Neoplasia Practice Questions

Q: Which of the following is NOT a familial breast cancer gene?

P16. ### Explanation The correct answer is **C. P16**. **Why P16 is the correct answer:** The **P16/INK4a** gene (located on chromosome 9p21) is a tumor suppressor gene that regulates the cell cycle by inhibiting Cyclin-Dependent Kinases (CDK4/6) [1]. While it is a critical gene in oncology, its germline mutations are primarily associated with **Familial Melanoma** and **Pancreatic Cancer**, not familial breast cancer [1]. In the context of breast pathology, P16 immunohistochemistry is more commonly used as a surrogate marker for HPV infection in cervical or oropharyngeal cancers, rather than a screening tool for hereditary breast syndromes. **Analysis of Incorrect Options:** * **BRCA1 (Option A):** The most common cause of familial breast cancer (Chromosome 17q). It is associated with a high risk of medullary carcinoma of the breast and serous ovarian carcinoma. * **P53 (Option B):** Germline mutations in *TP53* (Chromosome 17p) cause **Li-Fraumeni Syndrome**. Breast cancer is one of the "core" cancers in this syndrome, often occurring at a very young age. * **PTEN (Option D):** Germline mutations in *PTEN* (Chromosome 10q) lead to **Cowden Syndrome**. This syndrome is characterized by multiple hamartomas and a significantly increased risk of breast, thyroid (follicular), and endometrial cancers. **High-Yield Clinical Pearls for NEET-PG:** * **BRCA2:** Located on Chromosome 13q; associated with **male breast cancer** and prostatic/pancreatic cancers. * **STK11:** Associated with **Peutz-Jeghers Syndrome**, which carries an increased risk of breast cancer. * **CHEK2:** A cell cycle checkpoint gene also implicated in moderate-risk familial breast cancer. * **CDH1:** Mutations lead to **Hereditary Diffuse Gastric Cancer** and are specifically linked to **Lobular Carcinoma** of the breast. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 297-306.

Q: Which of the following genetic mutations is involved in breast carcinoma?

BRCA. **Explanation:** **Correct Answer: B. BRCA** The **BRCA1 and BRCA2** genes are tumor suppressor genes involved in the repair of double-stranded DNA breaks via homologous recombination [1]. Mutations in these genes lead to genomic instability, significantly increasing the risk of **hereditary breast and ovarian cancer syndromes** [1]. BRCA1 is specifically associated with "triple-negative" breast cancers, while BRCA2 is linked to male breast cancer and prostatic carcinoma [1]. **Analysis of Incorrect Options:** * **A. APC (Adenomatous Polyposis Coli):** This is a tumor suppressor gene associated with the Wnt signaling pathway. Mutations are primarily linked to **Familial Adenomatous Polyposis (FAP)** and colorectal carcinoma, not breast cancer. * **C. HbAc:** This is a distractor. It likely refers to HbA1c (Glycated Hemoglobin), which is a clinical marker for long-term glucose control in Diabetes Mellitus, having no role in oncogenesis. * **D. RB Gene:** The Retinoblastoma (RB) gene is the "governor of the cell cycle" (regulating the G1-S checkpoint). While it is mutated in various cancers, its primary associations are **Retinoblastoma** and **Osteosarcoma**. **High-Yield NEET-PG Pearls:** * **BRCA1 Location:** Chromosome 17q21. * **BRCA2 Location:** Chromosome 13q12.3. * **Li-Fraumeni Syndrome:** Another hereditary cause of breast cancer involving the **TP53** mutation (the "guardian of the genome") [1]. * **HER2/neu (ERBB2):** A proto-oncogene (tyrosine kinase receptor) amplified in ~15-20% of breast cancers, serving as a target for Trastuzumab [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1058-1060.

