11 Integumentary System

Question 1

Malignant tumor that commonly arises in skin (can also occur in mucosal surfaces, esophagus, meninges, eye)

Answer 1

Melanoma

Question 2

Large cells with expanded, irregular nuclei containing peripherally clumped chromatin and prominent eosinophilic nucleoli

Answer 2

Melanoma

Question 3

Spread of nested and single-cell melanoma cells within the epidermis

Answer 3

Radial growth phase

Question 4

nodular aggregates of infiltrating tumor cells within the dermis

Answer 4

Vertical growth phase

Question 5

Melanoma RFs

Answer 5

Sun exposure and hereditary predisposition (CDKN2A, BRAF or NRAS, PTEN, c-KIT tyrosine kinase)

Question 6

Cell origin of melanoma

Answer 6

Melanocytes

Question 7

RFs for melanoma development

Answer 7

Intermittent exposure to UV radiation
Susceptibility genes
beta-catenin mutation
Caucasian race

Question 8

Usual site of metastasis for this tumor

Answer 8

Liver, lungs, bones, brain

Question 9

Give the prognosis factors of melanoma

Answer 9

Breslow thickness, mitoses, regression, TILs, gender, location, sentinel node micrometastasis

Question 10

Neoplasm of melanocyes

Activating mutations int eh components of the Ras pathway

Answer 10

Melanocytic nevus / pigmented nevus/ benign nevus or mole

Question 11

Deep dermal and sometimes subcutaneous growth around
Identical to ordinary acquired nevi
Present at birth, large variants have increased melanoma risk

Answer 11

Congenital nevus

Question 12

Non-nested dermal infiltration, often with associated fibrosis
Highly dendritic, heavily pigmented nevus cells
Black-blue nodule, confused with melanoma

Answer 12

Blue nevus

Question 13

Fascicular growth
Large, plum cells with pink-blue cytoplasm fusiform cells
Common in children, red-pink nodule, confused with hemangioma

Answer 13

Spindle and epitheloid cell nevus (Spitz nevus)

Question 14

Lymphocytic infiltration surrounding nevus cells
Identical to ordinary acquired nevi
Host immune response against nevus cells and surrounding normal melanocytes

Answer 14

Halo nevus

Question 15

Which histologic type of nevus is considered precursor of malignant melanoma

Answer 15

Dysplastic nevus - risk factor for melanoma

Question 16

Common benign epidermal tumor

Answer 16

Seborrheic keratosis/ basal cell papilloma, brown wart, senile wart

Question 17

Seborrheic keratosis pathogenesis

Answer 17

Mutations in FGFR3 (receptor tyrosine kinase)

Leser-Trelat sign

Question 18

Paraneoplastic syndrome which includes seborrheic keratoses in large numbers

Answer 18

Leser-Trelat sign

Question 19

Composed of sheets of small cells resembling normal epidermal basal cells
Exophytic, sharply-demarcated neoplasms

Answer 19

Seborrheic keratosis

Question 20

SK characteristic features

Answer 20

Hyperkeratosis
Horn cysts
Invagination cysts

Question 21

Exuberant keratin production at the surface

Answer 21

Hyperkeratosis

Question 22

Small, intraepithelial keratin-filled cysts

Answer 22

Horn cysts

Question 23

Horn cysts which communicate with the surface

Answer 23

Pseudohorn cysts

Question 24

Invaginations of keratin into the main mass

Answer 24

Invagination cysts

Question 25

What is the clinical/appearance of this lesion that makes it appearr as a wart

Answer 25

Round, flat coin-like waxy plaques | Tan to dark brown papule or nodule

Question 26

Squamoproliferative disorders caused by HPV

Answer 26

Verrucae

Question 27

Most common type of wart | Growth is characterized by hypertrophy of dermal papillae, markedly papillomatous epidermis

Answer 27

Verrruca vulgaris

Question 28

Cytopathic effect of HPV

Answer 28

Vacuolated keratinocytes (koilocytes), which have a small shrunken nucleus surrounded by perinuclear haloes

Question 29

What are the morphologic characteristics that differentiates it from seborrheic keratosis

Answer 29

Very pointed papillomatous projections of the epidermis with a thin long column of parakeratosis Viral cytopathic changes

Question 30

Most common invasive cancer in humans

Answer 30

Basal cell carcinoma

Question 31

Basal cell Ca mutations

Answer 31

PTCH, TP53

Question 32

Pearly papules containing prominent dilated subepidermal blood vessels with telangiectasias Cords/islands of variably basophilic tumor cells with hyperchromatic nuclei Peripheral palisading

Answer 32

Basal cell carcinoma

Question 33

2 patterns of basal cell carcinoma

Answer 33

Multifocal growths | Nodular lesions

Question 34

Originate from epidermis, may extend over several square centimeters or more of skin surface

Answer 34

Multifocal growths

Question 35

Grows downward deeply into the dermis

Answer 35

Nodular lesions

Question 36

Common sites of predilection of basal cell carcinoma

Answer 36

Head > trunk > penis, vulva, perianal skin

Question 37

State a familial syndrome exhibiting basal cell carcinoma

Answer 37

Gorlin syndrome (nevoid basal cell carcinoma syndrome) - AD

Question 38

Flesh-colored, dome-shaped nodule | Arises from the infundibulum of a hair follicle and located in the dermis

Answer 38

Epidermal inclusion cyst