Neoplasia

Neoplasia US Medical PG Question 1: A 33-year-old woman comes to the physician 1 week after noticing a lump in her right breast. Fifteen years ago, she was diagnosed with osteosarcoma of her left distal femur. Her father died of an adrenocortical carcinoma at the age of 41 years. Examination shows a 2-cm, firm, immobile mass in the lower outer quadrant of the right breast. A core needle biopsy of the mass shows adenocarcinoma. Genetic analysis in this patient is most likely to show a defect in which of the following genes?

• A. BRCA1
• B. KRAS
• C. TP53 (Correct Answer)
• D. Rb
• E. PTEN

Neoplasia Explanation: ***TP53*** - This patient's presentation with **early-onset breast cancer**, a history of **osteosarcoma** at a young age, and a father's death from **adrenocortical carcinoma** at 41 years strongly suggests **Li-Fraumeni syndrome**. - Li-Fraumeni syndrome is an autosomal dominant disorder caused by a germline mutation in the **tumor suppressor gene TP53**, increasing the risk for multiple primary cancers at a young age. *BRCA1* - While **BRCA1 mutations** are associated with an increased risk of breast and ovarian cancer, they are not typically linked to osteosarcoma or adrenocortical carcinoma. - The constellation of cancers in this patient is more indicative of Li-Fraumeni syndrome than solely a BRCA1-related cancer syndrome. *KRAS* - **KRAS** is an oncogene commonly mutated in several cancers, including pancreatic, colorectal, and lung cancer, but is not primarily associated with either Li-Fraumeni syndrome or the specific tumors seen in this family history. - Mutations in KRAS are typically somatic mutations acquired during a person's lifetime, not germline mutations causing inherited cancer syndromes like the one suggested here. *Rb* - Mutations in the **retinoblastoma (Rb) gene** are associated with retinoblastoma and an increased risk of osteosarcoma, but not typically with adrenocortical carcinoma or breast cancer as part of a classic inherited syndrome. - The combination of breast cancer, osteosarcoma, and adrenocortical carcinoma points more specifically to TP53. *PTEN* - **PTEN mutations** are associated with Cowden syndrome, which increases the risk for breast cancer, thyroid cancer, and endometrial cancer, along with benign growths. - However, Cowden syndrome does not typically include osteosarcoma or adrenocortical carcinoma as prominent features, making PTEN less likely than TP53 for this specific family history.

Neoplasia US Medical PG Question 2: A 62-year-old woman presents to her physician with a painless breast mass on her left breast for the past 4 months. She mentions that she noticed the swelling suddenly one day and thought it would resolve by itself. Instead, it has been slowly increasing in size. On physical examination of the breasts, the physician notes a single non-tender, hard, and fixed nodule over left breast. An ultrasonogram of the breast shows a solid mass, and a fine-needle aspiration biopsy confirms the mass to be lobular carcinoma of the breast. When the patient asks about her prognosis, the physician says that the prognosis can be best determined after both grading and staging of the tumor. Based on the current diagnostic information, the physician says that they can only grade, but no stage, the neoplasm. Which of the following facts about the neoplasm is currently available to the physician?

• A. The tumor invades the pectoralis major.
• B. The tumor has spread via blood-borne metastasis.
• C. The tumor has not metastasized to the contralateral superior mediastinal lymph nodes.
• D. The tumor has metastasized to the axillary lymph nodes.
• E. The tumor cells exhibit marked nuclear atypia. (Correct Answer)

