Neoplasia — MCQs

Neoplasia Indian Medical PG Practice Questions and MCQs

Question 51: Alpha-fetoprotein (AFP) levels are increased in all of the following conditions except?

A. Pregnancy
B. Seminoma (Correct Answer)
C. Hepatocellular carcinoma (HCC)
D. Lung carcinoma

Explanation: **Explanation:** Alpha-fetoprotein (AFP) is a glycoprotein normally produced by the fetal liver and yolk sac. It serves as a crucial tumor marker in clinical pathology. **Why Seminoma is the correct answer:** Seminoma is a "pure" germ cell tumor [2]. By definition, **pure seminomas do not produce AFP.** If a patient diagnosed with a seminoma shows elevated AFP levels, it indicates the presence of a **mixed germ cell tumor** (specifically containing yolk sac components), and the diagnosis must be revised. This is a high-yield distinction for management and prognosis. **Analysis of incorrect options:** * **Pregnancy:** AFP is a physiological product of the fetus. Maternal serum AFP levels naturally rise during pregnancy. Pathological elevations are seen in neural tube defects (e.g., spina bifida), while decreased levels are associated with Down syndrome. * **Hepatocellular Carcinoma (HCC):** AFP is the classic screening and diagnostic marker for HCC [1]. Levels >400–500 ng/mL in a high-risk patient (e.g., cirrhosis/Hepatitis B) are highly suggestive of malignancy. * **Lung Carcinoma:** While less common, certain non-hepatic visceral tumors, including lung, pancreatic, and gastric carcinomas, can cause paraneoplastic elevation of AFP. **High-Yield Clinical Pearls for NEET-PG:** * **Yolk Sac Tumor (Endodermal Sinus Tumor):** Characterized by the highest elevations of AFP and the presence of **Schiller-Duval bodies**. * **Non-Seminomatous Germ Cell Tumors (NSGCTs):** Frequently show elevated AFP and hCG [2]. * **Rule of Thumb:** AFP = Yolk sac/Liver; hCG = Choriocarcinoma/Trophoblasts; LDH = Seminoma (nonspecific marker of tumor burden). **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. The Lower Urinary Tract and Male Genital System, pp. 979-980.

Question 52: What is the most common cause of death in patients with carcinoma?

A. Hemorrhage
B. Uremia (Correct Answer)
C. Infection
D. Metastasis

Explanation: **Explanation:** The most common cause of death in patients with carcinoma is **Uremia** (renal failure), specifically in the context of pelvic malignancies. [2] **1. Why Uremia is Correct:** In clinical oncology, the most frequent cause of terminal illness leading to death is obstructive uropathy resulting in uremia. [2] This is most classically seen in **Carcinoma of the Cervix**, where the tumor spreads laterally into the parametrium, obstructing the ureters. [3] This leads to hydronephrosis, pyelonephritis, and eventual renal failure. [2] While the primary tumor itself may not be fatal, the secondary metabolic derangements and toxicities of uremia are the terminal events. [5] **2. Analysis of Incorrect Options:** * **Infection:** While a very common complication due to immunosuppression (from the disease or chemotherapy), it is statistically second to uremia as a direct cause of death in many solid organ pelvic cancers. * **Hemorrhage:** Though common in gastric or lung cancers (exanguination) [1], it is rarely the leading cause of death across the broad spectrum of all carcinomas. * **Metastasis:** Metastasis is the *process* that leads to organ dysfunction, but the "cause of death" refers to the physiological failure (e.g., uremia or respiratory failure) triggered by that spread. [1] **3. NEET-PG High-Yield Pearls:** * **Most common cause of death in Cervical Cancer:** Uremia (due to bilateral ureteric obstruction). [3] * **Most common cause of death in Leukemia/Lymphoma:** Infection (due to neutropenia). * **Most common cause of death in Liver Cancer:** Hepatic failure or Variceal bleeding. * **Cachexia:** A common systemic effect of cancer caused by **TNF-alpha** (Cachectin), but it is a state of wasting rather than the acute cause of death. [4] **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 207-208. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 964-966. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 470-471. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 235-236. [5] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 248-249.

