Neoplasia Practice Questions

Q: Most commonly, this tumor is due to carcinoma of which of the following organs?

Stomach. ***Stomach*** - **Gastric adenocarcinoma** with **signet ring cells** is the most common primary source of **Krukenberg tumor**, accounting for 70-80% of cases. - The tumor characteristically shows **bilateral ovarian involvement** with **mucin-filled signet ring cells** and **cellular ovarian stroma**. *Breast* - While **breast carcinoma** can metastasize to the ovaries, it represents only 5-10% of **Krukenberg tumors**. - Breast metastases typically show **ductal or lobular patterns** rather than the classic **signet ring cell morphology**. *Colon* - **Colorectal adenocarcinoma** accounts for approximately 10-15% of ovarian metastases but rarely forms **Krukenberg tumors**. - Colonic metastases usually maintain **glandular architecture** without the characteristic **signet ring cell appearance**. *Uterus* - **Uterine carcinoma** rarely metastasizes to the ovaries and is not associated with **Krukenberg tumor formation**. - Uterine tumors typically spread by **direct extension** or **lymphatic spread** rather than **transcoelomic metastasis**.

Q: Which of the following tumours produces a marked elevation of Alpha fetoprotein?

Alpha fetoprotein. **Explanation:** **Alpha-fetoprotein (AFP)** is a glycoprotein normally synthesized by the fetal liver and yolk sac. In adult pathology, it serves as a highly specific tumor marker for two primary conditions: **Hepatocellular Carcinoma (HCC)** and **Yolk Sac Tumors** (Endodermal Sinus Tumors) [1]. A marked elevation (often >500 ng/mL) is diagnostic of these malignancies in the appropriate clinical context [1]. **Analysis of Options:** * **Placental Alkaline Phosphatase (PLAP):** This is a characteristic marker for **Seminoma** (in males) and **Dysgerminoma** (in females). While useful for diagnosis, it does not correlate with AFP production. * **Human Placental Lactogen (hPL):** This is primarily produced by syncytiotrophoblasts. It is a marker for **Placental Site Trophoblastic Tumors (PSTT)**, not yolk sac-derived tumors. * **CA 125:** This is the classic marker for **Serous Cystadenocarcinoma of the ovary**. It is used for monitoring treatment response rather than primary diagnosis, as it can be elevated in various inflammatory peritoneal conditions. **High-Yield Clinical Pearls for NEET-PG:** * **Yolk Sac Tumor:** Look for **Schiller-Duval bodies** (glomeruloid structures) on histology; AFP is the definitive marker. * **Hepatocellular Carcinoma:** AFP levels correlate with tumor size; however, 20% of HCC cases may be AFP-negative [1]. * **Neural Tube Defects:** AFP is also elevated in maternal serum during pregnancy if the fetus has anencephaly or spina bifida. * **Triple Marker Test:** AFP is *decreased* in Down Syndrome (Trisomy 21). **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 398-400.

Q: What is the paraneoplastic syndrome associated with Hodgkin's disease?

Cerebellar degenerative disease. **Explanation:** **Paraneoplastic Cerebellar Degeneration (PCD)** is a well-recognized neurological paraneoplastic syndrome associated with **Hodgkin’s Lymphoma**. The underlying mechanism is **immune-mediated**; the body produces "onconeural" antibodies (specifically **anti-Tr antibodies**) that cross-react with the Purkinje cells of the cerebellum. This leads to progressive ataxia, dysarthria, and nystagmus, often preceding the diagnosis of the lymphoma itself. **Analysis of Incorrect Options:** * **A. Nephrotic Syndrome:** While Hodgkin’s Lymphoma is classically associated with **Minimal Change Disease (MCD)**, it is considered a renal complication rather than the primary neurological paraneoplastic hallmark tested in this context. * **B. Retinopathy:** Cancer-associated retinopathy (CAR) is most commonly linked to **Small Cell Lung Cancer (SCLC)**, mediated by anti-recoverin antibodies. * **D. Acanthosis Nigricans:** This is a cutaneous paraneoplastic marker most strongly associated with **Gastrointestinal Adenocarcinomas** (especially Gastric Cancer), not lymphomas. **High-Yield Clinical Pearls for NEET-PG:** * **Hodgkin’s Lymphoma:** Associated with **Anti-Tr** antibodies (Cerebellar Degeneration) and **Minimal Change Disease** [1]. * **Small Cell Lung Cancer:** The "king" of paraneoplastic syndromes—associated with **SIADH, ACTH (Cushing’s), Lambert-Eaton Syndrome**, and **Anti-Hu** (Encephalomyelitis). * **Thymoma:** Classically associated with **Myasthenia Gravis**, Pure Red Cell Aplasia, and Hypogammaglobulinemia (Good Syndrome). * **Breast/Ovarian Cancer:** Associated with **Anti-Yo** antibodies causing cerebellar ataxia. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 556-557.

