Vascular Pathology Practice Questions

Q: Which of the following is NOT a histological feature of Kaposi's sarcoma?

Nodules are the initial lesion of Kaposi's sarcoma.. ### Explanation **Kaposi’s Sarcoma (KS)** is a low-grade vascular neoplasm associated with **Human Herpesvirus-8 (HHV-8)**. Understanding its morphological progression is key to identifying the correct histological features. **Why Option D is the Correct Answer (The False Statement):** Kaposi’s sarcoma characteristically progresses through three distinct stages: **Patch → Plaque → Nodule**. Therefore, **Nodules are the late-stage lesion**, not the initial one. The initial lesions are "Patches," which appear as flat, red-to-purple macules often mistaken for bruises. **Analysis of Other Options:** * **Option A:** In the early **Patch stage**, the lesion microscopically resembles **granulation tissue**, showing a proliferation of thin-walled, irregular vascular spaces in the upper dermis. * **Option B:** This describes the **Plaque stage**, where vascular proliferation becomes more prominent. The vessels are dilated and jagged (angulated), typically surrounded by a perivascular inflammatory infiltrate of **lymphocytes, plasma cells, and macrophages** (hemosiderin-laden). * **Option C:** This describes the **Nodular stage**. Here, the lesion becomes more cellular, consisting of sheets or fascicles of **atypical spindle cells** (of endothelial origin) that slit-like spaces containing red blood cells. **Clinical Pearls for NEET-PG:** * **Etiology:** Strongly linked to **HHV-8** (also known as KSHV). * **Histological Hallmark:** "Slit-like spaces" containing RBCs and **"Promontory sign"** (newly formed vessels protruding into pre-existing vascular spaces). * **Hyaline Globules:** Small, eosinophilic, PAS-positive cytoplasmic globules are often seen in the spindle cells. * **Classification:** Four types—Classic (European), Endemic (African), Transplant-associated (Immunosuppression), and AIDS-associated (most common and aggressive).

Q: A person with involvement of the upper respiratory tract, lungs, and kidneys shows evidence of granulomas on histopathology. What is the most likely diagnosis?

Wegener's Granulomatosis. The clinical triad of **upper respiratory tract** (sinusitis, otitis media, saddle-nose deformity), **lower respiratory tract** (nodules, cavitary lesions), and **kidneys** (pauci-immune glomerulonephritis) is the hallmark of **Granulomatosis with Polyangiitis (GPA)**, formerly known as **Wegener’s Granulomatosis** [1]. The presence of **granulomas** on histopathology is the defining feature that distinguishes it from other small-vessel vasculitides like Microscopic Polyangiitis (MPA) [1]. **Why other options are incorrect:** * **Goodpasture Syndrome:** Characterized by the "pulmonary-renal syndrome" (hemoptysis and hematuria) due to anti-GBM antibodies [1]. However, it **does not involve the upper respiratory tract** and does not show granulomas on biopsy. * **Tuberculosis:** While TB causes granulomas and can affect lungs and kidneys, it is an infectious process. The specific "triad" involvement, especially the destructive upper airway disease, is more characteristic of GPA in a vasculitis context. * **Sarcoidosis:** A multisystem granulomatous disease that commonly affects the lungs and hilar lymph nodes [1]. However, it rarely causes the aggressive necrotizing glomerulonephritis or the destructive upper airway lesions seen in GPA. **NEET-PG High-Yield Pearls:** * **Serology:** GPA is strongly associated with **c-ANCA (anti-PR3)**. * **Histopathology:** Look for the triad of vasculitis, mucosal inflammation, and **necrotizing granulomas** [1]. * **Renal Biopsy:** Shows "Pauci-immune" crescentic glomerulonephritis (minimal Ig/complement deposition). * **Treatment:** Induction with Cyclophosphamide or Rituximab plus Corticosteroids.

Q: A 20-year-old patient presents with a soft to firm reddish swelling progressing in size over the precordium. Histopathological examination showed findings consistent with this lesion. What is the most likely diagnosis?

Hemangioma. ***Hemangioma*** - A **soft to firm reddish swelling** that progresses in size is characteristic of hemangioma, especially in a **young patient**. - Histopathologically shows **dilated blood-filled vascular channels** lined by **benign endothelial cells**, consistent with vascular proliferation. *Fibroadenoma* - This is a **benign breast tumor** composed of **glandular and stromal tissue**, not typically found over the precordium. - Presents as a **well-circumscribed, mobile mass** in the breast, usually **non-reddish** in appearance. *Lipoma* - A **benign adipose tissue tumor** that appears **yellow** and soft, not reddish as described in this case. - Histologically shows **mature fat cells** without vascular proliferation or endothelial cell lining. *Dermatofibroma* - A **benign fibrous skin tumor** that typically presents as a **firm, brownish papule**, not a reddish swelling. - Histologically shows **fibrous tissue proliferation** in the dermis, lacking the vascular channels seen in hemangiomas.

