface has a variegated appearance with areas of hemorrhage and necrosis. The tumor is seen extending into the epididymis. Microscopically, there are cellular areas consisting of large and anaplastic cells with angry looking hyperchromatic nuclei having prominent nucleoli. These cells are arranged in a glandular, alveolar, papillary, and tubular pattern. There are frequent mitotic figures. There are areas showing cartilage, adipose tissue, and neuroepithelium. What is the most likely diagnosis in this case?
- A.
  
  Leydig cell tumor
- B.
  
  Sertoli cell tumor
- C.
  
  Seminoma
- D.
  
  Teratocarcinoma
- E.
  
  Mature teratoma
- F.
  
  Immature teratoma
5.

A 20-year-old male presents with bilateral gynecomastia. A thorough investigation reveals a 3 cms right testicular mass. Grossly, it is a well-circumscribed nodule measuring 3 cms in diameter. The cut surface shows a distinct golden brown homogenous appearance. Microscopically, the tumor cells are large to polygonal with round to oval nucleus and deeply acidophilic, abundantly granular cytoplasm. The cell boundaries are indistinct. The cytoplasm shows lipochromic pigment and rod shaped crystals. What is the most likely diagnosis in this case?
- A.
  
  Leydig cell tumor
- B.
  
  Sertoli cell tumor
- C.
  
  Seminoma
- D.
  
  Teratocarcinoma
- E.
  
  Mature teratoma
- F.
  
  Immature teratoma
6.

A 40-year-old male presents with a gradually enlarging mass in the scrotum. On examination there is a 5cm mass in the right testis. The mass measures 5x4x3 cm. The cut surface is solid, homogenous, light yellow, and contains sharply circumscribed zones of necrosis. Microscopically, the individual tumor cells are uniform, large, round to polyhedral cells. It is a distinct cell membrane with abundantly clear cytoplasm and large central nucleus with 1 or 2 prominent nucleoli. The tumor cells are characteristically arranged in nests outlined by fibrous bands and these bands are infiltrated by lymphocytes and plasma cells. What is the most likely diagnosis?
- A.
  
  Leydig cell tumor
- B.
  
  Sertoli cell tumor
- C.
  
  Seminoma
- D.
  
  Teratocarcinoma
- E.
  
  Mature teratoma
- F.
  
  Immature teratoma
7.

A 66-year-old male presents with a gradually enlarging mass in the scrotum. On examination, there is bilateral enlargement of the testes. The right testicular mass measures 5 cms in diameter and the left is 4 cms in diameter. The cut surface of both is soft, homogenous, and gray-white in color. Microscopically, both the masses show predominantly interstitial proliferation of malignant cells, which surrounds and infiltrates the seminiferous tubules. These cells are monotonous, large, with round to oval vesicular cleaved nuclei. They show 1or 2 prominent nucleoli and a moderate amount of cytoplasm. What is the most likely diagnosis?
- A.
  
  Seminoma
- B.
  
  Sperrnatocytic seminoma
- C.
  
  Yolk sac tumor
- D.
  
  Embryonal carcinoma
- E.
  
  Testicular Lymphoma
8.

A 2-year-old male child presents with a gradually enlarging mass in the scrotum. On examination, a 3 cms mass is palpable in the left testis. Grossly, the mass is well circumscribed but non-encapsulated. The cut surface is homogenous, yellow-white, and mucinous in appearance. Microscopically, it consists of a lace like network of medium sized cuboidal cells with an occasional area showing papillary structures and solid cords of cells. Also present within and outside the cytoplasm are eosinophilic hyaline-like globules, which stain positively for AFP by immunocytochemistry. What is the most likely diagnosis?
- A.
  
  Seminoma
- B.
  
  Sperrnatocytic seminoma
- C.
  
  Yolk sac tumor
- D.
  
  Embryonal carcinoma
- E.
  
  Testicular Lymphoma
9.

A 65-year-old man presents with a history of gradual enlargement of the scrotum over a course of 6 months. Or examination, he is found to have a mass in the right testis. Right-sided orchidectomy is performed. Grossly, the mass measures 5x4x3 cms and the cut surface has a soft gelatinous appearance. Microscopically, it is composed of cells with perfectly round nuclei and prominent variation in size. Bizarre giant forms, as well as small cells with a lymphocyte-like appearances are seen. Numerous mitoses are observed. There are no areas of lymphocytic infiltration. The patient is perfectly normal even 5 years following surgery. What is the BEST diagnosis in this case?
- A.
  