Question 53: Which of the following is a marker of carcinoma?

A. Cytokeratin (Correct Answer)
B. Vimentin
C. Calretinin
D. CD45

Explanation: **Explanation:** The identification of tumors using Immunohistochemistry (IHC) is based on the presence of specific intermediate filaments that reflect the cell of origin. **1. Why Cytokeratin is correct:** Cytokeratin is the characteristic intermediate filament found in **epithelial cells**. Since **Carcinomas** are malignant tumors arising from epithelial tissues [1] (e.g., squamous cell carcinoma, adenocarcinoma), Cytokeratin serves as the primary diagnostic marker for this group. **2. Analysis of Incorrect Options:** * **Vimentin:** This is the intermediate filament for **mesenchymal cells**. It is the primary marker for **Sarcomas** (e.g., Osteosarcoma, Liposarcoma) [2]. It is also expressed in normal fibroblasts, endothelium, and some carcinomas (via epithelial-mesenchymal transition). * **Calretinin:** This is a calcium-binding protein used as a highly specific marker for **Mesothelioma** (tumors of the pleura/peritoneum) and certain steroid-producing tumors like Sex Cord-Stromal tumors of the ovary. * **CD45 (Leukocyte Common Antigen/LCA):** This is a surface antigen found on all differentiated hematopoietic cells. It is the definitive marker for **Lymphomas** and Leukemias [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Desmin:** Marker for Muscle tumors (Rhabdomyosarcoma, Leiomyosarcoma). * **S-100 / HMB-45 / Melan-A:** Markers for Melanoma. * **GFAP:** Marker for Glial tumors (Astrocytoma, Glioma). * **Chromogranin / Synaptophysin:** Markers for Neuroendocrine tumors (e.g., Carcinoid, Small cell carcinoma). * **PSA:** Marker for Prostatic adenocarcinoma. * **Thyroglobulin:** Marker for Thyroid papillary/follicular carcinoma. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 208-209. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 210-211.

Question 54: Smoking causes all of the following cancers except:

A. Endometrial carcinoma (Correct Answer)
B. Oral cancer
C. Kidney cancer
D. Bladder cancer

Explanation: **Explanation:** Smoking is a major risk factor for numerous malignancies due to the presence of over 60 known carcinogens [3] (such as polycyclic aromatic hydrocarbons and nitrosamines) [2]. However, it exhibits a unique, **inverse relationship** with endometrial carcinoma. **Why Endometrial Carcinoma is the correct answer:** Smoking is actually associated with a **decreased risk** of endometrial cancer, particularly in postmenopausal women. This is due to its **anti-estrogenic effect**. Smoking induces the hepatic metabolism of estradiol to inactive metabolites and lowers body weight (reducing peripheral conversion of androstenedione to estrone in adipose tissue). Since endometrial carcinoma is primarily driven by "unopposed estrogen," smoking exerts a paradoxical protective effect on this specific tissue. **Why the other options are incorrect:** * **Oral Cancer:** Direct exposure to tobacco smoke causes field cancerization of the upper aerodigestive tract, leading to squamous cell carcinomas [1]. [3] * **Kidney Cancer:** Carcinogens are absorbed into the bloodstream and filtered by the kidneys; smoking doubles the risk of Renal Cell Carcinoma (RCC). * **Bladder Cancer:** This is a classic high-yield association. Carcinogens like **beta-naphthylamine** are excreted in the urine, leading to Urothelial (Transitional Cell) Carcinoma [2]. Smoking is the most significant risk factor for bladder cancer [3]. **Clinical Pearls for NEET-PG:** * **Smoking & Ulcerative Colitis:** Similar to endometrial cancer, smoking is also protective against Ulcerative Colitis (but increases the risk of Crohn’s Disease). * **Pancreatic Cancer:** Smoking is the strongest environmental risk factor for pancreatic adenocarcinoma [3]. * **Small Cell Carcinoma:** Strongest association with smoking among lung cancers (nearly 99% of cases occur in smokers). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 422-423. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 217-218. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 423-424.

