Responsi Patologi Anatomi 3.

2 Astroxon

A 5-year-old girl has a papule on her left cheek. On physical examination there is a firm, white
to flesh colored, dome shaped, pearly, and umbilicated papule.
The figure shows the representative microscopic appearance of the lesion.

1. Which of the following is TRUE regarding the lesion?

A. Caused by viral infection
B. Can progress to malignant tumor
C. Sun exposure is strong risk factor
D. Has predilection in palm and sole
E. More often in elderly
Pembahasan :
Diagnosis dari lesi tersebut adalah moluscum contagiosum ditandai dengan luka yang
berbentuk umbilicated papule. Penyakit ini disebabkan oleh poxvirus.
 Sumber : PPT Asistensi Integumen

(CASE FOR QUESTION NUMBER 2 & 3)

A 10-year-old girl has a routine check of her health status. On physical examination, a flat,
uniformly brown, 2-cm skin lesion is noted just above the right buttock. The lesion has been
present since birth and has not changed in appearance.
The figure shows the representative microscopic appearance of the lesion.

2. What is the most likely diagnosis of this lesion?

A. Molluscum contagiosum
B. Basal cell carcinoma
C. Squamous cell carcinoma
D. Pigmented nevus
E. Malignant melanoma
Pembahasan :
Dilihat dari soal, lesi ini ada sejak lahir dan tidak mengalami perubahan dengan berwarna
coklat pada keseluruhannya, sehingga kemungkinan lesi ini adalah naevus pigmentous
(andeng-andeng / tahi lalat)
BCC dan SCC → salah karena lesi ini berada pada daerah yang sedikit terpapar matahari
Malignant melanoma → salah karena warna dari lesi ini coklat secara keseluruhan
Moluscum contagiosum → lesi berbentuk datar bukan umbilicated papule

3. Which of the following cells that proliferate in the lesion?

A. Keratinocyte
B. Basal cell
C. Melanocyte
D. Infected keratinocyte
E. Stromal cell
Pembahasan :
Sel - sel naevus mengandung pigmen melanosit
 Sumber : PPT Asistensi Integumen
Tambahan bacaan : Melanocytic nevi and melanoma: unraveling a complex relationship
(uns.ac.id)

A 39-year-old woman has a nodule on her back that has become larger over the past 2
months. On physical examination, there is a 2.1-cm pigmented lesion with irregular borders
and irregular brown to black areas.
An excisional biopsy with wide margins is performed, and microscopic examination of the
biopsy specimen shows very pleomorphic cells with intra and extracellular brown pigment
and prominent nucleoli that extend 2 mm into the reticular dermis. There is a band of
lymphocytes beneath the lesion.

4. Which of the following is TRUE regarding the tumor?

A. Rhodent ulcer
B. Rare metastasis
C. Radiosensitive
D. Can be keratinized
E. More often in elderly
Pembahasan:
● Rhodent ulcer sinonim untuk basal cell carcinoma
● Melanoma maligna mudah bermetastasis
● Radiosensitive atau radioresistant sepertinya sampai sekarang masih belum pakem. Tapi
selama asistensi dll., radiosensitif tidak disebut sebagai salah satu ciri melanoma maligna
(disebut kalau basal cell carcinoma dan squamous cell carcinoma)
● Keratinisasi berhubungan dengan squamous cell carcinoma
 ● Melanoma maligna jarang sebelum pubertas, seringnya di atas usia 40 tahun (orang-
orang tua)
Sumber: PPT Asistensi Integumen, Neoplasma, BPP, Radiation sensitivity and sensitization in
melanoma

(CASE FOR QUESTION NUMBER 5, 6)

A 76-year-old man has had a slowly enlarging nodule on his right eyelid
for 4 years. On physical examination, there is a 0.3-cm pearly nodule
on the upper eyelid near the lateral limbus of the right eye. The lesion
is excised, but multiple frozen sections are made during the surgery to
minimize the extent of the resection and preserve the eyelid. The
microscopic appearance of the lesion is shown at low magnification in
the figure.

