Neoplasia Practice Questions

Q: AKT1 amplification is seen in which of the following cancers?

Gastric cancer. **Explanation:** The **PI3K/AKT/mTOR pathway** is a critical signaling cascade involved in cell growth, proliferation, and survival. Dysregulation of this pathway is a hallmark of various malignancies. **AKT1** (also known as Protein Kinase B alpha) is a key downstream effector of PI3K. **Why Gastric Cancer is Correct:** While mutations in the PI3K pathway are common across many cancers, **AKT1 gene amplification** is a specific molecular signature frequently identified in **Gastric Cancer**. Studies have shown that AKT1 amplification leads to protein overexpression, which correlates with advanced tumor stage, lymph node metastasis, and poor prognosis in gastric adenocarcinoma patients. **Analysis of Incorrect Options:** * **A. Bladder Cancer:** While the PI3K pathway is often activated in bladder cancer, it is more commonly associated with **PIK3CA mutations** or **PTEN loss** rather than primary AKT1 amplification. * **B. Colon Cancer:** Colorectal cancers frequently exhibit **PIK3CA mutations** (found in ~15-20% of cases) and **PTEN deletions**, but AKT1 amplification is not a characteristic driver for this malignancy. * **C. Breast Cancer:** In breast cancer (particularly ER+), the most common alteration in this pathway is the **AKT1 E17K mutation** (a point mutation in the pleckstrin homology domain), not gene amplification. **High-Yield Clinical Pearls for NEET-PG:** * **AKT1 E17K Mutation:** Most commonly associated with **Breast, Endometrial, and Ovarian cancers**. * **PTEN:** A tumor suppressor gene that acts as a negative regulator of the PI3K/AKT pathway. Its loss is a major driver in **Endometrial and Prostate cancers**. * **mTOR Inhibitors:** Drugs like Everolimus and Temsirolimus target this pathway and are used in Renal Cell Carcinoma (RCC) and Breast Cancer.

Q: Multifocal tumour of vascular origin in a patient of AIDS is:

Kaposi's sarcoma. **Explanation:** **Kaposi’s Sarcoma (KS)** is the correct answer because it is a classic AIDS-defining illness [1]. It is a **multifocal, low-grade vascular tumor** caused by **Human Herpesvirus 8 (HHV-8)**, also known as KSHV [1]. In the context of HIV, it typically presents as purple-red macules, plaques, or nodules on the skin, mucous membranes, and viscera [2]. The tumor cells are derived from vascular or lymphatic endothelial cells. **Analysis of Incorrect Options:** * **Astrocytoma:** While HIV patients are at risk for various CNS issues, astrocytomas are not specifically associated with AIDS nor are they typically multifocal tumors of vascular origin. * **Gastric Carcinoma:** Though HIV patients have an increased risk of certain GI malignancies, gastric adenocarcinoma is not an AIDS-defining illness and is epithelial, not vascular, in origin [1]. * **Primary CNS Lymphoma:** This is a common AIDS-defining malignancy (associated with **EBV**), but it is a tumor of **B-cell lymphoid origin**, not vascular origin [3]. **High-Yield Clinical Pearls for NEET-PG:** * **Histology:** Look for "slit-like vascular spaces" containing extravasated RBCs and spindle-shaped stromal cells [2]. * **Four Clinical Types:** Classic (European), Endemic (African), Iatrogenic (Transplant-related), and AIDS-associated (Epidemic). * **Pathogenesis:** HHV-8 encodes a G-protein coupled receptor that stimulates VEGF, leading to angiogenesis. * **Diagnosis:** Biopsy is definitive; HHV-8 immunostaining is highly specific. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 261-262. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 526-527. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 262-263.

Q: S100 is a marker for which of the following neoplasms?

