Neoplasia Practice Questions

Q: Alpha-fetoprotein (AFP) is raised in which of the following conditions?

Hepatic carcinoma. **Explanation:** **Alpha-fetoprotein (AFP)** is a glycoprotein normally synthesized by the fetal liver and yolk sac. In adults, it serves as a highly specific **tumor marker** when its levels are significantly elevated. **Why Hepatic Carcinoma is Correct:** AFP is the gold-standard serum marker for **Hepatocellular Carcinoma (HCC)** [1]. It is produced by malignant hepatocytes that have reverted to a fetal phenotype. A level >400 ng/mL in a patient with a liver mass is highly suggestive of HCC. Additionally, AFP is elevated in **Non-seminomatous Germ Cell Tumors (NSGCT)**, specifically Yolk Sac Tumors (Endodermal Sinus Tumors). **Why Other Options are Incorrect:** * **Renal Carcinoma:** Associated with markers like HIF-1α or CA-IX (in clear cell type), but not AFP. * **Pancreatic Carcinoma:** The primary marker is **CA 19-9**. * **Prostatic Carcinoma:** The specific marker is **PSA (Prostate-Specific Antigen)**; Acid Phosphatase may also be elevated in metastatic cases. **High-Yield Clinical Pearls for NEET-PG:** * **Triple Marker Test:** AFP is used in prenatal screening. Low levels are associated with **Down Syndrome**, while high levels in amniotic fluid/maternal serum indicate **Neural Tube Defects** (e.g., Anencephaly, Spina Bifida). * **Differential Diagnosis:** Moderate elevations of AFP can occur in non-neoplastic conditions like **Cirrhosis** and **Chronic Hepatitis**, so it must be correlated with imaging. * **Yolk Sac Tumor:** AFP is the most sensitive marker for diagnosis and monitoring recurrence in these pediatric germ cell tumors. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 399-400.

Q: Which is a specific marker for prostatic cancer?

Prostate specific antigen. **Explanation:** **Prostate Specific Antigen (PSA)** is the correct answer as it is a glycoprotein enzyme produced by the epithelial cells of the prostate gland. In clinical practice, PSA is the most widely used tumor marker for the screening, diagnosis, and monitoring of prostate cancer [1]. While PSA is "organ-specific" (produced only by prostatic tissue), it is not strictly "cancer-specific," as levels can also rise in benign prostatic hyperplasia (BPH) and prostatitis [1]. However, significantly elevated levels or a rapid "PSA velocity" are highly suggestive of malignancy [1]. **Analysis of Incorrect Options:** * **Lactate Dehydrogenase (LDH):** A non-specific marker of cell turnover. It is elevated in various conditions, including lymphomas, germ cell tumors (especially dysgerminoma), and hemolytic anemias. * **Chromogranin:** A marker for neuroendocrine tumors (e.g., carcinoid tumors, small cell carcinoma of the lung, or pheochromocytoma). * **CA 19-9:** A tumor marker primarily associated with pancreatic adenocarcinoma and cholangiocarcinoma. **NEET-PG High-Yield Pearls:** * **Free vs. Bound PSA:** A *lower* percentage of free PSA is more indicative of prostate cancer, whereas a higher percentage is seen in BPH [1]. * **PSA Density:** Calculated by dividing the PSA level by the prostate volume (measured via ultrasound); higher density increases the suspicion of cancer [1]. * **Prostatic Acid Phosphatase (PAP):** An older marker for prostate cancer, now largely replaced by PSA, but still relevant for identifying metastatic spread to the bone. * **Gleason Scoring:** The definitive histological grading system for prostate cancer prognosis based on glandular architecture. **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. 992-994.

Question 1

Serum alpha-fetoprotein concentration is elevated in which of the following conditions?

Accepted Answer

Hepatoma, Hepatoblastoma, Endodermal sinus tumor, and Cirrhosis

Answer

Hepatoma and Cirrhosis

Answer

Hepatoblastoma and Endodermal sinus tumor

Answer

Hepatoblastoma, Endodermal sinus tumor, and Chromosomal trisomy

Question 2

Which of the following can cause pseudomyxoma peritonei?

Accepted Answer

Adenocarcinoma of colon

Answer

Mucocele of appendix

Answer

Mucinous ovarian tumor

Answer

Ovarian dermoid

Question 3

Which of the following is an example of a mixed tumor?

Accepted Answer

Adenoacanthoma

Answer

Hamartoma

Answer

Glomus Tumor

Answer

Osteoma

Question 4

Alpha-fetoprotein (AFP) is raised in which of the following conditions?

Accepted Answer

Hepatic carcinoma

Answer

Renal carcinoma

Answer

Pancreatic carcinoma

Answer

Prostatic carcinoma

Question 5

All of the following conditions are premalignant except?

Accepted Answer

Bronchiectasis

Answer

Ulcerative colitis

Answer

Crohn's disease

Answer

Paget disease of bone

Question 6

Which of the following agents is associated with Burkitt's lymphoma?

Accepted Answer

EBV

Answer

HTLV-1

Answer

HTLV-3

Answer

HPV

Question 7

Which of the following is the site of malignant transformation of melanocytes in melanoma?

Accepted Answer

Junctional melanocytes

Answer

Epidermal cells

Answer

Basal cells

Answer

Follicular cells

Question 8

All of the following are examples of tumour markers, except:

Accepted Answer

Alpha-HCG

Answer

AFP

Answer

NSE

Answer

CEA

Question 9

DNA probes are valuable in the identification of genes in which of the following neoplasms?

Accepted Answer

Gliomas

Answer

Neuroblastoma

Answer

Breast cancer

Answer

Lymphomas

Question 10

Which is a specific marker for prostatic cancer?

Accepted Answer

Prostate specific antigen

Answer

Lactate dehydrogenase (LDH)

Answer

Chromogranin

Answer

Carbohydrate antigen 19-9 (CA 19-9)

Neoplasia — MCQs

Neoplasia — MCQs

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