Neoplasia Practice Questions

Q: Which of the following statements are correct with regard to Familial Adenomatous Polyposis ? 1. It is associated with mutation of APC gene located on the long arm of chromosome 5. 2. It is inherited as an autosomal recessive condition. 3. It is associated with 100% lifetime risk for development of Colorectal carcinoma. 4. Congenital hypertrophy of retinal pigment epithelium is present in half of the cases of familial adenomatous polyposis. Select the correct answer using the code given below :

1, 3 and 4. ***1, 3 and 4*** - Familial Adenomatous Polyposis is indeed associated with a mutation in the **APC gene** located on the **short arm of chromosome 5 (5q21-q22)** and carries a **nearly 100% lifetime risk** of developing colorectal carcinoma if left untreated [1]. - **Congenital hypertrophy of the retinal pigment epithelium (CHRPE)**, also known as bear claw lesions, is a characteristic extracolonic manifestation observed in approximately half of FAP patients, though it does not usually affect vision. *1, 2 and 3* - This option is incorrect because FAP is inherited as an **autosomal dominant** condition, not autosomal recessive. - Statement 2, claiming autosomal recessive inheritance, is false, rendering this combination incorrect. *2, 3 and 4* - This option incorrectly states that FAP is inherited as an **autosomal recessive** condition. It is an autosomal dominant disorder. - While statements 3 and 4 are correct, the inclusion of statement 2 makes this option invalid. *1, 2 and 4* - This option is incorrect due to the assertion that FAP is an **autosomal recessive** condition (statement 2). - FAP is correctly linked to the APC gene mutation (statement 1) and CHRPE (statement 4), but the inheritance pattern given here is wrong. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 821-822.

Q: The term "Gompertzian curve" is related to which one of the following ?

Tumour. ***Correct Option: Tumour*** - The **Gompertzian curve** describes the growth pattern of tumors, characterized by an initial exponential growth phase followed by a deceleration of growth as the tumor size increases - This deceleration occurs due to limiting factors like **nutrient supply, oxygen availability, and accumulation of waste products** - This model is widely used in **oncology** to understand tumor kinetics, predict responses to treatment, and explain why smaller tumors respond better to chemotherapy than larger ones - The concept is fundamental in understanding **tumor doubling time** and **fractional cell kill hypothesis** in cancer therapy *Incorrect Option: Intestinal obstruction* - **Intestinal obstruction** refers to a mechanical or functional blockage in the intestine - Its clinical course is acute and does not follow a growth curve model - The progression is determined by the degree and location of obstruction, not by cellular proliferation kinetics *Incorrect Option: Gallstone* - A **gallstone** is a hardened deposit of digestive fluid that forms in the gallbladder - Gallstone formation involves bile supersaturation and precipitation of cholesterol or bilirubin, not cellular growth - Its development does not follow the Gompertzian pattern of exponential growth followed by plateau *Incorrect Option: Hernia* - A **hernia** occurs when an organ or tissue protrudes through a weakness in the surrounding muscle or connective tissue - Hernia development is a **structural/anatomical defect**, not a process involving cellular proliferation - It does not involve growth kinetics and is unrelated to the Gompertzian curve concept

Q: The most common type of brain tumour associated with neurofibromatosis type 1 is

astrocytoma. ***Astrocytoma*** - **Pilocytic astrocytoma** is the most common brain tumor associated with **Neurofibromatosis type 1 (NF1)**, particularly in children and young adults [1]. - These tumors often occur in the **optic pathways**, **brainstem**, or **cerebellum** in patients with NF1. *Acoustic neuroma* - **Vestibular schwannomas** (acoustic neuromas) are characteristic of **Neurofibromatosis type 2 (NF2)**, not NF1 [2]. - NF2 typically involves **bilateral vestibular schwannomas** and other cranial nerve tumors [2]. *Meningioma* - Meningiomas are also more commonly associated with **NF2**, though they can occur sporadically [2]. - They are generally less common in NF1 patients and are not considered the hallmark brain tumor. *Medulloblastoma* - Medulloblastoma is a **highly malignant primary brain tumor** that occurs predominantly in children but is not specifically linked to NF1 [1]. - Its presence is not a defining feature of the NF1 syndrome. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1319-1320. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 724-728.

Q: Which of the following genetic syndromes are associated with brain tumours? 1. Neurofibromatosis type 1 2. Neurofibromatosis type 2 3. Tuberous sclerosis 4. Wiskott-Aldrich syndrome Select the answer using the code given below.

