Medical Science Tips

07/12/2025

A 25 year old commercial s*x worker presented to OPD with a complaint of multiple lesions over her ge****ls. On examination, there are multiple 1 to 2cm pink tan cauliflower like nodules over the v***a and perineum. Microscopic examination of the lesion revealed finger like projections with acanthosis of the stratified squamous epithelium and koilocytosis. What is the most likely cause of her presentation?
A) Condylomata lata
B) Lichen sclerosis
C) Condylomata acuminata
D) Squamous cell carcinoma

Correct Answer: C) Condylomata acuminata

The patient has:

- Multiple pink-tan, cauliflower-like, exophytic nodules

- Located on v***a and perineum

- Histology: finger-like projections, acanthosis, koilocytosis (HPV cytopathic change)

These features are classic for condylomata acuminata (anoge***al warts) caused by HPV types 6 and 11.

According to:

* CDC STI Guidelines – ge***al warts are soft, papillomatous, cauliflower-like lesions; koilocytosis is typical histology.

* Williams Gynecology – HPV 6/11 lesions show acanthosis, papillomatosis, and koilocytosis.

* Harrison’s – condylomata acuminata are exophytic, verrucous lesions caused by low-risk HPV.

Why the Other Options Are Incorrect

A) Condylomata lata

Why incorrect:
- Caused by secondary syphilis (Treponema pallidum).
- Lesions are broad-based, flat, moist, smooth, often grey or whitish—not cauliflower-like.
- Histology does not show koilocytosis.
- CDC and WHO syphilis guidelines describe condylomata lata as flat, velvety, moist plaques, not papillomatous warts.

Key features from standard references:
- Not exophytic
- Not associated with HPV changes such as koilocytosis
- Typically highly infectious mucous patches

B) Lichen sclerosus
Why incorrect:
- A chronic inflammatory dermatosis, NOT an STI.
- Lesions are white, atrophic, parchment-like plaques, often leading to scarring.
- No exophytic or cauliflower-like growths.
- Histology shows thinning of epithelium, homogenization of collagen, not acanthosis with koilocytes.

References:
*Williams Gynecology – lichen sclerosus leads to white plaques, fissuring, thinning.
*Dermatology texts (e.g., Fitzpatrick’s) – no verrucous growths or viral cytopathic effect.

D) Squamous cell carcinoma (SCC)
Why incorrect:
- Vulvar SCC typically presents as ulcerated, indurated, or erythematous plaques or masses.
- Can be exophytic, but histology shows keratin pearls, atypia, invasion—not koilocytosis.
- While high-risk HPV (16, 18) can be involved, the described lesion is benign and typical for low-risk HPV 6/11 ge***al warts.

References:
*Harrison’s – SCC shows dysplasia → carcinoma in situ → invasion.
*Williams Gynecology – SCC morphology differs from benign condyloma; histology clearly distinct.

Condition Morphology Histology
Condylomata acuminata (HPV 6/11)Pink, papillomatous, cauliflower-likeKoilocytosis, acanthosis, papillomatosis
Condylomata lata (Syphilis)Flat, smooth, moist plaquesPlasma cell infiltrate, no koilocytes
Lichen White, thin, atrophic plaques Thinning epithelium, sclerosis
SCCUlcerative or indurated massAtypia, keratin pearls, invasion

07/12/2025

A 70 year old man presented to OPD with a complaint of RUQ abdominal pain of three months duration.
Abdominal ultrasound showed multiple discrete sub-capsular nodules in the liver. Serum Alpha Fetoprotein is
within the normal range.
What is the most likely diagnosis?
A) Hepatocellular carcinoma
B) Cholangiocarcinoma
C) Focal nodular hyperplasia
D) Metastases

07/12/2025

A 37 year old lady presented to OPD with a complaint of irregular vaginal bleeding of three months duration. Pelvic ultrasound revealed endometrial thickening. Endometrial biopsy confirmed the diagnosis of atypical endometrial hyperplasia. What is the most likely condition that could be associated with this presentation?
A)Human papilloma virus
B) Long term use of IUCD
C) Pelvic inflammatory disease
D) Unopposed estrogenic stimulation

Correct Option: D) Unopposed estrogenic stimulation
Why?
Atypical endometrial hyperplasia (AEH)—also called endometrial intraepithelial neoplasia (EIN)—is caused primarily by chronic, unopposed estrogen exposure, which stimulates endometrial proliferation without progesterone-mediated differentiation.

Key Pathophysiology
Estrogen ↑ → endometrial glandular proliferation
No progesterone → no secretory transformation → crowded, atypical glands → EIN/AEH
Can progress to endometrioid endometrial carcinoma

Common causes of unopposed estrogen
Obesity (peripheral aromatization of androgens)
Polycystic ovarian syndrome (anovulation → no progesterone)
Estrogen-only therapy
Estrogen-secreting tumors (e.g., granulosa cell tumors)
Chronic anovulation

Standard References
Williams Gynecology: Describes EIN as a premalignant lesion strongly linked to prolonged unopposed estrogen exposure.
ACOG Practice Bulletin on Endometrial Hyperplasia: Unopposed estrogen is the major risk factor.
UpToDate (Endometrial Hyperplasia: Pathology and Risk Factors): Chronic anovulation, obesity, and exogenous estrogen are primary causes.
WHO Classification: EIN/AEH arises from estrogen-driven endometrial proliferation.

07/12/2025

A 31 year old lady presented to OPD with a complaint of right breast lump of three months duration. On physical examination, there is firm to hard irregular mass over the UOQ of the breast. Mammography revealed a3x2cm irregular density with micro calcification. Biopsy demonstrated extensive fat necrosis. What is the most likely diagnosis of this patient?
A) Invasive ductal carcinoma
B) Fibrocystic changes
C) Pregnancy
D) Trauma

Trauma — Correct Answer

Why this is correct:
necrosis is classically associated with trauma, including:
blunt trauma
compression injury
seat belt injury
post-biopsy or post-surgery trauma
unrecognized minor trauma

necrosis can mimic cancer:
hard, irregular mass
skin retraction
suspicious calcifications

:
foamy macrophages
lipid-laden cysts
fibrosis
calcifications
→ all classic for fat necrosis.

Because biopsy confirmed extensive fat necrosis, the underlying cause is trauma, even if the patient does not recall it (a common clinical scenario).

Final Answer: D) Trauma

Fat necrosis on biopsy most strongly suggests trauma as the underlying etiology, supported by standard surgical and radiology references.

07/12/2025