Neoplasia Practice Questions

Q: Which of the following parotid malignancies is known for perineural spread?

Adenoid cystic carcinoma. **Explanation:** **Adenoid Cystic Carcinoma (ACC)** is the correct answer because it is classically characterized by its high propensity for **perineural invasion (PNI)**. In the context of the parotid gland, the tumor cells tend to track along the facial nerve (CN VII), often leading to facial nerve palsy—a clinical hallmark that distinguishes it from benign lesions. Histologically, it presents with a "Swiss-cheese" (cribriform) pattern, and its ability to spread along nerve sheaths often results in recurrence and late distant metastasis, even years after surgery. **Analysis of Incorrect Options:** * **Pleomorphic Adenoma (A):** This is the most common benign salivary gland tumor. While it can recur if the capsule is breached during surgery, it does not exhibit perineural spread. * **Warthin’s Tumor (C):** Also known as Papillary Cystadenoma Lymphomatosum, this is a benign tumor strongly associated with smoking. It is typically found in the tail of the parotid and does not invade nerves. * **Ductal Papilloma (D):** This is a rare, benign epithelial tumor of the salivary ducts. It lacks the invasive characteristics required for perineural spread. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site for ACC:** Submandibular gland (though it occurs in the parotid, it is the most common malignant tumor of the minor salivary glands) [1]. * **Histological Hallmark:** Cribriform pattern with "cylindromatous" appearance (basement membrane-like material in spaces). * **Clinical Sign:** Pain is a frequent early symptom in ACC due to its affinity for nerves. * **Prognosis:** Characterized by a "relentless" course; 5-year survival is good, but 10-20 year survival is poor due to late metastases (often to the lungs). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 753-755.

Q: Keratin is a tumor marker for which of the following?

Carcinoma cervix. **Explanation:** **1. Why Carcinoma Cervix is Correct:** Keratin is an intermediate filament found in epithelial cells. It is the hallmark immunohistochemical (IHC) marker for **Carcinomas** (malignant tumors of epithelial origin) [1]. Since Carcinoma Cervix (most commonly Squamous Cell Carcinoma) arises from the epithelial lining of the cervix, it expresses Cytokeratin [2]. In pathology, "Keratin" or "Cytokeratin" (CK) is used to differentiate carcinomas from sarcomas, lymphomas, and melanomas [2]. **2. Why Other Options are Incorrect:** * **Neurofibroma (Option B):** This is a benign nerve sheath tumor. Its characteristic marker is **S-100**, reflecting its neural crest origin. * **Rhabdomyosarcoma (Option C):** This is a malignant tumor of skeletal muscle. Key markers include **Desmin**, **Myogenin**, and **MyoD1**. * **Choriocarcinoma (Option D):** This is a germ cell tumor/trophoblastic tumor. Its most specific diagnostic marker is **hCG** (human Chorionic Gonadotropin). **3. High-Yield Clinical Pearls for NEET-PG:** * **Cytokeratin (CK):** The most specific marker for epithelial differentiation (Carcinomas) [1]. * **Vimentin:** The marker for mesenchymal cells (Sarcomas). * **S-100:** Positive in Melanoma, Schwannoma, and Neurofibroma. * **LCA (CD45):** The primary marker for Lymphomas. * **Synaptophysin/Chromogranin:** Markers for Neuroendocrine tumors (e.g., Small cell carcinoma) [2]. * **PSA:** Marker for Prostatic Carcinoma. * **Thyroglobulin:** Marker for Thyroid Carcinoma (Papillary/Follicular). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, p. 1004. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 470-471.

Question 1

Which of the following is NOT a rare histological variant of carcinoma breast with a better prognosis?

Accepted Answer

Inflammatory carcinoma

Answer

Colloid carcinoma

Answer

Medullary carcinoma

Answer

Tubular carcinoma

Question 2

Which of the following is NOT a feature of malignant transformation by cultured cells?

Accepted Answer

Increased requirement for growth factors

Answer

Increased cell density

Answer

Alterations of cytoskeletal structures

Answer

Loss of anchorage

Question 3

Which of the following parotid malignancies is known for perineural spread?

Accepted Answer

Adenoid cystic carcinoma

Answer

Pleomorphic adenoma

Answer

Warthin's tumor

Answer

Ductal papilloma

Question 4

A 54-year-old woman diagnosed with early-stage breast cancer undergoes lumpectomy. The pathology report confirms the early stage and notes significant desmoplasia in the surrounding tissue. What does the term desmoplasia refer to?

Accepted Answer

Proliferation of non-neoplastic fibrous connective tissue.

Answer

An irregular accumulation of blood vessels.

Answer

Scanty connective tissue causing the neoplasm to be soft and fleshy.

Answer

Normal tissue misplaced within another organ.

Question 5

A patient presents with a mediastinal mass showing sheets of epithelial cells with an arborizing pattern and positivity for keratin, interspersed with lymphoid cells. What is the most likely diagnosis?

Accepted Answer

Thymoma

Answer

Thymic carcinoid

Answer

Primary mediastinal lymphoma

Answer

Non-Hodgkin lymphoma

Question 6

Keratin is a tumor marker for which of the following?

Accepted Answer

Carcinoma cervix

Answer

Neurofibroma

Answer

Rhabdomyosarcoma

Answer

Choriocarcinoma

Question 7

Germline mutations in which of the following genes are not associated with hereditary breast cancer?

Accepted Answer

GATA2

Answer

CHEK2

Answer

BRCA2

Answer

TP53

Question 8

All the following can cause GIT cancers except?

Accepted Answer

Hepatitis B virus

Answer

EBV

Answer

HIV

Answer

H. pylori

Question 9

Which among the following is a marker of carcinoma?

Accepted Answer

Cytokeratin

Answer

Vimentin

Answer

Calretinin

Answer

CD 45

Question 10

In Burkitt's lymphoma, which chromosomal translocation is typically seen?

Accepted Answer

t(8;14)

Answer

t(12;14)

Answer

t(4;8)

Answer

t(12;18)

Neoplasia — MCQs

Neoplasia — MCQs

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