Neoplasia Explanation: ***The tumor cells exhibit marked nuclear atypia.*** - **Grading** assesses the **histological appearance** of cancer cells and tissues, including features like nuclear atypia, mitotic rate, and architectural features, which are directly observable from the **fine-needle aspiration biopsy**. - **Nuclear atypia** refers to abnormal changes in the size, shape, and chromatin pattern of cell nuclei, indicating a higher degree of anaplasia and aggressiveness. *The tumor invades the pectoralis major.* - **Invasion into surrounding tissues**, especially muscle, is a feature determined during **surgical staging** or comprehensive imaging, which is not described as being performed yet. - This information relates to the **"T" (tumor size/extension)** component of TNM staging, which cannot be fully assessed with only a biopsy. *The tumor has spread via blood-borne metastasis.* - **Distant metastasis** is part of the **"M" (metastasis)** component of TNM staging, requiring imaging studies (e.g., PET scan, CT scan) or biopsies of suspected metastatic sites. - The current diagnostic information (biopsy of the primary tumor) does not provide details about **blood-borne spread**. *The tumor has not metastasized to the contralateral superior mediastinal lymph nodes.* - Information about **lymph node involvement**, even in distant locations like the mediastinum, falls under the **"N" (nodes)** component of TNM staging, which requires thorough imaging or surgical dissection. - The current biopsy focuses on the primary breast mass and cannot rule out distant lymph node metastasis. *The tumor has metastasized to the axillary lymph nodes.* - **Axillary lymph node metastasis** is also part of the **"N" component** of staging and is typically determined by sentinel lymph node biopsy or axillary dissection performed during surgery, or through imaging. - A fine-needle aspiration of the primary breast mass does not provide information about regional lymph node involvement.

Neoplasia US Medical PG Question 3: Patient 1 – A 26-year-old woman presents to her primary care physician for an annual exam. She currently does not have any acute concerns and says her health has been generally well. Medical history is significant for asthma, which is managed with an albuterol inhaler. Her last pap smear was unremarkable. She is currently sexually active with one male and consistently uses condoms. She occasionally smokes marijuana and drinks wine once per week. Her mother recently passed away from advanced ovarian cancer. Her sister is 37-years-old and was recently diagnosed with breast cancer and ovarian cancer. Physical examination is remarkable for a mildly anxious woman. Patient 2 – A 27-year-old woman presents to her primary care physician for an annual exam. She says that she would like to be screened for breast cancer since two of her close friends were recently diagnosed. She noticed she has a small and mobile mass on her left breast, which increases in size and becomes tender around her time of menses. Family history is remarkable for hypertension in the father. The physical exam is significant for a small, well-defined, and mobile mass on her left breast that is not tender to palpation. Which of the following is the best next step in management for patient 1 and 2?

• A. Patient 1 – Breast ultrasound. Patient 2 – Return in 3 months for a clinical breast exam
• B. Patient 1 – Reassurance. Patient 2 – Breast ultrasound
• C. Patient 1 – CA-125 testing. Patient 2 – BRCA testing
• D. Patient 1 – BRCA testing. Patient 2 – Breast ultrasound (Correct Answer)
• E. Patient 1 – Breast and ovarian ultrasound. Patient 2 – Mammography

Neoplasia Explanation: ***Patient 1 – BRCA testing. Patient 2 – Breast ultrasound*** - Patient 1 has a strong family history of early-onset **breast and ovarian cancer** (**mother and sister**), suggesting a high probability of an inherited genetic mutation, such as **BRCA1/2**, which warrants genetic testing. - Patient 2 presents with a **small, mobile, well-defined breast mass** that is likely benign, and a **breast ultrasound** is the appropriate initial imaging for further characterization in a young woman. *Patient 1 – Breast ultrasound. Patient 2 – Return in 3 months for a clinical breast exam* - Patient 1's primary concern is genetic predisposition due to family history, an **ultrasound** is not the initial or primary screening method for future cancer risk. - Patient 2 has a palpable mass; waiting 3 months for a **clinical breast exam** without initial imaging (ultrasound) is not appropriate for evaluating a new breast lump. *Patient 1 – Reassurance. Patient 2 – Breast ultrasound* - Patient 1's family history of **early-onset breast and ovarian cancer** is a significant risk factor; therefore, simple **reassurance** without further investigation is inappropriate. - While a **breast ultrasound** is appropriate for Patient 2, the recommendation for Patient 1 is incorrect. *Patient 1 – CA-125 testing. Patient 2 – BRCA testing* - **CA-125** is a tumor marker primarily used for monitoring ovarian cancer treatment or recurrence, not for initial screening in asymptomatic individuals, especially in a young woman with no active symptoms. - **BRCA testing** is indicated for Patient 1 due to family history, but not for Patient 2 who has a likely benign breast mass and no significant family history. *Patient 1 – Breast and ovarian ultrasound. Patient 2 – Mammography* - Regular **breast and ovarian ultrasounds** are not recommended as primary screening tools for genetic risk in asymptomatic high-risk individuals like Patient 1. - **Mammography** is less sensitive in young women (under 30) due to higher breast tissue density, making **ultrasound** the preferred initial imaging for Patient 2.

