Neoplasia Practice Questions

Q: "HMB 45" is a marker for which of the following?

Melanoma. **Explanation:** **HMB-45 (Human Melanoma Black-45)** is a monoclonal antibody that reacts against a specific antigen located in the **melanosomes** (specifically the gp100 glycoprotein). It is highly specific for cells showing melanocytic differentiation. 1. **Why Melanoma is correct:** HMB-45 is one of the most specific markers for **Malignant Melanoma** [1]. It stains activated or neoplastic melanocytes but is typically negative in normal adult resting melanocytes (except for fetal control). It is particularly useful in identifying amelanotic melanomas that lack visible pigment [1]. 2. **Why other options are incorrect:** * **Sarcoma:** These are tumors of mesenchymal origin. Common markers include **Vimentin** (universal), Desmin (muscle), or CD31 (vascular). * **Carcinoma:** These are tumors of epithelial origin. The hallmark immunohistochemical (IHC) marker for carcinomas is **Cytokeratin (CK)**. **High-Yield Clinical Pearls for NEET-PG:** * **Other Melanoma Markers:** * **S-100:** Highly sensitive but lacks specificity (also positive in neural tumors, Langerhans cells, and cartilage). It is usually the first screening marker used. * **Melan-A (MART-1):** Another highly specific marker for melanocytic lineage. * **SOX-10:** A nuclear marker gaining popularity for its high sensitivity in both primary and metastatic melanoma. * **Diagnostic Utility:** In a "Round Cell Tumor" or "Undifferentiated Tumor" workup, a panel including CK (Carcinoma), Vimentin (Sarcoma), LCA (Lymphoma), and S-100/HMB-45 (Melanoma) is standard. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, pp. 1151-1152.

Q: A 50-year-old female patient presented with swelling of the left upper limb with characteristic skin lesions. She has a history of undergoing Modified Radical Mastectomy (MRM) followed by chemotherapy and radiotherapy 7 years ago. A skin biopsy was taken. Which of the following markers would be most likely positive in this patient?

CD31. ### Explanation **Diagnosis: Stewart-Treves Syndrome (Post-mastectomy Angiosarcoma)** The clinical presentation describes a classic case of **Stewart-Treves Syndrome**. This refers to the development of **angiosarcoma** in the setting of chronic lymphedema, most commonly occurring in the upper limb of a female patient several years after a Modified Radical Mastectomy (MRM) with axillary lymph node dissection. **Why CD31 is the correct answer:** Angiosarcoma is a malignant neoplasm of endothelial cells. **CD31 (PECAM-1)** is the most sensitive and specific diagnostic marker for vascular tumors as it is expressed on the surface of endothelial cells [1]. Other positive markers would include **CD34** and **Factor VIII-related antigen (von Willebrand factor)** [1]. **Analysis of Incorrect Options:** * **B. CD30:** This is a marker for Reed-Sternberg cells in Hodgkin Lymphoma, Anaplastic Large Cell Lymphoma (ALCL), and Embryonal Carcinoma. It has no role in vascular tumors. * **C. CD117 (c-KIT):** This is the characteristic marker for Gastrointestinal Stromal Tumors (GIST), Mastocytosis, and Seminoma. * **D. CD45 (LCA):** Known as Leukocyte Common Antigen, it is a pan-hematopoietic marker used to identify lymphomas and leukemias. **Clinical Pearls for NEET-PG:** * **Latency:** Stewart-Treves syndrome typically occurs **5–10 years** after mastectomy. * **Appearance:** Presents as persistent "bruise-like" purple-red nodules or plaques on a lymphedematous limb [1]. * **Risk Factors:** Chronic lymphedema is the primary trigger; radiotherapy (post-radiation angiosarcoma) can also contribute. * **High-Yield Markers for Angiosarcoma:** CD31 (Best), CD34, ERG (highly specific nuclear marker), and FLI-1. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 527-528.

Q: HMB45 is a marker for which of the following?

Melanoma. **Explanation:** **HMB-45 (Human Melanoma Black-45)** is a monoclonal antibody that reacts against **gp100**, a specific oncofetal antigen found in **melanosomes**. It is highly specific for cells showing melanocytic differentiation. In clinical pathology, it is a primary immunohistochemical (IHC) marker used to confirm the diagnosis of **Melanoma**, particularly when the tumor is amelanotic or poorly differentiated [1]. **Analysis of Options:** * **A. Melanoma (Correct):** HMB-45 is highly specific for activated or neoplastic melanocytes [1]. While S100 is more sensitive for melanoma, HMB-45 is more specific. * **B. Synovial sarcoma:** Characterized by a (X;18) translocation. Key markers include **TLE1**, Cytokeratin, and EMA. * **C. Rhabdomyosarcoma:** A skeletal muscle tumor. Key markers include **Desmin, Myogenin (Myf4), and MyoD1**. * **D. Neurofibroma:** A benign nerve sheath tumor. While it may express **S100**, it does not contain melanosomes and is negative for HMB-45. **NEET-PG High-Yield Pearls:** * **Melanoma Marker Hierarchy:** * **S100:** Most sensitive (best for screening/ruling out). * **HMB-45 & Melan-A (MART-1):** Highly specific (best for confirming). * **SOX10:** Excellent marker for both primary and metastatic melanoma. * **Exceptions:** HMB-45 can also be positive in **PEComas** (Perivascular Epithelioid Cell tumors), such as **Angiomyolipoma** (AML) of the kidney and Lymphangioleiomyomatosis (LAM). * **Desmoplastic Melanoma:** Often characteristically **negative** for HMB-45 and Melan-A, but positive for S100/SOX10. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, pp. 1151-1152.

