Neoplasia Practice Questions

Q: What is the most common extranodal site for lymphoma?

Stomach. **Explanation:** **Why Stomach is Correct:** Extranodal lymphomas account for approximately 25–40% of all Non-Hodgkin Lymphomas (NHL). The **Gastrointestinal (GI) tract** is the most common primary extranodal site, and within the GI tract, the **stomach** is the most frequently involved organ (50–60% of cases). The most common histological subtypes found in the stomach are **MALToma** (Mucosa-Associated Lymphoid Tissue lymphoma) and **Diffuse Large B-Cell Lymphoma (DLBCL)** [1]. A key risk factor for gastric MALToma is chronic infection with *Helicobacter pylori* [1]. **Analysis of Incorrect Options:** * **Esophagus:** This is the least common site for lymphoma in the GI tract. Primary esophageal lymphoma is extremely rare. * **Intestine:** While the small intestine (specifically the ileum due to Peyer's patches) is the second most common GI site, it lags significantly behind the stomach in frequency. * **Skin:** Cutaneous lymphomas (like Mycosis Fungoides) are the second most common extranodal site overall after the GI tract, but they do not surpass the stomach in incidence. **NEET-PG High-Yield Pearls:** * **Most common site for Extranodal Lymphoma:** Stomach. * **Most common GI Lymphoma subtype:** DLBCL (overall), though MALToma is classically associated with the stomach. * **H. pylori association:** Eradication of *H. pylori* can lead to regression of low-grade gastric MALTomas [1]. * **IPSID (Immunoproliferative Small Intestinal Disease):** A specific type of lymphoma involving the proximal small intestine, often associated with *Campylobacter jejuni*. * **Waldeyer’s Ring:** The second most common site for extranodal lymphoma in the head and neck region. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 356-357.

Q: What is the most common cause of renal tumors in adults?

Smoking. **Explanation:** Renal Cell Carcinoma (RCC) accounts for approximately 85-90% of all primary renal tumors in adults. Among the various environmental and lifestyle risk factors, **Smoking (Tobacco use)** is established as the most significant and common preventable risk factor. 1. **Why Smoking is Correct:** Tobacco use doubles the risk of developing RCC. The mechanism involves the systemic absorption of polycyclic aromatic hydrocarbons and nitrosamines, which are excreted via the kidneys, leading to direct urothelial and parenchymal DNA damage. There is a clear dose-response relationship between pack-years and tumor incidence. 2. **Why Incorrect Options are Wrong:** * **Family History:** While hereditary syndromes like Von Hippel-Lindau (VHL) are high-yield, they account for only **4-5%** of all RCC cases. The vast majority are sporadic. * **Obesity:** This is a significant risk factor (especially in women) due to increased estrogen levels and lipid peroxidation, but statistically, it follows smoking in prevalence. * **Hypertension:** There is a correlation between hypertension (and antihypertensive medications) and RCC, but it is considered a secondary risk factor compared to tobacco. **High-Yield Clinical Pearls for NEET-PG:** * **Most common histological subtype:** Clear Cell Carcinoma (associated with **VHL gene** deletion on Chromosome **3p**) [1]. * **Classic Triad (only in 10%):** Hematuria, palpable mass, and flank pain. * **Paraneoplastic Syndromes:** RCC is the "Great Mimicker," often causing polycythemia (via EPO), hypercalcemia (via PTHrP), and Cushing’s syndrome (via ACTH). * **Staging:** The most important prognostic factor is the **TNM stage**, specifically the involvement of the renal vein or IVC [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 957-958.

Question 1

A malignant epithelial cell neoplasm derived from any of the three germ layers is referred to as:

Accepted Answer

Teratoma

Answer

Sarcoma

Answer

Carcinoma

Answer

Mixed cell tumor

Question 2

Which of the following tumors has the propensity to metastasize through lymph nodes?

Accepted Answer

Alveolar rhabdomyosarcoma

Answer

Osteosarcoma

Answer

Both

Answer

None

Question 3

Wilms tumor is associated with all of the following except?

Accepted Answer

Bilateral polycystic kidney

Answer

Hemihypertrophy

Answer

Aniridia

Answer

Hypertension

Question 4

What is the most common extranodal site for lymphoma?

Accepted Answer

Stomach

Answer

Esophagus

Answer

Intestine

Answer

Skin

Question 5

Tumor lysis syndrome is characterized by all of the following electrolyte abnormalities except?

Accepted Answer

Hypercalcemia

Answer

Hyperkalemia

Answer

Hyperuricemia

Answer

Hyperphosphatemia

Question 6

A 2-year-old boy is found to have bilateral retinal tumors. Molecular studies demonstrate a germline mutation in one allele of the Rb gene. Which of the following genetic events best explains the mechanism of carcinogenesis in this patient?

Accepted Answer

Loss of heterozygosity

Answer

Balanced translocation

Answer

Expansion of trinucleotide repeat

Answer

Gene amplification

Question 7

What is the most important prognostic factor in breast carcinoma?

Accepted Answer

Stage of the tumour at the time of diagnosis

Answer

Histological grade of the tumour

Answer

Status of estrogen and progesterone receptors

Answer

Overexpression of p53 tumor suppressor gene

Question 8

Her2 neu receptor is used in breast carcinoma for what purpose?

Accepted Answer

Predicting response to treatment

Answer

Diagnosis of cancer

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Screening of breast carcinoma

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Detecting recurrence

Question 9

What is the most common cause of renal tumors in adults?

Accepted Answer

Smoking

Answer

Family history

Answer

Obesity

Answer

Hypertension

Question 10

What is the most important prognostic indicator of a mesenchymal tumor?

Accepted Answer

Type of primary

Answer

Size

Answer

Site

Neoplasia — MCQs

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