Melanoma. **Explanation:** **S100** is a calcium-binding protein primarily found in cells derived from the **neural crest**. It is a highly sensitive, though not highly specific, immunohistochemical (IHC) marker used in diagnostic pathology. **Why Melanoma is the Correct Answer:** Melanocytes are neural crest-derived cells. **Melanoma** is the classic neoplasm associated with S100 positivity. While newer markers like HMB-45 and Melan-A are more specific, S100 remains the most sensitive screening marker for melanoma; a negative S100 result almost always rules out a diagnosis of melanoma. **Analysis of Other Options:** * **Schwannoma:** While Schwannomas are also S100 positive (as Schwann cells are neural crest-derived), in the context of standard NEET-PG questions, **Melanoma** is the primary association taught and tested for S100. *Note: If this were a "Multiple Correct" type question, Schwannoma would also be technically correct.* * **Histiocytoma:** Fibrous histiocytomas are typically negative for S100. However, Langerhans Cell Histiocytosis (LCH) is S100 positive, but "Histiocytoma" usually refers to fibrohistiocytic tumors which are negative. * **Hemangioma:** This is a vascular tumor derived from endothelial cells. The characteristic marker for vascular tumors is **CD31** or **CD34**, not S100. **High-Yield Clinical Pearls for NEET-PG:** * **S100 Positive Tissues:** Melanocytes, Schwann cells, Chondrocytes (cartilage), Adipocytes (fat), and Langerhans cells. * **S100 Positive Tumors:** Melanoma, Schwannoma, Neurofibroma, Chondrosarcoma, and Lipoma. * **Specific Melanoma Markers:** HMB-45 (highly specific for premelanosomes) and Melan-A (MART-1). * **Rule of Thumb:** If a spindle cell tumor is S100 negative, it is very unlikely to be a nerve sheath tumor or melanoma.

Q: What is a Turban tumor?

Cutaneous cylindroma. **Explanation:** **Cutaneous Cylindroma (Option C)** is a benign adnexal tumor, traditionally thought to arise from eccrine or apocrine sweat glands [1]. It is nicknamed a **"Turban Tumor"** because multiple nodules can enlarge and coalesce over the scalp, resembling a turban [1]. * **Histopathology (High-Yield):** On microscopy, it shows a characteristic **"Jigsaw puzzle" appearance** [1]. It consists of nests of basaloid cells surrounded by thick, eosinophilic, PAS-positive hyaline basement membrane material [1]. * **Genetics:** It is associated with mutations in the **CYLD gene**. When multiple, it is often part of **Brooke-Spiegler Syndrome** (along with trichoepitheliomas and spiradenomas) [1]. **Why other options are incorrect:** * **Basal Cell Carcinoma (A):** The most common skin cancer, typically presenting as a pearly papule with telangiectasia or a "rodent ulcer" [2]. It shows peripheral palisading on histology, not a jigsaw pattern [2]. * **Squamous Cell Carcinoma (B):** Presents as scaling, friable plaques or erosions [3]. Histology shows keratin pearls and intercellular bridges. * **Dermatofibroma (C):** A common benign fibrous nodule, usually on the legs, characterized by the "dimple sign" (invagination upon lateral pressure) [2]. **NEET-PG High-Yield Pearls:** 1. **Jigsaw puzzle pattern** = Cylindroma [1]. 2. **CYLD Gene mutation** = Cylindroma. 3. **Brooke-Spiegler Syndrome** = Multiple Cylindromas + Trichoepitheliomas [1]. 4. **Turban Tumor** = Clinical gross appearance of confluent scalp cylindromas [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, pp. 1154-1156. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, pp. 1160-1162. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, p. 1158.

Q: Syndrome of inappropriate Antidiuretic Hormone secretion (SIADH) is a characteristic paraneoplastic association of which of the following carcinomas?

