NBME 21 Squamous cell carcinoma (NBME Answers)

Retired NBME 21 Answers

nbme21/Block 2/Question#24 (reveal difficulty score)
A 65-year-old man dies in a motor vehicle ...
Squamous cell carcinoma 🔍 / 📺 / 🌳 / 📖
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+13 upvote downvote
submitted by ∗tinydoc(276)

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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

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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 +8

drdoom ^ linkifying: https://webpath.med.utah.edu/LUNGHTML/LUNG068.html +5

zevvyt I also didn't choose infarct cuz i think the lung would have a red infarct. +1

+8 upvote downvote
submitted by ∗hungrybox(1277)

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

Source: Radiopedia

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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. +6

+4 upvote downvote
submitted by ∗lnsetick(107)

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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.

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

+2 upvote downvote
submitted by ∗bharatpillai(40)

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

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brotherimodu That's what I thought too. +

madamestep Same here. What's a good way to distinguish morphology? +

+2 upvote downvote
submitted by ∗bbr(58)

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Abscess: You'd see a hole (remember the air/fluid level on x ray?)

Hamartomas: Benign neoplasm of normal tissue (you'd see more Lung tissue, whatever this white stuff is....it ain't normal red lung tissue). Infarct: No wedge?

Malignant lymphoma: (idk how to rule out)

Mesothelioma: Pleural plaques (this is intra-parenchymal)

Squamous cell Carcinoma: bingo. Centrally located.

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+1 upvote downvote
submitted by joanmadd(10)

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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?

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+0 upvote downvote
submitted by mattfoley_govtcheese(7)

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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.

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+0 upvote downvote
submitted by mdsu(0)

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

Squamous cell carcinoma; Central - Hilar mass- Cavitation

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+0 upvote downvote
submitted by ∗medstudent(18)

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FA 2020 p. 684

SCC: Hilar mass arising from bronchus; cavitation, cigarettes, hypercalcemia.

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-2 upvote downvote
submitted by ∗samsam3711(31)

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Esophageal squamous cell cancers are more common in smokers

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