5. What is the most likely diagnosis?

A. Molluscum contagiosum
B. Squamous cell carcinoma
C. Basal cell carcinoma
D. Malignant melanoma
E. Pigmented nevus
Pembahasan :
Tertulis di kasus bahwa tumornya bertumbuh/membesar secara lambat (salah satu ciri dari
basal cell carcinoma). Pengobatan pada kasus sesuai, yaitu eksisi luas jaringan tumornya.
Pada gambar, terlihat epidermis yang masih utuh dan massa di basal (di sekitar massanya
juga terlihat putih-putih celah antara sel tumor dan stromanya).
Sumber: PPT Asistensi Integumen dan BPP

6. Which of the following is TRUE regarding the lesion?

A. Has predilection in inferior extremity
B. Sun exposure is strong risk factor
C. Often metastasis
D. Caused by viral infection
E. More often in prepuberty
 Pembahasan :
BCC sering ditemukan di lokasi tubuh yang sering terpapar oleh sinar matahari. Sinar matahari
juga diduga sebagai ko-karsinogen yang kuat terhadap penyakit ini.

A 65-year-old man has a nodule on his penis. On physical

examination there is a white-grey cauliflower-like nodule
that is ill defined, and easy to bleed.
The figure shows the representative microscopic
appearance of the lesion.

7. Which of the following immunostaining most likely positive in the tumor?

A. Desmin, SMA
B. Osteocalcin, osteonectin
C. S100, HMB45
D. BerEP4
E. P40, P63
Pembahasan :
Pada preparat dan soal, terdapat gambaran bunga kol yang merupakan ciri khas dari SCC.
Pengecatan IHC yang tepat untuk mendiagnosis SCC adalah P40 dan P63
 Sumber : PPT Asistensi Integumen

(CASE FOR QUESTION NUMBER 8 & 9)

A 38-year old healthy man notes occasional pain in his right index finger
when using a hammer. On palpation of the right proximal phalanx there
is point tenderness. A radiograph shows a 1-cm oval lucency in this
phalanx, with a surrounding rim of bright, radiodense bone. The
microscopic appearance of the excised lesion is shown in the figure.

8. Which of the following cells is most likely to have given rise to this lesion?
A. Chondrocyte
B. Osteocyte
C. Osteoblast
D. Fibroblast
E. Macrophage
Pembahasan :
Dilihat dari pemeriksaan radiografi pasien, terlihat gambaran ‘O ring sign’ yang merujuk
kepada diagnosis chondroma. Oleh karena itu, sel yang berkembang atau tumbuh pada
tumor ini adalah kondrosit / sel tulang rawan.
 Sumber : PPT Asistensi Neoplasma Tulang

9. Which of the following is TRUE regarding the lesion ?

A. Usually occur in adolescent
B. Multiple lession can be an ollier disease
C. Mononuclear spindle cell is the neoplasm cell
D. Tend to metastasize
E. Atypical stroma
Umumnya pada usia muda seperti pembahasan no 8

A 30-year-old woman has experienced pain in the area of the left knee for
1 month. On physical examination, there is tenderness to palpation of the
distal left thigh and knee. The area is firm, but there is no erythema or
warmth. A radiograph of the left leg shows a 7-cm mass in the distal femoral
epiphyseal area, with a "soap bubble" appearance. Microscopic
examination of a curettage specimen of the lesion shows the findings in the
figure. The lesion recurs in the next ear; it is excised and does not recur
again.

10. What is the most likely diagnosis ?

A. Osteosarcoma
B. Osteoma
C. Chondrosarcoma
D. Giant Cell Tumor
E. Chondroma
 Pembahasan :
Pada soal terdapat ciri lesi yaitu terdapat gambaran ‘soap bubble’ yang menunjukkan
diagnosis kepada Giant Cell Tumor. Selain itu, tumor ini juga sering ditemukan pada area
distal femur dan tumor ini juga tumbuh ke dua arah, epifisis dan metafisis tulang

Sumber : PPT Asistensi Neoplasma Tulang

(CASE FOR QUESTION NUMBER 11 & 12)

A 45-year-old man has experienced pain in the area of the left hip
and upper thigh for the past 7 months. On physical examination,
there is tenderness on deep palpation of the left side of the groin.
The range of motion at the left hip is decreased, but there is no
swelling or warmth on palpation. Pelvic and left leg radiographs
show an upper femoral metaphyseal mass lesion that erodes and
infiltrates into the surrounding bone cortex. The proximal femur is
excised and on sectioning has the gross appearance shown in the
figure.

