Neoplasia Practice Questions

Q: What is the most common lymphoma associated with Sicca syndrome?

MALToma. **Explanation:** **Sicca syndrome** (primary Sjögren syndrome) is a chronic autoimmune disorder characterized by lymphocytic infiltration of the exocrine glands (lacrimal and salivary). Patients with Sjögren syndrome have a **40-fold increased risk** [1] of developing non-Hodgkin lymphoma compared to the general population. **1. Why MALToma is correct:** The chronic antigenic stimulation by the autoimmune process leads to the development of **Extranodal Marginal Zone B-cell Lymphoma**, also known as **MALToma** [1]. In the context of Sicca syndrome, this typically arises within the **parotid gland**. The transition from benign lymphoepithelial lesions to malignant lymphoma is a classic progression in these patients. **2. Why the other options are incorrect:** * **Burkitt lymphoma:** This is a high-grade B-cell lymphoma associated with EBV infection and the c-MYC translocation; it is not linked to chronic autoimmune sialadenitis. * **Diffuse large B-cell lymphoma (DLBCL):** While DLBCL can occur as a secondary transformation of a MALToma, it is not the *most common* primary lymphoma associated with Sicca syndrome. * **Lymphoplasmacytic lymphoma:** This is associated with Waldenström macroglobulinemia and typically involves the bone marrow and spleen, not the exocrine glands. **Clinical Pearls for NEET-PG:** * **Most common site:** Parotid gland (look for unilateral swelling in a Sjögren patient). * **Key Marker:** A sudden decrease in serum rheumatoid factor or the development of hypogammaglobulinemia in a Sjögren patient may signal the onset of lymphoma. * **Other MALToma associations:** *H. pylori* (Stomach - most common overall), *Chlamydophila psittaci* (Ocular adnexa), and *Borrelia burgdorferi* (Skin). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 235-236.

Q: Which of the following is described as a unicentric, non-functional, anatomically benign, and clinically persistent tumor?

Ameloblastoma. **Explanation:** The question describes the classic definition of **Ameloblastoma** as proposed by Robinson. 1. **Why Ameloblastoma is correct:** Ameloblastoma is a true neoplasm of odontogenic epithelium. It is characterized as: * **Unicentric:** It originates from a single center (though it can be multicentric in rare cases). * **Non-functional:** It does not produce hard tooth structures (enamel or dentin). * **Anatomically Benign:** Histologically, it lacks features of malignancy (like anaplasia or rapid metastasis). * **Clinically Persistent:** It is locally invasive, has a high recurrence rate, and can cause significant bone destruction, making it "locally malignant" in behavior. 2. **Analysis of Incorrect Options:** * **CEOT (Pindborg Tumor):** While it is a neoplasm, it is characterized by the production of amyloid-like material and calcifications (Liesegang rings), which differentiates its "functional" nature from Ameloblastoma. * **Enameloma (Enamel Pearl):** This is a developmental anomaly (ectopic enamel), not a true persistent neoplasm. * **Odontoma:** These are considered **hamartomas** rather than true neoplasms. They are "functional" as they produce mature enamel, dentin, and cementum. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Mandible (80%), specifically the molar-ramus area. * **Radiological appearance:** Classically described as a **"Soap bubble"** or **"Honeycombed"** multilocular radiolucency. * **Histopathology:** Shows "Vickers-Gorlin" features—palisading basal cells with **reverse polarity** and subnuclear vacuolization. * **Most common variant:** Follicular type. * **Unicystic Ameloblastoma:** Often associated with an impacted third molar, mimicking a dentigerous cyst.

Q: Which electrolyte imbalance is characteristic of tumor lysis syndrome?

Hyperkalemia. **Explanation:** **Tumor Lysis Syndrome (TLS)** is an oncologic emergency caused by the rapid destruction of a large number of metabolically active tumor cells (most commonly in high-grade lymphomas and leukemias) following chemotherapy [1]. When these cells rupture, they release their intracellular contents into the systemic circulation. **Why Hyperkalemia is Correct:** Potassium is the primary intracellular cation. The massive lysis of tumor cells leads to an immediate release of potassium into the bloodstream, resulting in **Hyperkalemia**. This is the most dangerous component of TLS as it can lead to lethal cardiac arrhythmias. **Analysis of Incorrect Options:** * **Hypercalcemia:** In TLS, **Hypocalcemia** occurs, not hypercalcemia. This happens because the release of intracellular phosphorus leads to hyperphosphatemia; the excess phosphate binds to serum calcium, causing it to precipitate as calcium phosphate crystals. * **Hypokalemia:** This is the opposite of what occurs in TLS. Potassium levels rise due to cellular rupture. * **Increased serum sodium:** Sodium is primarily an extracellular ion; its levels are not characteristically elevated by the release of intracellular contents in TLS. **High-Yield Clinical Pearls for NEET-PG:** * **The Metabolic Tetrad of TLS:** 1. **Hyperkalemia** (Risk of arrhythmias) 2. **Hyperphosphatemia** (From breakdown of intracellular proteins) 3. **Hyperuricemia** (From catabolism of purines/nucleic acids) [1] 4. **Hypocalcemia** (Secondary to hyperphosphatemia) * **Renal Failure:** Hyperuricemia and calcium phosphate crystals can lead to acute kidney injury (AKI) [1]. * **Prophylaxis:** Aggressive hydration and **Allopurinol** (xanthine oxidase inhibitor) or **Rasburicase** (recombinant urate oxidase) are used to manage uric acid levels. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 941-942.

