Nomenclature and Classification of Tumors — MCQs
Most common benign breast tumour:
Which gene mutation is commonly associated with malignant melanoma?
Which of the following is the ovarian counterpart of testicular seminoma?
Identify the condition represented in the image of a testicular tumor.
Which statement is incorrect about the pathology of the bone tumor?
Which of the following is an epiphyseal tumor?
Seminoma corresponds to
The most chemoresistant tumor amongst the following:
What is the term for a localized malformation composed of an excessive but disorganized arrangement of cells and tissues indigenous to the site?
Which of the following is an epiphyseal lesion?
Nomenclature and Classification of Tumors Indian Medical PG Practice Questions and MCQs
Question 1: Most common benign breast tumour:
- A. Phyllodes tumour
- B. Fibroadenosis
- C. DCIS
- D. Fibroadenoma (Correct Answer)
Explanation: ***Fibroadenoma*** - **Fibroadenomas** are the **most common benign breast tumors**, typically presenting as mobile, firm, and non-tender masses [1]. - They are composed of both **glandular and stromal tissue** and are more prevalent in younger women [1]. *Phyllodes tumour* - **Phyllodes tumors** are much **rarer** than fibroadenomas and can be benign, borderline, or malignant [3]. - They tend to grow **rapidly** and are characterized by a leaf-like stromal pattern [3]. *Fibroadenosis* - **Fibroadenosis** (or fibrocystic changes) refers to a collection of **benign changes** in the breast tissue, including cysts, fibrosis, and epithelial hyperplasia, rather than a single tumor [2]. - It is a common condition causing lumpy and painful breasts, especially before menstruation [4]. *DCIS* - **Ductal Carcinoma In Situ (DCIS)** is a **non-invasive form of breast cancer** where abnormal cells are confined to the milk ducts. - It is not a benign tumor and carries a risk of progression to invasive breast cancer. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 448-449. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 445-446. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1074. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1052.
Question 2: Which gene mutation is commonly associated with malignant melanoma?
- A. MYCN
- B. CDKN2A (Correct Answer)
- C. RET
- D. BRAF
Explanation: ***CDK2A*** - CDK2A mutations are implicated in malignant melanoma as they disrupt the **cell cycle regulation**, contributing to uncontrolled cell growth [1]. - Loss of CDK2A function leads to reduced **p16INK4A**, a crucial inhibitor of cyclin-dependent kinases involved in **G1/S phase transition** [1,3]. - Germline mutations of p16 (CDKN2A) are present in 25% of melanoma-prone kindreds [2], and germline mutations in CDKN2A are associated with familial forms of melanoma [3]. *RET* - RET mutations are primarily associated with **medullary thyroid carcinoma** and **multiple endocrine neoplasia type 2**, not melanoma. - It is involved in the signaling pathways but does not have a direct link to melanoma pathogenesis. *None* - Suggesting "none" misrepresents the reality that specific mutations do occur in malignant melanoma, including **CDK2A** and **BRAF**. - This option fails to recognize the importance of genetic alterations in cancer development and progression. *N-myc* - N-myc mutations are primarily associated with **neuroblastoma** and not typically linked to malignant melanoma. - In melanoma, mutations of this gene do not play a significant role in its pathophysiology compared to another tumor suppressor gene like **CDK2A**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, pp. 1150-1151. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 297-298. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 305-306.
Question 3: Which of the following is the ovarian counterpart of testicular seminoma?
- A. Dermoid
- B. Dysgerminoma (Correct Answer)
- C. Endodermal sinus tumor
- D. Brenner tumor
Explanation: ***Dysgerminoma*** - **Dysgerminoma** is the most common malignant germ cell tumor of the ovary and is histologically identical to testicular **seminoma** [1]. - Both tumors arise from **primordial germ cells** and share similar morphology, including large, uniform cells with clear cytoplasm and prominent nucleoli, often arranged in nests and separated by fibrous septa with lymphocytic infiltration [1], [3]. *Dermoid* - **Dermoid cysts**, also known as mature cystic teratomas, are germ cell tumors composed of well-differentiated tissues from all three germ layers (ectoderm, mesoderm, endoderm) [2]. - They are typically benign and do not have a direct testicular counterpart that is histologically identical to seminoma. *Brenner tumor* - **Brenner tumors** are uncommon epithelial ovarian tumors characterized by nests of transitional epithelial cells resembling urothelium, separated by a fibrous stroma. - They are not germ cell tumors and do not have a testicular counterpart to seminoma. *Endodermal sinus tumor* - The **endodermal sinus tumor** (yolk sac tumor) is another type of malignant germ cell tumor of the ovary, but it is characterized by structures resembling the primitive yolk sac and the presence of **Schiller-Duval bodies**. - While it has a testicular counterpart, it is not histologically identical to seminoma; its testicular counterpart is also called a yolk sac tumor and is distinct from seminoma [3]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1034-1035. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1035-1036. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 979-980.