Q: What is an important feature in Henoch-Schönlein purpura?

Raised IgA. **Explanation:** **Henoch-Schönlein Purpura (HSP)**, now commonly referred to as **IgA Vasculitis**, is a small-vessel vasculitis characterized by the deposition of immune complexes containing **Immunoglobulin A (IgA)**. 1. **Why "Raised IgA" is correct:** The hallmark of HSP is a Type III hypersensitivity reaction where IgA-dominant immune complexes deposit in the walls of small vessels (capillaries, venules, and arterioles). This leads to systemic inflammation. Clinically, serum IgA levels are elevated in approximately 50% of patients, and immunofluorescence microscopy of skin or renal biopsies characteristically shows granular IgA deposits [1]. 2. **Why other options are incorrect:** * **Membranous glomerulonephritis:** HSP is associated with **IgA Nephropathy** (Berger’s disease-like picture), characterized by mesangial proliferation [2], not membranous glomerulonephritis (which involves subepithelial IgG/C3 deposits). * **Absent radial pulse:** This is a classic feature of **Takayasu Arteritis** ("Pulseless disease"), a large-vessel vasculitis. * **Aneurysm of branching point:** This refers to **Berry Aneurysms** (associated with ADPKD) or the "string of beads" appearance seen in **Polyarteritis Nodosa (PAN)**, a medium-vessel vasculitis. **NEET-PG High-Yield Pearls:** * **Classic Tetrad:** 1. Palpable purpura (buttocks/legs), 2. Arthralgia, 3. Abdominal pain (colic/intussusception), 4. Renal disease (hematuria). * **Epidemiology:** Most common vasculitis in children; often follows an Upper Respiratory Tract Infection (URTI) [2]. * **Biopsy:** Shows Leukocytoclastic vasculitis with IgA deposition. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 535-536. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 928-929.

Question 1

What is the most common cause of aortic aneurysm?

Accepted Answer

Atherosclerosis

Answer

Syphilis

Answer

Trauma

Answer

Congenital

Question 2

A study of atheromatous plaques shows that the release of growth factors, including PDGF, FGF, and TNF-a, leads to increased extracellular matrix production. As a result, the size of the plaques increases. Which of the following cells is most likely to release these growth factors in the plaques?

Accepted Answer

Smooth muscle

Answer

Endothelium

Answer

Fibroblast

Answer

Platelet

Question 3

Which of the following is NOT a histological feature of Kaposi's sarcoma?

Accepted Answer

Nodules are the initial lesion of Kaposi's sarcoma.

Answer

Microscopically, the lesion is similar to granulation tissue.

Answer

Characterized by dilated and irregular blood vessels with interspersed infiltrate of lymphocytes and plasma cells.

Answer

Atypical blood vessels have a solid spindle cell appearance.

Question 4

A person with involvement of the upper respiratory tract, lungs, and kidneys shows evidence of granulomas on histopathology. What is the most likely diagnosis?

Accepted Answer

Wegener's Granulomatosis

Answer

Goodpasture Syndrome

Answer

Tuberculosis

Answer

Sarcoidosis

Question 5

Atheromatous changes of blood vessels affect which organ earliest?

Accepted Answer

Heart

Answer

Kidney

Answer

Liver

Answer

Spleen

Question 6

What is the typical histological change seen in benign hypertension?

Accepted Answer

Intimal proliferation and hyalinization of the muscular media of medium-sized arteries/arterioles

Answer

Formation of new vessels

Answer

Loss of endothelial cells of arterioles

Answer

Fibrinoid necrosis of small arteries/arterioles

Question 7

Which of the following statements is NOT true regarding hypersensitivity vasculitis?

Accepted Answer

Affects small, medium-sized, and larger arteries commonly.

Answer

May be due to deposition of immune complexes or delayed hypersensitivity.

Answer

Represents an immunologic response to an antigen.

Answer

None of the above.

Question 8

A 20-year-old patient presents with a soft to firm reddish swelling progressing in size over the precordium. Histopathological examination showed findings consistent with this lesion. What is the most likely diagnosis?

Accepted Answer

Hemangioma

Answer

Fibroadenoma

Answer

Lipoma

Answer

Dermatofibroma

Question 9

What is the most common site of acute aortic dissection?

Accepted Answer

Right lateral wall of ascending aorta

Answer

Arch of aorta

Answer

Suprarenal abdominal aorta

Answer

Infrarenal abdominal aorta

Question 10

What is an important feature in Henoch-Schönlein purpura?

Accepted Answer

Raised IgA

Answer

Membranous glomerulonephritis

Answer

Absent radial pulse

Answer

Aneurysm of branching point

Vascular Pathology — MCQs

Vascular Pathology — MCQs

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