Neoplasia Practice Questions

Q: Hereditary non-polyposis colorectal cancer (HNPCC), also known as Lynch syndrome, is caused by mutations in which type of genes?

MMR. ***MMR*** - Hereditary non-polyposis colorectal cancer (**HNPCC**), also known as **Lynch syndrome**, is caused by germline mutations in **DNA Mismatch Repair (MMR)** genes [1]. - Defective MMR function, most commonly due to mutations in **MLH1**, **MSH2**, **MSH6**, or **PMS2**, leads to an accumulation of mutations throughout the genome, a state known as **microsatellite instability (MSI)**. *APC* - Mutations in the **APC** gene, a tumor suppressor, are the cause of **Familial Adenomatous Polyposis (FAP)**, a different hereditary colorectal cancer syndrome [1]. - FAP is characterized by the development of hundreds to thousands of colonic polyps, whereas HNPCC typically presents with fewer polyps that rapidly progress to carcinoma [1]. *MYC* - **MYC** is a **proto-oncogene** involved in cell cycle control and proliferation; its dysregulation contributes to the development of many cancers, but it is not the primary genetic cause of HNPCC. - It is not a DNA repair gene, but rather a transcription factor that, when overexpressed, promotes uncontrolled cell growth. *TERT1* - This likely refers to the **TERT** gene, which encodes **telomerase reverse transcriptase**, an enzyme essential for maintaining telomere length. - While reactivation of **telomerase** is a critical step for cellular immortalization in many cancers, inherited mutations in this gene are not the cause of Lynch syndrome. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 817, 821-822.

Q: HPV infection is most commonly associated with which type of cancer?

Oropharyngeal cancer. ***Oropharyngeal cancer*** - HPV (particularly HPV-16 and HPV-18) is strongly associated with oropharyngeal cancers, especially those affecting the **base of tongue and tonsils** [2], [3] - HPV-positive oropharyngeal cancers represent a distinct epidemiological entity with **better prognosis** compared to tobacco/alcohol-related cases - Among the options listed, oropharyngeal cancer is the **only HPV-associated malignancy** [3] - Note: Cervical cancer is the **most common HPV-related cancer overall** (not listed in options) [1], [3] *Incorrect: Esophageal cancer* - Primarily associated with **tobacco, alcohol, Barrett's esophagus, and chronic GERD** - Not significantly associated with HPV infection *Incorrect: Lung cancer* - Main risk factors include **smoking, radon exposure, asbestos, and air pollution** - No established HPV association *Incorrect: Stomach cancer* - Associated with **H. pylori infection, dietary factors (nitrosamines), and chronic gastritis** - Not linked to HPV infection **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1007-1008. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 739-741. [3] 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. 219-220.

Q: A three-year-old boy has been observed by his parents to be increasingly clumsy for the past 6 months. On a physical examination, there is a cauliflower-like growth in the left eye, leukocoria, and an absent red reflex. The microscopic appearance of the specimen shows Flexner-Wintersteiner rosettes. Which gene is involved in the given condition?

Rb gene. ***Rb gene***- The constellation of leukocoria, absent red reflex, and the microscopic finding of **Flexner-Wintersteiner rosettes** are pathognomonic for **retinoblastoma** [1, 3]. - The **Rb gene** (Retinoblastoma gene) is a critical **tumor suppressor gene** located on chromosome 13q14, and its inactivation leads to the development of this malignancy [1, 2]. *ATP 7B gene* - This gene is responsible for **Wilson disease**, an autosomal recessive disorder causing excessive **copper accumulation** in the liver, brain, and cornea (Kayser-Fleischer rings). - It is not associated with primary malignant retinal tumors like retinoblastoma. *Rhodopsin gene* - Mutations in the **rhodopsin gene** are the most common cause of **autosomal dominant retinitis pigmentosa**, which presents with progressive night blindness and visual field loss. - This condition involves retinal degeneration and does not cause a mass-forming neoplasm with leukocoria. *FBN 1 gene* - The **FBN1 gene** codes for **Fibrillin-1** and is mutated in **Marfan syndrome**, a connective tissue disorder. - While Marfan syndrome often causes ocular issues like **ectopia lentis** (lens dislocation), it does not cause retinoblastoma. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 737-738. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, p. 300. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Eye, p. 1342.

Q: Most common cause of squamous cell carcinoma at the base of the tongue is:

HPV. ***HPV*** - **Human Papillomavirus**, particularly **HPV-16**, is the predominant etiological factor for **squamous cell carcinoma (SCC) of the oropharynx**, which includes the base of the tongue [1]. - **HPV-positive SCC** has rapidly increased in incidence and constitutes the majority of these cancers in non-smokers and non-drinkers [1]. *EBV* - **Epstein-Barr Virus (EBV)** is strongly associated with **Nasopharyngeal Carcinoma (NPC)**, endemic Burkitt's lymphoma, and post-transplant lymphoproliferative disorder [2]. - It is not considered the primary or most common oncogenic agent for **base of tongue SCC** [2]. *HCV* - **Hepatitis C Virus (HCV)** is the chief cause of viral **Hepatocellular Carcinoma (HCC)** and is also linked to certain **B-cell non-Hodgkin's lymphomas**. - There is no established role for HCV in the pathogenesis or high prevalence of **squamous cell carcinoma of the head and neck**. *CMV* - **Cytomegalovirus (CMV)** is a herpesvirus typically associated with opportunistic infections (e.g., retinitis, colitis) in **immunocompromised patients**. - While studies have investigated its oncogenic potential, CMV is not a significant or common causative agent for **oral or pharyngeal SCC**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 738-741. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 744-745.