Q: Regarding the phyllodes tumor, all of the following statements are true, except:

Most of these tumors are high grade. **Explanation:** Phyllodes tumors are fibroepithelial neoplasms of the breast that arise from the **intralobular stroma** [1]. Understanding their grading and behavior is crucial for NEET-PG. **Why Option C is the correct answer (False statement):** The majority of phyllodes tumors (approximately 60–75%) are **low-grade (benign)** [1]. Only a small percentage are classified as borderline or high-grade (malignant). Grading is based on stromal cellularity, mitotic rate, nuclear pleomorphism, and the nature of the tumor borders. **Analysis of other options:** * **Option A (True):** Unlike common fibroadenomas which can be interlobular, phyllodes tumors specifically arise from the **intralobular stroma** [1]. * **Option B (True):** Recent molecular studies have identified that the **overexpression of HOXB13** (a homeobox gene) is a significant biomarker for increased stromal proliferation and is associated with higher grades and more aggressive clinical behavior. * **Option D (True):** Phyllodes tumors are biphasic (epithelial and stromal). However, the malignant potential resides solely in the **stromal component** [1]. Consequently, when these tumors metastasize (most commonly to the lungs via hematogenous spread), the deposits consist only of the sarcomatous stromal elements, not the epithelium [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Morphology:** Characterized by "leaf-like" (phyllodes) projections of stroma covered by epithelium [1]. * **Age:** Typically occurs in the 6th decade (older than fibroadenoma patients). * **Treatment:** Wide local excision with 1cm margins is preferred over simple enucleation to prevent local recurrence [1]. * **Distinction:** Unlike fibroadenomas, phyllodes tumors show increased stromal cellularity and "stromal overgrowth" [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1072-1074.

Question 1

Desmoplasia is defined as:

Accepted Answer

Abundant collagenous stroma in a tumor

Answer

Increase in number of neoplastic cells

Answer

Benign tumors arising in fibrous tissue

Answer

Benign cartilaginous tumors

Question 2

Psammoma bodies may be seen in all of the following conditions, except?

Accepted Answer

Follicular carcinoma of the thyroid

Answer

Papillary carcinoma of the thyroid

Answer

Meningioma

Answer

Serous cystadenocarcinoma of the ovary

Question 3

A 45-year-old woman presents with abdominal pain and vaginal bleeding. A hysterectomy is performed and shows a benign tumor of the uterus derived from a smooth muscle cell. What is the appropriate diagnosis?

Accepted Answer

Leiomyoma

Answer

Angiomyolipoma

Answer

Leiomyosarcoma

Answer

Myxoma

Question 4

Which of the following is NOT a familial breast cancer gene?

Accepted Answer

P16

Answer

BRCA1

Answer

P53

Answer

PTEN

Question 5

Which among the following is not a feature of follicular lymphoma?

Accepted Answer

(11;14) translocation

Answer

BCL2 over expression

Answer

BCL6 rearrangement

Answer

CD5 negative

Question 6

Mutation in the p53 gene is associated with which malignancy?

Accepted Answer

Colorectal carcinoma

Answer

Endometrial carcinoma type 1

Answer

Retinoblastoma

Answer

Prostate cancer

Question 7

Which of the following genetic mutations is involved in breast carcinoma?

Accepted Answer

BRCA

Answer

APC

Answer

HbAc

Answer

RB gene

Question 8

Regarding the phyllodes tumor, all of the following statements are true, except:

Accepted Answer

Most of these tumors are high grade

Answer

Intralobular stromal tumor

Answer

Overexpression of HOXB13 is associated with more aggressive clinical behavior

Answer

Metastasis of only the non-epithelial/stromal component

Question 9

All of the following are examples of a round cell tumor, except?

Accepted Answer

Haemangioblastoma

Answer

Neuroblastoma

Answer

Ewing's sarcoma

Answer

Medulloblastoma

Question 10

Cancer cells derive nutrition from:

Accepted Answer

Glycolysis

Answer

Oxidative phosphorylation

Answer

Increase in mitochondria

Answer

From a fast food joint

Neoplasia — MCQs

Neoplasia — MCQs

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