Neoplasia — MCQs

Neoplasia Indian Medical PG Practice Questions and MCQs

Question 361: Most commonly, this tumor is due to carcinoma of which of the following organs?

A. Stomach (Correct Answer)
B. Breast
C. Colon
D. Uterus

Explanation: ***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**.

Question 362: Which of the following describes cells that are abnormal in appearance and may become premalignant?

A. Aplasia
B. Dysplasia (Correct Answer)
C. Karyomegaly
D. Pleomorphism

Explanation: **Explanation:** **Dysplasia** is the correct answer as it refers to disordered growth and maturation of an epithelium [1]. It is characterized by a loss of architectural uniformity and cellular orientation. Dysplastic cells exhibit increased nuclear-to-cytoplasmic (N/C) ratio, hyperchromasia, and increased mitotic figures. Crucially, dysplasia is considered a **pre-malignant** condition; while it does not always progress to cancer and can be reversible if the stimulus is removed, it often precedes invasive carcinoma (Carcinoma in situ) [1][2]. **Analysis of Incorrect Options:** * **Aplasia:** Refers to the failure of an organ or tissue to develop or function. It is a developmental defect (e.g., Bone marrow aplasia), not a premalignant cellular change. * **Karyomegaly:** Simply means an enlarged nucleus. While seen in malignancy, it is a morphological feature rather than a clinical state of premalignancy. It can also occur in non-neoplastic conditions like viral infections or radiation. * **Pleomorphism:** This term describes variation in the size and shape of cells and their nuclei. While pleomorphism is a hallmark of both dysplasia and neoplasia (anaplasia), it is a descriptive morphological feature, not a clinical diagnosis of a premalignant state. **High-Yield Clinical Pearls for NEET-PG:** * **Reversibility:** Unlike neoplasia, mild to moderate dysplasia is potentially **reversible** if the inciting stimulus (e.g., smoking, chronic irritation) is removed [1]. * **Carcinoma in situ (CIS):** When dysplastic changes involve the full thickness of the epithelium but do not breach the basement membrane, it is termed CIS [1]. * **Grading:** Dysplasia is often graded as Low Grade (LSIL) or High Grade (HSIL), particularly in the cervix (CIN system), which dictates clinical management [2]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 209-211. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 222-223.

Question 363: What is the most common malignant neoplasm of infancy?

A. Malignant teratoma
B. Neuroblastoma (Correct Answer)
C. Wilms' tumor
D. Hepatoblastoma

Explanation: **Explanation:** **Neuroblastoma** is the most common extracranial solid malignant tumor of childhood and the **most common malignancy of infancy** (children under 1 year of age) [2]. It originates from primordial neural crest cells of the sympathetic nervous system, most commonly occurring in the adrenal medulla or the sympathetic chain [2], [3]. **Why the other options are incorrect:** * **Malignant Teratoma:** While teratomas are the most common germ cell tumors in neonates (specifically Sacrococcygeal teratomas), the majority are benign at birth [2]. * **Wilms’ Tumor (Nephroblastoma):** This is the most common primary renal tumor in children, but its peak incidence is between **2 to 5 years** of age, making it less common than neuroblastoma in the first year of life [1]. * **Hepatoblastoma:** This is the most common liver tumor in children, but its overall incidence is significantly lower than that of neuroblastoma [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Genetic Marker:** Amplification of the **N-myc (MYCN)** oncogene is the most important prognostic factor (indicates poor prognosis) [5]. * **Diagnosis:** Characterized by elevated urinary catecholamine metabolites (**VMA and HVA**) [4]. * **Histopathology:** Shows **Homer-Wright rosettes** (cells arranged around a central fibrillar space). * **Clinical Sign:** Often presents as a firm, irregular abdominal mass that **crosses the midline** (unlike Wilms’ tumor, which usually does not cross the midline). * **Blueberry Muffin Baby:** This term refers to cutaneous metastases of neuroblastoma (or congenital infections) seen in infants [4]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles... Part 3 (Systematic Pathology), pp. 211-212. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 483-484. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 419-420. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, p. 486. [5] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 486-487.

Question 364: Which of the following tumours produces a marked elevation of Alpha fetoprotein?

A. Alpha fetoprotein (Correct Answer)
B. Placental alkaline phosphatase
C. Human placental lactogen
D. CA 125

Explanation: **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.