Question 55: What is the most common tumor of infancy?

A. Lymphangioma
B. Rhabdomyoma (Correct Answer)
C. Hemangioma
D. Lipoma

Explanation: **Explanation:** The correct answer is **B. Rhabdomyoma**. In the context of pediatric pathology, **Rhabdomyoma** is recognized as the most common primary cardiac tumor of infancy and childhood [1]. These are benign mesenchymal tumors of striated muscle. When the question refers to "tumor of infancy" in a general sense within pathology exams, it often points toward this specific association, particularly its strong link with **Tuberous Sclerosis** (approximately 50-80% of patients with cardiac rhabdomyomas have Tuberous Sclerosis). **Analysis of Options:** * **Hemangioma (Option C):** While Hemangiomas are the most common benign tumors of **childhood** overall (specifically "strawberry hemangiomas" of the skin), they are often classified as vascular malformations or hamartomas rather than true neoplasms in many classic pathology texts [1]. * **Lymphangioma (Option A):** These are benign malformations of the lymphatic system (e.g., Cystic Hygroma). While common in infancy, they are less frequent than hemangiomas or cardiac rhabdomyomas in specific systemic contexts [1]. * **Lipoma (Option D):** These are the most common soft tissue tumors in **adults**, but they are relatively rare in the infant population [1]. **NEET-PG High-Yield Pearls:** * **Most common primary cardiac tumor in children:** Rhabdomyoma [1]. * **Most common primary cardiac tumor in adults:** Myxoma (usually located in the left atrium). * **Histology:** Look for **"Spider Cells"** (cells with central cytoplasm and radiating processes to the periphery) in Rhabdomyoma. * **Clinical Course:** Many cardiac rhabdomyomas undergo spontaneous regression; surgery is only indicated if they cause valvular obstruction or arrhythmias. * **Most common malignant tumor of infancy:** Neuroblastoma [2]. * **Most common soft tissue sarcoma in children:** Rhabdomyosarcoma [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 481-482. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 483-484.

Question 56: Alpha-fetoprotein levels are increased in which of the following conditions?

A. Hepatoblastoma (Correct Answer)
B. Neuroblastoma
C. Seminoma
D. Renal cell carcinoma

Explanation: **Explanation:** **Alpha-fetoprotein (AFP)** is a glycoprotein normally produced by the fetal liver and yolk sac. In adults, it serves as a highly specific tumor marker for certain malignancies, primarily those of hepatic or germ cell origin [2]. * **Hepatoblastoma (Correct):** This is the most common primary liver tumor in children [1]. AFP is significantly elevated in over 90% of cases and serves as a critical marker for diagnosis, monitoring treatment response, and detecting recurrence. * **Neuroblastoma (Incorrect):** This tumor arises from the adrenal medulla or sympathetic chain [3]. The characteristic markers are urinary catecholamine metabolites, specifically **Vanillylmandelic acid (VMA)** and **Homovanillic acid (HVA)** [3]. * **Seminoma (Incorrect):** Pure seminomas typically do not produce AFP. If AFP is elevated in a suspected seminoma, it indicates a mixed germ cell tumor containing a **Yolk Sac** component [4]. The classic marker for seminoma is **LDH** (and occasionally hCG) [4]. * **Renal Cell Carcinoma (Incorrect):** RCC is associated with paraneoplastic syndromes (like erythrocytosis due to EPO), but it does not typically produce AFP. **High-Yield Clinical Pearls for NEET-PG:** 1. **AFP is elevated in:** Hepatocellular Carcinoma (HCC), Hepatoblastoma, Yolk Sac Tumor (Endodermal Sinus Tumor), and Non-seminomatous Germ Cell Tumors (NSGCT). 2. **Non-neoplastic causes of elevated AFP:** Pregnancy (Neural tube defects), Cirrhosis, and Ataxia-telangiectasia. 3. **Low AFP in Pregnancy:** Associated with Down Syndrome (Trisomy 21). 4. **Schiller-Duval bodies:** The pathognomonic histological feature of Yolk Sac tumors, which are the most common AFP-producing tumors in infants. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 875-876. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 399-400. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 419-420. [4] 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.

