84 關於惡性高血壓（malignant hypertension）的腎臟病理變化，下列何者最不適當？

 細動脈類纖維蛋白壞死（fibrinoid necrosis of arterioles）

增生性細動脈炎（hyperplastic arteriolitis）

腎小球壞死或血栓變化（necrotic or thrombotic changes in glomeruli）

玻璃質細動脈硬化（hyaline arteriolosclerosis）

D

NOTE: MALIGNANT STAGE!!!!!

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85 一位42歲男性因嘔吐來急診，醫師檢查嘔吐物時發現內含膽汁，則最可能是下列那種疾病？

 十二指腸末端腫瘤阻塞 胃幽門阻塞

食道腫瘤阻塞 食道弛緩不能症

A

OF COURSE IT IS A!!!!!

WITH BILES VOMITUS!!!!

==============

86 一位75歲男性在不同的靜脈位置交替發生血栓。此種移走性血栓靜脈炎（migratory thrombophlebitis）的現象（亦稱Trousseau sign），最常併發於下列何種疾病？

胰臟、大腸或肺癌 慢性骨髓炎 鬱血性心臟衰竭 末期腎疾病

A

TROUSSEAU: CA OF PCLUNG

================

88 下列有關淋巴瘤（lymphoma）的敘述，何者錯誤？

 鼻NK / T細胞淋巴瘤與EB病毒有相當強的關聯

大致而言，T細胞淋巴瘤較B細胞淋巴瘤病程較嚴重，預後較差

B細胞為CD20陽性，而T細胞為CD3陽性

大多小孩的淋巴瘤為淋巴母細胞淋巴瘤（lymphoblastic lymphoma）及濾泡淋巴瘤（follicular lymphoma）

D

FOLLICULAR NOT COMMON IN CHILD. IT IS COMMON IN ADULT!

Lymphoma type	Relativeincidence	Histopathology	Cell markers	Overall 5-year survival	Other comments
Precursor T-cell leukemia/lymphoma	40% of lymphomas in childhood.[17]	Lymphoblasts with irregular nuclear contours, condensed chromatin, small nucleoli and scant cytoplasm without granules.[17]	TdT, CD2, CD7[17]		It often presents as amediastinal massbecause of involvement of thethymus.[17] It is highly associated withNOTCH1mutations.[17] Most common inadolescent males.[17]
Follicular lymphoma	40% of lymphomas in adults[17]	Small "cleaved" cells (centrocytes) mixed with large activated cells (centroblasts). Usually nodular ("follicular") growth pattern[17]	CD10, surfaceIg[17]	72-77%[18]	Occurs in older adults. Usually involves lymph nodes, bone marrow and spleen.[17]Associated with t(14;18) translocationoverexpressing Bcl-2.[17] Indolent[17]
Diffuse large B cell lymphoma	40 to 50% of lymphomas in adults[17]	Variable. Most resemble B cells of large germinal centers. Diffuse growth pattern.[17]	Variable expression ofCD10 and surface Ig[17]	60%[19]	Occurs in all ages, but most commonly in older adults. Often occurs outside lymph nodes. Aggressive.[17]
Mantle cell lymphoma	3 to 4% of lymphomas in adults[17]	Lymphocytes of small to internediate size growing in diffuse pattern[17]	CD5[17]	50%[20]to 70%[20]	Occurs mainly in adult males. Usually involves lymph nodes, bone marrow, spleen and GI tract. Associated with t(11;14) translocation overexpressing cyclin D1. Moderately aggressive.[17]
B-cell chronic lymphocytic leukemia/lymphoma	3 to 4 % of lymphomas in adults[17]	Small resting lymphocytes mixed with variable number of large activated cells. Lymph nodes are diffusely effaced[17]	CD5, surfaceimmunoglobulin[17]	50%.[21]	Occurs in older adults. Usually involves lymph nodes, bone marrow and spleen. Most patients have peripheral blood involvement.Indolent.[17]
MALT lymphoma	~5% of lymphomas in adults[17]	Variable cell size and differentiation. 40% show plasma cell differentiation.Homing of B cells to epithelium creates lymphoepithelial lesions.[17]	CD5, CD10, surface Ig[17]		Frequently occurs outside lymph nodes. Very indolent. May be cured by local excision.[17]
Burkitt's lymphoma	< id="cite_ref-Robbins12-8_16-28" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; ">[17]	Round lymphoid cells of intermediate size with several nucleoli. Starry-sky appearance by diffuse spread with interspersedapoptosis.[17]	CD10, surface Ig[17]	50%[22]	Endemic in Africa, sporadic elsewhere. More common in immunocompromised and in children. Often visceral involvement. Highly aggressive.[17]
Mycosis fungoides	Most common cutaneous lymphoid malignancy	Usually small lymphoid cells with convoluted nuclei that often infiltrate the epidermis, creating Pautier microabscesses[17]	CD4[17]	75%[23]	Localized or more generalized skin symptoms. Generally indolent. In a more aggressive variant,[17]Sézary's disease, there is skin erythemaand peripheral blood involvement.[17]
Peripheral T-cell lymphoma-Not-Otherwise-Specified	Most common T cell lymphoma[17]	Variable. Usually a mix small to large lymphoid cells with irregular nuclear contours.[17]	CD3[17]		Probably consists of several rare tumor types. It is often disseminated and generally aggressive.[17]
Nodular sclerosisform of Hodgkin lymphoma	Most common type of Hodgkin's lymphoma[17]	Reed-Sternberg cellvariants and inflammation. usually broad sclerotic bands that consists of collagen.[17]	CD15, CD30[17]		Most common in young adults. It often arises in themediastinum orcervical lymph nodes.[17]
Mixed-cellularity subtype of Hodgkin lymphoma	Second most common form of Hodgkin's lymphoma[17]	Many classic Reed-Sternberg cells and inflammation[17]	CD15, CD30[17]		Most common in men. More likely to be diagnosed at advanced stages than the nodular sclerosis form. Epstein-Barr virus involved in 70% of cases.[