WBR0804

Author	[[PageAuthor::Gonzalo A. Romero, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Dermatology
Prompt	[[Prompt::A 68-year-old man comes to the clinic complaining of an ulcer on his face. He has been a sailor for his entire life. It is indolent in nature. The patient states that it has been growing slowly over the past 9 months. On physical exam it is clean looking, has 2 cm in diameter and is located on the lower lip. There are no lymphadenopathies in the head or neck. A surgeon performs an excision with clear margins. The pathologist finds epithelized cells in concentric fashion with a focus of central keratinization on the microscope. Which of the following risk factors and types of cancer has similar findings on the microscope?]]
Answer A	AnswerA::Smoking - squamous cell carcinoma of the esophagus
Answer A Explanation	[[AnswerAExp::Correct. See overall explanation]]
Answer B	AnswerB::Alcohol - adenocarcinoma of the esophagus
Answer B Explanation	[[AnswerBExp::Incorrect. Alcohol consumption and smoking are associated with squamous cell carcinoma of the esophagus. Adenocarcinomas are often associated with a history of gastroesophageal reflux disease and Barrett's esophagus.]]
Answer C	AnswerC::Cocaine - septal nasal perforation
Answer C Explanation	[[AnswerCExp::Incorrect. This association is correct, but does not cause the the changes found on light microscopy. Cocaine causes vasoconstriction which limits the blood flow causing ischemic necrosis and nasal septum perforation.]]
Answer D	AnswerD::Low fiber diet - adenocarcinoma of the colon
Answer D Explanation	[[AnswerDExp::Incorrect. High fiber diet, particularly cereal and whole grains, can absorb carcinogens from the diet decreasing colorectal cancer risk.]]
Answer E	AnswerE::Smoking - bronchogenic adenocarcinoma
Answer E Explanation	[[AnswerEExp::Incorrect. Smoking is associate with higher risk of developing bronchogenic adenocarcinoma. Its histologic findings correspond to malignant mucin producing cells (glands).]]
Right Answer	RightAnswer::A
Explanation	[[Explanation::Educational Objective: See also: Basal cell carcinoma Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::skin cancer, WBRKeyword::Squamous cell carcinoma, WBRKeyword::keratin pearls
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::