Polyps and Neoplasms — MCQs
Grape-like, polypoid, bulky mass protruding through vagina in 4-year old girl is characteristic of
Which of the following is the most common epithelial tumor of the stomach?
The highest life time risk of pancreatic malignancy is seen with:
Which of the following genes is least likely to be involved in the development of carcinoma of the colon?
Which condition is associated with the highest risk of colorectal cancer?
Identify the condition shown in the image.
A 5-year-old child presented with a history of blood in the stools. On examination, there was a polypoid mass in the rectum, a biopsy of which showed as below. The most probable diagnosis is?
In a patient presenting with gallbladder abnormalities, which condition is characterized by a speckled appearance of the gallbladder mucosa resembling a strawberry?
Consider the following: 1. Cholesterolosis 2. Adenomyomatosis 3. Polyposis 4. Cholelithiasis To which of the above does cholecystoses refer to?
Which of the following statements about MALToma is true?
Polyps and Neoplasms Indian Medical PG Practice Questions and MCQs
Question 1: Grape-like, polypoid, bulky mass protruding through vagina in 4-year old girl is characteristic of
- A. Leiomyosarcoma
- B. Inflammatory polyp
- C. Sarcoma botryoides (Correct Answer)
- D. Fibrosarcoma
Explanation: ***Sarcoma botryoides*** - This is a highly characteristic presentation of **embryonal rhabdomyosarcoma (sarcoma botryoides)** in young girls, where the tumor forms a **grape-like (botryoid) mass** protruding from the vagina [1]. - It typically arises from the **vagina wall or cervix** in infants and young children, often presenting with bleeding or a mass [1]. *Leiomyosarcoma* - Leiomyosarcoma is a malignant tumor of **smooth muscle**, occurring more commonly in older women [2]. - It typically presents as a **solitary, firm mass** in the uterus or vagina, not typically with a grape-like appearance [2]. *Inflammatory polyp* - An inflammatory polyp is a **benign, non-malignant outgrowth** of tissue, often associated with chronic inflammation. - While it can protrude, it lacks the **destructive, bulky, and invasive nature** implied by "grape-like, polypoid, bulky mass" in the context of a child. *Fibrosarcoma* - Fibrosarcoma is a malignant tumor of **fibrous connective tissue**, which can occur anywhere in the body. - It is uncommon in the vagina, especially in young children, and generally presents as a **firm, infiltrative mass** rather than the distinctive grape-like pattern. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1004-1005. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1024-1025.
Question 2: Which of the following is the most common epithelial tumor of the stomach?
- A. Gastric adenocarcinoma (Correct Answer)
- B. GIST
- C. Sarcoma
- D. Carcinoid tumor
Explanation: ***Gastric adenocarcinoma*** - This is the **most common** malignant epithelial tumor of the stomach, accounting for over 90% of all gastric cancers [1], [2]. - It arises from the **glandular epithelial cells** lining the stomach [1]. *GIST* - **Gastrointestinal Stromal Tumors (GISTs)** are mesenchymal tumors, originating from the interstitial cells of Cajal, not epithelial cells [2]. - While they are common **non-epithelial** tumors of the stomach, they are far less frequent than gastric adenocarcinoma [2]. *Sarcoma* - **Sarcomas** are rare **mesenchymal tumors** of the stomach, arising from connective tissues like muscle or fat, not epithelial cells. - They constitute a very small percentage of gastric malignancies. *Carcinoid tumor* - **Carcinoid tumors** are **neuroendocrine tumors** that originate from enterochromaffin-like cells in the stomach. - While they are epithelial in origin, they are much less common than gastric adenocarcinoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 779. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 354-355.
Question 3: The highest life time risk of pancreatic malignancy is seen with:
- A. Familial adenomatous polyposis
- B. Peutz-Jeghers syndrome (Correct Answer)
- C. Hereditary nonpolyposis colorectal cancer
- D. Li-Fraumeni syndrome
Explanation: ***Peutz-Jeghers syndrome*** - **Peutz-Jeghers syndrome** is an autosomal dominant disorder characterized by **hamartomatous polyps** in the gastrointestinal tract and mucocutaneous pigmentation. - It significantly increases the lifetime risk of various cancers, including **pancreatic cancer**, with estimates as high as 11-36% by age 70 [1]. *Familial adenomatous polyposis* - **Familial adenomatous polyposis (FAP)** is primarily associated with a very high lifetime risk of **colorectal cancer** [2]. - While there is a slightly increased risk of pancreatic cancer in FAP patients, it is considerably lower than the risk seen in Peutz-Jeghers syndrome. *Hereditary nonpolyposis colorectal cancer* - **Hereditary nonpolyposis colorectal cancer (HNPCC)**, also known as **Lynch syndrome**, is mainly associated with a high risk of **colorectal** and **endometrial cancers**. - While it does increase the risk of other extra-colonic cancers like gastric, ovarian, and urinary tract cancers, the lifetime risk of pancreatic cancer is lower compared to Peutz-Jeghers syndrome. *Li-Fraumeni syndrome* - **Li-Fraumeni syndrome** is caused by a germline mutation in the **TP53 tumor suppressor gene**, leading to a high predisposition to a wide variety of cancers at a young age. - Common cancers include soft tissue sarcomas, osteosarcomas, breast cancer, brain tumors, and adrenocortical carcinomas; however, the lifetime risk for **pancreatic cancer** is not as prominently high as in Peutz-Jeghers syndrome.