Q: Which of the following is the primary tumor marker for hepatocellular carcinoma?

Alpha-fetoprotein (AFP). **Explanation:** **Alpha-fetoprotein (AFP)** is the primary and most widely used tumor marker for **Hepatocellular Carcinoma (HCC)** [1], [2]. AFP is a glycoprotein normally synthesized by the fetal liver and yolk sac. In adults, levels are typically negligible; however, they rise significantly in HCC due to the dedifferentiation of hepatocytes into a fetal-like state. For NEET-PG, remember that while AFP is sensitive, it can also be elevated in non-seminomatous germ cell tumors (Yolk sac tumors) and benign conditions like cirrhosis or chronic hepatitis [1], [2]. **Analysis of Incorrect Options:** * **Carcinoembryonic Antigen (CEA):** Primarily used for monitoring **Colorectal Carcinoma** [2]. It is also elevated in pancreatic, gastric, and breast cancers, but is not specific for HCC [2]. * **Human Chorionic Gonadotropin (HCG):** The hallmark marker for **Choriocarcinoma** and hydatidiform moles. It is also elevated in certain germ cell tumors (e.g., seminoma, dysgerminoma). * **CA 19-9:** The primary marker for **Pancreatic Adenocarcinoma** and cholangiocarcinoma (bile duct cancer). **High-Yield Clinical Pearls for NEET-PG:** * **Diagnostic Threshold:** In a patient with cirrhosis, an AFP level **>400 ng/mL** combined with characteristic imaging (e.g., arterial enhancement and venous wash-out on CT/MRI) is highly suggestive of HCC. * **Fibrolamellar Variant:** A rare subtype of HCC occurring in young adults without cirrhosis; notably, **AFP levels are usually normal** in these patients. * **Other HCC Markers:** DCP (Des-gamma-carboxy prothrombin) and Glypican-3 are emerging 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.

Question 1

What is the term for a benign tumor of smooth muscle?

Accepted Answer

Leiomyoma

Answer

Rhabdomyoma

Answer

Fibroma

Answer

Angiomyoma

Question 2

"HMB 45" is a marker for which of the following?

Accepted Answer

Melanoma

Answer

Sarcoma

Answer

Carcinoma

Answer

None of the above

Question 3

Which of the following is a poor prognostic factor for melanoma?

Accepted Answer

Spread to lymphatics

Answer

Size of tumour

Answer

Shape

Answer

Colour of tumour

Question 4

Which of the following are suspected carcinogens for bladder carcinoma?

Accepted Answer

All the above

Answer

Phenacitin

Answer

Tobacco

Answer

Aniline dye

Question 5

Retinoblastoma can result from a mutation in:

Accepted Answer

RB 1 gene

Answer

Ras proto-oncogene

Answer

ErbB proto-oncogene

Answer

p 53 gene

Question 6

What is the least common site for the spread of melanoma?

Accepted Answer

Kidney

Answer

Gastrointestinal tract (GIT)

Answer

Lungs

Answer

Liver

Question 7

A 50-year-old female patient presented with swelling of the left upper limb with characteristic skin lesions. She has a history of undergoing Modified Radical Mastectomy (MRM) followed by chemotherapy and radiotherapy 7 years ago. A skin biopsy was taken. Which of the following markers would be most likely positive in this patient?

Accepted Answer

CD31

Answer

CD30

Answer

CD117

Answer

CD45

Question 8

All are true regarding foregut carcinoid tumors, except?

Accepted Answer

Bone metastasis is not a feature.

Answer

Foregut tumors generally have a low serotonin content.

Answer

Argentaffin-negative but argyrophilic.

Answer

Often multifactorial.

Question 9

HMB45 is a marker for which of the following?

Accepted Answer

Melanoma

Answer

Synovial sarcoma

Answer

Rhabdomyosarcoma

Answer

Neurofibroma

Question 10

Which of the following is the primary tumor marker for hepatocellular carcinoma?

Accepted Answer

Alpha-fetoprotein (AFP)

Answer

Carcinoembryonic antigen (CEA)

Answer

Human chorionic gonadotropin (HCG)

Answer

Carbohydrate antigen 19-9 (CA-19)

Neoplasia — MCQs

Neoplasia — MCQs

On this page

Practice by Chapter

Want unlimited practice?