Neoplasia — MCQs

Neoplasia Indian Medical PG Practice Questions and MCQs

Question 721: Out of the following, select the histologic type of endometrial cancer which has the worst prognosis:

A. Clear cell carcinoma
B. Papillary serous carcinoma (Correct Answer)
C. Mucinous adenocarcinoma
D. Well differentiated endometrioid adenocarcinoma

Explanation: ***Papillary serous carcinoma*** - This subtype is considered a **Type II endometrial cancer**, which is often **aggressive**, poorly differentiated, and has a high metastatic potential. [1] - It frequently presents at an advanced stage and has a **poor prognosis** due to its rapid growth and tendency for widespread peritoneal dissemination. [1] *Clear cell carcinoma* - While also a **Type II endometrial cancer** with an aggressive course, it generally has a slightly better prognosis than papillary serous carcinoma. - It is characterized by polygonal cells with **clear cytoplasm** and often presents with more localized disease compared to serous carcinoma. *Mucinous adenocarcinoma* - This is typically classified as a **Type I endometrial cancer**, which is low-grade and generally associated with a **favorable prognosis**. [1] - It is characterized by cells producing **mucin**, often resembling endocervical adenocarcinoma. *Well differentiated endometrioid adenocarcinoma* - This is the **most common type of endometrial cancer** and is typically a **Type I cancer**, associated with a very **good prognosis**. [1] - It is characterized by glandular differentiation that closely resembles normal endometrial glands, driven by unopposed estrogen exposure. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1021-1024.

Question 722: Which one of the following statements regarding seminoma testis is correct ?

A. It frequently metastasizes to the liver and bones
B. Its five-year survival rates approach 50 per cent
C. It does not respond to radiation
D. It is the most common type of testicular cancer (Correct Answer)

Explanation: ***It is the most common type of testicular cancer*** - **Seminoma** accounts for approximately **50% of all germ cell tumors** of the testis, making it the most common type [1]. - It typically affects men between the ages of **30 and 40 years**. *It frequently metastasizes to the liver and bones* - While seminoma can metastasize, its most common sites of spread are the **retroperitoneal lymph nodes** first, then distant sites like the lungs [2]. - Metastasis to the **liver and bones** is less frequent, especially in earlier stages. *Its five-year survival rates approach 50 per cent* - **Seminoma** generally has an **excellent prognosis**, with 5-year survival rates ranging from **95% for localized disease** to about 70-80% for metastatic disease [1]. - A 50% survival rate is significantly lower than actual outcomes for seminoma. *It does not respond to radiation* - **Seminoma is highly radiosensitive**, making radiation therapy a cornerstone of treatment for localized disease and regional lymph node involvement. - This characteristic distinguishes it from non-seminomatous germ cell tumors, which are generally less responsive to radiation. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 979-984. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 510-512.

Question 723: Which of the following breast cancers is most often bilateral ?

A. Lobular carcinoma of the breast (Correct Answer)
B. Medullary carcinoma of the breast
C. Ductal carcinoma of the breast
D. Colloid carcinoma of the breast

Explanation: ***Lobular carcinoma of the breast*** - **Invasive lobular carcinoma (ILC)** is the breast cancer subtype most frequently associated with **bilateral disease**, occurring in 5% to 28% of cases. [1] - This higher rate of bilaterality is partly due to the diffuse growth pattern of lobular carcinoma, which can make it more challenging to detect and may lead to synchronous or metachronous involvement of both breasts. [1] *Medullary carcinoma of the breast* - **Medullary carcinoma** is a rare and often well-circumscribed type of breast cancer that typically presents as a solitary mass and is not characteristically bilateral. [1] - It has a generally better prognosis than other invasive ductal carcinomas and is often associated with a BRCA1 mutation. [1] *Ductal carcinoma of the breast* - **Invasive ductal carcinoma (IDC)**, also known as no special type (NST), is the most common form of breast cancer, but it is less frequently bilateral than lobular carcinoma. [1] - While bilateral IDC can occur, it is a less defining characteristic compared to ILC. *Colloid carcinoma of the breast* - **Colloid (mucinous) carcinoma** is a distinct and relatively rare subtype of invasive ductal carcinoma, characterized by tumor cells floating in pools of mucin. - It usually presents as a solitary mass and is not known for a higher incidence of bilaterality. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 454-456.

Question 724: The histological grade best correlates with the prognosis in which one of the following malignancies?

