Neoplasia Practice Questions

Q: What is the most common carcinoma of the breast?

Ductal carcinoma. Explanation: Invasive Ductal Carcinoma (IDC), also known as "Invasive Carcinoma of No Special Type (NST)," is the most common histological subtype of breast cancer, accounting for approximately 70–80% of all cases [1]. It originates from the ductal epithelium and is characterized by its ability to incite a prominent fibrotic response (desmoplasia), which gives the tumor its classic "hard" or "scirrhous" consistency on palpation. Analysis of Options: * B. Colloid (Mucinous) Carcinoma: This is a rare subtype (approx. 2–3%) typically seen in elderly women. It is characterized by clusters of tumor cells floating in "pools of mucus" and generally carries a better prognosis than IDC. * C. Lobular Carcinoma: This is the second most common type (approx. 10–15%) [2]. It is unique for its "Indian file" pattern of cell arrangement and is frequently bilateral and multicentric due to the loss of E-cadherin expression [2]. * D. Sarcoma Phylloides: This is a fibroepithelial tumor, not a carcinoma. While it can be malignant, it arises from the intralobular stroma and is much rarer than epithelial ductal cancers. NEET-PG High-Yield Pearls: * Most common site: Upper Outer Quadrant (UOQ) of the breast. * Molecular Marker: Loss of E-cadherin is the hallmark of Lobular Carcinoma; it is present in Ductal Carcinoma. * Mammography: IDC often presents as a radiodense mass with "spiculated" margins. * Prognostic Factor: The most important prognostic factor for breast cancer is the axillary lymph node status, while the most important factor for long-term survival is the tumor stage at diagnosis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1064. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 454-455.

Q: The BRCA2 gene is associated with which type of carcinoma?

Breast. **Explanation:** **BRCA2 (Breast Cancer 2)** is a tumor suppressor gene located on **chromosome 13q12.3**. Its primary function is to encode a protein involved in the repair of double-stranded DNA breaks via **homologous recombination**. When this gene undergoes a germline mutation, the DNA repair mechanism is compromised, leading to genomic instability and a significantly increased risk of malignancies, most notably **Breast Carcinoma** [1]. * **Why Option A is Correct:** BRCA2 mutations are associated with a high lifetime risk of female breast cancer (approx. 45%) and are the most common cause of **hereditary male breast cancer**. * **Why Options B, C, and D are Incorrect:** While BRCA2 mutations increase the risk of several systemic cancers, they are not classically associated with primary Lung, Liver, or Gastric carcinomas. Lung cancer is primarily linked to smoking and EGFR/ALK mutations; Liver cancer to HBV/HCV and cirrhosis; and Gastric cancer to *H. pylori* and CDH1 mutations. **High-Yield Clinical Pearls for NEET-PG:** 1. **Chromosome Locations:** BRCA1 is on **17q21**, while BRCA2 is on **13q12**. (Mnemonic: BRCA**1** is on **17**, BRCA**2** is on **13**). 2. **Associated Malignancies:** Beyond breast cancer, BRCA2 is strongly linked to **Ovarian cancer** (though less than BRCA1), **Prostate cancer** (aggressive forms), and **Pancreatic cancer** [1]. 3. **Fanconi Anemia:** Biallelic mutations in BRCA2 (FANCD1) result in a subtype of Fanconi Anemia. 4. **Treatment:** Tumors with BRCA mutations are particularly sensitive to **PARP inhibitors** (e.g., Olaparib) due to the concept of synthetic lethality. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1058-1059.

Q: Sarcoma of the soft tissues spreads by which of the following routes?

Blood vessels. **Explanation:** **1. Why Blood Vessels (Hematogenous Spread) is Correct:** The primary mode of metastasis for **sarcomas** (malignant tumors of mesenchymal origin) is the hematogenous route [1]. This occurs because sarcomas are typically highly vascularized and lack a well-developed lymphatic drainage system within the tumor stroma. Consequently, malignant cells invade thin-walled veins and capillaries, commonly leading to secondary deposits in the **lungs** (the most frequent site of distant metastasis for most sarcomas) [1]. **2. Analysis of Incorrect Options:** * **Lymphatics:** This is the characteristic route for **carcinomas** (malignant tumors of epithelial origin) [1]. While most sarcomas avoid lymphatics, there are notable exceptions (see Clinical Pearls). * **Direct Invasion & Local Infiltration:** While sarcomas are locally aggressive and infiltrate surrounding tissues (muscles, fascia), these terms describe **local growth patterns** rather than the primary route of distant metastasis. In the context of "spread" in oncology exams, the question usually refers to the mode of systemic dissemination. **3. Clinical Pearls for NEET-PG:** * **The "Rule of Exceptions":** While sarcomas spread via blood, remember the mnemonic **SCARE** for sarcomas that frequently spread via **lymphatics**: * **S**ynovial sarcoma * **C**lear cell sarcoma * **A**ngiosarcoma * **R**habdomyosarcoma * **E**pithelioid sarcoma * **Carcinoma Exception:** Conversely, Renal Cell Carcinoma (RCC), Hepatocellular Carcinoma (HCC), Follicular Carcinoma of Thyroid, and Choriocarcinoma prefer **hematogenous spread** over lymphatics [1]. * **First Site:** For most sarcomas, the first evidence of hematogenous spread is seen on a Chest X-ray or CT as "cannon-ball" pulmonary nodules [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, p. 282.

Question 1

Kaposi sarcoma associated herpes virus causes all of the following, except?

Accepted Answer

Burkitt's lymphoma

Answer

Primary effusion lymphoma

Answer

Castleman disease

Answer

Kaposi sarcoma

Question 2

Which autosomal recessive condition presents as a cancer syndrome in children?

Accepted Answer

Ataxia-telangiectasia

Answer

Neurofibromatosis

Answer

Sturge-Weber syndrome

Answer

Tuberous sclerosis complex

Question 3

Beta-naphthyl amine dyes predispose to which of the following cancers?

Accepted Answer

Urinary bladder carcinoma

Answer

Renal carcinoma

Answer

Hepatic carcinoma

Answer

Lung carcinoma

Question 4

All of the following cancers commonly metastasize to the liver EXCEPT?

Accepted Answer

Prostate

Answer

Breast

Answer

Colon

Answer

Pancreas

Question 5

What is the most common carcinoma of the breast?

Accepted Answer

Ductal carcinoma

Answer

Colloid carcinoma

Answer

Lobular carcinoma

Answer

Sarcoma phylloides

Question 6

Which virus is implicated in Burkitt's lymphoma?

Accepted Answer

EBV

Answer

HTLV

Answer

HPV

Answer

HHV8

Question 7

The BRCA2 gene is associated with which type of carcinoma?

Accepted Answer

Breast

Answer

Lung

Answer

Liver

Answer

Gastric

Question 8

What is the term for a benign tumor of voluntary muscle?

Accepted Answer

Rhabdomyoma

Answer

Leiomyoma

Answer

Rhabdomyosarcoma

Answer

Leiomyosarcoma

Question 9

Which of the following is NOT a feature of dyskeratosis?

Accepted Answer

Most common congenital syndrome involving nails

Answer

Premalignant leukoplakia

Answer

Atrophy and telangiectasia

Answer

Hypopigmented macules

Question 10

Sarcoma of the soft tissues spreads by which of the following routes?

Accepted Answer

Blood vessels

Answer

Lymphatics

Answer

Direct invasion

Answer

Local infiltration

Neoplasia — MCQs

Neoplasia — MCQs

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