Question 365: Psammoma bodies are seen in all except?

A. Seminoma (Correct Answer)
B. Meningioma
C. Papillary carcinoma of the thyroid
D. Papillary serous cystadenocarcinoma of the ovary

Explanation: **Explanation:** Psammoma bodies are characteristic microscopic findings consisting of **concentric, laminated calcified structures** [1]. They represent a form of **dystrophic calcification** occurring in areas of single-cell necrosis within papillary or whorled structures [1]. **1. Why Seminoma is the correct answer:** Seminoma is a germ cell tumor of the testis that typically presents with a "fried-egg" appearance (clear cytoplasm and central nuclei) and fibrous septae infiltrated with lymphocytes. It **does not** form papillary structures or psammoma bodies. Instead, if calcification occurs in the testis, it is usually diffuse (microlithiasis) rather than in the form of psammoma bodies. **2. Why the other options are incorrect:** * **Meningioma:** Specifically the psammomatous variant, these tumors exhibit characteristic whorled patterns of arachnoidal cells that undergo central necrosis and calcification. * **Papillary Carcinoma of the Thyroid:** This is the most common thyroid cancer [2]. Psammoma bodies are found in the cores of the papillae and are a high-yield diagnostic feature [2]. * **Papillary Serous Cystadenocarcinoma of the Ovary:** These tumors frequently show extensive psammoma body formation within the papillary fronds. **NEET-PG High-Yield Pearls:** To remember the common tumors associated with Psammoma bodies, use the mnemonic **"PSaMMoma"**: * **P:** **P**apillary CA of thyroid [2], **P**rolactinoma (rarely). * **S:** **S**erous cystadenocarcinoma of ovary, **S**omatostatinoma. * **M:** **M**eningioma, **M**esothelioma. * **M:** **M**embrane (Endometrial adenocarcinoma - specifically the serous type). *Note: Psammoma bodies are rare in follicular or medullary thyroid carcinoma; their presence strongly points toward the Papillary subtype [2].* **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 134-135. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, p. 1099.

Question 366: Sarcoma botryoides is a type of?

A. Rhabdomyoma
B. Rhabdomyosarcoma (Correct Answer)
C. Lymphangioma
D. Leiomyoma

Explanation: ### Explanation **Correct Answer: B. Rhabdomyosarcoma** **Sarcoma botryoides** (also known as Embryonal Rhabdomyosarcoma - Botryoid variant) is a malignant tumor derived from primitive skeletal muscle cells (rhabdomyoblasts) [1]. The term "botryoides" is derived from the Greek word *botrys*, meaning "a cluster of grapes," which describes its characteristic macroscopic appearance [1]. It typically presents as soft, polypoid, friable masses protruding from mucosal-lined passages [2]. * **Mechanism:** It arises in hollow, mucosal-lined structures. In children, it is most commonly found in the **vagina** (infants/toddlers), **urinary bladder**, and sometimes the biliary tract [1]. * **Histopathology:** A hallmark feature is the **Cambium layer**, a dense zone of undifferentiated tumor cells situated immediately beneath the intact surface epithelium. **Why incorrect options are wrong:** * **A. Rhabdomyoma:** This is a rare *benign* tumor of skeletal muscle [3]. While it shares the same cell of origin, it does not exhibit the "grape-like" growth or the malignancy associated with Sarcoma botryoides. * **C. Lymphangioma:** This is a benign malformation of the lymphatic system (e.g., cystic hygroma), unrelated to skeletal muscle precursors [3]. * **D. Leiomyoma:** This is a benign tumor of *smooth muscle*, most commonly found in the uterus (fibroids). Sarcoma botryoides specifically involves striated (skeletal) muscle precursors. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Vagina in girls < 5 years old; Bladder in boys. * **Classic Presentation:** "Grape-like" mass protruding from the vagina in an infant [1]. * **Microscopic Marker:** Presence of **Desmin** and **Myogenin** (immunohistochemistry markers for skeletal muscle) [2]. * **Cytogenetics:** Embryonal rhabdomyosarcomas often show a loss of heterozygosity at 11p15.5. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1004-1005. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1224-1225. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 481-482.

