UPSC-CMS 2009 — Pathology
4 Previous Year Questions with Answers & Explanations
In a patient with breast cancer, the following are poor prognostic factors except
Consider the following: 1. Cholesterolosis 2. Adenomyomatosis 3. Polyposis 4. Cholelithiasis To which of the above does cholecystoses refer to?
The following disorders are predisposing conditions for carcinoma of the colon except
Folic acid deficiency is characterized by the following features except
UPSC-CMS 2009 - Pathology UPSC-CMS Practice Questions and MCQs
Question 1: In a patient with breast cancer, the following are poor prognostic factors except
- A. Aneuploid status
- B. Age less than 35 years
- C. High grade
- D. Absence of epidermal growth factor receptor (Correct Answer)
Explanation: ***Absence of epidermal growth factor receptor*** - The **absence of epidermal growth factor receptor (EGFR/HER1) overexpression** is associated with a **better prognosis** in breast cancer. - **EGFR overexpression** is more commonly seen in aggressive breast cancers, particularly **triple-negative breast cancers** (ER-negative, PR-negative, HER2-negative), and is associated with poor outcomes [2]. - When EGFR is absent or not overexpressed, the tumor tends to have less aggressive biological behavior. *Aneuploid status* - **Aneuploid status** (abnormal chromosome number) is a well-recognized **poor prognostic factor** in breast cancer, indicating genetic instability and aggressive tumor behavior [2]. - It is associated with **increased risk of recurrence** and poorer response to therapy. *Age less than 35 years* - **Younger age** (less than 35 years) at diagnosis is a **poor prognostic factor** for breast cancer. - This is often due to more aggressive tumor biology, **higher grade tumors**, hormone receptor negativity, and delayed diagnosis in younger women. *High grade* - A **high histological grade** (Grade III) indicates a more aggressive tumor with rapid cell division, marked nuclear pleomorphism, and poor differentiation, signifying a **poor prognosis** [1]. - High-grade tumors are more likely to metastasize and have higher recurrence rates. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 458-459. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1064-1066.
Question 2: Consider the following: 1. Cholesterolosis 2. Adenomyomatosis 3. Polyposis 4. Cholelithiasis To which of the above does cholecystoses refer to?
- A. 1 and 2 only (Correct Answer)
- B. 1 and 3 only
- C. 1, 2 and 3
- D. 2, 3 and 4
Explanation: ***1 and 2 only*** - **Cholecystoses** is a term used in pathology to describe a group of **non-inflammatory, degenerative changes** in the gallbladder wall, classically comprising two main entities: **cholesterolosis** and **adenomyomatosis**. - **Cholesterolosis** involves the accumulation of cholesterol esters in macrophages within the gallbladder mucosa, creating a characteristic **"strawberry gallbladder"** appearance on gross examination. - **Adenomyomatosis** is characterized by **hyperplasia of the muscularis propria** with epithelial invaginations forming **Rokitansky-Aschoff sinuses**, which are deep diverticula extending into the thickened muscle layer [1]. - These conditions are typically benign, often incidental findings, and distinct from inflammatory or neoplastic processes. *1, 2 and 3* - This option incorrectly includes **polyposis** as a separate category of cholecystoses. - While **cholesterol polyps** and **adenomyomatous polyps** can be manifestations of cholesterolosis and adenomyomatosis respectively, "polyposis" itself is not traditionally classified as a distinct cholecystosis in standard pathology references (Robbins, WHO classification). - Gallbladder polyps represent a heterogeneous group including neoplastic and non-neoplastic lesions, but are not listed as a separate cholecystosis category. *2, 3 and 4* - This option incorrectly includes **cholelithiasis** (gallstones), which is a completely separate condition involving calculi formation within the gallbladder lumen [3]. - Cholelithiasis is an **inflammatory/metabolic condition**, not a degenerative change of the gallbladder wall itself as seen in cholecystoses [2]. - It also incorrectly excludes **cholesterolosis**, which is one of the two classical cholecystoses. *1 and 3 only* - This option incorrectly excludes **adenomyomatosis**, which is one of the two classical and well-established forms of cholecystoses. - It also incorrectly includes **polyposis** as a separate category, which is not supported by standard pathology literature. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 404-405. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 883-884. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 403-404.
Question 3: The following disorders are predisposing conditions for carcinoma of the colon except
- A. Villous adenoma
- B. Familial polyposis coli
- C. Escherichia coli (Correct Answer)
- D. Peutz-Jeghers syndrome
Explanation: ***Escherichia coli*** - For this 2009 examination, *Escherichia coli* was not recognized as a direct predisposing condition for **colorectal carcinoma**. - **Note for modern learners:** Recent research (post-2010) has identified that certain E. coli strains, particularly pks+ E. coli producing colibactin toxin, can cause DNA damage and are associated with increased colorectal cancer risk. However, this knowledge was not established at the time of this exam. - In the context of classic predisposing conditions, E. coli remains the correct answer for this historical question. *Villous adenoma* - **Villous adenomas** are a type of colorectal polyp with the highest malignant potential among adenomatous polyps (up to 40% risk) [1]. - These are well-established **precancerous lesions** that can progress to **colorectal cancer**, especially when large (>2 cm) or showing high-grade dysplasia [1]. - This is a major predisposing condition for colorectal carcinoma. *Familial polyposis coli* - Also known as **Familial Adenomatous Polyposis (FAP)**, this autosomal dominant disorder causes hundreds to thousands of adenomatous polyps in the colon and rectum [2]. - Nearly **100% of untreated patients** develop **colorectal cancer** by age 40-50 [2]. - This is one of the most significant hereditary predisposing conditions for colorectal carcinoma. *Peutz-Jeghers syndrome* - This **autosomal dominant** disorder features multiple **hamartomatous polyps** throughout the GI tract and characteristic mucocutaneous pigmentation [3]. - Patients have a **15-fold increased risk** of colorectal cancer and elevated risks for other malignancies (gastric, small bowel, pancreatic, breast, ovarian, lung) [3]. - This is an established hereditary predisposing condition for colorectal carcinoma. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 371-373. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 821-822. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 813-814.
Question 4: Folic acid deficiency is characterized by the following features except
- A. Macrocytes
- B. Howell-Jolly bodies
- C. Hypersegmented neutrophils
- D. Microcytes (Correct Answer)
Explanation: ***Microcytes*** - **Folic acid deficiency** causes **macrocytic anemia** [1][2], meaning red blood cells are larger than normal, not microcytic (smaller than normal). - **Microcytes** are characteristic of **iron deficiency anemia** or thalassemia. *Macrocytes* - **Folic acid deficiency** leads to defective DNA synthesis, resulting in larger, immature red blood cells known as **macrocytes** [2]. - This is a hallmark of **megaloblastic anemia**, which includes both folic acid and vitamin B12 deficiencies [4]. *Howell-Jolly bodies* - These are **nuclear remnants** found in red blood cells that indicate impaired splenic function or accelerated red blood cell production. - While not exclusive to folic acid deficiency, they can be seen due to the **dyserythropoiesis** (abnormal red blood cell development) associated with it. *Hypersegmented neutrophils* - **Hypersegmented neutrophils** are a classic morphological finding in peripheral blood smears of patients with **folic acid deficiency** (and vitamin B12 deficiency) [2][3]. - This occurs due to abnormal maturation of neutrophils in the bone marrow, where the nucleus divides into a higher number of lobes (typically 5 or more) [3]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 594-595. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 593-594. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, p. 654. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 130-131.