Neoplasia US Medical PG Question 4: An epidemiologist is evaluating the efficacy of Noxbinle in preventing HCC deaths at the population level. A clinical trial shows that over 5 years, the mortality rate from HCC was 25% in the control group and 15% in patients treated with Noxbinle 100 mg daily. Based on this data, how many patients need to be treated with Noxbinle 100 mg to prevent, on average, one death from HCC?

• A. 20
• B. 73
• C. 10 (Correct Answer)
• D. 50
• E. 100

Neoplasia Explanation: ***10*** - The **number needed to treat (NNT)** is calculated by first finding the **absolute risk reduction (ARR)**. - **ARR** = Risk in control group - Risk in treatment group = 25% - 15% = **10%** (or 0.10). - **NNT = 1 / ARR** = 1 / 0.10 = **10 patients**. - This means that **10 patients must be treated with Noxbinle to prevent one death from HCC** over 5 years. *20* - This would result from an ARR of 5% (1/0.05 = 20), which is not supported by the data. - May arise from miscalculating the risk difference or incorrectly halving the actual ARR. *73* - This value does not correspond to any standard calculation of NNT from the given mortality rates. - May result from confusion with other epidemiological measures or calculation error. *50* - This would correspond to an ARR of 2% (1/0.02 = 50), which significantly underestimates the actual risk reduction. - Could result from incorrectly calculating the difference as a proportion rather than absolute percentage points. *100* - This would correspond to an ARR of 1% (1/0.01 = 100), grossly underestimating the treatment benefit. - May result from confusing ARR with relative risk reduction or other calculation errors.

Neoplasia US Medical PG Question 5: A 39-year-old African American woman is admitted to the hospital following a seizure with a severe post-ictal headache. She was diagnosed with breast cancer 1 year ago when she presented with a hard, rock-like, immobile mass with irregular borders accompanied by changes in the breast skin, including erythema and dimpling. She had ipsilateral mobile axillary lymphadenopathy at that time. A biopsy confirmed the diagnosis of stage 2B invasive breast cancer. Her mother died at 42 years of age due to the same type of breast cancer. A CT scan done during this admission reveals multiple metastatic lesions in the brain and liver, along with the involvement of supra- and infra-clavicular lymph nodes. Which of the following molecular profile most likely characterizes this patient?

• A. PR, ER, HER2 positive
• B. HER2 positive
• C. Progesterone receptor (PR) positive
• D. ER, PR, HER2 negative (Correct Answer)
• E. Estrogen receptor (ER) positive

Neoplasia Explanation: ***ER, PR, HER2 negative*** - This patient's presentation with aggressive breast cancer at a relatively young age (39 years old), family history of early-onset breast cancer, rapid progression to metastatic disease in the brain and liver, and involvement of multiple lymph nodes (axillary, supra- and infra-clavicular) are all highly suggestive of a **triple-negative breast cancer (TNBC)**. - TNBC is characterized by the absence of **estrogen receptors (ER)**, **progesterone receptors (PR)**, and **human epidermal growth factor receptor 2 (HER2)** overexpression, making it an aggressive subtype with limited targeted treatment options and a poor prognosis, consistent with the patient's rapidly worsening condition. *PR, ER, HER2 positive* - This molecular profile (also known as triple-positive breast cancer) generally indicates a more favorable prognosis due to the availability of **hormonal therapy** (for ER/PR positivity) and **anti-HER2 targeted therapy**. - The aggressive course and rapid metastatic spread described in the patient are less typical for triple-positive disease, which often responds well to various targeted treatments. *HER2 positive* - HER2-positive breast cancer can be aggressive, but the presence of HER2 positivity allows for **HER2-targeted therapies** (e.g., trastuzumab, pertuzumab), which significantly improve outcomes. - While HER2-positive cancers can metastasize to the brain, the overall clinical picture, especially the aggressive growth and lack of other receptor expression, aligns more with triple-negative disease. *Progesterone receptor (PR) positive* - PR positivity, often alongside ER positivity, indicates a **hormone-sensitive breast cancer**, which typically has a better prognosis and is amenable to **endocrine therapy**. - The aggressive and rapid metastatic progression to multiple sites, including brain and liver, is not characteristic of a purely PR-positive tumor without other aggressive features. *Estrogen receptor (ER) positive* - ER-positive breast cancer is the most common subtype and is generally associated with a **better prognosis** and responsiveness to **endocrine therapy**. - The patient's aggressive disease course, including early metastasis and family history of early-onset, aggressive breast cancer, does not align with the typical presentation of an exclusively ER-positive tumor.

