Neoplasia — MCQs

A 62-year-old man with a history of chronic alcohol use dies suddenly. At autopsy, the heart weighs 520 g (normal <400 g) and appears dilated with a flabby myocardium. Histological sections of the myocardium show hypertrophied cardiomyocytes with enlarged, irregular nuclei, and prominent interstitial fibrosis. There is no significant vacuolization of cardiomyocytes. Which of the following best describes the primary histopathologic mechanism underlying the cardiac enlargement and dysfunction in this condition?

A 58-year-old man with a 40-pack-year smoking history presents with progressive dyspnea and a dry cough. Chest CT reveals bilateral pleural plaques and a right pleural effusion. A transbronchial lung biopsy is performed. The photomicrograph shows elongated, golden-brown, beaded structures with a translucent core surrounded by an iron-protein coat within macrophages and lung parenchyma. Which of the following best describes the pathological significance of this finding?

A 52-year-old woman with no significant past medical history undergoes resection of a 2.1 cm thyroid nodule discovered incidentally on ultrasound. Gross examination reveals a lesion with a pale, fleshy cut surface. Histology shows papillary architecture with cells exhibiting ground-glass 'Orphan Annie eye' nuclei, nuclear grooves, and intranuclear cytoplasmic pseudoinclusions. Concentric laminated calcified structures approximately 50–100 µm in diameter are identified within several papillary fronds. The tumor cells are positive for CK19, HBME-1, and galectin-3. Which of the following structures are represented by the concentric calcified findings in this specimen?

A 34-year-old woman undergoes excisional biopsy of a right axillary lymph node that has been enlarged for 3 months. She reports intermittent fevers, night sweats, and a 6 kg weight loss. The photomicrograph shows effacement of normal nodal architecture by a mixed infiltrate of lymphocytes, eosinophils, plasma cells, and neutrophils. Large binucleate cells with prominent eosinophilic 'owl-eye' nucleoli are present and stain positive for CD15 and CD30 but negative for CD45. A smaller mononuclear variant of the same cell is also visible. Which of the following background inflammatory cell patterns, if identified as predominant on this biopsy, is characteristic of the subtype associated with the worst overall prognosis?

A 61-year-old Caucasian male presents to your office complaining of morning headaches of 6 weeks duration. A head MRI reveals a likely metastasis of unknown origin in the supratentorial region of the brain. On biopsy, the neoplastic mass is shown to have a mutation in BRAF, a protein kinase, in which a glutamic acid is substituted for valine at position 600 of the protein. Where did this metastasis most likely originate?