  Seminoma
- B.
  
  Sperrnatocytic seminoma
- C.
  
  Yolk sac tumor
- D.
  
  Embryonal carcinoma
- E.
  
  Testicular Lymphoma
10.

A 22-year-old medical student felt a painless, firm mass in his left testis. The testis was surgically removed. Photomicrographs of the surgical specimen are shown in the Figures below. The MOST likely diagnosis is which of the following?
- A.
  
  Choriocarcinoma
- B.
  
  Embryonal carcinoma
- C.
  
  Leydig cell tumor
- D.
  
  Seminoma
- E.
  
  Teratocarcinoma
11.

A 40-year-old African-American woman attends the clinic after she noticed a lump in her left breast. On examination, the lump measures 5 cms in diameter and presents in the upper outer quadrant and upper inner quadrant of the left breast. The overlying skin appears to be normal. The cortralateral breast does not show any swelling. An excision biopsy is done. Grossly, the mass is well circumscribed, firm, and lobulated. The cut surface shows a whorled pattern with clefts. Microscopically, the clefts are lined by epithelial cells and are surrounded by a stroma consisting of spindle cells with occasional bizarre giant cells. What is the most likely diagnosis in this case?
- A.
  
  Fibroadenoma
- B.
  
  Benign phyllodes tumour
- C.
  
  Fibrocystic disease
- D.
  
  Sclerosing adenosis
- E.
  
  Malignant phyllodes tumor
12.

A 36-year-old female attends the clinic as she noticed a vague lump in her breast while doing a routine breast examination. On examination, the mass is ill defined and firm. The skin is free and the mass is not attached to the deep fascia. No lymph nodes are enlarged. The contralateral breast is free of any lesion. The biopsy shows microscopic cysts lined by a layer of cuboidal epithelium with some cysts showing apocrine metaplasia. What is the most likely diagnosis in this case?
- A.
  
  Fibroadenoma
- B.
  
  Benign phyllodes tumour
- C.
  
  Fibrocystic disease
- D.
  
  Sclerosing adenosis
- E.
  
  Malignant phyllodes tumor
13.

A 45-year old woman presents with an area of irregularity palpated by her gynecologist in her right breast. On the mammogram her breasts showed dense fibroglandular tissue with possible microcalcifications in the area of the palpable lump. A sonographic exam revealed an immobile 10 mm hypoechoic mass with irregular projection borders. What is the probable diagnosis?
- A.
  
  Benign cyst
- B.
  
  Fibroadenoma
- C.
  
  Infected galactocele
- D.
  
  Gynomastia
- E.
  
  Infiltrating duct carcinoma
14.

A 35-year-old woman comes to the clinic with the complaint of disfiguration of her right breast. On examination, the skin over the breast has the classic 'peau diorange' appearance. The pits in the skin correspond with which of the following?
- A.
  
  Ligaments of Cooper
- B.
  
  Lymphatic vessels
- C.
  
  Opening of lobules
- D.
  
  Sebaceous gland openings
- E.
  
  Subcutaneous fibrosis
15.

A 55-year-old man presents with an asymptomatic retroareolar mass around the right nipple that he noticed a week ago while taking a bath. On physical exam, a hard, poorly defined, non-tender mass was felt beneath the right areola. Mammographic and biopsy findings revealed a diagnosis of breast carcinoma. What histological type of breast carcinoma does this male patient most likely have?
- A.
  
  Infiltrating ductal carcinoma
- B.
  
  Lobular carcinoma in situ
- C.
  
  Infiltrating lobular carcinoma
- D.
  
  Papillary carcinoma
- E.
  
  Mucinous carcinoma
16.

A dimorphic fungal infection is endemic in the semi-arid regions of the South Western U.S., and mostly concentrated in south-central Arizona and SanJoaquin Valley of California. Detection of the fungal elements in infected tissues in the form of large spherules containing endospores is diagnostic of this mycosis. What feature is associated with the pathogenesis of this fungal infection?
- A.
  
  Main mode of entry into the human host is by inoculation through skin
- B.
  
  Soft tissue abscess is the most common lesion produced by the fungus
- C.
  
  Asymptomatic infections are uncommon after primary exposure
- D.
  
  Capsular material helps the fungus survive in the host
- E.
  
  Cell-mediated immune response of the host is of critical importance in resistance