Neoplasia Practice Questions

Q: What is the commonest site of metastasis for Wilms' tumour?

Lungs. **Explanation:** Wilms’ tumour (Nephroblastoma) is the most common primary renal malignancy in children. The correct answer is **Lungs** because Wilms’ tumour typically spreads via the **hematogenous route**. Once the tumour cells enter the renal vein and inferior vena cava, the first major capillary bed they encounter is in the pulmonary circulation, making the lungs the most frequent site of distant spread [1]. **Analysis of Options:** * **B. Lungs (Correct):** Approximately 80% of patients with metastatic disease at diagnosis will have pulmonary involvement. These often appear as "cannonball" metastases on a chest X-ray. * **A. Bones:** Unlike Neuroblastoma (the main differential diagnosis), Wilms’ tumour rarely metastasizes to the bones. Bone pain or lesions should prompt a clinician to consider Clear Cell Sarcoma of the Kidney (CCSK) instead. * **C. Liver:** The liver is the second most common site of distant metastasis, but it occurs less frequently than pulmonary spread. * **D. Brain:** Brain metastasis is extremely rare in Wilms’ tumour and usually only occurs in the very late stages of aggressive or relapsed disease. **High-Yield Clinical Pearls for NEET-PG:** * **Triphasic Morphology:** On histology, Wilms’ tumour classically shows three components: Blastemal, Stromal, and Epithelial cells. * **WAGR Syndrome:** Associated with *WT1* gene deletion (Wilms’ tumour, Aniridia, Genitourinary anomalies, and intellectual disability/Retardation). * **Beckwith-Wiedemann Syndrome:** Associated with *WT2* gene (imprinting defect), characterized by macroglossia, organomegaly, and hemihypertrophy. * **Staging:** Unlike many other tumours, the presence of lung metastasis in Wilms' tumour classifies it as **Stage IV**. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 492-493.

Question 1

Which of the following is NOT a tumor marker?

Accepted Answer

Alpha-1 antitrypsin

Answer

Tartarate resistant alkaline phosphatase

Answer

CEA

Answer

AFP

Question 2

Which of the following is NOT a chemical carcinogen?

Accepted Answer

Beta carotene

Answer

Benzene

Answer

Thorotrast

Answer

Nitrates

Question 3

Which of the following is a marker for squamous cell carcinoma?

Accepted Answer

Cytokeratin

Answer

Vimentin

Answer

Desmin

Answer

Myogenin

Question 4

A 68-year-old man with a history of metastatic prostate cancer presents with significant weight loss, loss of appetite, and loss of energy over the past 2 months. Which of the following is most likely responsible for his current spectrum of conditions?

Accepted Answer

Tumor necrosis factor-alpha

Answer

Platelet-derived growth factor

Answer

Fibroblast growth factor

Answer

Interleukin-2

Question 5

Which one of the following is a benign tumor?

Accepted Answer

All of the above

Answer

Atheroma

Answer

Granuloma

Answer

Papilloma

Question 6

What is the nature of a hamartoma?

Accepted Answer

Non-neoplastic

Answer

Neoplastic

Answer

Afflicted by trauma

Answer

Hormonal disturbance

Question 7

Which of the following tumors is the prototype of hereditary tumors of childhood?

Accepted Answer

Retinoblastoma

Answer

Leukemia

Answer

Neuroblastoma

Answer

Wilms tumor

Question 8

Polycythemia is seen with which tumor?

Accepted Answer

Renal cell carcinoma

Answer

Endometrial carcinoma

Answer

Lung carcinoma

Answer

Fibrosarcoma

Question 9

What is the commonest site of metastasis for Wilms' tumour?

Accepted Answer

Lungs

Answer

Bones

Answer

Liver

Answer

Brain

Question 10

Which of the following is the most reliable feature suggestive of malignant transformation of pheochromocytoma exclusively?

Accepted Answer

None of the above

Answer

Presence of mitotic figures

Answer

Capsular invasion

Answer

Vascular invasion

Neoplasia — MCQs

Neoplasia — MCQs

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