Question 367: Verrucous carcinoma is an:

A. Extremely well differentiated squamous cell carcinoma (Correct Answer)
B. Poorly differentiated squamous cell carcinoma
C. Example of condyloma
D. An example of adenocarcinoma

Explanation: **Explanation:** **Verrucous carcinoma** is a distinct, low-grade variant of squamous cell carcinoma (SCC). The correct answer is **Option A** because this tumor is characterized by its **extremely well-differentiated** nature. Histologically, it consists of mature squamous epithelium with minimal cytologic atypia, lacking the nuclear pleomorphism and high mitotic figures seen in classic SCC. * **Why Option A is correct:** It grows as a slow-growing, exophytic, "wart-like" mass. While it is locally aggressive and can invade deep into underlying tissues (pushing border), it rarely metastasizes. * **Why Option B is incorrect:** Poorly differentiated SCC shows significant cellular atypia, frequent mitoses, and high metastatic potential, which is the exact opposite of the indolent nature of verrucous carcinoma. * **Why Option C is incorrect:** While it resembles a condyloma (wart) macroscopically, a condyloma is a benign lesion caused by HPV [1]. Verrucous carcinoma is a true malignancy, though some cases (especially in the anogenital region) are associated with HPV types 6 and 11. * **Why Option D is incorrect:** Adenocarcinoma arises from glandular epithelium. Verrucous carcinoma arises strictly from squamous epithelium. **High-Yield Pearls for NEET-PG:** * **Common Sites:** Oral cavity (often associated with smokeless tobacco/betel nut chewing—called **Ackerman’s tumor**), glans penis (Buschke-Löwenstein tumor), and the sole of the foot (Epithelioma cuniculatum). * **Morphology:** Characterized by a "shaggy," cauliflower-like appearance and a **"pushing" rather than "infiltrating" margin** of invasion. * **Clinical Note:** Biopsies must be deep; superficial biopsies often mistake it for simple hyperplasia or a benign wart due to the lack of cellular atypia [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1000-1002.

Question 368: What is the paraneoplastic syndrome associated with Hodgkin's disease?

A. Nephrotic syndrome
B. Retinopathy
C. Cerebellar degenerative disease (Correct Answer)
D. Acanthosis nigricans

Explanation: **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.

Question 369: Colon carcinoma is associated with all the following except:

A. Rb (Correct Answer)
B. Mismatch repair genes
C. APC
D. b-catenin

Explanation: ### Explanation The correct answer is **A. Rb**. **1. Why Rb is the correct answer:** The **Retinoblastoma (Rb) gene** is a tumor suppressor gene located on chromosome 13q14 [1]. While it is the "master switch" of the cell cycle, its mutations are classically associated with **Retinoblastoma** and **Osteosarcoma**. It is not a primary driver or a characteristic component of the established molecular pathways of colorectal carcinogenesis. **2. Why the other options are incorrect:** Colorectal cancer (CRC) typically develops through two distinct genetic pathways, both of which involve the other options: * **APC (Option C) and β-catenin (Option D):** These are part of the **Adenoma-Carcinoma Sequence** (Chromosomal Instability Pathway) [3]. The *APC* gene is a negative regulator of β-catenin. Loss of *APC* leads to the accumulation of β-catenin, which translocates to the nucleus and activates genes promoting cell proliferation [2]. This pathway accounts for ~80% of sporadic CRCs and is the hallmark of Familial Adenomatous Polyposis (FAP). * **Mismatch Repair (MMR) Genes (Option B):** These are involved in the **Microsatellite Instability (MSI) Pathway**. Mutations in genes like *MLH1* and *MSH2* lead to the accumulation of errors in repetitive DNA sequences. This pathway is characteristic of **Lynch Syndrome** (HNPCC) and about 15% of sporadic cases. **3. Clinical Pearls for NEET-PG:** * **APC Mutation:** Usually the "first hit" or earliest event in the classic adenoma-carcinoma sequence. * **DCC Gene:** (Deleted in Colon Cancer) is another high-yield gene associated with the late stages of colon cancer progression. * **K-RAS Mutation:** Follows *APC* loss and leads to the formation of a polyp (adenoma) [3]. * **p53 Mutation:** Often the final step leading to the transformation of an adenoma into a carcinoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 298-300. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 304-305. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 819.

Question 370: Multiple cutaneous sebaceous adenomas are seen in which of the following conditions?

A. Gardner's syndrome
B. Turcott's syndrome
C. Muir-Torre syndrome (Correct Answer)
D. Cowden syndrome

Explanation: ### 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.

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Neoplasia — MCQs

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