Question 4: Identify the condition represented in the image of a testicular tumor.
- A. Non-seminomatous germ cell tumor
- B. Teratoma (testicular tumor)
- C. Seminoma (Correct Answer)
- D. Leydig cell tumor
Explanation: ***Seminoma*** - Seminoma is a type of **germ cell tumor** that typically presents with a **painless testicular mass**, making it one of the common types of testicular cancer [1]. - This condition is characterized by the presence of **large, uniform cells** and is highly sensitive to **radiation therapy**, which aids in management [1]. *Non-seminoma* - Non-seminomas encompass a group of tumors including **embryonal carcinoma**, **choriocarcinoma**, and **yolk sac tumor**, which often present with more variable histological features [1]. - Generally considered more aggressive than seminomas, they may yield **higher levels of tumor markers** such as **AFP** or **hCG** [1]. *Teratoma* - Teratomas typically contain **multiple germ layers (ectoderm, mesoderm, and endoderm)**, often presenting with more complex histopathology compared to seminomas [1]. - They can occur in both children and adults, but in adults, they are often a component of a **non-seminomatous germ cell tumor** instead of a pure form [1,2]. *Germ cell differentiate tumor* - This term broadly refers to any tumor originating from **germ cells**, including both seminomas and non-seminomas, lacking specificity [1]. - It does not reflect the defined characteristics of seminoma and can encompass a range of histological types with diverse behaviors [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 979-982. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 512-513.
Question 5: Which statement is incorrect about the pathology of the bone tumor?
- A. Tumor has distinct margin
- B. Tumor arises from epiphyseal to metaphyseal region
- C. Eccentric lesion
- D. Chemotherapy is the treatment of choice for all bone tumors. (Correct Answer)
Explanation: ***Tumor has distinct margin*** - A **distinct margin** often indicates a benign tumor, while malignant tumors typically show **infiltrative margins**. - In bone tumors, particularly malignant ones, the lack of clear demarcation is a key pathological feature. *Chemotherapy is the treatment of choice* - While chemotherapy may be used for certain **malignant bone tumors**, it is not the first-line treatment for most bone tumors [1]. - The primary treatment is often **surgical excision**, especially for localized lesions [1]. *Tumor arise from epiphyseal to metaphyseal region* - While some tumors can originate in these areas, many actually arise from the **diaphyseal** region in bone tumors like osteosarcoma. - This option misrepresents the common locations where various tumors develop, as osteochondromas tend to develop near the epiphyses of limb bones [2]. *Eccentric lesion* - Many bone tumors do indeed present as **eccentric lesions**, especially benign ones like **osteochondromas**. - However, this feature does not apply universally, as some malignant tumors can also be **central or infiltrative** in nature. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 673-674. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 672-673.
Question 6: Which of the following is an epiphyseal tumor?
- A. Osteosarcoma
- B. Osteoid osteoma
- C. Chondroblastoma (Correct Answer)
- D. Adamantinoma
Explanation: ***Chondroblastoma*** - **Chondroblastoma** is a rare, benign cartilaginous tumor that typically originates in the **epiphysis** of long bones before the closure of growth plates. - It is histologically characterized by chondroblast-like cells, multinucleated giant cells, and chondroid matrix, and radiographically appears as a lytic lesion with a sclerotic rim in the epiphysis. *Osteosarcoma* - **Osteosarcoma** is the most common primary malignant bone tumor and typically originates in the **metaphysis** of long bones, particularly around the knee. - It invades the surrounding bone and soft tissues, often presenting with a **Codman triangle** or **sunburst pattern** on imaging studies. *Osteoid osteoma* - **Osteoid osteoma** is a benign bone-forming tumor primarily found in the **cortex** of long bones, although it can occur in other locations, presenting with nocturnal pain relieved by NSAIDs. - It is characterized by a central radiolucent nidus surrounded by reactive sclerotic bone. *Adamantinoma* - **Adamantinoma** is an extremely rare, low-grade malignant tumor that almost exclusively occurs in the **tibia diaphysis**. - It is thought to originate from epithelial cells and presents as a lytic lesion within the cortical bone, often with a polycystic appearance.