Small cell lung carcinoma. **Explanation:** **Small cell lung carcinoma (SCLC)** is the correct answer because it is a neuroendocrine tumor derived from Kulchitsky cells [2]. These cells have the metabolic machinery to synthesize and ectopically secrete polypeptide hormones [1]. **SIADH** occurs when the tumor secretes excessive Antidiuretic Hormone (Arginine Vasopressin), leading to water retention, dilutional hyponatremia, and concentrated urine [1]. SCLC is the most common cause of paraneoplastic SIADH, occurring in approximately 7–10% of patients. **Analysis of Incorrect Options:** * **Lobular carcinoma of breast:** While breast cancer can cause paraneoplastic syndromes (like hypercalcemia via PTHrP), it is not classically associated with SIADH. * **Non-small cell lung carcinoma (NSCLC):** Specifically, **Squamous Cell Carcinoma** of the lung is famously associated with hypercalcemia due to the secretion of Parathyroid Hormone-related Protein (PTHrP), not SIADH. * **Fibrosarcoma:** This mesenchymal tumor is more commonly associated with **hypoglycemia** due to the secretion of Insulin-like Growth Factor (IGF-2), a condition known as Doege-Potter syndrome. **High-Yield Clinical Pearls for NEET-PG:** * **SCLC "3 Cs":** **C**ushing Syndrome (Ectopic ACTH), **C**onfusion (SIADH/Hyponatremia), and **C**arcinoid-like syndrome. * **Lambert-Eaton Myasthenic Syndrome (LEMS):** Another high-yield paraneoplastic association of SCLC involving antibodies against voltage-gated calcium channels. * **Rule of Thumb:** If the question mentions a lung mass + Hyponatremia = **Small Cell**; Lung mass + Hypercalcemia = **Squamous Cell**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 725-727. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 337-338.

Question 1

AKT1 amplification is seen in which of the following cancers?

Accepted Answer

Gastric cancer

Answer

Cancer of the bladder

Answer

Cancer of the colon

Answer

Breast cancer

Question 2

All of the following are features of borderline tumors except?

Accepted Answer

Stromal invasion seen

Answer

Occurs in younger age

Answer

Mitotic figures < 9/10 per high power field

Answer

Very good prognosis

Question 3

Multifocal tumour of vascular origin in a patient of AIDS is:

Accepted Answer

Kaposi's sarcoma

Answer

Astrocytoma

Answer

Gastric carcinoma

Answer

Primary CNS lymphoma

Question 4

S100 is a marker for which of the following neoplasms?

Accepted Answer

Melanoma

Answer

Schwannoma

Answer

Histiocytoma

Answer

Hemangioma

Question 5

What is a Turban tumor?

Accepted Answer

Cutaneous cylindroma

Answer

Basal cell carcinoma

Answer

Squamous cell carcinoma

Answer

Dermatofibroma

Question 6

Squamous cell carcinoma of the lip is least likely to develop in which of the following individuals?

Accepted Answer

Brunette individual who constantly drinks tea

Answer

Scandinavian fisherman

Answer

Redheaded individual with a year-round tan

Answer

Man who smokes a clay pipe

Question 7

A 70-year-old male, a chronic tobacco chewer for 50 years, presents with a six-month history of a large, fungating, soft papillary lesion in the oral cavity that has penetrated the mandible. Lymph nodes are not palpable. Biopsies show benign-appearing papillomatosis with hyperkeratosis and acanthosis infiltrating the subjacent tissues. What is the most likely diagnosis?

Accepted Answer

Verrucous carcinoma

Answer

Squamous cell papilloma

Answer

Squamous cell carcinoma

Answer

Malignant mixed tumor

Question 8

Syndrome of inappropriate Antidiuretic Hormone secretion (SIADH) is a characteristic paraneoplastic association of which of the following carcinomas?

Accepted Answer

Small cell lung carcinoma

Answer

Lobular carcinoma of breast

Answer

Non-small cell lung carcinoma

Answer

Fibrosarcoma

Question 9

Which condition is associated with the S-100 marker?

Accepted Answer

Malignant melanoma

Answer

Multiple myeloma

Answer

Prostate carcinoma

Answer

Medullary carcinoma thyroid

Question 10

Smoking is a causative factor for all the following carcinomas, except:

Accepted Answer

Nasopharyngeal carcinoma

Answer

Esophageal carcinoma

Answer

Laryngeal carcinoma

Answer

Urinary bladder carcinoma

Neoplasia — MCQs

Neoplasia — MCQs

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