Neoplasia Practice Questions

Q: Which tumor marker is elevated in both hepatocellular carcinoma and testicular cancer?

AFP. **Explanation:** **AFP (Alpha-Fetoprotein)** is the correct answer because it is a glycoprotein normally produced by the fetal liver and yolk sac. In adults, its elevation is a hallmark of two specific conditions: 1. **Hepatocellular Carcinoma (HCC):** It serves as a primary screening and diagnostic marker [1]. 2. **Germ Cell Tumors (GCTs):** Specifically, it is elevated in **Yolk Sac Tumors** (Endodermal sinus tumors) and **Non-seminomatous germ cell tumors (NSGCTs)** of the testis. Note that AFP is *never* elevated in pure seminomas. **Analysis of Incorrect Options:** * **CEA (Carcinoembryonic Antigen):** Primarily used for monitoring **Colorectal Carcinoma**. It can also be elevated in pancreatic, gastric, and breast cancers, but it is not a specific marker for HCC or testicular GCTs. * **hCG (human Chorionic Gonadotropin):** This is the marker for **Choriocarcinoma** and is also elevated in some Seminomas (syncytiotrophoblastic components). While relevant to testicular cancer, it is not associated with HCC. * **CA 19-9:** This is the highly specific marker for **Pancreatic Adenocarcinoma** and **Cholangiocarcinoma**. **High-Yield Clinical Pearls for NEET-PG:** * **The "Rule of 500":** In a patient with cirrhosis, an AFP level >500 ng/mL is highly suggestive of HCC [1]. * **Yolk Sac Tumors:** AFP is the definitive marker; look for **Schiller-Duval bodies** on histology. * **Mixed GCTs:** If a testicular biopsy shows "Seminoma" but serum AFP is elevated, the diagnosis must be revised to a **Mixed Germ Cell Tumor**, as pure seminomas do not produce AFP. **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: What is the primary tumor marker for Hepatocellular Carcinoma (HCC)?

AFP. **Explanation:** **Alpha-Fetoprotein (AFP)** is the gold-standard serum tumor marker for **Hepatocellular Carcinoma (HCC)**. [1] AFP is a glycoprotein normally produced by the fetal yolk sac and liver. In adults, pathological elevation (typically >400 ng/mL) is highly suggestive of HCC in the context of chronic liver disease or cirrhosis. It is also used to monitor treatment response and recurrence. [1] **Analysis of Incorrect Options:** * **A. CEA (Carcinoembryonic Antigen):** Primarily associated with **Colorectal Carcinoma**. It is also elevated in pancreatic, gastric, and breast cancers, but is non-specific for the liver. [2] * **C. CA-125 (Cancer Antigen 125):** The primary marker for **Serous Ovarian Carcinoma**. It can also be elevated in endometriosis or pelvic inflammatory disease. * **D. HMB-45 (Human Melanoma Black):** This is an immunohistochemical (IHC) marker used to identify **Melanoma**. It is not a serum marker. **High-Yield Clinical Pearls for NEET-PG:** * **AFP** is also elevated in **Yolk Sac Tumors** (Endodermal sinus tumors) of the ovary or testes. [2] * **Screening:** For patients with cirrhosis, the AASLD recommends screening for HCC every 6 months using **Ultrasound +/- AFP**. [1] * **Fibrolamellar variant of HCC:** Characteristically occurs in young adults without cirrhosis and typically has **normal AFP levels**. * **Other HCC Markers:** Des-gamma-carboxyprothrombin (DCP) and Glypican-3 (IHC marker) are emerging high-yield markers for HCC. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 399-400. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, p. 346.

Q: Psammoma bodies are characteristic findings in which of the following carcinomas?

Thyroid carcinoma. **Explanation:** Psammoma bodies are microscopic, concentric, laminated calcified structures. They represent a form of **dystrophic calcification** occurring in necrotic tumor cells, where calcium salts deposit in layers around a single necrotic cell, creating a "sand-like" appearance (from the Greek *psammos*, meaning sand). **1. Why Thyroid Carcinoma is Correct:** Psammoma bodies are a hallmark feature of **Papillary Thyroid Carcinoma (PTC)** [1]. They are found in approximately 40-50% of cases, typically within the cores of the papillae or the surrounding stroma. Their presence in a fine-needle aspiration (FNA) or biopsy is highly suggestive of PTC [1]. **2. Analysis of Incorrect Options:** * **Carcinoma of the Breast:** While calcifications (microcalcifications) are common in Ductal Carcinoma in Situ (DCIS), they are usually amorphous or granular rather than the classic laminated Psammoma bodies. * **Carcinoma of the Stomach:** Gastric adenocarcinomas typically present with signet-ring cells or glandular patterns; they do not characteristically form Psammoma bodies. * **Carcinoma of the Testis:** Testicular tumors (like Seminomas or Yolk sac tumors) do not typically show these structures. **3. High-Yield NEET-PG Clinical Pearls:** To remember the common tumors associated with Psammoma bodies, use the mnemonic **"PSaMMoma"**: * **P:** **P**apillary thyroid carcinoma [1] * **S:** **S**erous cystadenocarcinoma of the ovary (most common site) * **M:** **M**eningioma * **M:** **M**esothelioma (Pleural) **Key Fact:** Psammoma bodies are an example of **dystrophic calcification** (occurs in dying/necrotic tissues with normal serum calcium levels), distinguishing them from metastatic calcification. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, p. 1099.

Question 1

Which of the following is an oncogenic retrovirus?

Accepted Answer

HTLV-1

Answer

HPV

Answer

EBV

Answer

HBV

Question 2

Which is the most aggressive variant of ameloblastoma?

Accepted Answer

Granular cell type

Answer

Follicular type

Answer

Plexiform type

Answer

Acanthomatous type

Question 3

Which tumor marker is elevated in both hepatocellular carcinoma and testicular cancer?

Accepted Answer

AFP

Answer

CEA

Answer

HCG

Answer

CA-19

Question 4

What is the most specific marker for prostate cancer?

Accepted Answer

Prostate-specific antigen (PSA)

Answer

Prostatic acid phosphatase (PAP)

Answer

Placental alkaline phosphatase (PLAP)

Answer

Neuron-specific enolase (NSE)

Question 5

What is the primary tumor marker for Hepatocellular Carcinoma (HCC)?

Accepted Answer

AFP

Answer

CEA

Answer

CA-125

Answer

HMB99

Question 6

Which of the following histological features is characteristic of a benign lesion?

Accepted Answer

Well differentiated

Answer

Atypical

Answer

High mitotic figures

Answer

Locally invasive

Question 7

Blood-borne metastasis is unusual in which of the following neoplasms?

Accepted Answer

Medullary carcinoma breast

Answer

Osteosarcoma

Answer

Choriocarcinoma

Answer

Renal cell carcinoma

Question 8

Psammoma bodies are characteristic findings in which of the following carcinomas?

Accepted Answer

Thyroid carcinoma

Answer

Carcinoma of the breast

Answer

Carcinoma of the stomach

Answer

Carcinoma of the testis

Question 9

What is the most common carcinoma that causes splenic metastasis?

Accepted Answer

Carcinoma of the ovary

Answer

Carcinoma of the pancreas

Answer

Carcinoma of the stomach

Answer

Carcinoma of the cervix

Question 10

Presence of epithelial pearls in the spinous layer of epithelium is characteristic of which of the following conditions?

Accepted Answer

Carcinoma

Answer

Pre-cancer

Answer

Dysplasia

Answer

Metaplasia

Neoplasia — MCQs

Neoplasia — MCQs

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