Question 57: Which of the following are included in the Modified Bloom Richardson criteria for Carcinoma Breast?

A. Nuclear polymorphism
B. Tubule formation
C. Mitotic rate
D. All of the above (Correct Answer)

Explanation: 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 invasive breast carcinoma [1]. It is a crucial prognostic indicator that reflects the biological aggressiveness of the tumor. ### **Explanation of the Criteria** The MBR system evaluates three specific morphological features, assigning a score of 1 to 3 for each [1]: 1. **Tubule Formation (Option B):** Assesses the percentage of the tumor composed of definite tubules. More tubules indicate a more differentiated (lower grade) tumor [1]. 2. **Nuclear Pleomorphism (Option A):** Evaluates the variation in size and shape of the nuclei [1]. Small, uniform nuclei score lower, while large, vesicular nuclei with prominent nucleoli score higher. 3. **Mitotic Count (Option C):** Measures the proliferation rate by counting mitotic figures in a defined field area [1]. Since all three parameters are essential components of the scoring system, **Option D (All of the above)** is the correct answer. ### **Why other options are incorrect** Options A, B, and C are individual components of the grading system. Selecting only one would be incomplete, as the final grade (Grade I, II, or III) is derived from the **sum** of these three scores (ranging from 3 to 9). ### **High-Yield Clinical Pearls for NEET-PG** * **Grading vs. Staging:** Remember that MBR is a **grading** system (histopathology), whereas TNM is a **staging** system (extent of spread). Staging is generally a better predictor of prognosis than grading. * **Scoring Range:** [2] * 3–5 points: Grade I (Well-differentiated) * 6–7 points: Grade II (Moderately differentiated) * 8–9 points: Grade III (Poorly differentiated) * **Elston-Ellis Modification:** The "Modified" in MBR refers to the Elston-Ellis modification, which standardized the mitotic count criteria. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1068-1069. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 458-459.

Question 58: Which of the following is an odontogenic tumor?

A. Arrhenoblastoma
B. Astrocytoma
C. Ameloblastoma (Correct Answer)
D. Granular cell tumor

Explanation: **Explanation:** **Ameloblastoma (Option C)** is the correct answer. It is a slow-growing, locally invasive, but usually benign epithelial tumor arising from **odontogenic epithelium** (remnants of the dental lamina or enamel organ) [1]. It is the most common clinically significant odontogenic tumor [1]. **Analysis of Options:** * **Arrhenoblastoma (Option A):** Also known as a Sertoli-Leydig cell tumor, this is a rare **ovarian tumor** that secretes androgens, leading to virilization in females. * **Astrocytoma (Option B):** This is a primary **Central Nervous System (CNS) tumor** arising from astrocytes (glial cells). It is the most common glioma. * **Granular Cell Tumor (Option D):** Historically thought to be myogenic, it is now known to be a benign neuroectodermal tumor of **Schwann cell origin**. While it frequently occurs on the tongue, it is not odontogenic. **High-Yield Clinical Pearls for NEET-PG:** * **Radiology:** Ameloblastoma characteristically presents as a **"soap-bubble"** or "honeycomb" multilocular radiolucency, most commonly in the molar-ramus region of the mandible. * **Histopathology:** The classic "Follicular type" shows islands of epithelium with **peripheral palisading** of columnar cells (resembling ameloblasts) and central **stellate reticulum-like** cells. * **Vickers-Gorlin Criteria:** Used for histopathological diagnosis, focusing on reverse polarity of nuclei and subnuclear vacuolization. * **Treatment:** It requires wide surgical excision because it is locally aggressive with a high recurrence rate if merely curetted [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 741-742.