1, 2 and 3. ***1, 2 and 3*** - **Neurofibromatosis type 1 (NF1)**, **Neurofibromatosis type 2 (NF2)**, and **Tuberous sclerosis (TSC)** are all well-established genetic syndromes associated with an increased risk of developing various brain tumors [1]. - NF1 is linked to **optic pathway gliomas**, NF2 to **schwannomas** and **meningiomas**, and TSC to **subependymal giant cell astrocytomas (SEGAs)** [1], [2]. *1 and 2 only* - This option is incomplete as it correctly identifies NF1 and NF2 but omits Tuberous sclerosis, which is also strongly associated with brain tumours [1]. - While NF1 and NF2 are major genetic risk factors for brain tumors, excluding TSC would be an inaccurate representation of conditions linked to these abnormalities [1]. *1, 3 and 4* - This option incorrectly includes **Wiskott-Aldrich syndrome (WAS)**, which is an **immunodeficiency disorder** and not typically associated with primary brain tumours. - Although WAS can lead to an increased risk of lymphomas, these are generally not considered primary brain tumors [1] in the context of genetic syndromes predisposing to such growths. *2, 3 and 4* - This option again incorrectly includes **Wiskott-Aldrich syndrome** while omitting **Neurofibromatosis type 1**, a significant genetic syndrome linked to brain tumors [1]. - Omitting NF1, a condition known for an increased risk of gliomas, renders this option incomplete and inaccurate. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 724-725. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1318-1319.

Q: Which of the following are correct about glomus tumour? 1. It arises from Suquet-Hoyer canals. 2. Its usual site is nail bed. 3. It is usually a small purple nodule. 4. It is painless.

1, 2 and 3. ***1, 2 and 3*** - Glomus tumors originate from the **Suquet-Hoyer canals**, specialized arteriovenous anastomoses involved in thermoregulation. - They are most frequently found in the **nail bed** (especially subungual region) as small, **purple** (reddish-blue) nodules and are typically very painful. - The classic triad includes severe pain, cold sensitivity, and point tenderness. *1, 2 and 4* - This option incorrectly states that glomus tumors are **painless**. In fact, they are characterized by severe pain due to their rich innervation. - While correct that they arise from Suquet-Hoyer canals and are found in the nail bed, the **painlessness** aspect is inaccurate. *2, 3 and 4* - This option incorrectly includes the statement that glomus tumors are **painless**, which contradicts a key distinguishing feature. - Although glomus tumors are typically found in the nail bed and appear as purple nodules, pain is a characteristic clinical feature, not absence of pain. *1, 3 and 4* - This option incorrectly states that glomus tumors are **painless** and omits the correct statement about the usual nail bed location. - While they do arise from Suquet-Hoyer canals and can be small purple nodules, their characteristic severe pain makes this option incorrect.

Q: The commonest variety of peritoneal metastasis is

discrete nodules. ***discrete nodules*** - Peritoneal metastasis most commonly manifests as **discrete nodules** scattered across the peritoneal surfaces [1]. - These nodules vary in size and distribution, often arising from the implantation of malignant cells shed from a primary tumor. *plaques of varying sizes* - While plaques can occur, they are generally less common than discrete nodules as the primary manifestation of **peritoneal carcinomatosis**. - Plaques often represent confluent growth of numerous smaller nodules rather than the initial, more frequent presentation. *drop metastasis in pelvis* - **Drop metastases** to the pelvis are a common site for peritoneal dissemination due to gravity and fluid dynamics within the peritoneal cavity. - However, referring to it as simply "drop metastasis in pelvis" describes a location rather than the morphology, which is typically **nodular**. *diffuse adhesion* - **Diffuse adhesions** typically result from chronic inflammation or surgical procedures, connecting peritoneal surfaces. - While extensive tumor growth can lead to adhesions, the initial and most common pattern of metastasis is individual **tumor cell implantation** forming **discrete nodules**, not diffuse initial adherence. **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. 233-234.

Q: Which of the following statements regarding papillary thyroid cancer is correct? 1. It is the most common malignant tumour of thyroid gland. 2. It is more common in young females. 3. It has propensity for haematogenous spread. 4. Distant metastases are uncommon.

1. It is the most common malignant tumour of thyroid gland.. ***1. It is the most common malignant tumour of thyroid gland.*** - **Papillary thyroid cancer (PTC)** accounts for approximately **80-85% of all thyroid cancers**, making it the most prevalent type [1]. - This is the definitive correct statement among the options provided. *2. It is more common in young females.* - While PTC is indeed **more common in females** (3:1 female-to-male ratio), the term "young" is imprecise for exam purposes [3]. - PTC typically occurs in the **3rd to 5th decades** (30-50 years), which is more accurately described as "middle-aged" rather than "young" [1], [2]. - The statement lacks specificity needed for a definitive answer. *3. It has propensity for haematogenous spread.* - This is **incorrect**. PTC primarily spreads via the **lymphatic system** to regional cervical lymph nodes [2]. - **Hematogenous spread** is characteristic of **follicular thyroid carcinoma**, not papillary type [2]. - While distant hematogenous metastases can occur in advanced PTC, it is **not** the characteristic pattern of spread. *4. Distant metastases are uncommon.* - While this statement has merit (distant metastases occur in only 5-10% at presentation), it is less definitively correct than statement 1. - The majority of PTC metastases are **locoregional lymphatic** spread rather than distant. - However, when distant metastases do occur, it affects prognosis significantly (lungs > bones). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1098-1100. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 428-430. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1095-1096.