Q: A 48-year-old woman presents with new-onset seizures and behavioral changes that began approximately 6 months ago. Advanced imaging reveals multiple round metastatic lesions in her brain. Her past medical history is remarkable for a black lesion on her toe that was excised 20 years prior. A thorough workup and multiple additional imaging studies reveal no primary malignancy. A lesion on the arm is noted and shown. Which of the following most likely characterizes this type of malignancy?

Originates from cells in the stratum basalis. ***Originates from cells in the stratum basalis*** - **Melanoma** arises from **melanocytes** located in the **stratum basalis** (basal layer) of the epidermis, which produce melanin pigment. - The history of a **black lesion on the toe** 20 years prior with current **brain metastases** strongly suggests metastatic melanoma from the original site. *Negative staining for HMB45* - **HMB45** is a **positive marker** for melanoma, not negative, as it specifically stains melanocytes and melanoma cells. - **S-100 protein** and **Melan-A** are also characteristically **positive** in melanoma diagnosis. *Prognosis typically determined by the amount of horizontal spread* - Melanoma prognosis is determined by **Breslow thickness** (vertical depth of invasion), not horizontal spread. - **Clark's level** (anatomical depth) and **mitotic rate** are also important prognostic factors, but vertical invasion is key. *Signet ring cells are commonly seen on histology* - **Signet ring cells** are characteristic of **adenocarcinoma** (especially gastric), not melanoma. - Melanoma typically shows **epithelioid cells**, **spindle cells**, or **nevoid cells** with **melanin pigment** on histology.

Question 1

Which of the following genetic changes is commonly observed in cancers?

Accepted Answer

Methylation of tumor suppressor genes

Answer

Hypomethylation of oncogenes

Answer

Loss of heterozygosity

Answer

Mutation of introns

Question 2

What is the most common lymphoma associated with Sicca syndrome?

Accepted Answer

MALToma

Answer

Burkitt lymphoma

Answer

Diffuse large B-cell lymphoma (DLBCL)

Answer

Lymphoplasmacytic lymphoma

Question 3

Which of the following is described as a unicentric, non-functional, anatomically benign, and clinically persistent tumor?

Accepted Answer

Ameloblastoma

Answer

CEOT

Answer

Enameloma

Answer

Odontorna

Question 4

Which electrolyte imbalance is characteristic of tumor lysis syndrome?

Accepted Answer

Hyperkalemia

Answer

Hypercalcemia

Answer

Hypokalemia

Answer

Increased serum sodium

Question 5

All of the following predispose to squamous cell carcinoma, EXCEPT?

Accepted Answer

Lichen planus of mouth

Answer

Bowen's disease

Answer

Inverted papilloma of nose

Answer

Chronic irritation of oral mucosa by jagged teeth

Question 6

A 60-year-old woman presents with a large breast mass that she first detected 3 months ago. Mammography reveals a well-circumscribed mass measuring 8 cm in diameter. A breast biopsy shows loose fibroconnective tissue with a sarcomatous stroma, abundant mitoses, and nodules and ridges lined by cuboidal epithelial cells. What is the most likely diagnosis?

Accepted Answer

Phyllodes tumor

Answer

Fibroadenoma

Answer

Medullary carcinoma

Answer

Paget disease

Question 7

Overexpression of BCL-2 proteins occurs in which of the following conditions?

Accepted Answer

Follicular lymphoma

Answer

Burkitt's lymphoma

Answer

Diffuse large B-cell lymphoma

Answer

Small lymphocytic lymphoma

Question 8

What is the most important prognostic indicator for Wilms tumor?

Accepted Answer

Histological type

Answer

Nuclear grade

Answer

Size

Answer

Pathological staging

Question 9

A 48-year-old woman presents with new-onset seizures and behavioral changes that began approximately 6 months ago. Advanced imaging reveals multiple round metastatic lesions in her brain. Her past medical history is remarkable for a black lesion on her toe that was excised 20 years prior. A thorough workup and multiple additional imaging studies reveal no primary malignancy. A lesion on the arm is noted and shown. Which of the following most likely characterizes this type of malignancy?

Accepted Answer

Originates from cells in the stratum basalis

Answer

Negative staining for HMB45

Answer

Prognosis typically determined by the amount of horizontal spread

Answer

Signet ring cells are commonly seen on histology

Question 10

Which of the following is not a tumor marker?

Accepted Answer

β2Microglobulin

Answer

Carcinoembryonic antigen (CEA)

Answer

Human Chorionic Gonadotropin (hCG)

Answer

α Fetoprotein (AFP)

Neoplasia — MCQs

Neoplasia — MCQs

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