Q: Multiple cutaneous sebaceous adenomas are seen in which of the following conditions?

Muir-Torre syndrome. ### Explanation **Muir-Torre syndrome** is a phenotypic variant of **Lynch syndrome** (Hereditary Non-Polyposis Colorectal Cancer - HNPCC). It is characterized by the association of at least one **sebaceous gland tumor** (sebaceous adenoma, sebaceous carcinoma, or sebaceous epithelioma) and at least one internal malignancy (most commonly colorectal or genitourinary cancers) [1]. The underlying pathophysiology involves germline mutations in **DNA mismatch repair (MMR) genes**, most frequently **MSH2** (90%) and MLH1 [1]. #### Analysis of Options: * **Gardner’s Syndrome (Option A):** A variant of Familial Adenomatous Polyposis (FAP) characterized by intestinal polyps plus extraintestinal manifestations like **osteomas** (mandible), **epidermoid cysts**, and **desmoid tumors**. It is not typically associated with sebaceous adenomas. * **Turcot’s Syndrome (Option B):** Characterized by the association of intestinal polyposis with **Central Nervous System (CNS) tumors**. Specifically, FAP with Medulloblastoma or Lynch syndrome with Glioblastoma multiforme. * **Cowden Syndrome (Option C):** Part of the PTEN hamartoma tumor syndrome. It presents with multiple **trichilemmomas** (hair follicle tumors), oral papillomas, and an increased risk of breast, thyroid, and endometrial cancers. #### NEET-PG High-Yield Pearls: * **Muir-Torre Syndrome:** Think "Sebaceous tumors + Internal malignancy + MSH2 mutation." * **Sebaceous Adenoma:** This is the most specific cutaneous marker for Muir-Torre syndrome. * **Microsatellite Instability (MSI):** These patients exhibit MSI due to defective MMR genes [1]. * **Screening:** Patients presenting with a sebaceous adenoma should be screened for internal malignancies via colonoscopy and imaging. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 817.

Question 1

Most commonly, this tumor is due to carcinoma of which of the following organs?

Accepted Answer

Stomach

Answer

Breast

Answer

Colon

Answer

Uterus

Question 2

Which of the following describes cells that are abnormal in appearance and may become premalignant?

Accepted Answer

Dysplasia

Answer

Aplasia

Answer

Karyomegaly

Answer

Pleomorphism

Question 3

What is the most common malignant neoplasm of infancy?

Accepted Answer

Neuroblastoma

Answer

Malignant teratoma

Answer

Wilms' tumor

Answer

Hepatoblastoma

Question 4

Which of the following tumours produces a marked elevation of Alpha fetoprotein?

Accepted Answer

Alpha fetoprotein

Answer

Placental alkaline phosphatase

Answer

Human placental lactogen

Answer

CA 125

Question 5

Psammoma bodies are seen in all except?

Accepted Answer

Seminoma

Answer

Meningioma

Answer

Papillary carcinoma of the thyroid

Answer

Papillary serous cystadenocarcinoma of the ovary

Question 6

Sarcoma botryoides is a type of?

Accepted Answer

Rhabdomyosarcoma

Answer

Rhabdomyoma

Answer

Lymphangioma

Answer

Leiomyoma

Question 7

Verrucous carcinoma is an:

Accepted Answer

Extremely well differentiated squamous cell carcinoma

Answer

Poorly differentiated squamous cell carcinoma

Answer

Example of condyloma

Answer

An example of adenocarcinoma

Question 8

What is the paraneoplastic syndrome associated with Hodgkin's disease?

Accepted Answer

Cerebellar degenerative disease

Answer

Nephrotic syndrome

Answer

Retinopathy

Answer

Acanthosis nigricans

Question 9

Colon carcinoma is associated with all the following except:

Accepted Answer

Rb

Answer

Mismatch repair genes

Answer

APC

Answer

b-catenin

Question 10

Multiple cutaneous sebaceous adenomas are seen in which of the following conditions?

Accepted Answer

Muir-Torre syndrome

Answer

Gardner's syndrome

Answer

Turcott's syndrome

Answer

Cowden syndrome

Neoplasia — MCQs

Neoplasia — MCQs

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