Neoplasia US Medical PG Question 6: A 38-year-old man presents to his primary care practitioner for 2 months of rectal bleeding. He also reports occasional diarrhea and abdominal pain. His family history is relevant for his father and uncle, who died from complications of colorectal cancer. Colonoscopy shows more than 10 colorectal adenomas. Which of the following genes is most likely affected in this patient?

• A. RAS
• B. TP53
• C. hMLH1
• D. PPAR
• E. APC (Correct Answer)

Neoplasia Explanation: ***APC*** - This patient's presentation with **numerous colorectal adenomas** (over 10), early-onset symptoms (38 years old), and a strong **family history of colorectal cancer** (father and uncle) is highly characteristic of **Familial Adenomatous Polyposis (FAP)**. - FAP is an **autosomal dominant** condition caused by a germline mutation in the **APC tumor suppressor gene**, leading to the development of hundreds to thousands of adenomatous polyps in the colon, which inevitably progress to colorectal cancer if untreated. *RAS* - **RAS mutations** are commonly found in sporadic colorectal cancers and play a role in tumor growth and progression, but they are not typically associated with the **hereditary syndrome of multiple adenomas** seen in this patient. - RAS activation leads to an increase in **cell proliferation** and can contribute to the development of many cancers, but not as the primary genetic defect in a polyposis syndrome. *TP53* - **TP53** is a well-known tumor suppressor gene, and mutations are involved in various cancers, including colorectal cancer (often in its later stages). However, germline mutations in TP53 are associated with **Li-Fraumeni syndrome**, which involves a broad spectrum of early-onset cancers and is not primarily characterized by numerous colonic adenomas. - TP53 mutations are generally hallmarks of **genomic instability** and are more often seen in the progression of sporadic cancers rather than initiating a polyposis syndrome. *hMLH1* - **hMLH1** is a gene involved in **DNA mismatch repair**. Germline mutations in this gene, along with other mismatch repair genes (e.g., MSH2, MSH6, PMS2), are responsible for **Lynch syndrome (hereditary non-polyposis colorectal cancer - HNPCC)**. - While Lynch syndrome is an important cause of hereditary colorectal cancer, it is characterized by fewer polyps (typically <10) that progress rapidly to cancer, and an increased risk of other cancers (e.g., endometrial), which differs from the presentation of **hundreds of adenomas** seen in FAP. *PPAR* - **PPARs (Peroxisome Proliferator-Activated Receptors)** are a group of nuclear receptor proteins that play roles in metabolism, cell differentiation, and inflammation. - While PPAR pathways have been investigated for their potential role in cancer development and as therapeutic targets, **mutations in PPAR genes are not directly linked** to a common hereditary colorectal cancer syndrome characterized by numerous adenomas like FAP.

Neoplasia US Medical PG Question 7: You are currently employed as a clinical researcher working on clinical trials of a new drug to be used for the treatment of Parkinson's disease. Currently, you have already determined the safe clinical dose of the drug in a healthy patient. You are in the phase of drug development where the drug is studied in patients with the target disease to determine its efficacy. Which of the following phases is this new drug currently in?