Question 4: Which of the following genes is least likely to be involved in the development of carcinoma of the colon?
- A. K-ras
- B. Beta-Catenin (Correct Answer)
- C. APC
- D. Mismatch Repair Genes
Explanation: ***Beta-Catenin*** - While **beta-catenin protein accumulation** is critical in colorectal cancer pathogenesis (primarily through APC mutations), direct mutations in the **CTNNB1 gene** (encoding beta-catenin) are **rare in colorectal cancer** (~5% of cases) [1]. - Most colorectal cancers achieve beta-catenin activation indirectly through **APC inactivation**, making beta-catenin gene mutations the least likely mechanism among the listed options [1]. - This contrasts with other cancers (e.g., hepatocellular carcinoma, endometrial cancer) where direct CTNNB1 mutations are more common. *APC* - The **adenomatous polyposis coli (APC) gene** is mutated in approximately **80% of sporadic colorectal cancers**, representing the earliest and most common genetic alteration in the **adenoma-carcinoma sequence** [1]. - APC loss leads to beta-catenin accumulation and constitutive **Wnt pathway activation**, driving uncontrolled cell proliferation [2]. - Germline APC mutations cause **familial adenomatous polyposis (FAP)** [5]. *K-ras* - **K-ras oncogene** mutations occur in **30-50% of colorectal cancers**, typically as an intermediate event in the adenoma-carcinoma progression [1]. - These activating mutations lead to constitutive signaling through the **MAPK pathway**, promoting cell proliferation and survival independent of growth factor signals. *Mismatch Repair Genes* - **Mismatch repair (MMR) genes** (MLH1, MSH2, MSH6, PMS2) are involved in **15-20% of all colorectal cancers** [4]. - Germline mutations cause **Lynch syndrome (HNPCC)** (~3% of CRCs) [5]. - Sporadic **MLH1 promoter hypermethylation** accounts for 12-15% of colorectal cancers, leading to **microsatellite instability (MSI-high)** tumors [3]. - MMR deficiency represents an alternative, well-established pathway of colorectal carcinogenesis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 819. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 304-305. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 819-821. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 373-374. [5] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 821-822.
Question 5: Which condition is associated with the highest risk of colorectal cancer?
- A. Crohn's disease
- B. Ulcerative colitis
- C. Familial polyposis (Correct Answer)
- D. Infantile polyp
Explanation: ***Familial polyposis*** - Familial polyposis, particularly **Familial Adenomatous Polyposis (FAP)**, is associated with a nearly **100% risk of colorectal cancer** if untreated due to the development of numerous adenomatous polyps [1]. - Patients with FAP typically require **prophylactic colectomy** due to this high risk [1]. *Crohn's disease* - While Crohn's disease does increase the risk of colorectal cancer, the risk is **lower** compared to conditions like familial polyposis. - Colorectal cancer develops more commonly in long-standing cases and with **persistence of inflammation**. *Ulcerative colitis* - Ulcerative colitis also carries an increased risk for colorectal cancer, but it requires a longer duration of disease (often **over 8 years**) to significantly increase risk. - Cancer risk in ulcerative colitis is related to the extent of **colonic involvement**, making it less severe than familial polyposis. *Infantile polyp* - Infantile polyps are benign growths occurring in children and are generally **not associated with increased colorectal cancer risk** [1]. - These polyps usually **do not progress** to malignancy and are often discovered incidentally.
Question 6: Identify the condition shown in the image.