A. Soft tissue sarcoma (Correct Answer)
B. Melanoma
C. Colonic adenocarcinoma
D. Prostate cancer

Explanation: ***Soft tissue sarcoma*** - **Histological grade is THE MOST IMPORTANT prognostic factor** for soft tissue sarcomas, more significant than size or depth in many cases. - The **FNCLCC (French Federation of Cancer Centers) grading system** is the gold standard, which grades tumors based on differentiation, mitotic count, and necrosis. - Grade directly predicts metastatic potential and survival - high-grade sarcomas have significantly worse prognosis than low-grade tumors [2]. - This is consistently emphasized in **WHO classification of soft tissue tumors** and oncology guidelines. *Colonic adenocarcinoma* - While histological grade (well, moderate, poorly differentiated) is assessed, **TNM staging** (particularly T stage - depth of invasion, and N stage - lymph node involvement) is far more important for prognosis. - Stage is the primary determinant of treatment and survival, not grade. *Melanoma* - Prognosis is primarily determined by **Breslow thickness** (tumor depth in mm), presence of **ulceration**, and **mitotic rate**. - Histological grade per se is not the primary prognostic factor - tumor thickness is paramount. *Prostate cancer* - Uses the **Gleason score/Grade Group system**, which assesses architectural patterns rather than traditional cytological differentiation [1]. - While the Gleason score is crucial, this is a specific grading system, not conventional "histological grade" as understood in general pathology. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 993-994. [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. 207-208.

Question 725: Which tumour marker is most often elevated in ovarian granulosa cell tumour?

A. Alpha fetoprotein
B. CA 125
C. Inhibin (Correct Answer)
D. Beta-HCG

Explanation: ***Inhibin*** - **Inhibin** is a polypeptide hormone produced by granulosa cells, making it a highly specific and sensitive marker for **granulosa cell tumors** of the ovary [1]. - Its levels correlate with tumor burden and can be used for monitoring treatment response and detecting recurrence [1]. *Alpha fetoprotein* - **Alpha-fetoprotein (AFP)** is a tumor marker more commonly associated with **yolk sac tumors (endodermal sinus tumors)**, which are a type of germ cell tumor, not granulosa cell tumors. - Elevated AFP can also be seen in hepatocellular carcinoma and some testicular tumors. *CA 125* - **CA 125** is the most widely used tumor marker for **epithelial ovarian cancer**, which is the most common type of ovarian cancer. - While it can be mildly elevated in other conditions, it is not specifically elevated in granulosa cell tumors. *Beta-HCG* - **Beta-human chorionic gonadotropin (β-HCG)** is primarily elevated in **gestational trophoblastic disease** (e.g., choriocarcinoma) and some germ cell tumors, such as dysgerminomas and embryonal carcinomas, if they have syncytiotrophoblastic elements [2]. - It is not a typical marker for granulosa cell tumors. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1036-1037. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1034-1036.

Question 726: Which one of the following is not a premalignant condition for colon cancer?

A. Ulcerative colitis
B. Villous adenoma
C. Familial adenomatous polyposis coli
D. Sporadic hamartomatous polyps (Correct Answer)

Explanation: ***Sporadic hamartomatous polyps*** - **Sporadic hamartomatous polyps** are benign lesions composed of normal tissue elements arranged in a disorganized manner and do not carry significant risk of malignant transformation. - Unlike adenomatous polyps, sporadic hamartomatous polyps lack **dysplastic epithelium** and are not considered premalignant [2]. - **Important distinction:** While **hamartomatous polyposis syndromes** (e.g., Peutz-Jeghers syndrome, Juvenile polyposis syndrome) do increase cancer risk due to the large number of polyps and associated genetic mutations, individual sporadic hamartomatous polyps themselves are not premalignant [3]. *Ulcerative colitis* - **Ulcerative colitis** is a chronic inflammatory bowel disease that significantly increases the risk of developing colorectal cancer, especially with long-standing disease (>8-10 years) or extensive colonic involvement. - The chronic inflammation leads to **dysplasia**, which is a precursor to malignancy, making it a true premalignant condition. *Villous adenoma* - **Villous adenomas** are a type of adenomatous polyp with the highest propensity for malignant transformation (30-40% harbor carcinoma) [4]. - They have a characteristic finger-like villous architecture and often contain **high-grade dysplasia**, significantly increasing the likelihood of progression to invasive carcinoma [1], [4]. *Familial adenomatous polyposis coli* - **Familial adenomatous polyposis (FAP)** is an autosomal dominant disorder caused by **APC gene mutation**, characterized by the development of hundreds to thousands of adenomatous polyps throughout the colon and rectum [2]. - Nearly **100% of individuals with untreated FAP** will develop colorectal cancer by age 40, making it one of the most highly penetrant premalignant conditions [2]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 371-372. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 821-822. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 813-814. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 815-817.

Question 727: Acinic cell carcinoma is found in

A. salivary glands (Correct Answer)
B. breast
C. thyroid
D. stomach

Explanation: ***salivary glands*** - **Acinic cell carcinoma** is a rare malignant tumor that primarily arises in the **major salivary glands**, most commonly the **parotid gland** [1]. - Its name derives from its histologic resemblance to **serous acinar cells**, which are characteristic of salivary gland tissue. *breast* - While various carcinomas occur in the breast, **acinic cell carcinoma** is not a primary breast cancer type [2]. - Breast cancers originate from **ductal** or **lobular epithelial cells** [2]. *thyroid* - Thyroid cancers include **papillary**, **follicular**, **medullary**, and **anaplastic carcinomas**, which originate from thyroid follicular or parafollicular cells. - **Acinic cell carcinoma** is not a recognized type of thyroid malignancy. *stomach* - The stomach is susceptible to **adenocarcinomas**, particularly **intestinal** and **diffuse types**, as well as other less common tumors. - **Acinic cell carcinoma** is not found as a primary tumor in the stomach. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 753-755. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1059-1060.

