Neoplasia Practice Questions

Q: Which of the following is not a paraneoplastic syndrome of Renal cell carcinoma?

Cushing's syndrome. **Explanation:** Renal Cell Carcinoma (RCC) is famously known as the **"Internist’s Tumor"** because of its propensity to present with a wide array of paraneoplastic syndromes (PNS) [1]. **Why Cushing’s Syndrome is the Correct Answer:** Cushing’s syndrome is caused by the ectopic production of **ACTH**. While it is a classic PNS for **Small Cell Carcinoma of the Lung** and Medullary Thyroid Carcinoma, it is **not** typically associated with RCC [1]. RCC is more commonly associated with ectopic production of PTHrP (Hypercalcemia), Erythropoietin, and Renin. **Analysis of Incorrect Options:** * **Erythrocytosis:** Occurs in ~5-10% of RCC patients due to the ectopic secretion of **Erythropoietin (EPO)** by the tumor cells [2]. * **Amyloidosis:** Chronic inflammation and tumor-related proteins in RCC can lead to **Secondary (AA) Amyloidosis**. This is a recognized systemic complication of the disease. * **Hypertension:** This is a common PNS in RCC, occurring due to the secretion of **Renin** by the tumor or due to compression of the renal artery (Goldblatt kidney mechanism). **High-Yield Clinical Pearls for NEET-PG:** * **Stauffer Syndrome:** A unique PNS of RCC characterized by reversible hepatic dysfunction (elevated LFTs) in the absence of liver metastases. * **Most Common PNS in RCC:** Hypercalcemia (due to PTHrP) [1]. * **Classic Triad:** Hematuria, flank pain, and palpable mass (seen in only 10% of cases; usually signifies advanced disease). * **Genetic Association:** Deletion of the **VHL gene** on Chromosome 3p is the most common genetic defect in sporadic and familial clear cell RCC. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 338-339. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 492-493.

Q: Deletion of the short arm of chromosome 11 is seen in which of the following conditions?

Wilms tumor. ### Explanation **Correct Option: C. Wilms tumor** Wilms tumor (Nephroblastoma) is the most common primary renal tumor of childhood. The pathogenesis is closely linked to the **WT1 gene**, located on the **short arm of chromosome 11 (11p13)** [1]. Deletions or mutations in this region lead to the loss of this tumor suppressor gene, which is essential for normal renal and gonadal development. This deletion is classically associated with **WAGR syndrome** (Wilms tumor, Aniridia, Genitourinary anomalies, and intellectual disability/Range of developmental delays) [1]. **Analysis of Incorrect Options:** * **A. Osteosarcoma:** Most commonly associated with mutations in the **RB1 gene (13q14)** and **TP53 gene (17p13)**. While 11p abnormalities are not characteristic, hereditary retinoblastoma patients have a significantly high risk for osteosarcoma. * **B. Meningioma:** Characterized by the deletion or mutation of the **NF2 gene** located on the **long arm of chromosome 22 (22q12)**. * **D. Colon carcinoma:** Primarily associated with the **APC gene (5q21)** in familial adenomatous poplyposis (FAP) and the **DCC gene (18q21)** in the adenoma-carcinoma sequence. **High-Yield Clinical Pearls for NEET-PG:** * **WT1 (11p13):** Associated with WAGR syndrome and Denys-Drash syndrome [1]. * **WT2 (11p15.5):** Associated with **Beckwith-Wiedemann Syndrome** (macroglossia, hemihypertrophy, and organomegaly). * **Histology Triad:** Wilms tumor typically shows a triphasic pattern consisting of **blastemal, stromal, and epithelial** cells. * **Prognostic Marker:** The presence of **anaplasia** (TP53 mutation) is the most important adverse prognostic factor in Wilms tumor. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 487-488.

Q: Which of the following tumors shows increased serum elevation of placental alkaline phosphatase and positive immunohistochemical staining for placental alkaline phosphatase?

Seminoma. **Explanation:** **Seminoma** is the most common germ cell tumor of the testis. It characteristically expresses **Placental Alkaline Phosphatase (PLAP)**, which serves as both a serum marker and a highly sensitive immunohistochemical (IHC) marker [1]. PLAP is an enzyme normally produced by the placenta; its elevation in a male patient is highly suggestive of a germ cell origin, specifically seminoma or dysgerminoma (its female counterpart). **Analysis of Options:** * **A. Seminoma (Correct):** Shows diffuse membranous positivity for PLAP, c-KIT (CD117), and OCT3/4 [1]. Serum PLAP levels are elevated in approximately 40-50% of cases. * **B. Hepatoblastoma:** This is a childhood liver tumor. Its primary markers are **Alpha-fetoprotein (AFP)** and Beta-catenin (nuclear staining). * **C. Hepatocellular Carcinoma (HCC):** The classic serum marker is **AFP**. IHC markers include HepPar-1, Glypican-3, and Arginase-1. * **D. Peripheral Neuroectodermal Tumor (PNET/Ewing Sarcoma):** These belong to the small round blue cell tumor family. The characteristic IHC marker is **CD99 (MIC2)**, and they are associated with the t(11;22) translocation. **NEET-PG High-Yield Pearls:** 1. **Seminoma vs. Non-Seminoma:** Seminomas *never* produce AFP. If AFP is elevated, it indicates a non-seminomatous component (like Yolk Sac Tumor). 2. **HCG in Seminoma:** About 10-15% of seminomas contain syncytiotrophoblastic giant cells which can cause a mild elevation in serum **beta-HCG** [1]. 3. **Classic IHC Triad for Seminoma:** PLAP (+), CD117 (+), and OCT3/4 (+). Note that CD30 is typically negative (positive in Embryonal Carcinoma) [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 980-982.