Q: In a patient with breast cancer, the following are poor prognostic factors except

Absence of epidermal growth factor receptor. ***Absence of epidermal growth factor receptor*** - The **absence of epidermal growth factor receptor (EGFR/HER1) overexpression** is associated with a **better prognosis** in breast cancer. - **EGFR overexpression** is more commonly seen in aggressive breast cancers, particularly **triple-negative breast cancers** (ER-negative, PR-negative, HER2-negative), and is associated with poor outcomes [2]. - When EGFR is absent or not overexpressed, the tumor tends to have less aggressive biological behavior. *Aneuploid status* - **Aneuploid status** (abnormal chromosome number) is a well-recognized **poor prognostic factor** in breast cancer, indicating genetic instability and aggressive tumor behavior [2]. - It is associated with **increased risk of recurrence** and poorer response to therapy. *Age less than 35 years* - **Younger age** (less than 35 years) at diagnosis is a **poor prognostic factor** for breast cancer. - This is often due to more aggressive tumor biology, **higher grade tumors**, hormone receptor negativity, and delayed diagnosis in younger women. *High grade* - A **high histological grade** (Grade III) indicates a more aggressive tumor with rapid cell division, marked nuclear pleomorphism, and poor differentiation, signifying a **poor prognosis** [1]. - High-grade tumors are more likely to metastasize and have higher recurrence rates. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 458-459. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1064-1066.

Question 1

Which of the following statements are correct with regard to Familial Adenomatous Polyposis ?

1. It is associated with mutation of APC gene located on the long arm of chromosome 5.
2. It is inherited as an autosomal recessive condition.
3. It is associated with 100% lifetime risk for development of Colorectal carcinoma.
4. Congenital hypertrophy of retinal pigment epithelium is present in half of the cases of familial adenomatous polyposis.

Select the correct answer using the code given below :

Accepted Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Question 2

The term "Gompertzian curve" is related to which one of the following ?

Accepted Answer

Tumour

Answer

Intestinal obstruction

Answer

Gallstone

Answer

Hernia

Question 3

The most common type of brain tumour associated with neurofibromatosis type 1 is

Accepted Answer

astrocytoma

Answer

acoustic neuroma

Answer

meningioma

Answer

medulloblastoma

Question 4

Which of the following genetic syndromes are associated with brain tumours?

1. Neurofibromatosis type 1
2. Neurofibromatosis type 2
3. Tuberous sclerosis
4. Wiskott-Aldrich syndrome

Select the answer using the code given below.

Accepted Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

1 and 2 only

Answer

2, 3 and 4

Question 5

Which of the following are correct regarding Li-Fraumeni syndrome?

1. It has autosomal dominant inheritance and is associated with P53 gene.
2. It has autosomal recessive inheritance and is associated with P53 gene.
3. It is associated with an increased risk of sarcomas and leukaemia.
4. It is associated with an increased risk of brain tumours and osteosarcomas. Select the answer using the code given below.

Accepted Answer

1, 3 and 4

Answer

1 and 4 only

Answer

1 and 3 only

Answer

1 only

Question 6

Which of the following are correct about glomus tumour?

1. It arises from Suquet-Hoyer canals.
2. Its usual site is nail bed.
3. It is usually a small purple nodule.
4. It is painless.

Accepted Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 3 and 4

Question 7

The commonest variety of peritoneal metastasis is

Accepted Answer

discrete nodules

Answer

plaques of varying sizes

Answer

drop metastasis in pelvis

Answer

diffuse adhesion

Question 8

Which of the following statements regarding papillary thyroid cancer is correct?

1. It is the most common malignant tumour of thyroid gland.
2. It is more common in young females.
3. It has propensity for haematogenous spread.
4. Distant metastases are uncommon.

Accepted Answer

1. It is the most common malignant tumour of thyroid gland.

Answer

2. It is more common in young females.

Answer

4. Distant metastases are uncommon.

Answer

3. It has propensity for haematogenous spread.

Question 9

The following disorders are predisposing conditions for carcinoma of the colon except

Accepted Answer

Escherichia coli

Answer

Villous adenoma

Answer

Familial polyposis coli

Answer

Peutz-Jeghers syndrome

Question 10

In a patient with breast cancer, the following are poor prognostic factors except

Accepted Answer

Absence of epidermal growth factor receptor

Answer

Aneuploid status

Answer

Age less than 35 years

Answer

High grade

Neoplasia — MCQs

Neoplasia — MCQs

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