Neoplasia Practice Questions

Q: Which of the following features is NOT evaluated for the histological grading of breast carcinoma?

Tumor necrosis. The histological grading of breast carcinoma is primarily performed using the **Nottingham Grading System** (also known as the Elston-Ellis modification of the Scarff-Bloom-Richardson scale) [1]. This system evaluates three specific morphological features to determine the aggressiveness of the tumor. ### Why Tumor Necrosis is the Correct Answer: **Tumor necrosis (Option A)** is a feature often seen in high-grade or aggressive tumors (especially the comedo subtype of DCIS), but it is **not** a formal component of the Nottingham Grading System [1]. While it may have prognostic significance, it is not assigned a numerical score during the grading process. ### Evaluation of Other Options (The Nottingham Criteria): The grading system assigns a score of 1 to 3 for each of the following three criteria [1]: * **Tubule Formation (Option C):** Evaluates how much of the tumor is organized into tubes or glands. More tubules indicate a lower grade (better differentiation) [1]. * **Nuclear Pleomorphism (Option D):** Assesses the variation in size and shape of the nuclei. Uniform nuclei score low, while highly irregular, enlarged nuclei score high [1]. * **Mitotic Count (Option B):** Measures the proliferation rate by counting the number of mitotic figures per 10 high-power fields (HPF) [1]. ### NEET-PG Clinical Pearls: * **Grading vs. Staging:** Remember that **Stage** (TNM) is generally a more powerful predictor of prognosis than **Grade** in breast cancer. * **Scoring:** The total score ranges from 3 to 9. * Grade I (Well-differentiated): 3–5 points. * Grade II (Moderately differentiated): 6–7 points. * Grade III (Poorly differentiated): 8–9 points. * **High-Yield Fact:** The Nottingham system is specifically used for **Invasive Carcinoma** (No Special Type/Ductal), not for In-situ lesions [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1068.

Q: What percentage of medullary carcinoma of the breast presents with bilaterality?

20%. **Explanation:** Medullary carcinoma of the breast is a distinct subtype of invasive ductal carcinoma, accounting for approximately 1-7% of all breast cancers. It is characterized by a well-circumscribed border, high-grade nuclei, and a prominent lymphoplasmacytic infiltrate [1]. **Why 20% is correct:** A defining clinical feature of medullary carcinoma is its higher propensity for **bilaterality** compared to other histological types. Approximately **20% of cases** present with bilateral involvement (either synchronous or metachronous). This is a high-yield fact for NEET-PG, as it contrasts with the typical 5-10% bilaterality seen in standard invasive ductal carcinoma (NOS). **Analysis of Incorrect Options:** * **A (<5%):** This is the typical rate of bilaterality for most common breast cancers, but it underestimates the specific incidence in medullary carcinoma. * **B (10%):** While closer to the average for Lobular Carcinoma (which is also known for bilaterality/multifocality), it is still lower than the reported incidence for Medullary Carcinoma. * **D (50%):** This is an overestimation. No common subtype of breast cancer presents with 50% bilaterality. **High-Yield Clinical Pearls for NEET-PG:** * **Triple Negative:** Medullary carcinomas are typically ER, PR, and HER2/neu negative (Triple Negative), yet they paradoxically have a **better prognosis** than standard invasive carcinomas [1]. * **BRCA1 Association:** There is a strong association between medullary carcinoma and **BRCA1 mutations**. * **Microscopic Hallmark:** "Pushing" borders (non-infiltrative) and syncytial growth patterns with no gland formation [1]. * **Differential:** It can mimic a fibroadenoma on imaging due to its circumscribed nature. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 455-456.

Q: Which of the following is included in the Modified Bloom Richardson criteria for Carcinoma Breast?

Mitotic rate. The **Modified Bloom-Richardson (MBR) grading system**, also known as the Nottingham Grading System, is the standard method used to determine the histological grade of breast carcinoma [1]. It is a semi-quantitative system that assesses the biological aggressiveness of a tumor based on three specific morphological features. ### Why Mitotic Rate is Correct: The MBR system assigns a score of 1 to 3 for each of the following three criteria [1]: 1. **Tubule Formation:** Percentage of the tumor forming definite tubules. 2. **Nuclear Pleomorphism:** Evaluation of the size and shape of the nuclei. 3. **Mitotic Count (Rate):** The number of mitoses per 10 high-power fields (HPF). The sum of these scores (ranging from 3 to 9) determines the Grade (I, II, or III) [1]. Therefore, **Mitotic rate** is a core component of this scoring system. ### Why Other Options are Incorrect: * **Desmoplasia (A):** This refers to the reactive fibrosis (stromal response) surrounding a tumor. While characteristic of invasive ductal carcinoma (giving it a "scirrhous" or hard feel), it is not a parameter used for histological grading. * **Lymphovenous Embolism (B):** The presence of tumor cells within lymphatic or vascular spaces is a critical prognostic factor for metastasis, but it is not part of the MBR grading criteria. ### High-Yield Clinical Pearls for NEET-PG: * **Grading vs. Staging:** Remember that MBR is a **Grading** system (microscopic), whereas TNM is a **Staging** system (clinical/extent). * **Prognostic Significance:** Grade III tumors (score 8-9) are poorly differentiated and have the worst prognosis [1]. * **Most Common Type:** Invasive Breast Carcinoma of No Special Type (NST), formerly called Invasive Ductal Carcinoma, is the most common type graded using this system [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1068-1069.

Question 1

Which of the following features is NOT evaluated for the histological grading of breast carcinoma?

Accepted Answer

Tumor necrosis

Answer

Mitotic count

Answer

Tubule formation

Answer

Nuclear pleomorphism

Question 2

CEA is elevated in all of the following conditions except:

Accepted Answer

Prostatic carcinoma

Answer

Alcoholic cirrhosis

Answer

Ulcerative colitis

Answer

Carcinoma colon

Question 3

Which of the following pre-malignant conditions is associated with the highest probability of progression to malignancy?

Accepted Answer

Erythroplakia

Answer

Dysplasia

Answer

Hyperplasia

Answer

Leukoplakia

Question 4

The retinoblastoma gene regulates which phase transition?

Accepted Answer

G1 to S phase

Answer

G2 to M phase

Answer

G0 to S1 phase

Answer

S to G1 phase

Question 5

What percentage of medullary carcinoma of the breast presents with bilaterality?

Accepted Answer

20%

Answer

Less than 5%

Answer

10%

Answer

50%

Question 6

Which of the following is included in the Modified Bloom Richardson criteria for Carcinoma Breast?

Accepted Answer

Mitotic rate

Answer

Desmoplasia

Answer

Lymphovenous embolism

Answer

All

Question 7

Which of the following is NOT a characteristic typically observed in virus-induced tumor cells?

Accepted Answer

Changes in cell size

Answer

Loss of cellular orientation

Answer

Loss of contact inhibition

Answer

Formation of multicellular tumor spheroids

Question 8

Which gene is associated with apoptosis?

Accepted Answer

BCL-2

Answer

BRAC

Answer

RET

Answer

All of the above

Question 9

Leiomyoma is a tumor of which tissue type?

Accepted Answer

Smooth muscle

Answer

Cerebral tissue

Answer

Striated muscle

Answer

Cardiac muscle

Question 10

Rosettes typically seen in Neuroblastoma are:

Accepted Answer

Homer-wright rosettes

Answer

Flexner Wintersteiner rosettes

Answer

Perivascular rosettes

Answer

Neurocytic rosettes

Neoplasia — MCQs

Neoplasia — MCQs

On this page

Practice by Chapter

Want unlimited practice?