• A. Phase 4
• B. Phase 1
• C. Phase 2 (Correct Answer)
• D. Phase 0
• E. Phase 3

Neoplasia Explanation: ***Phase 2*** - **Phase 2 trials** involve studying the drug in patients with the target disease to assess its **efficacy** and further evaluate safety, typically involving a few hundred patients. - The question describes a stage after safe dosing in healthy patients (Phase 1) and before large-scale efficacy confirmation (Phase 3), focusing on efficacy in the target population. *Phase 4* - **Phase 4 trials** occur **after a drug has been approved** and marketed, monitoring long-term effects, optimal use, and rare side effects in a diverse patient population. - This phase is conducted post-market approval, whereas the question describes a drug still in development prior to approval. *Phase 1* - **Phase 1 trials** primarily focus on determining the **safety and dosage** of a new drug in a **small group of healthy volunteers** (or sometimes patients with advanced disease if the drug is highly toxic). - The question states that the safe clinical dose in a healthy patient has already been determined, indicating that Phase 1 has been completed. *Phase 0* - **Phase 0 trials** are exploratory, very early-stage studies designed to confirm that the drug reaches the target and acts as intended, typically involving a very small number of doses and participants. - These trials are conducted much earlier in the development process, preceding the determination of safe clinical doses and large-scale efficacy studies. *Phase 3* - **Phase 3 trials** are large-scale studies involving hundreds to thousands of patients to confirm **efficacy**, monitor side effects, compare it to commonly used treatments, and collect information that will allow the drug to be used safely. - While Phase 3 does assess efficacy, it follows Phase 2 and is typically conducted on a much larger scale before submitting for regulatory approval.

Neoplasia US Medical PG Question 8: A researcher is investigating the behavior of two novel chemotherapeutic drugs that he believes will be effective against certain forms of lymphoma. In order to evaluate the safety of these drugs, this researcher measures the concentration and rate of elimination of each drug over time. A partial set of the results is provided below. Time 1: Concentration of Drug A: 4 mg/dl Concentration of Drug B: 3 mg/dl Elimination of Drug A: 1 mg/minute Elimination of Drug B: 4 mg/minute Time 2: Concentration of Drug A: 2 mg/dl Concentration of Drug B: 15 mg/dl Elimination of Drug A: 0.5 mg/minute Elimination of Drug B: 4 mg/minute Which of the following statements correctly identifies the most likely relationship between the half-life of these two drugs?

• A. The half-life of drug A is always longer than that of drug B
• B. The half-life of both drug A and drug B are constant
• C. The half-life of both drug A and drug B are variable
• D. The half-life of drug A is variable but that of drug B is constant
• E. The half-life of drug A is constant but that of drug B is variable (Correct Answer)

Neoplasia Explanation: ***The half-life of drug A is constant but that of drug B is variable*** - Drug A shows a **constant fraction** eliminated per unit time (1 mg/minute from 4 mg/dl, then 0.5 mg/minute from 2 mg/dl), indicating **first-order kinetics** and thus a constant half-life. - Drug B's elimination rate remains constant (4 mg/minute) despite varying concentrations (3 mg/dl then 15 mg/dl), which suggests **zero-order kinetics** and a variable half-life dependent on concentration. *The half-life of drug A is always longer than that of drug B* - This statement is incorrect because Drug B exhibits **zero-order kinetics**, meaning its **half-life changes** with concentration, making a constant comparison invalid. - At very high concentrations, Drug B's half-life could actually be longer than Drug A's if the elimination rate is slow relative to the large amount of drug. *The half-life of both drug A and drug B are constant* - This is incorrect because Drug B demonstrates **zero-order kinetics**, where the elimination rate is constant, but the **half-life is variable** and directly depends on the drug concentration. - For zero-order kinetics, a constant amount of drug is eliminated per unit time, not a constant fraction, which causes the half-life to change. *The half-life of both drug A and drug B are variable* - This is incorrect because Drug A exhibits **first-order kinetics**, where a **constant proportion** of the drug is eliminated per unit time, resulting in a **constant half-life**. - Its elimination rate is directly proportional to its concentration (1 mg/min from 4 mg/dl, 0.5 mg/min from 2 mg/dl), which defines first-order kinetics. *The half-life of drug A is variable but that of drug B is constant* - This statement is the opposite of what the data indicates for Drug A; Drug A's elimination is **proportional to its concentration**, signifying **first-order kinetics** and a constant half-life. - Drug B's elimination rate is constant regardless of concentration, which points to **zero-order kinetics** and thus a variable half-life.

