UPSC-CMS 2021 — Pathology

Q: Which one of the following is NOT associated with BRCA1/BRCA2 genes?

Liver cancer. ***Liver cancer*** - **BRCA1/BRCA2 mutations** are primarily associated with an increased risk of breast, ovarian, and prostate cancers, but not typically with **liver cancer**. - While liver cancer does have genetic predispositions, they are generally linked to other genes and environmental factors like chronic viral hepatitis or alcohol abuse. *Ovarian cancer* - **BRCA1/BRCA2 gene mutations** significantly increase the risk of developing **hereditary ovarian cancer**, particularly serous ovarian carcinoma [2]. - Individuals with these mutations often undergo prophylactic oophorectomy to reduce their risk [2]. *Prostate cancer* - **BRCA1/BRCA2 mutations**, especially **BRCA2**, are associated with an increased risk of developing **prostate cancer**, often an aggressive form, particularly in younger men. - Screening guidelines for men with BRCA mutations may include earlier and more frequent PSA testing. *Breast cancer* - **BRCA1 and BRCA2 genes** are tumor suppressor genes, and mutations in these genes are the most common cause of **hereditary breast cancer** [1], [2]. - Individuals with BRCA mutations have a significantly higher lifetime risk of developing breast cancer, and often have a higher incidence of bilateral breast cancer [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1058. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1058-1059. [Practice more Pathology PYQs on OnCourse]

Q: Which of the following statements regarding hepatic adenomas are correct? 1. They are almost exclusively seen in females aged 25-50 years 2. They are associated with the use of oral contraceptive pills 3. They do not have any malignant potential 4. Majority are detected incidentally on imaging

1, 2 and 4. ***1, 2 and 4*** - **Hepatic adenomas** are indeed almost exclusively seen in **females aged 25-50 years**, primarily due to their association with hormonal factors. - They are strongly associated with the use of **oral contraceptive pills** (OCPs) and other exogenous estrogens [1]. - The majority of hepatic adenomas are detected **incidentally on imaging** performed for other reasons, as they are often asymptomatic unless complications arise. - While most hepatic adenomas are benign, they do carry a **risk of malignant transformation**, particularly larger lesions or certain subtypes [1]. *2, 3 and 4* - This option incorrectly states that hepatic adenomas **do not have any malignant potential**; however, certain subtypes and larger adenomas can undergo malignant transformation [1]. - The other statements regarding association with OCPs and incidental detection are correct. *1, 3 and 4* - This choice incorrectly claims that hepatic adenomas **do not have any malignant potential**, which is false as there is a recognized risk of transformation to **hepatocellular carcinoma** [1]. - It also omits the correct statement about their association with OCPs. *1, 2 and 3* - This option incorrectly asserts that hepatic adenomas **do not have any malignant potential**, which contradicts current medical understanding as they can transform into **hepatocellular carcinoma** [1]. - It also omits the common finding that they are often detected incidentally. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 874-875. [Practice more Pathology PYQs on OnCourse]

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Which one of the following is NOT associated with BRCA1/BRCA2 genes?

The malignancy associated with Stewart-Treves syndrome is

Which of the following statements regarding hepatic adenomas are correct? 1. They are almost exclusively seen in females aged 25-50 years 2. They are associated with the use of oral contraceptive pills 3. They do not have any malignant potential 4. Majority are detected incidentally on imaging

UPSC-CMS 2021 - Pathology UPSC-CMS Practice Questions and MCQs

Question 1: Which one of the following is NOT associated with BRCA1/BRCA2 genes?