11. Which of the following cell types is most likely to be proliferating

in this mass?
A. Osteocyte
B. Osteoblast
C. Osteoclast
D. Plasma cell
E. Chondrocyte
12. What is the most likely diagnosis?
A. Chondroma
B. Chondrosarcoma
C. Osteoma
D. Osteosarcoma
E. Ameloblastoma

Pembahasan 11 dan 12
Pertama,pasien merasakan nyeri ketika ada palpasi -> ciri dari sarcoma. Pilihan sisa 2,
chondrosarcoma atau osteosarcoma. Kenapa ga ameloblastoma? Ciri khas dia itu jinak, dan
warna nya kecoklatan. Nah kalau diliat dari usia, ini 45 tahun, masuknya ke chondrosarcoma.
Tapi, letak tumornya di bagian paha, yang merupakan titik tersering osteosarcoma. Nah, jadi
buat nentuin penyakitnya kita liat dari ciri-ciri tumornya. “Show an upper femoral
metaphyseal mass lesion that erodes and infiltrates into the surrounding bone cortex” ->
adanya erosi dari tumor tersebut dan menyebar ke bagian dalam tulang. Erosi ini merupakan
ciri khas dari chondrosarcoma.

CASE FOR QUESTION NUMBER 13 & 14

A 19-year-old man falls and strikes his leg. He feels intense pain. On physical examination
there is swelling in his lower leg. Radiographic examination reveals periosteal reaction, sun
burst, and Codmann triangle appearance. Macroscopy of the tumor is shown.

13. Which of the following immunostaining most likely positive in the tumor?
A. P40, P64
B. BerEP4
C. S100, HMB45
D. Osteocalcin, osteonectin
E. Desmin, SMA
Pembahasan:
Ada ciri khas sun burst appearance dan Codmann triangle dari osteosarcoma.
 Sumber: PPT Asistensi Neoplasma Tulang, Osteocalcin and osteonectin immunoreactivity in
the diagnosis of osteosarcoma

14. Which of the following is TRUE regarding the tumor?

A. Caused by malignant chondrocyte
B. Well circumscribed
C. Has predilection in long bone metaphysis
D. Slow growing tumor
E. More often in elderly

Pembahasan:

Sumber: PPT Asistensi Neoplasma Tulang

 34-year-old woman has had a slowly enlarging nodule on his right
jaw for 1 years. On physical examination, there is a 4-cm hard
nodule, fixed, on the mandible. The lesion is excised, macroscopic
examination shows cystic tumor with thin wall that can be
indented when pressed. The microscopic appearance of the lesion
is shown in the figure.

15. Which of the following cells that proliferate in the lesion?

A. Osteoblast
B. Odontogenic epithelium
C. Osteocyte
D. Chondrocyte
E. Giant cell
Pembahasan: letak dari lesi ada di mandibula -> ciri khas dari ameloblastoma. Jadi yang
berproliferasi adalah sel odontogenic epithelium

16. Which of the following is TRUE is OSTEOMA?

A. Has predilection in flat bone
B. Radiographic finding is Codmann triangle
C. Often progress to malignant tumor
D. Often called Brown tumor
E. More often in prepuberty
Pembahasan : Kita coba bahas setiap pilihan. Pilihan B itu salah karena Codmann merupakan
ciri osteosarcoma. Pilihan D salah juga karena brown tumor itu ciri dari Giant Cell Tumor.
Pilihan E salah karena osteoma terjadi di usia 40-50 tahunan. Jadi tersisa A dan C. Pilihan A
pilihan yang bisa dipilih karena di ppt dituliskan bahwa predileksi dari osteoma ada di os
facialis dan tulang cranium yang dimana merupakan tulang pipih.
 CASE FOR NUMBER 17-18
A 33-year-old man has noticed a lump over his right flank. The lump is
painless and has enlarged slowly over the past 3 years. On physical
examination, a soft 2-cm nodule is palpable in the subcutis of the right
flank above the iliaccrest. The lesion is excised. Gross specimen is shown
in thepicture, it is circumscribed and has a uniformly yellow cut surface.

17. Which of the following is the most likely diagnosis for this lesion?
A. Leiomyoma
B. Fibrosarcoma
C. Fibroma
D. Lipoma
E. Liposarcoma
Pembahasan : Soal bisa langsung diidentifikasi. Kita langsung liat ke warna dari lesi, yaitu
uniformly yellow / kuning full. Artinya, tidak ada tanda keganasan, dan yang berwarna kuning
itu adalah lemak. Jadi jawabannya lipoma

18. Which of the following is the most likely prognosis for this lesion?
A. Metastases to regional lymph nodes will occur
B. Family members will develop similar lesions
C. No recurrence is expected
D. More skin lesions will develop over time
E. Radiotherapy will be cure for the patient
Pembahasan : Ditanya tentang progonosis dari lipoma. Jadi jawabannya adalah C karena
sebagian besar dari tumor jinak itu jarang mengalami rekurens/ kejadian berulang.

