Neoplasia — MCQs

A 68-year-old man comes to the physician for evaluation of a lump in his left axilla that he first noticed 1 year ago. He reports that the size of the mass has varied over time and that there have been similar masses in his neck and groin. He has not had fever, weight loss, or night sweats. Physical examination shows a nontender, rubbery mass in the left axilla and a similar, smaller mass in the right groin. His spleen is palpable 3 cm below the left costal margin. Laboratory studies, including complete blood count, are within reference ranges. Genetic analysis obtained on resection of the axillary mass shows a t(14;18) translocation. Which of the following is the most likely diagnosis?

A 45-year-old woman gravida 1, para 1, comes to the physician because of a 2-month history of a right breast lump and a 4.5-kg (10-lb) weight loss. She has not had any breast pain or nipple discharge. She had right breast mastitis 10 years ago while breastfeeding but has no other history of serious illness. Palpation of the right breast shows a 3-cm firm mass with well-defined margins lateral to the right nipple. There is dimpling of the overlying skin but no rash. The left breast is normal. A mammogram shows a density with calcifications in a star-shaped formation in the same location of the mass. Histological examination of a biopsy specimen from the breast mass is most likely to show which of the following?

A 1-year-old, pale-looking boy presents with high-grade fever and ecchymosis, which he has been experiencing for the past 2 weeks. The boy has achieved all developmental milestones on time and has no history of medical illness in the past. Lab investigations reveal the following: Hemoglobin 5.5 g/dL WBC 112,000/mm3 Platelets 15,000/mm3 ESR 105/1st hour The boy is referred to a hematologist, who suspects that he may be suffering from the neoplastic proliferation of immature B cells. The physician decides to do a flow cytometry analysis. Detection of which of the following markers would help confirm the suspected diagnosis?

A 55-year-old man comes to the physician because of worsening fatigue and recurrent bleeding from his gums for 2 weeks. Physical examination shows marked pallor. There are scattered red, nonblanching pinpoint spots on his trunk and extremities. Laboratory studies show a hemoglobin of 8.0 g/dL, a leukocyte count of 80,000/mm3, and a platelet count of 104,000/mm3. Genetic analysis of a bone marrow aspirate shows leukemic cells with a balanced translocation between the long arms of chromosome 15 and 17. These cells are most likely to stain positive for which of the following?

An 85-year-old man who recently immigrated to the US from Spain presents to your office complaining of hoarseness and dysphagia for the past 2 months. He says his symptoms have been getting progressively worse, and he expresses concerns about the difficulty swallowing as he cannot eat well and has even lost 9 kg (20 lb) since his last visit 3 months ago. He denies any shortness of breath, coughing of blood, and chest pain. His bowel and bladder habit are normal. Past medical history is unremarkable. He has a 60-pack-year history of smoking tobacco and drinks alcohol occasionally. Which of the following is the most likely cause of his symptoms?

A previously healthy 27-year-old man comes to the physician because of a 3-week history of anxiety, diarrhea, and a 4.1-kg (9-lb) weight loss. On questioning, he also reports that he noticed a painless mass on his left testicle 2 weeks ago. His pulse is 110/min and irregular and blood pressure is 150/70 mm Hg. Examination shows diaphoresis and a fine tremor of the outstretched fingers. Testicular examination shows a 3-cm, firm, nontender mass on the left scrotum that does not transilluminate. This patient's underlying condition is most likely to be associated with which of the following findings?

A 6-year-old boy is brought to the physician because of worsening headaches and a rash for 2 weeks. His mother reports that the rash started on his abdomen and diffusely spread to other areas. Over the past 2 months, he has had recurrent episodes of otitis media. Examination shows a diffuse, erythematous, papular rash involving the groin, abdomen, chest, and back. His cervical lymph nodes are palpable bilaterally. An x-ray of the skull shows well-defined lytic lesions of the left occipital bone and the mastoid bone. Electron microscopy of a biopsy of the patient's posterior cervical lymph nodes shows polygonal cells with organelles shaped like tennis rackets. The cells stain positive for S-100. Clonal proliferation of which of the following types of cells is most likely seen on microscopy?

A 67-year-old woman comes to the physician because of a 3-week history of fatigue and worsening back and abdominal pain. During this period, she has also had excessive night sweats and a 4.6-kg (10-lb) weight loss. She has had swelling of the neck for 3 days. She does not smoke or drink alcohol. Vital signs are within normal limits. Physical examination shows a 4-cm, supraclavicular, nontender, enlarged and fixed lymph node. The spleen is palpated 2 cm below the left costal margin. Laboratory studies show: Hemoglobin 10.4 g/dL Mean corpuscular volume 87 μm3 Leukocyte count 5,200/mm3 Platelet count 190,000/mm3 Serum Lactate dehydrogenase 310 U/L A CT scan of the thorax and abdomen shows massively enlarged paraaortic, axillary, mediastinal, and cervical lymph nodes. Histopathologic examination of an excised cervical lymph node shows lymphocytes with a high proliferative index that stain positive for CD20. Which of the following is the most likely diagnosis?

A 71-year-old woman comes to the physician with a 2-month history of fatigue, anorexia, abdominal swelling, shortness of breath, and a 5-kg (11-lb) weight loss. She appears chronically ill. Examination shows jaundice, bilateral temporalis muscle wasting, hepatosplenomegaly, and tense ascites. Ultrasonography of the abdomen shows multiple hepatic masses and enlargement of the portal vein. Which of the following is the most likely cause of these masses?

A 55-year-old woman comes to the physician with concerns about swelling and pain in her right breast. Physical examination shows erythema and prominent pitting of the hair follicles overlying the upper and lower outer quadrants of the right breast. There are no nipple changes or discharge. A core needle biopsy shows invasive carcinoma of the breast. Which of the following is the most likely explanation for this patient's skin findings?