FRCPath Part1 Course
Head and Neck EMQ 1 Identify the special stain / immuno which would aid in diagnosis for each case. A. B. C. D. E. F. G. H. I. J.
CD1a S-100 CD68 Synaptophysin ZielNeelson CD45 DPAS p16 EBV ISH GFAP
1. A 37 year old female presents with a polyp on the tongue which is excised. The H and E stained section shows sheets of plump polygonal cells with abundant eosinophilic granular cytoplasm filling the lamina propria. 2. A 75 year old female undergoes incisional biopsy of a mixed red and white plaque on the tongue. There is some irregular pseudoepitheliomatous hyperplasia of the epithelium and mild atypia. Aggregates of neutrophils are readily detected in the surface parakeratin. 3. A 30 year old male undergoes biopsy of a white patch on the lateral border of the tongue. Histological examination shows parakeratosis and a band like layer of cells with clear cytoplasm in the upper stratum spinosum. 4. A 45 year old oriental male presents with an enlarged cervical lymph node and on panendoscopy is found to have a mass in the nasopharynx. 5. An 8 year old male presents with premature loosening of deciduous molars on the lower left side and an osteolytic lesion is seen on plain X-ray. Curettings show sheets of mononuclear cells with oval nuclei admixed with clusters of eosinophils.
EMQ 2 Many syndromes present with signs in the head and neck region. Match the syndrome to the clinical description. A. B. C. D. E. F. G. H. I. J.
Neurofibromatosis type 2 Fanconi’s anaemia Gardners syndrome Down’s syndrome Albrights syndrome (McCune-Albright) Osteogenesis imperfecta Gorlin Goltz syndrome MEN2b Cowdens syndrome Plummer-Vinson syndrome
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FRCPath Part1 Course 1. A 21 year old male who on a routine dental Xray was found to have bilateral multilocular jaw cysts and also on further examination, a pearly plaque with central telangiectasia on the forehead 2. A 60 year old female with long standing dysphagia and anaemia undergoes pharyngolaryngectomy for a post-cricoid (hypopharyngeal) squamous cell carcinoma 3. A 25 year old never smoker who has a biopsy proven squamous cell carcinoma of the tongue 4. An 8 year old boy with multiple mucosal polyps especially around the lips and a fixed thyroid mass which is reported as probably malignant on cytology 5. A 9 year old female with pigmented skin lesions, early onset of puberty and a painless unilateral swelling of the maxilla along with radiological abnormalities of the ribs and right femur. EMQ 3 Tumours most commonly (but not uniquely) encountered in the head and neck. A. B. C. D. E. F. G. H. I. J.
Granular cell tumour Adenomatoid odontogenic tumour Adenoid cystic carcinoma Acinic cell carcinoma Squamous cell carcinoma Ameloblastoma Myoepithelioma Polymorphous low grade adenocarcinoma Mucoepidermoid carcinoma Pleomorphic adenoma
1. A 36 year old female with a multilocular radiolucency of the left body of mandible. Histology shows islands of epithelium composed of loosely cohesive cells centrally with peripheral palisading and reverse polarity 2. A 45 year old male has a biopsy of the floor of mouth swelling which consists of cribriform islands of angular basaloid cells arranged around gland like spaces filled with homogenous eosinophilic or basophilic material. 3. A palatal biopsy from a 15 year old female showing lobular islands of cytologically bland polygonal cells with distinct cell boundaries admixed with scattered mucous / goblet cells. 4. A multinodular submandibular tumour which has rather variable appearances including cellular areas containing ductal structures, sheets and strands of hyaline plasmacytoid cells, all embedded in a loose myxoid stroma. 5. A well defined parotid gland tumour, reported as probably benign by the radiologist, composed of sheets of plump cells with voluminous basophilic granular cytoplasm with a smaller population of clear cells and focal areas of papillary cystic architectural change EMQ 4 Sinonasal tract – match the diagnosis with the scenarios. A. B. C. D.
Tuberculosis Wegeners granulomatosis Capillary haemangioma Nasopharyngeal angiofibroma www.oxbridgemedica.com
FRCPath Part1 Course E. F. G. H. I. J. K.
Haemangiopericytoma Malignant melanoma Intestinal type adenocarcinoma Mucocele NK/T cell lymphoma Sinonasal undifferentiated carcinoma Olfactory neuroblastoma
1. A 50 year old female with a polypoid mass in the roof of the nasal fossa comprising lobular sheets of small blue round cells embedded in a fibrillary background and with occasional rosettes. 2. A 14 year old male also with a polypoid mass in the roof of the nasal fossa composed of variable sized vessels embedded in a variably cellular and collagenised fibroblastic stroma with stellate shaped fibroblasts a notable feature 3. A 57 year old carpenter presents with nasal discharge and obstruction. Curettings comprise mucinous material containing glandular structures and papillary strands of columnar cells showing cytological atypia and frequent mitoses 4. Crusting and ulceration of the nasal septum, altered renal function in a 39 year old female. A biopsy from the nasal cavity is largely necrotic but in viable areas, some non-caseating granulomata containing multinucleated giant cells are seen. 5. A 52 year old male also with crusting and ulceration of the nasal mucosa but with no other systemic symptoms. The biopsy shows geographic ulceration with sheets of small, medium and large cells present in viable areas which frequently invade vessel walls. MCQ 5 Lymph nodes lying deep to sternocleidomastoid at a level bounded superiorly by omohyoid muscle and inferiorly by the clavicle are located in anatomical level A. IIa B. IIb C. III D. IV E. V MCQ 6 A tumour resected from the postero-lateral part of the tongue is seen to be composed of lobules of atypical cells with a high n:c ratio showing peripheral palisading, a thickened basement membrane and focal evidence of keratinisation. Cystic spaces containing mucoid material are seen and there is high grade dysplasia of the surface epithelium. There is also comedo type necrosis within larger islands. This is a: A. Adenosquamous squamous cell carcinoma B. Adenoid cystic carcinoma C. Adenoid / acantholytic squamous cell carcinoma D. Basaloid squamous cell carcinoma E. Moderately differentiated squamous cell carcinoma
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FRCPath Part1 Course MCQ 7 A resected squamous cell carcinoma of mandibular alveolus with a diameter of 22mm and depth of 7mm shows superficial erosion of the cortex of the mandible but not full thickness loss of cortical plate. This is most appropriately graded: A. pT1 B. pT2 C. pT3 D. pT4 E. pT4a MCQ 8 Which of the following statements is true: A. High risk HPV can cause squamous cell carcinoma at any site in the head and neck B. HPV associated tumours are well differentiated C. HPV associated tumours have a better prognosis and are more sensitive to non surgical therapy than non-HPV tumours D. HPV is a rare cause of head and neck cancer E. HPV associated tumours present with large primaries and rarely metastasize to cervical lymph nodes MCQ 9 A patient underwent bilateral selective neck dissections at the same time as removal of a floor of mouth SCC. Pathological assessment found 4 positive LNs on the right, largest 35mm and one on the left, diameter 10mm. The pathological stage is: A. pN1 B. pN2a C. pN2b D. pN2c E. pN3 MCQ 10 Which of these statements is true for oral SCC: A. Perineural invasion does not influence prognosis B. ECS is an important prognosticator and presence implies an aggressive tumour and poor prognosis C. pT staging is based purely on size criteria D. A cohesive pattern of invasion is associated with a poor prognosis
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