Question 728: Most common neoplasm of thyroid gland is:

A. Follicular carcinoma
B. Papillary carcinoma (Correct Answer)
C. Squamous cell carcinoma
D. Medullary carcinoma

Explanation: ***Papillary carcinoma*** - **Papillary carcinoma** accounts for about 80% [1] of all thyroid cancers, making it the most common type [1,2]. - It typically presents as a **cold nodule** on scintigraphy and has an excellent prognosis [2]. - Characterized by **Orphan Annie eye nuclei** [2,3] and **psammoma bodies** on histology. - Spreads primarily via **lymphatic route** to regional lymph nodes [2]. *Follicular carcinoma* - **Follicular carcinoma** is the second most common type of thyroid cancer, accounting for about 10-15% of cases [2]. - It tends to metastasize via a **hematogenous route** to distant sites like bones and lungs [2], unlike papillary carcinoma which spreads lymphatically. - Diagnosis requires demonstration of **capsular or vascular invasion** on histology. *Squamous cell carcinoma* - **Squamous cell carcinoma** of the thyroid is extremely rare and usually aggressive. - It's not considered one of the common primary thyroid neoplasms. - May arise from thyroglossal duct remnants or represent metastasis. *Medullary carcinoma* - **Medullary carcinoma** accounts for about 5-10% of thyroid cancers [2]. - Arises from **parafollicular C cells** that produce calcitonin [4]. - Can be sporadic or familial (associated with MEN 2A and 2B syndromes) [2,5]. - Shows **amyloid deposition** on histology. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1098-1099. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 429-430. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, p. 1099. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 428-429.

Question 729: All of the following are premalignant lesions except:

A. Giant Hairy Naevus
B. Actinic Solar Keratosis
C. Bowen’s Disease
D. Rhinophyma (Correct Answer)

Explanation: ***Rhinophyma*** - **Rhinophyma** is a severe form of rosacea that causes an **enlarged, bulbous, red nose** due to sebaceous gland hyperplasia and fibrosis, but it is **not considered a premalignant lesion**. - While it can be disfiguring and cosmetically concerning, it does not inherently carry an increased risk of developing into cancer. *Giant Hairy Naevus* - A **giant hairy nevus** is a congenital melanocytic nevus covering a large body surface area and has a significantly **increased risk of transforming into melanoma**. - The risk of malignant transformation is estimated to be between 5% and 10% over the lifetime of an affected individual. *Actinic Solar Keratosis* - **Actinic keratosis** is a very common **precancerous lesion** caused by chronic sun exposure, which has the potential to progress to **squamous cell carcinoma (SCC)** [1]. - It is characterized by rough, scaly patches on sun-exposed areas and is considered an **in-situ SCC** [1], [2]. *Bowen’s Disease* - **Bowen's disease** is a form of **squamous cell carcinoma in situ (SCCis)**, meaning it is a superficial form of skin cancer that has not yet invaded the deeper layers of the skin [2], [3]. - While it is not fully invasive, it is considered a **premalignant condition** because it can progress to invasive squamous cell carcinoma if left untreated [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, p. 1156. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Disorders Involving Inflammatory And Haemopoietic Cells, pp. 644-645. [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. 209-210.

Question 730: Which of the following statements regarding hepatic adenomas are correct? 1. They are almost exclusively seen in females aged 25-50 years 2. They are associated with the use of oral contraceptive pills 3. They do not have any malignant potential 4. Majority are detected incidentally on imaging

A. 2, 3 and 4
B. 1, 2 and 4 (Correct Answer)
C. 1, 3 and 4
D. 1, 2 and 3

Explanation: ***1, 2 and 4*** - **Hepatic adenomas** are indeed almost exclusively seen in **females aged 25-50 years**, primarily due to their association with hormonal factors. - They are strongly associated with the use of **oral contraceptive pills** (OCPs) and other exogenous estrogens [1]. - The majority of hepatic adenomas are detected **incidentally on imaging** performed for other reasons, as they are often asymptomatic unless complications arise. - While most hepatic adenomas are benign, they do carry a **risk of malignant transformation**, particularly larger lesions or certain subtypes [1]. *2, 3 and 4* - This option incorrectly states that hepatic adenomas **do not have any malignant potential**; however, certain subtypes and larger adenomas can undergo malignant transformation [1]. - The other statements regarding association with OCPs and incidental detection are correct. *1, 3 and 4* - This choice incorrectly claims that hepatic adenomas **do not have any malignant potential**, which is false as there is a recognized risk of transformation to **hepatocellular carcinoma** [1]. - It also omits the correct statement about their association with OCPs. *1, 2 and 3* - This option incorrectly asserts that hepatic adenomas **do not have any malignant potential**, which contradicts current medical understanding as they can transform into **hepatocellular carcinoma** [1]. - It also omits the common finding that they are often detected incidentally. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 874-875.

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Neoplasia — MCQs

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