Question 7: Seminoma corresponds to
- A. Dysgerminoma (Correct Answer)
- B. Granulosa tumour
- C. Choriocarcinoma
- D. Luteal cyst
Explanation: ***Dysgerminoma*** - **Dysgerminoma** is the ovarian equivalent of a testicular **seminoma**, both originating from **germ cells** and exhibiting similar histological features [1], [3]. - They tend to be sensitive to **radiotherapy** and **chemotherapy**, often presenting as solid, lobulated tumors. *Granulosa tumour* - **Granulosa cell tumors** are sex cord-stromal tumors, not germ cell tumors, and are characterized by **estrogen production**. - They do not share the same cellular origin or histological features with seminoma. *Choriocarcinoma* - **Choriocarcinoma** is a highly malignant germ cell tumor that differentiates towards trophoblastic tissue and produces **human chorionic gonadotropin (hCG)** [2], [5]. - While it is a type of germ cell tumor, it is distinct from seminoma/dysgerminoma due to its unique differentiation and aggressive nature [4]. *Luteal cyst* - A **luteal cyst** is a benign functional ovarian cyst that forms from the corpus luteum after ovulation, not a neoplastic germ cell tumor. - It is a physiological structure, distinct from cancerous growths like seminoma or dysgerminoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1140-1141. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 979-980. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1034-1035. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 512-513. [5] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 980-982.
Question 8: The most chemoresistant tumor amongst the following:
- A. Osteosarcoma
- B. Clear cell sarcoma
- C. Undifferentiated pleomorphic sarcoma (Correct Answer)
- D. Synovial sarcoma
Explanation: ***Undifferentiated pleomorphic sarcoma*** - **Undifferentiated pleomorphic sarcoma (UPS)** is known for its aggressive nature and inherent resistance to conventional chemotherapy. - Its **heterogeneous genetic profile** and lack of specific therapeutic targets contribute to its poor response to systemic treatments. *Osteosarcoma* - While osteosarcoma is a highly aggressive bone tumor, it is generally considered **chemosensitive**, particularly to agents like **methotrexate, doxorubicin, and cisplatin**. - **Neoadjuvant chemotherapy** is a standard part of treatment, often leading to significant tumor necrosis and improved outcomes. *Clear cell sarcoma* - **Clear cell sarcoma** is a rare soft tissue sarcoma with a distinct genetic translocation, t(12;22), involving the **EWSR1 gene**. - Although it can be challenging to treat, it is not consistently ranked as the most chemoresistant among sarcomas; specific targeted therapies are being investigated. *Synovial sarcoma* - **Synovial sarcoma** is often sensitive to chemotherapy, particularly regimens containing **ifosfamide and doxorubicin**. - Its response to chemotherapy can be variable, but it is generally *more chemosensitive* than undifferentiated pleomorphic sarcoma.
Question 9: What is the term for a localized malformation composed of an excessive but disorganized arrangement of cells and tissues indigenous to the site?
- A. Hamartoma (Correct Answer)
- B. Malignant tumor
- C. Choristoma
- D. None of the options
Explanation: ***Hamartoma*** - A **hamartoma** is an overgrowth of cells and tissues that are normally found in the affected area, but in a disordered fashion, creating a tumor-like growth [1]. - It's a **benign (non-cancerous)** lesion, often congenital, that grows at the same rate as the surrounding tissues. *Malignant tumor* - A **malignant tumor** is characterized by uncontrolled cell growth that invades surrounding tissues and can metastasize to distant sites. - Unlike a hamartoma, a malignant tumor consists of **abnormal, dysplastic cells** that do not resemble the normal tissues of the organ. *Choristoma* - A choristoma is a **benign tumor-like growth** consisting of normal cells or tissues that are **heterotopic**, meaning they are located in an abnormal site. - An example is the presence of pancreatic tissue in the wall of the stomach, which is normal tissue in an abnormal location, unlike a hamartoma which has normal tissue in the correct location but in a disorganized manner. *None of the options* - This option is incorrect because **hamartoma** accurately describes the overgrowth of a skin structure at a localized region made of normal, but disorganized, tissue [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Disorders Involving Inflammatory And Haemopoietic Cells, pp. 651-652.
Question 10: Which of the following is an epiphyseal lesion?
- A. Fibrosarcoma
- B. Chondroblastoma (Correct Answer)
- C. Chondrosarcoma
- D. Non-ossifying fibroma
Explanation: **Chondroblastoma** - **Chondroblastoma** is a rare, benign bone tumor that typically arises in the **epiphysis** of long bones before epiphyseal fusion. - It specifically originates from **chondroblasts** within the epiphyseal growth plate region. *Fibrosarcoma* - **Fibrosarcoma** is a malignant tumor of fibrous connective tissue origin, typically found in the **metaphysis** or **diaphysis** of long bones. - It rarely affects the **epiphyseal** region and is characterized by aggressive local invasion and metastases. *Chondrosarcoma* - **Chondrosarcoma** is a malignant tumor of cartilage, commonly arising in the **metaphysis** or **diaphysis** of long bones, particularly the femur, humerus, and pelvis. - While it involves cartilage, its typical location is not primarily **epiphyseal** and it is characterized by malignant cartilaginous matrix. *Non-ossifying fibroma* - A **non-ossifying fibroma** (NOF), also known as a fibrous cortical defect, is a common benign fibrous lesion typically found in the **metaphysis** of long bones. - These lesions are usually asymptomatic and self-limiting, often resolving spontaneously, and do not originate in the **epiphysis**.
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