Neoplasia — MCQs
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Which of the following is NOT typically associated with chronic HPV infection?
A researcher is studying the ability of breast cancer cells to metastasize. Neoplastic cells obtained from 30 patients with stage IV ductal carcinoma of the breast are tagged with a fluorescent antibody. The cells are then inserted into a medium resembling normal human tissue. After 2 weeks, all samples show in vitro hematogenous invasion and migration away from the original site of insertion. Which of the following properties is most likely responsible for the ability of these neoplastic cells to metastasize?
Which of the following breast lesions characteristically shows central necrosis with calcification?
Which of the following is true about Anaplasia?
Which patient has the best prognosis in breast cancer?
AFP is a tumour marker for which of the following?
Gleason's grading system is for -
Field carcinogenesis theory is commonly seen in
A newborn child is noted to have a bulky abdominal tumor. CT scans reveal that the mass involves the right abdomen and retroperitoneum. The tumor is resected, revealing ganglion cells and primitive, small, round cells occasionally organized in rosettes, embedded in a fibrillary pink matrix. Special studies confirm the likely diagnosis. Which of the following features of this tumor is associated with a poorer prognosis?
Which of the following statements about Von-Hippel Lindau syndrome is true:
Neoplasia Indian Medical PG Practice Questions and MCQs
Question 751: Which of the following is NOT typically associated with chronic HPV infection?
- A. Integration into host genome
- B. Increased p53 activity (Correct Answer)
- C. Expression of E6 and E7 proteins
- D. Cellular proliferation
Explanation: ***Increased p53 activity*** - Chronic **HPV infection**, particularly by high-risk types, leads to the expression of the viral **E6 protein**, which targets **p53 for degradation**. [3] - Therefore, chronic HPV infection is typically associated with **decreased p53 activity**, not increased, as E6's role is to neutralize this tumor suppressor. [2] *Integration into host genome* - This is a hallmark of transforming infections by high-risk **HPVs**, allowing for stable expression of **viral oncogenes** like E6 and E7. - This integration is crucial for the development of HPV-associated malignancies, as it ensures persistent expression of viral proteins that disrupt **cell cycle control**. [1] *Expression of E6 and E7 proteins* - **E6 and E7** are the main viral oncogenes expressed during persistent **high-risk HPV infection**. - **E6 targets p53** for degradation, and **E7 inactivates retinoblastoma protein (pRb)**, leading to uncontrolled cell proliferation. [2] *Cellular proliferation* - The effects of **E6 and E7** on **p53 and pRb** remove the checks and balances on cell growth, promoting **uncontrolled cellular proliferation**. [1] - This excessive proliferation is a key step in the development of **HPV-associated neoplasia and cancer**. **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. Neoplasia, pp. 334-335. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 739-741.
Question 752: A researcher is studying the ability of breast cancer cells to metastasize. Neoplastic cells obtained from 30 patients with stage IV ductal carcinoma of the breast are tagged with a fluorescent antibody. The cells are then inserted into a medium resembling normal human tissue. After 2 weeks, all samples show in vitro hematogenous invasion and migration away from the original site of insertion. Which of the following properties is most likely responsible for the ability of these neoplastic cells to metastasize?
- A. Loss of cellular polarity
- B. Presence of fibrous tissue capsule
- C. Overexpression of HER2/neu
- D. Increase in N:C ratio
- E. Release of matrix metalloproteinase (Correct Answer)
Explanation: ***Release of matrix metalloproteinase*** - **Matrix metalloproteinases (MMPs)** degrade components of the **extracellular matrix (ECM)** and **basement membrane**, allowing cancer cells to invade surrounding tissues and metastasize [1]. - The in vitro observation of **hematogenous invasion** and **migration** confirms the ability to break down barriers critical for metastasis [2]. *Loss of cellular polarity* - While **loss of polarity** is a feature of malignant transformation, it primarily contributes to disorganized growth and invasion rather than the active breakdown of the physical barriers required for long-distance metastasis. - It does not directly explain the enzymatic degradation of the **ECM** necessary for transmural passage into blood vessels [2]. *Presence of fibrous tissue capsule* - A **fibrous tissue capsule** typically indicates a **benign tumor** or a well-demarcated malignant tumor with limited invasiveness, restricting spread. - Its presence would hinder, rather than promote, the ability of cancer cells to metastasize. *Overexpression of HER2/neu* - **HER2/neu overexpression** is a marker of aggressive breast cancer and can promote cell proliferation and survival. - However, it does not directly facilitate the enzymatic degradation of the **extracellular matrix** required for active invasion and migration [2]. **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. 232-233. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 314-316.
