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NBME 21 Answers

nbme21/Block 2/Question#24
A 65-year-old man dies in a motor vehicle ...
Squamous cell carcinoma🔍

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 +11  upvote downvote
submitted by tinydoc(157),

infarcts would be a more peripheral wedge shape

abcess wouldnt be invasive to the surrounding area i think.

squamous cell is more centrally located

wasn't 100% sure but thats the best answer slthough stupid to give 0 symptoms and just a picture, nothing like an actual clinical scenario

tsl19  Squamous cell is centrally located and has cavitation, which you can see in the pic. Similar to this one: https://webpath.med.utah.edu/LUNGHTML/LUNG068.html +3  
drdoom  ^ linkifying: https://webpath.med.utah.edu/LUNGHTML/LUNG068.html +3  
zevvyt  I also didn't choose infarct cuz i think the lung would have a red infarct. +  



 +6  upvote downvote
submitted by hungrybox(578),

Macroscopically, squamous cell carcinoma tends to be off-white in color, arising from, and extending into a bronchus.

Source: Radiopedia

privatejoker  Lol am I the only one that picked Malignant Lymphoma? I thought I remembered Sattar mentioning that metastases are the most common form of cancer to be found in the lung? I tend to pick the "most common" presentation when given so little information to work with +2  
blueberrymuffinbabey  but metastases typically present with multiple lesions so I think at least in exams when it's showing you a solitary lesion, think a primary tumor. +1  



 +4  upvote downvote
submitted by lnsetick(68),

I don’t think it was cavitary; I think that was just the bronchus. I think abscesses tend to be smaller, and wouldn’t affect the surrounding parenchyma much. I wasn’t super confident in picking squamous cell carcinoma, but I did know that squamous cell carcinoma tends to be a centrally-located lung tumor.

fallabella4  Squamous cell carcinoma of the esophagus presents itself as an raised plaque with ulcerations +  



 +0  upvote downvote
submitted by joanmadd(1),

I know that small cell carcinoma wasn't an option in this question, but would there be any possible way to distinguish small cell from squamous cell on this specific gross pathology?




 +0  upvote downvote
submitted by mdsu(0),

Lung abscess pic https://commons.wikimedia.org/wiki/File:Lung_abscess_(7468374032).jpg

Squamous cell carcinoma; Central - Hilar mass- Cavitation




My choice for Squamous Cell Carcinoma was guided by the central location of the tumor. To me, that didn’t look like the cavity you’d get with abscess but a huge tumor.




am i the only one who chose mesothelioma? didnt that look like a pleural plaque posteriorly to anyone?

brotherimodu  That's what I thought too. +  



Esophageal squamous cell cancers are more common in smokers




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