Q: All of the following are true regarding this picture except: (Recent NEET Pattern 2016-17)

Usually bilateral. ***Usually bilateral*** - Paget's disease of the nipple, as depicted in the image (lesions on the nipple with surrounding dermatitis-like changes), is almost always an **unilateral condition**. - Its bilateral occurrence is exceedingly rare and would suggest a different or coincidental pathology. - **This is the FALSE statement** - Paget's disease is typically unilateral, not bilateral. *Associated with underlying invasive carcinoma of breast* - **Paget's disease of the nipple** is histologically characterized by the presence of **Paget cells** (adenocarcinoma cells) in the epidermis of the nipple and areola [2]. - In a vast majority of cases (90-95%), it is associated with an underlying **ductal carcinoma in situ (DCIS)** or an **invasive ductal carcinoma** originating from the lactiferous ducts [1], [2]. *Itching is a common symptom* - **Itching (pruritus)** is a **prominent and common symptom** of Paget's disease of the nipple, along with burning, pain, and crusting. - The eczematous changes often lead to significant discomfort and itching. *Treatment is simple mastectomy with axillary lymph node dissection* - The standard treatment for Paget's disease of the nipple, especially when associated with an underlying invasive carcinoma, is **surgical excision**. - A **simple mastectomy** removes the entire breast and is often combined with **axillary lymph node dissection** or sentinel lymph node biopsy to assess for nodal involvement [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 456-457. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1061-1062.

Q: This appearance of mammary skin is due to:

Lymphatic penetration. ***Lymphatic penetration*** - The image illustrates **peau d'orange**, a classic sign of **inflammatory breast cancer**, caused by tumor cells blocking lymphatic drainage in the skin of the breast [1]. - This blockage leads to **edema** and accentuation of hair follicles, creating an orange peel-like appearance [1]. *Intra-epithelial cancer* - **Intra-epithelial cancer** (e.g., Paget disease of the nipple) primarily affects the epidermis and presents as a scaly, eczematous rash, not the diffuse skin thickening and pitting seen here [2]. - While it can be associated with an underlying invasive cancer, the visual presentation in the image is not typical for a purely intra-epithelial process [2]. *Sub-epidermal cancer* - **Sub-epidermal cancer** refers to malignancies located beneath the epidermis, often presenting as a palpable mass or nodule [1]. - It would not typically cause the widespread **skin edema** and **lymphatic obstruction** characteristic of peau d'orange, which affects a broader area of the skin due to involvement of dermal lymphatics [1]. *Vascular embolization* - **Vascular embolization** involves the blockage of blood vessels, which can lead to ischemia, necrosis, or localized discoloration. - It does not explain the characteristic **lymphatic obstruction** and **edema** that causes the peau d'orange appearance in the mammary skin [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 453-454. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1061-1062.

Question 1

Hereditary non-polyposis colorectal cancer (HNPCC), also known as Lynch syndrome, is caused by mutations in which type of genes?

Accepted Answer

MMR

Answer

APC

Answer

TERT1

Answer

MYC

Question 2

HPV infection is most commonly associated with which type of cancer?

Accepted Answer

Oropharyngeal cancer

Answer

Esophageal cancer

Answer

Lung cancer

Answer

Stomach cancer

Question 3

Which of the following is not related to disease progression?

Accepted Answer

Duration

Answer

Depth

Answer

Stage of Cancer

Answer

Site

Question 4

Which of the following is true about p53?

Accepted Answer

It stabilizes RNA

Answer

It retains the telomerase enzyme in the nucleus

Answer

It increases telomere length in the liver.

Answer

It synthesizes RNA

Question 5

A three-year-old boy has been observed by his parents to be increasingly clumsy for the past 6 months. On a physical examination, there is a cauliflower-like growth in the left eye, leukocoria, and an absent red reflex. The microscopic appearance of the specimen shows Flexner-Wintersteiner rosettes. Which gene is involved in the given condition?

Accepted Answer

Rb gene

Answer

Rhodopsin gene

Answer

FBN 1 gene

Answer

ATP 7B gene

Question 6

Asbestos exposure may be associated with which of the following malignancies?

Accepted Answer

Mesothelioma

Answer

Hepatic angiosarcoma

Answer

Skin carcinoma

Answer

Acute myeloid leukemia

Question 7

Most common cause of squamous cell carcinoma at the base of the tongue is:

Accepted Answer

HPV

Answer

EBV

Answer

HCV

Answer

CMV

Question 8

All of the following are true regarding this picture except: (Recent NEET Pattern 2016-17)

Accepted Answer

Usually bilateral

Answer

Associated with underlying invasive carcinoma of breast

Answer

Itching is a common symptom

Answer

Treatment is simple mastectomy with axillary lymph node dissection

Question 9

This appearance of mammary skin is due to:

Accepted Answer

Lymphatic penetration

Answer

Intra-epithelial cancer

Answer

Sub-epidermal cancer

Answer

Vascular embolization

Question 10

All are true about the condition shown in the image except:

Accepted Answer

Overexpression of HER 2/neu shows poor response to adriamycin

Answer

Occurs due to lymphatics destruction

Answer

Peau d'orange

Answer

Van Nuys prognostic index

Neoplasia — MCQs

Neoplasia — MCQs

On this page

Practice by Chapter

Want unlimited practice?