2015 29 Vasculitis

    Multiple choice question

    The slide below shows a biopsy from a purpuric lesion on the leg of a 18 y/o man who recently recovered from an upper respiratory tract infection. The biopsy showed classic features of leukocytoclastic vasculitis. However, in some cases the biopsy of leukocytoclasitc vasculitis can be false-negative because it is taken too early or two late in the cycle of lesion development. The timing of biopsy is critical for highest diagnostic yield.

    The lesion represented in this specimen was most likely biopsied within what time frame after appearance of the lesion?

    2015 5 Taube question #4

    Multiple choice question

    81 y/o woman with history of lichen sclerosus presented with raised plaque on the vulva. A biopsy was performed. It showed so called differentiated vulvar intraepithelial neoplasia (VIN).

    Which of the following is true about this entity?

    2015 6 Taube question #3

    Multiple choice question

    75 y/o woman with an eroded plaque on the mons pubis. The images below show HE and panel of special studies performed on the biopsy of this lesion.

    Which of the following is the correct diagnosis?

    Taube question #2

    Multiple choice question

    A 43 y/o woman presents with vulvar burning and pruritus. The biopsy shown below shows spongiotic and psoriasiform epidermal hyperplasia with focal intracorneal neutrophils. In this locations such findings are sufficient to be suspicious for psoriasis.

    Which of the following statements is incorrect regarding vulvar psoriasis?

    2015 30 Spongiotic vulvitis

    Multiple choice question

    A 56 y/o female presented with vulvar pruritus involving labia. A biopsy was performed. It showed spongiotic dermatitis consistent with contact dermatitis.

    Which of the following statements is incorrect regarding spongiotic eruptions of the vulva?

    2015 31 Retention cyst of a salivary duct

    Multiple choice question

    Inflammatory salivary gland conditions are far more common than neoplastic lesions. Of the inflammatory conditions, mucoceles are the most frequently encountered. Although the term “mucocele” often is used loosely to mean any cyst-like or true cyst filled with mucin, it is less confusing to use the term mucocele for mucous extravasation lesions not lined by epithelium, and salivary duct cyst for those caused by cystically dilated ducts; these latter cysts usually exhibit other reactive changes such as oncocytic or squamous metaplasia.

    This was a blister-like lesion removed from the mandibular vestibule. Which is the correct answer?

    2015 32

    Multiple choice question

    The most common pigmented lesion of exogenous etiology of the oral mucosa is the amalgam tattoo caused by traumatic implantation of amalgam. As such, a scar is almost always present. Granules may be fine or coarse. When fine, they may be mistaken for fine melanin granules of a melanotic macule. The presence of abundant melanin pigment within the basal cells, lack of melanocytic hyperplasia and lack of scarring distinguishes a melanotic macule from amalgam tattoo.

    This is a slate-grey macule on the mucosa.  


    The sections below show a biopsy of a slate-gray macule on the gingival mucosa in a 44 year old female showing typical features of amalgam tottoo

    Which statement regarding this lesion is correct?

    2015 33 localized juvenile spongiotic gingival hyperplasia

    Multiple choice question

    Gingival nodules are some of the most common biopsies encountered by the pathologist. These are generally reactive nodular proliferations of mesenchymal tissue composed primarily of fibrous tissue, metaplastic ossification, osteoclast-like giant cells, endothelial cells and blood vessels, or a combination of the above. Other nodules include tumors of odontogenic etiology including peripheral ameloblastoma and peripheral odontogenic fibroma.

    This was a red papule removed from the gingival margin of a 12-year-old who was wearing orthodontic braces. Which is the correct diagnosis?

    Sook Bin Woo question #3

    Multiple choice question

    Frictional keratoses of the oral cavity generally take two forms. When they occur on the nonkeratinized mucosa, they are usually caused by chronic parafunctional habits such as lip or tongue chewing/nibbling. When they occur on the keratinized mucosa, they resemble lichen simplex chronicus of the skin. These should always be reported as being frictional/factitial  keratoses or reactive keratoses. A diagnosis of parakeratosis or hyperkeratosis, NOS would be relegated to the category of leukoplakia, a premalignant condition that requires continued follow-up and surveillance biopsies, unlike frictional keratoses.

    What does the following biopsy that was present bilaterally on the buccal mucosa represent?

    Sook Bin Woo question #2

    Multiple choice question

    Oral epithelial dysplasia should be evaluated not only based on cytologic changes of keratinocytes but also through low power features such as verrucous architecture, endophytic proliferation, and atrophy without inflammation. Cytologic features of dysplasia are similar to those seen in other squamous epithelium. In addition, human papilloma virus (HPV)-associated oral epithelial dysplasia show prominent apoptosis and karyorrhexis and are all associated with strong, continuous p16 staining and association with high risk HPV subtypes. But it is only if one recognizes the histopathology that a p16 study would be ordered.

    What does the following lesion of the ventral tongue show?

    Sook Bin Woo question #1

    Multiple choice question

    The keratocystic odontogenic tumor (formerly odontogenic keratocyst) is now considered a cystic tumor because many cases show mutation of the PTCH gene, especially those associated with the basal cell carcinoma-jaw-cyst syndrome. The cyst is lined by parakeratinized stratitifed squamous epithelium that is generally uniformly 7-10 cells thick and shows palisading of the basal cell nuclei. This cyst must be distinguished from other keratinzing cysts because it has a recurrence rate of 30-50% depending on how it is treated, while other keratinizing cysts do not.

    What is the the best diagnosis for this radiolucency removed from around an impacted third molar illustrated below? Please note that this cyst shows no evidence of parakeratosis. 

    Jordan question #17

    Multiple choice question

    Which of the following features are not characteristic of patients with HPV-related squamous cell carcinoma of the oropharynx?

    2015 1 Jordan HPV in oropharingeal SCC

    Multiple choice question

    The most common subtype of HPV involved in oropharyngeal squamous cell carcinomas is:

    2015 36 HPV

    Multiple choice question

    Which of the following methods is least useful for detecting high-risk HPV in head and neck squamous cell carcinoma?

    Jordan question #14

    Multiple choice question

    Which of the following lesions is typically seen at the apices of vital anterior mandibular teeth in middle-aged females?

    Jordan question #13

    Multiple choice question

    In contrast to fibrous dysplasia, what statement is correct concerning ossifying fibroma?

    2015 2 Jordan question #12

    Multiple choice question

    Human papilloma virus (HPV) has been found in which of the following oral lesions?

    Jordan question #11 Adenoid cystic

    Multiple choice question

    The 5 year survival rate of one of the following salivary gland tumors is fair, but at 15 years it is very poor. Which of the following malignant tumor exhibits this slow, but unrelenting behavior?

    2015 35 Pleomorphic adenoma

    Multiple choice question

    Which of the following features would you NOT expect in a pleomorphic adenoma of the parotid gland?

    Jordan question #9

    Multiple choice question

    Using direct immunofluorescence examination, deposits of IgG are consistently demonstrated between epithelial cells in oral lesions of which of the following?

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