CASE FOR NUMBER 19

50-year-old woman has noticed a lump in the abdomen since 4 months
ago. USG examination revealed a 13-cm ill defined nodule in intramural of
the uterus. Grossly, it was solid, reddish mass, fragile in some area of the
tumor, with foci of hemorrhage and necrotic. Microscopy of the specimen
shown in the picture.

19. Which of the following is the most likely diagnosis for this lesion?
A. Liposarcoma
B. Lipoma
C. Fibrosarcoma
D. Leiomyoma
 E. Leiomyosarcoma
Pembahasan : ada kata hemorrhage and necrotic yang berarti ada pendarahan dan jaringan
nekrotik. Ini merupakan ciri dari leiomyosarcoma karena ada tanda keganasannya.

CASE FOR QUESTION NO 20 & 21

A 47 year old man has had dull, constant pain in the midsection of the right
tight for the past 4 months. On physical examination, there is pain on
palpation of the anterior right thigh, which worsens with movement. The
right thigh appears to have a larger circumference than the left thigh. A
radiograph of the right upper leg and pelvis shows no fracture, but there is
an ill defined soft tissue mass anterior to the femur. MRI shows a 10 x 8 x
7 cm solid mass deep to the quadriceps, but it does not involve the femur.
Histopathologic examination shown in the picture.

20. What is the most likely diagnosis?

A. Fibrosarcoma
B. Lipoma
C. Liposarcoma
D. Leiomyoma
E. Leiomyosarcoma
Pembahasan:
Terlihat jaringan lemak imatur dan palm-leaf appearance di gambaran mikroskopisnya.

Sumber: BPP dan PPT Asistensi Mesenkim

21. Which if the following statement is TRUE regarding the tumor?

A. Usually occur in children
B. Often occur in retroperitoneal and deep seated location
C. Well defined (berbatas tegas)
D. Associated with Meig’s syndrome
E. Histopathology shows herringbone pattern
 Pembahasan:

Sumber: BPP dan PPT Asistensi Mesenkim

CASE FOR QUESTION NO 22 & 23

A 33-year-old woman noticed a menometrorrhagia over several months ago.
USG examination revealed a 3 cm well defined nodule in subserosa of uterus.
The lesion is excised. Grossly, it’s circumscribed and has a uniformly white cut
surface with whorl pattern. Macroscopy of the specimen shown in the
picture.

22. Which of the following is the most likely diagnosis for this lesion?
A. Lipoma
B. Fibrosarcoma
C. Fibroma
D. Liposarcoma
E. Leiomyoma
Pembahasan:

Sumber: BPP dan PPT Asistensi Mesenkim

23. Which of the following is TRUE regarding the lesion?
A. Family members will develop similar lesions
B. No recurrence is expected
C. Metastases to regional lymph nodes will occur
D. Associated with Meigs syndrome
E. Radiotherapy will be cure for the patient
Pembahasan:
Biasanya yang kambuh/recur itu sarcoma kaya leiomyosarcoma, pilihan B tidak karena
leiomyoma tidak menular, leiomyoma jinak jadi tidak metastasis, Meigs syndrome itu di
fibroma, radiotherapy untuk keganasan dan leiomyoma biasanya hanya medikasi atau
pembedahan.
Sumber: BPP dan PPT Asistensi Neoplasma Mesenkim

CASE FOR QUESTION NO 24 & 25

A 50 year old woman has noticed a lump in the left abdomen since 1 year ago, shortness of breath
and abdominal enlargement since 1 month ago. X-ray examination showed pleural effusion and
ascites. USG examination revealed a 6 cm well defined nodule in the left ovarium. Grossly, it was
round, solid, white, well defined mass. Specimen shown in the picture.

24. Which of the following is the most likely diagnosis for this lesion?
A. Leiomyoma
B. Fibroma
C. Fibrosarcoma
D. Lipoma
E. Liposarcoma
Pembahasan:
Ciri makroskopisnya putih padat tanpa kapsul, mikroskopis seperti sel-sel tumor asal fibroblas
di antara serabut kolagen ireguler. Kasusnya juga mengarah ke Meigs syndrome yang salah
satunya terdiri atas fibroma di ovarii.
Sumber: BPP dan PPT Asistensi Mesenkim
25. Which of the following statement is TRUE regarding the patient condition?
A. Histopathology most likely showed herringbone pattern
B. Metastases to regional lymph nodes will occur
C. Meig’s syndrome
D. More ovarian tumor will develop over time
E. Radiotherapy will be cure for the patient
Pembahasan:

Sumber: BPP dan PPT Asistensi Mesenkim