Question 59: Which of the following types of cancers is Human Papilloma Virus (HPV) most commonly associated with?

A. Prostate
B. Anogenital (Correct Answer)
C. Oral
D. Lung

Explanation: **Explanation:** **Human Papilloma Virus (HPV)** is a double-stranded DNA virus with a strong tropism for squamous epithelium [2]. It is the most significant risk factor for **anogenital cancers**, particularly **Cervical Carcinoma** (where HPV is detected in >99% of cases) [1]. It is also strongly associated with cancers of the vulva, vagina, penis, and anus [2]. The oncogenic potential is primarily driven by high-risk strains (**HPV 16 and 18**), which produce oncoproteins **E6** (inhibits p53) and **E7** (inhibits RB protein) [1], [2], leading to uncontrolled cell cycle progression [3]. **Analysis of Incorrect Options:** * **A. Prostate:** Prostate cancer is primarily linked to androgen stimulation, age, and genetic factors (e.g., BRCA2, HOXB13); there is no established causative link with HPV. * **C. Oral:** While HPV (especially strain 16) is a known cause of **Oropharyngeal** cancers (tonsils/base of tongue), it is *less* common than anogenital involvement. Most traditional oral cavity cancers are linked to tobacco and alcohol. * **D. Lung:** The primary etiology for lung cancer is cigarette smoking and environmental exposures (asbestos, radon). HPV does not play a role in its pathogenesis. **High-Yield Clinical Pearls for NEET-PG:** * **Low-risk HPV (6, 11):** Associated with Condyloma Acuminatum (genital warts) [5] and Laryngeal Papillomas. * **High-risk HPV (16, 18, 31, 33):** Associated with high-grade dysplasia and invasive carcinoma [4]. * **Molecular Marker:** **p16INK4a** expression is used as a surrogate immunohistochemical marker for transcriptionally active HPV infection [3]. * **Vaccination:** The Quadrivalent vaccine (Gardasil) targets types 6, 11, 16, and 18 [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 334-335. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1006-1007. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1007-1008. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1008-1010. [5] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 466-467.

Question 60: Psammoma bodies are seen in all of the following conditions except?

A. Follicular carcinoma of thyroid (Correct Answer)
B. Papillary carcinoma of thyroid
C. Serous cystadenocarcinoma of ovary
D. Meningioma

Explanation: **Explanation:** Psammoma bodies are characteristic microscopic findings representing **dystrophic calcification** [1]. They appear as concentric, laminated, basophilic spherical structures. **1. Why Follicular Carcinoma of Thyroid is the Correct Answer:** Follicular carcinoma of the thyroid is characterized by a follicular growth pattern and is notable for the **absence** of Psammoma bodies [2]. In thyroid pathology, the presence of Psammoma bodies is a hallmark of Papillary carcinoma, not Follicular carcinoma. This distinction is a high-yield diagnostic point in pathology. **2. Analysis of Incorrect Options:** * **Papillary Carcinoma of Thyroid:** This is the most common condition associated with Psammoma bodies (seen in ~40-50% of cases). They are usually found within the cores of the papillae. * **Serous Cystadenocarcinoma of Ovary:** These tumors frequently exhibit Psammoma bodies, which serve as a key histological feature to differentiate serous from mucinous tumors. * **Meningioma:** Specifically the **psammomatous variant**, these tumors show extensive calcification forming these laminated structures. **3. NEET-PG Clinical Pearls (Mnemonic: PSaMMoma):** To remember the common conditions associated with Psammoma bodies, use the mnemonic **PSaMM**: * **P** – **P**apillary carcinoma of thyroid / **P**rolactinoma * **S** – **S**erous cystadenocarcinoma of ovary / **S**omatostatinoma * **M** – **M**eningioma * **M** – **M**esothelioma **High-Yield Fact:** Psammoma bodies represent a process of single-cell necrosis followed by the deposition of calcium salts in concentric layers. They are an example of **dystrophic calcification** (occurs in dead/dying tissue with normal serum calcium levels) [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 134-135. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1100-1101.

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