Question 753: Which of the following breast lesions characteristically shows central necrosis with calcification?
- A. Cribriform sub type of DCIS
- B. Lobular carcinoma in situ
- C. Colloid carcinoma
- D. Comedo sub type of DCIS (Correct Answer)
Explanation: ***Comedo sub type of DCIS*** - This subtype is characterized by high-grade pleomorphic tumor cells with **central necrosis** within the ducts [1]. - The necrotic debris often calcifies, leading to characteristic **microcalcifications** visible on mammograms [2]. *Cribriform sub type of DCIS* - This subtype features uniform cells forming gland-like spaces within the ducts, but **typically lacks significant central necrosis** and extensive calcification [1]. - It usually presents with a **low nuclear grade** and less aggressive features compared to comedo DCIS [1]. *Lobular carcinoma in situ* - Characterized by small, discohesive cells filling and expanding the acini of the lobules, but it **does not involve ductal necrosis or calcification**. - It is often an **incidental finding** and represents a marker for increased risk of invasive carcinoma in either breast, rather than an obligate precursor lesion visible with calcifications. *Colloid carcinoma* - This is a type of **invasive ductal carcinoma** where tumor cells float in abundant extracellular mucin. - While it is an invasive cancer, it does not typically present with the extensive **ductal necrosis and calcification** seen in comedo DCIS. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1062-1064. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 452-453.
Question 754: Which of the following is true about Anaplasia?
- A. Benign and fully reversible
- B. Loss of cohesion between cells
- C. Change of epithelium type
- D. Loss of differentiation (Correct Answer)
Explanation: ***Loss of differentiation*** - **Anaplasia** is defined as the loss of structural and functional differentiation in cells, indicating a reversal to a more primitive state [1]. - It is a hallmark feature of **malignancy** and is associated with increased proliferative capacity and aggressiveness of tumors [1]. *Benign and fully reversible* - **Anaplasia** is a characteristic of **malignant tumors** and is generally not reversible without treatment [1]. - Benign cellular changes are typically reversible and maintain their differentiation features [1]. *Loss of cohesion between cells* - While loss of cohesion can occur in some aggressive tumors, it is more specifically related to changes in cell adhesion molecules and is not the primary definition of **anaplasia**. - **Anaplasia** refers to the loss of differentiation, not solely the physical separation of cells [1]. *Change of epithelium type* - This description refers to **metaplasia**, which is the reversible change of one differentiated cell type to another differentiated cell type [1]. - **Anaplasia** involves a loss of differentiation, not merely a change to a different, still differentiated, cell type [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 276-280.
Question 755: Which patient has the best prognosis in breast cancer?
- A. Luminal B
- B. Luminal A (Correct Answer)
- C. Triple negative breast cancer
- D. HER2-positive breast cancer
Explanation: ***Luminal A*** - Luminal A breast cancer is characterized by **estrogen receptor (ER)-positive**, **progesterone receptor (PR)-positive**, and **HER2-negative** status, along with a **low Ki-67 index** [1]. - This subtype generally has the **best prognosis** among all breast cancer subtypes due to its hormone sensitivity and slower proliferation rate, making it highly responsive to endocrine therapy [1]. *Luminal B* - Luminal B breast cancer is typically **ER-positive**, **PR-negative or low**, and can be **HER2-positive or negative**, but notably has a **high Ki-67 index**, indicating rapid cell proliferation [1]. - Compared to Luminal A, it has a **worse prognosis** due to its more aggressive biological behavior, requiring more intensive treatment approaches. *HER2-positive breast cancer* - HER2-positive breast cancer is characterized by **overexpression or amplification of HER2 (human epidermal growth factor receptor 2)** [1]. - Although it was historically associated with poor prognosis, the introduction of **targeted HER2 therapy (trastuzumab, pertuzumab)** has significantly improved outcomes [2]. - However, it still has a **more aggressive course than Luminal A**, with higher proliferation rates and requires targeted therapy in addition to standard treatment. *Triple negative breast cancer* - Triple negative breast cancer is characterized by **ER-negative, PR-negative, and HER2-negative** status, lacking all three major hormone receptors [1]. - This subtype generally has the **worst prognosis** among breast cancer subtypes due to lack of targeted therapy options and more aggressive biological behavior with higher recurrence rates [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1059-1066. [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. 258-259.
