Neoplasia Practice Questions

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

Papillary serous carcinoma. ***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.

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

It is the most common type of testicular cancer. ***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.

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

Lobular carcinoma of the breast. ***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.

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

Inhibin. ***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.

Q: Acinic cell carcinoma is found in

salivary glands. ***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.

Q: Most common neoplasm of thyroid gland is:

Papillary carcinoma. ***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.

Q: 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

1, 2 and 4. ***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.

Question 1

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

Accepted Answer

Papillary serous carcinoma

Answer

Clear cell carcinoma

Answer

Mucinous adenocarcinoma

Answer

Well differentiated endometrioid adenocarcinoma

Question 2

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

Accepted Answer

It is the most common type of testicular cancer

Answer

It frequently metastasizes to the liver and bones

Answer

Its five-year survival rates approach 50 per cent

Answer

It does not respond to radiation

Question 3

Which of the following breast cancers is most often bilateral ?

Accepted Answer

Lobular carcinoma of the breast

Answer

Medullary carcinoma of the breast

Answer

Ductal carcinoma of the breast

Answer

Colloid carcinoma of the breast

Question 4

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

Accepted Answer

Soft tissue sarcoma

Answer

Melanoma

Answer

Colonic adenocarcinoma

Answer

Prostate cancer

Question 5

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

Accepted Answer

Inhibin

Answer

Alpha fetoprotein

Answer

CA 125

Answer

Beta-HCG

Question 6

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

Accepted Answer

Sporadic hamartomatous polyps

Answer

Ulcerative colitis

Answer

Villous adenoma

Answer

Familial adenomatous polyposis coli

Question 7

Acinic cell carcinoma is found in

Accepted Answer

salivary glands

Answer

breast

Answer

thyroid

Answer

stomach

Question 8

Most common neoplasm of thyroid gland is:

Accepted Answer

Papillary carcinoma

Answer

Follicular carcinoma

Answer

Squamous cell carcinoma

Answer

Medullary carcinoma

Question 9

All of the following are premalignant lesions except:

Accepted Answer

Rhinophyma

Answer

Giant Hairy Naevus

Answer

Actinic Solar Keratosis

Answer

Bowen’s Disease

Question 10

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

Accepted Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 3

Neoplasia — MCQs

Neoplasia — MCQs

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