Neoplasia US Medical PG Question 9: A 27-year-old woman presents for her routine annual examination. She has no complaints. She has a 3-year-old child who was born via normal vaginal delivery with no complications. She had a Pap smear during her last pregnancy and the findings were normal. Her remaining past medical history is not significant, and her family history is also not significant. Recently, one of her close friends was diagnosed with breast cancer at the age of 36, and, after reading some online research, she wants to be checked for all types of cancer. Which of the following statements would be the best advice regarding the most appropriate screening tests for this patient?

• A. “Your last Pap smear 3 years ago was normal. We can repeat it after 2 more years.”
• B. “Remember that information on the internet is vague and unreliable. You don't need any screening tests at this time.”
• C. “Yes, you are right to be concerned. Let us do a mammogram and a blood test for CA-125.”
• D. “You need HPV (human papillomavirus) co-testing only.”
• E. “We should do a Pap smear now. Blood tests are not recommended for screening purposes.” (Correct Answer)

Neoplasia Explanation: ***We should do a Pap smear now. Blood tests are not recommended for screening purposes.*** - The current guidelines recommend Pap smears every 3 years for women aged 21-29. Although her last Pap smear was 3 years ago, it was done during pregnancy, and a **repeat Pap smear is indicated now** as she is at the end of the 3-year interval. - **Blood tests like CA-125 are not recommended for routine cancer screening** in asymptomatic women due to their low specificity and sensitivity, which can lead to false positives and unnecessary invasive procedures. *“Your last Pap smear 3 years ago was normal. We can repeat it after 2 more years.”* - While a 3-year interval is generally appropriate, her last Pap smear was done 3 years ago and was performed during pregnancy, making a **repeat Pap smear indicated now** to remain within current screening guidelines. - Delaying the Pap smear for another two years would exceed the recommended 3-year interval for cervical cancer screening in her age group. *“Remember that information on the internet is vague and unreliable. You don't need any screening tests at this time.”* - While caution about internet information is valid, it is **inaccurate to suggest no screening tests are needed** as the patient is due for a Pap smear based on her age and last screening date. - Dismissing a patient's concerns outright without acknowledging valid screening needs can harm patient-doctor trust and lead to missed opportunities for preventive care. *“Yes, you are right to be concerned. Let us do a mammogram and a blood test for CA-125.”* - **Routine mammograms are not recommended for women under 40** without specific risk factors (e.g., strong family history, genetic mutations), which are not present here. - **CA-125 is primarily used for monitoring ovarian cancer treatment** or evaluating women with symptoms, not for general population screening due to its low specificity. *“You need HPV (human papillomavirus) co-testing only.”* - **HPV co-testing (HPV test + Pap smear) is recommended for women aged 30 and older**, or as a follow-up to abnormal Pap smear results. - For women aged 21-29, **primary Pap smear screening alone is recommended** every 3 years.

Neoplasia US Medical PG Question 10: A 33-year-old Caucasian female presents to her primary care provider for skin problems and difficulty breathing. She has not sought medical care in over 10 years due to anxiety around physicians. However, she has experienced gradual onset of diffuse pruritus, skin induration, and limited finger mobility over the past 5 years that has negatively impacted her work as an accountant. More recently, she has developed exertional shortness of breath and is concerned that it may impact her ability to care for her 3-year-old son. She reports no prior medical conditions and takes fish oil. She smokes 1 pack of cigarettes per day and drinks socially. Her temperature is 98.6°F (37°C), blood pressure is 145/85 mmHg, pulse is 85/min, and respirations are 22/min. On exam, she appears anxious with minimally increased work of breathing. Dry rales are heard at her lung bases bilaterally. Her fingers appear shiny and do not have wrinkles on the skin folds. A normal S1 and S2 are heard on cardiac auscultation. This patient’s lung disease is caused by increased secretion of which of the following substances within the lungs?