Question 756: AFP is a tumour marker for which of the following?
- A. Chordoma
- B. RCC
- C. HCC (Correct Answer)
- D. Oncocytoma
Explanation: ***Correct Option: HCC*** - **Alpha-fetoprotein (AFP)** is the most widely recognized tumor marker for **Hepatocellular Carcinoma (HCC)**, the most common primary liver cancer [1] - Elevated AFP levels (>400 ng/mL) are highly suggestive of HCC and are used for **diagnosis, monitoring treatment response, and surveillance for recurrence** [1] - AFP is also elevated in **yolk sac tumors** and some **non-seminomatous germ cell tumors**, but HCC remains the primary clinical association [1] *Incorrect: Chordoma* - **Chordomas** are rare malignant bone tumors arising from notochord remnants, typically in the skull base or sacrum - **No specific tumor marker** is routinely used; brachyury (transcription factor) may be used as an immunohistochemical marker for diagnosis - AFP is not associated with chordomas *Incorrect: RCC* - **Renal Cell Carcinoma (RCC)** is the most common kidney malignancy - No highly specific tumor markers exist for RCC; occasionally **elevated LDH, alkaline phosphatase, or calcium** may be seen - AFP is not a marker for RCC *Incorrect: Oncocytoma* - **Renal oncocytoma** is a **benign** renal tumor composed of oncocytes (cells with abundant mitochondria) - Diagnosed primarily by **imaging and histology**, not serum markers - AFP has no role in oncocytoma diagnosis or monitoring **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 399-400.
Question 757: Gleason's grading system is for -
- A. Carcinoma colon
- B. Carcinoma prostate (Correct Answer)
- C. Carcinoma thyroid
- D. Carcinoma testis
Explanation: ***Carcinoma prostate*** - The **Gleason grading system** is a widely used and crucial method for assessing the **aggressiveness** and **prognosis** of **prostate cancer** [1]. - It evaluates the **architectural patterns** of glandular differentiation in prostate cancer tissue, assigning primary and secondary grades that are summed to create a **Gleason score** [1]. *Carcinoma colon* - The grading of **colorectal carcinoma** typically involves assessing factors such as gland formation, nuclear pleomorphism, and mitotic activity, but does not use the **Gleason system**. - Instead, colon cancer is often graded as **well, moderately, or poorly differentiated** adenocarcinoma. *Carcinoma thyroid* - **Thyroid carcinomas** are graded based on their specific histological subtype (e.g., papillary, follicular, medullary, anaplastic) and features such as **nuclear characteristics**, **invasion**, and **mitotic activity**. - The **Gleason system** is not applicable to thyroid cancer. *Carcinoma testis* - **Testicular cancers** are primarily classified and staged based on their specific **histological type** (e.g., seminoma, embryonal carcinoma, teratoma). - While grading occurs within some subtypes (e.g., germ cell tumors), the **Gleason system** is not used for testicular malignancies. **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.
Question 758: Field carcinogenesis theory is commonly seen in
- A. Head and neck cancer (Correct Answer)
- B. Cervical cancer
- C. Prostate cancer
- D. Breast cancer
Explanation: ***Head and neck cancer*** - **Field carcinogenesis** refers to the concept that a large area of tissue is exposed to carcinogens, leading to multiple primary tumors or recurrences [1]. - In **head and neck squamous cell carcinoma**, extensive exposure of the mucosal lining to tobacco and alcohol promotes widespread genetic alterations [1]. *Cervical cancer* - Primarily linked to **human papillomavirus (HPV) infection**, which causes localized lesions that may progress [2]. - While different areas of the cervix can be affected, the underlying mechanism is more focal infection rather than diffuse field exposure. *Prostate cancer* - Development is often associated with **age**, **genetics**, and **hormonal factors** (androgens). - It typically arises from a single or a few distinct foci within the prostate gland, not pervasive field change [3]. *Breast cancer* - Characterized by distinct lesions originating from ductal or lobular epithelium and influenced by **hormones** and **genetics** [4]. - While multifocal breast cancer can occur, it is generally considered the result of multiple independent events or spread from an initial lesion, not a widespread "field" of precancerous tissue in the same way as head and neck. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 738-739. [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. 222-223. [3] 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. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1059-1060.