A. Ovarian cancer
B. Liver cancer (Correct Answer)
C. Prostate cancer
D. Breast cancer

Explanation: ***Liver cancer*** - **BRCA1/BRCA2 mutations** are primarily associated with an increased risk of breast, ovarian, and prostate cancers, but not typically with **liver cancer**. - While liver cancer does have genetic predispositions, they are generally linked to other genes and environmental factors like chronic viral hepatitis or alcohol abuse. *Ovarian cancer* - **BRCA1/BRCA2 gene mutations** significantly increase the risk of developing **hereditary ovarian cancer**, particularly serous ovarian carcinoma [2]. - Individuals with these mutations often undergo prophylactic oophorectomy to reduce their risk [2]. *Prostate cancer* - **BRCA1/BRCA2 mutations**, especially **BRCA2**, are associated with an increased risk of developing **prostate cancer**, often an aggressive form, particularly in younger men. - Screening guidelines for men with BRCA mutations may include earlier and more frequent PSA testing. *Breast cancer* - **BRCA1 and BRCA2 genes** are tumor suppressor genes, and mutations in these genes are the most common cause of **hereditary breast cancer** [1], [2]. - Individuals with BRCA mutations have a significantly higher lifetime risk of developing breast cancer, and often have a higher incidence of bilateral breast cancer [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1058. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1058-1059.

Question 2: The malignancy associated with Stewart-Treves syndrome is

A. Basal cell carcinoma
B. Liposarcoma
C. Lymphangiosarcoma (Correct Answer)
D. Malignant melanoma

Explanation: ***Lymphangiosarcoma*** - **Stewart-Treves syndrome** is characterized by the development of **lymphangiosarcoma** in a setting of chronic lymphedema, most commonly following a radical mastectomy for breast cancer [2]. - The chronic lymphatic obstruction and subsequent lymphedema [2] are thought to create an environment conducive to the development of this rare and aggressive **vascular malignancy** [1]. *Basal cell carcinoma* - This is a common **skin cancer** that typically arises from the basal cells of the epidermis and is primarily associated with **ultraviolet (UV) radiation exposure**, not chronic lymphedema [4]. - While it can occur in individuals with a history of radiation therapy (which might be part of breast cancer treatment), it is not the specific malignancy defining Stewart-Treves syndrome [3]. *Liposarcoma* - **Liposarcoma** is a malignant tumor of **adipose tissue** and does not have a direct association with chronic lymphedema or Stewart-Treves syndrome. - It arises from fat cells and can occur in various locations but is not typically linked to impaired lymphatic drainage. *Malignant melanoma* - This highly aggressive **skin cancer** arises from **melanocytes** and is strongly associated with **UV radiation exposure** and genetic predisposition. - While skin cancers can occur in patients with breast cancer, **melanoma** is not the specific malignancy that defines Stewart-Treves syndrome. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 527-528. [2] 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. 125-126. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, pp. 1157-1158. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Disorders Involving Inflammatory And Haemopoietic Cells, pp. 643-644.

Question 3: Which of the following statements regarding hepatic adenomas are correct? 1. They are almost exclusively seen in females aged 25-50 years 2. They are associated with the use of oral contraceptive pills 3. They do not have any malignant potential 4. Majority are detected incidentally on imaging

A. 2, 3 and 4
B. 1, 2 and 4 (Correct Answer)
C. 1, 3 and 4
D. 1, 2 and 3

Explanation: ***1, 2 and 4*** - **Hepatic adenomas** are indeed almost exclusively seen in **females aged 25-50 years**, primarily due to their association with hormonal factors. - They are strongly associated with the use of **oral contraceptive pills** (OCPs) and other exogenous estrogens [1]. - The majority of hepatic adenomas are detected **incidentally on imaging** performed for other reasons, as they are often asymptomatic unless complications arise. - While most hepatic adenomas are benign, they do carry a **risk of malignant transformation**, particularly larger lesions or certain subtypes [1]. *2, 3 and 4* - This option incorrectly states that hepatic adenomas **do not have any malignant potential**; however, certain subtypes and larger adenomas can undergo malignant transformation [1]. - The other statements regarding association with OCPs and incidental detection are correct. *1, 3 and 4* - This choice incorrectly claims that hepatic adenomas **do not have any malignant potential**, which is false as there is a recognized risk of transformation to **hepatocellular carcinoma** [1]. - It also omits the correct statement about their association with OCPs. *1, 2 and 3* - This option incorrectly asserts that hepatic adenomas **do not have any malignant potential**, which contradicts current medical understanding as they can transform into **hepatocellular carcinoma** [1]. - It also omits the common finding that they are often detected incidentally. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 874-875.