- A. Villous adenoma
- B. Hyperplastic polyp
- C. Juvenile polyp
- D. Peutz-Jeghers syndrome (Correct Answer)
Explanation: ***Juvenile polyp*** - Juvenile polyps are commonly found in children and present as **solitary lesions**, usually in the rectum [1]. - They typically appear **smooth**, with a characteristic lobulated surface, emphasizing their benign nature. *Villous adenoma* - Villous adenomas are characterized by **frond-like projections** and have a higher risk of malignant transformation [2]. - These lesions usually occur in adults and are typically larger and more **invasive** compared to juvenile polyps [2]. *Hyperplastic polyp* - Hyperplastic polyps are small, **benign lesions** that result from epithelial overgrowth with a typical **smooth surface** [3]. - They are usually found in the colon and do not present with the distinctive features of juvenile polyps. *Peutz-Jeghers polyp* - Peutz-Jeghers polyps are associated with **Peutz-Jeghers syndrome** and exhibit a **hamartomatous** appearance, often protruding from various gastrointestinal sites [1]. - These polyps are typically more **complex** and can be found in older children and adults, differing significantly from juvenile polyps [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 813. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 371-372. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 811-813.
Question 7: A 5-year-old child presented with a history of blood in the stools. On examination, there was a polypoid mass in the rectum, a biopsy of which showed as below. The most probable diagnosis is?
- A. Villous adenoma
- B. Juvenile polyp (Correct Answer)
- C. Vascular malformation
- D. Serrated adenoma
Explanation: ***Juvenile polyp*** - The image shows **dilated, cystically appearing glands** within an inflamed lamina propria, which is characteristic of a juvenile polyp. - Juvenile polyps are the most common cause of **rectal bleeding** in children under 10 years of age and are typically benign. *Villous adenoma* - Villous adenomas are **neoplastic polyps** with a **villous (finger-like) architecture** and are more commonly seen in older adults [1]. - They typically show **dysplastic changes** and are considered premalignant [1]. *Vascular malformation* - Vascular malformations consist of **abnormally formed blood vessels** (e.g., arteriovenous malformations, hemangiomas) and would appear as dilated or aberrant vessels on histology. - While they can cause bleeding, the image does not show a predominance of vascular structures. *Serrated adenoma* - Serrated adenomas are characterized by **sawtooth-like glandular infoldings** and show varying degrees of dysplasia. - They are typically found in adults and are considered premalignant, not benign growths usually found in children. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 371-372.
Question 8: In a patient presenting with gallbladder abnormalities, which condition is characterized by a speckled appearance of the gallbladder mucosa resembling a strawberry?
- A. Gangrene of the gallbladder
- B. Porcelain gallbladder
- C. Adenomatosis of the gallbladder
- D. Cholesterolosis of the gallbladder (Correct Answer)
Explanation: ***Cholesterolosis of the gallbladder*** - This condition is characterized by the accumulation of **cholesterol esters** and **triglycerides** within macrophages in the lamina propria of the gallbladder, creating a **speckled appearance** often referred to as a "**strawberry gallbladder**". - It is typically asymptomatic but can be associated with **cholelithiasis** (gallstones) in some cases. *Gangrene of the gallbladder* - This is a severe complication of **acute cholecystitis** where the gallbladder tissue dies due to **ischemia**, often appearing necrotic and dark, not speckled. - It presents with severe abdominal pain, fever, and signs of **sepsis**, which is distinct from a speckled appearance. *Porcelain gallbladder* - This condition involves **extensive calcification of the gallbladder wall**, making it brittle and rigid, and is often associated with an increased risk of gallbladder cancer. - Its appearance is typically hard and white due to calcification, not speckled like a strawberry. *Adenomatosis of the gallbladder* - This term is often used interchangeably with **adenomyomatosis**, which involves **hypertrophy of the muscularis propria** and **outpouchings of the mucosa** (Rokitansky-Aschoff sinuses). - It presents as nodular or diffuse thickening of the gallbladder wall, not a speckled mucosal pattern.
Question 9: 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 10: Which of the following statements about MALToma is true?
- A. They are primary gastric lymphomas
- B. H. Pylori infection is a known risk factor (Correct Answer)
- C. They are a type of T cell lymphoma
- D. Exclusively seen in the gastric antrum
Explanation: ***H. Pylori infection is a risk factor*** - MALToma, or **mucosa-associated lymphoid tissue lymphoma**, is often associated with chronic **H. Pylori infection**, making it a significant risk factor [1]. - **Eradication of H. Pylori** can lead to regression of MALT lymphoma, further supporting the association. *They are a type of T cell lymphoma* - MALToma is classified as a **B-cell lymphoma**, primarily arising from **marginal zone B cells** [1]. - T-cell lymphomas differ significantly in their **pathophysiology** and typical clinical presentations. *They are secondary gastric lymphomas* - MALTomas typically arise **primarily** in the gastric mucosa rather than as secondary lymphomas from another site [1]. - Secondary lymphomas are usually related to more aggressive forms and are often associated with **systemic involvement**. *Commonly seen in gastric cardia* - MALTomas are most frequently found in the **stomach** but are not specifically concentrated in the **gastric cardia** region. - They can also manifest in other areas such as the **antrum**, making this statement misleading. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 356-358.
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