Question 759: A newborn child is noted to have a bulky abdominal tumor. CT scans reveal that the mass involves the right abdomen and retroperitoneum. The tumor is resected, revealing ganglion cells and primitive, small, round cells occasionally organized in rosettes, embedded in a fibrillary pink matrix. Special studies confirm the likely diagnosis. Which of the following features of this tumor is associated with a poorer prognosis?
- A. Advanced stage at diagnosis
- B. Amplification of N-myc gene (Correct Answer)
- C. Numerous ganglion cells
- D. Cellular aneuploidy
Explanation: ***Amplification of N-myc gene*** - **N-myc (MYCN) gene amplification** is the most critical adverse prognostic factor in **neuroblastoma**, indicating a more aggressive tumor with rapid growth and poor response to therapy [1]. - Its presence is associated with **increased likelihood of metastasis**, treatment failure, and poor survival regardless of stage [1]. - MYCN amplification is found in ~20-25% of neuroblastomas and is an independent predictor of poor outcome. *Advanced stage at diagnosis* - While advanced stage (stage 3 or 4) generally correlates with a poorer prognosis, **N-myc amplification** is an independent molecular marker that is a stronger predictor of outcome [1]. - Tumors with MYCN amplification can have an aggressive course even at lower stages, and conversely, some high-stage tumors without MYCN amplification may have a better outcome. *Numerous ganglion cells* - The presence of numerous **ganglion cells** indicates a more differentiated tumor type, such as a **ganglioneuroma** or **ganglioneuroblastoma** (intermixed type). - Increased differentiation is generally associated with a **better prognosis** in neuroblastic tumors, representing favorable histology. *Cellular aneuploidy* - In neuroblastoma, **hyperdiploidy** (DNA index >1, with more than the diploid number of chromosomes) is associated with a **favorable prognosis**, particularly in infants [1]. - In contrast, **diploid tumors** (DNA index = 1) tend to have a worse prognosis [1]. - The term "cellular aneuploidy" alone is ambiguous; the prognostic significance depends on whether it refers to hyperdiploidy (favorable) or diploidy (unfavorable). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 486-487.
Question 760: Which of the following statements about Von-Hippel Lindau syndrome is true:
- A. Supratentorial lesions are uncommon
- B. Tumors of Schwann cells are common
- C. Hemangioblastomas seen in craniospinal axis (Correct Answer)
- D. Predominantly supratentorial hemangioblastomas
Explanation: ***Hemangioblastomas seen in craniospinal axis*** - **Von Hippel-Lindau (VHL) syndrome** is characterized by the development of **hemangioblastomas**, which are the hallmark tumor of this condition [1]. - These tumors typically occur in the **retina**, **cerebellum**, and **spinal cord** (craniospinal axis), making this the most defining feature of VHL syndrome [1]. - Hemangioblastomas are **highly vascular** tumors that can cause symptoms due to mass effect or hemorrhage [1]. *Supratentorial lesions are uncommon* - This statement is **true** - hemangioblastomas in VHL predominantly occur **infratentorially** (cerebellum and brainstem) rather than supratentorially [1]. - While supratentorial hemangioblastomas can rarely occur, they are much less common than infratentorial lesions. - However, this is a less specific feature compared to the presence of hemangioblastomas in the craniospinal axis, which is the hallmark finding. *Predominantly supratentorial hemangioblastomas* - This is **incorrect** - hemangioblastomas in VHL are characteristically **infratentorial** (below the tentorium cerebelli), not supratentorial [1]. - The cerebellum is the most common site, followed by the spinal cord and retina [1]. - This directly contradicts the typical distribution pattern of VHL-associated tumors. *Tumors of Schwann cells are common* - **Schwann cell tumors**, such as **vestibular schwannomas** (acoustic neuromas), are characteristic of **Neurofibromatosis type 2 (NF2)**, not Von Hippel-Lindau syndrome [2]. - VHL is associated with hemangioblastomas, clear cell renal cell carcinoma, pheochromocytoma, and pancreatic neuroendocrine tumors - not schwannomas [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 724-727. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 727-728.
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