Q: CAR-T cells are used in the treatment of which of the following cancers?

Acute lymphoblastic leukemia. **Explanation:** **Chimeric Antigen Receptor (CAR) T-cell therapy** is a revolutionary form of adoptive immunotherapy where a patient’s T-cells are genetically engineered to express a synthetic receptor that recognizes specific tumor antigens without the need for MHC presentation. **Why Option A is Correct:** The most successful application of CAR-T therapy to date is in B-cell malignancies. The engineered T-cells typically target **CD19**, a surface marker found on almost all B-cells. **Acute Lymphoblastic Leukemia (ALL)**, specifically B-ALL, shows high expression of CD19, making it highly susceptible to this therapy. It is currently FDA-approved for relapsed or refractory B-cell ALL in children and young adults [1]. **Why Other Options are Incorrect:** * **Options B, C, and D (Soft tissue sarcoma, Medulloblastoma, Small cell lung carcinoma):** These are all **solid tumors**. CAR-T therapy faces significant challenges in solid tumors due to the lack of unique tumor-specific antigens, poor penetration into the dense tumor microenvironment, and local immunosuppressive factors. While research is ongoing, they are not currently standard indications for CAR-T therapy. **High-Yield Clinical Pearls for NEET-PG:** * **Target Antigen:** Most common target is **CD19** (used in Tisagenlecleucel and Axicabtagene ciloleucel). * **Major Side Effect:** **Cytokine Release Syndrome (CRS)**, characterized by high fever and hypotension due to massive release of IL-6. * **Management of CRS:** The IL-6 receptor antagonist **Tocilizumab** is the drug of choice. * **Neurotoxicity:** Also known as ICANS (Immune Effector Cell-Associated Neurotoxicity Syndrome), it is the second most common serious side effect. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 635-636.

Question 1

Which of the following statements regarding carcinoid tumors is not true?

Accepted Answer

Carcinoid tumors exhibit 4 distinctive histological forms.

Answer

Extensive involvement of the small intestine is associated with a higher chance of lung involvement.

Answer

The 5-year survival rate for carcinoid tumors is greater than 60%.

Answer

Eighty percent of appendiceal carcinoids are incidentally detected during surgery for other indications.

Question 2

A 56-year-old woman presents with vaginal bleeding for 1 week. Her last menstrual period was 10 years ago. Physical examination reveals a palpable lower abdominal mass. Endometrial biopsy shows endometrial carcinoma, and an abdominal CT scan shows a 6-cm mass in the left ovary. A total abdominal hysterectomy is performed. Microscopically, the ovarian mass is identified as a granulosa-theca cell tumor producing estrogen. Which of the following best describes the relationship between the endometrial carcinoma and the estrogen-producing ovarian tumor?

Accepted Answer

Promotion of carcinogenesis by estrogen

Answer

Genetic susceptibility to tumorigenesis

Answer

Mutational inactivation of a tumor suppressor gene

Answer

Paraneoplastic syndrome

Question 3

Both breasts are affected in which type of breast carcinoma?

Accepted Answer

Lobular

Answer

Inflammatory

Answer

Infiltrating

Answer

Ductal

Question 4

Which of the following is not a paraneoplastic syndrome of Renal cell carcinoma?

Accepted Answer

Cushing's syndrome

Answer

Erythrocytosis

Answer

Amyloidosis

Answer

Hypertension

Question 5

Which gene is associated with superficial papillary urothelial neoplasm?

Accepted Answer

p16

Answer

p53

Answer

p7

Answer

KRAS

Question 6

Deletion of the short arm of chromosome 11 is seen in which of the following conditions?

Accepted Answer

Wilms tumor

Answer

Osteosarcoma

Answer

Meningioma

Answer

Colon carcinoma

Question 7

What type of tumour may occur in the residual breast or overlying skin following wide local excision and radiotherapy for mammary carcinoma?

Accepted Answer

Angiosarcoma

Answer

Leiomyosarcoma

Answer

Squamous cell carcinoma

Answer

Basal cell carcinoma

Question 8

Which of the following tumors shows increased serum elevation of placental alkaline phosphatase and positive immunohistochemical staining for placental alkaline phosphatase?

Accepted Answer

Seminoma

Answer

Hepatoblastoma

Answer

Hepatocellular carcinoma

Answer

Peripheral neuroectodermal tumor

Question 9

The translocation most commonly seen in follicular lymphoma is?

Accepted Answer

t(14;18)

Answer

t(11;14)

Answer

t(9;22)

Answer

t(8;14)

Question 10

CAR-T cells are used in the treatment of which of the following cancers?

Accepted Answer

Acute lymphoblastic leukemia

Answer

Soft tissue sarcoma

Answer

Medulloblastoma

Answer

Small cell lung carcinoma

Neoplasia — MCQs

Neoplasia — MCQs

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