• A. Interleukin 1
• B. Tumor necrosis factor alpha
• C. Interleukin 2
• D. Transforming growth factor beta (Correct Answer)
• E. Interferon gamma

Neoplasia Explanation: ***Transforming growth factor beta*** - The patient's symptoms of **diffuse pruritus, skin induration, limited finger mobility**, exertional shortness of breath, and **shiny fingers without wrinkles** are highly suggestive of **systemic sclerosis (scleroderma)**. - The lung disease in scleroderma, often **interstitial lung disease (ILD)**, is characterized by **fibrosis driven by excessive collagen deposition**, a process significantly mediated by **transforming growth factor beta (TGF-β)**. *Interleukin 1* - **Interleukin-1 (IL-1)** is a pro-inflammatory cytokine primarily involved in acute inflammation and fever, not directly implicated as the primary driver of fibrosis in scleroderma-associated lung disease. - While IL-1 can contribute to inflammation in various autoimmune diseases, it does not directly stimulate the **fibrotic pathways** in the same manner as TGF-β. *Tumor necrosis factor alpha* - **Tumor necrosis factor-alpha (TNF-α)** is a prominent pro-inflammatory cytokine involved in many autoimmune and inflammatory conditions, including rheumatoid arthritis. - Although it plays a role in the inflammatory process, TNF-α is not considered the primary mediator responsible for the **fibrotic changes** seen in systemic sclerosis. *Interleukin 2* - **Interleukin-2 (IL-2)** is crucial for the proliferation and differentiation of T cells, particularly regulatory T cells, and is primarily involved in immune regulation and response to infection. - Its direct role in the **pathogenesis of fibrosis** in the context of scleroderma-associated lung disease is not as central as that of TGF-β. *Interferon gamma* - **Interferon-gamma (IFN-γ)** is a cytokine predominantly associated with anti-viral responses and the activation of macrophages and natural killer cells in cell-mediated immunity. - While it has immunomodulatory effects, IFN-γ is generally considered to have **anti-fibrotic properties** in some contexts, rather than promoting fibrosis in scleroderma.

Neoplasia Flashcard 1 of 10

Question: Tumor cells upregulate _____ to evade anti-tumor T-cells

Answer: PD-L1

Neoplasia Flashcard 2 of 10

Question: When performing Immunohistochemistry; a _____ stain can be used to identify Sarcomas, Endometrial Carcinoma, RCC, Meningioma

Answer: Vimentin

Neoplasia Flashcard 3 of 10

Question: Tumor cells commonly produce _____ factors (ex. FGF / VEGF), which are necessary for tumor survival and growth

Answer: angiogenic

Neoplasia Flashcard 4 of 10

Question: Which form of radiation is associated with the following types of cancer?_____ Basal Cell Carcinoma of the SkinSquamous Cell Carcinoma of the SkinMelanoma of the Skin

Answer: Non-Ionizing Radiation

Neoplasia Flashcard 5 of 10

Question: fibroma

Answer:

Extra Information: pulling sensation in groinbundles of spindle-shaped fiibroblasts

Neoplasia Flashcard 6 of 10

Question: Brenner tumor

Answer:

Extra Information: "coffee bean" nuclei on H&E Solid tumor, tan-yellow color, appears encapsulated. Looks like bladderbenign

Neoplasia Flashcard 7 of 10

Question: mucinous cystadenocarcinoma

Answer:

Extra Information: malignant

Neoplasia Flashcard 8 of 10

Question: mucinous cystadenoma

Answer:

Extra Information: multilocular cyst with mucous secreting epitheliumbenign

Neoplasia Flashcard 9 of 10

Question: teratoma

Answer:

Extra Information: cystic growths fillled with fat, teeth, hair, bone, cartilagemature (dermoid cyst) - usually benign immature - aggressively malignant 

Neoplasia Flashcard 10 of 10

Question: yolk sac tumor (ovary or testicle or testicular)

Answer: germ cell tumor

Extra Information: increased AFPSchiller-Duval bodies (resemble glomeruli)yellow, friable solid massyoung children