Neoplasia Practice Questions

Q: Which of the following is NOT typically associated with chronic HPV infection?

Increased p53 activity. ***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.

Q: Which of the following breast lesions characteristically shows central necrosis with calcification?

Comedo sub type of DCIS. ***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.

Q: Which of the following is true about Anaplasia?

Loss of differentiation. ***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.

Q: AFP is a tumour marker for which of the following?

HCC. ***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.

Q: Gleason's grading system is for -

Carcinoma prostate. ***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.

Q: 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?

Amplification of N-myc gene. ***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 1

Which of the following is NOT typically associated with chronic HPV infection?

Accepted Answer

Increased p53 activity

Answer

Integration into host genome

Answer

Expression of E6 and E7 proteins

Answer

Cellular proliferation

Question 2

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?

Accepted Answer

Release of matrix metalloproteinase

Answer

Loss of cellular polarity

Answer

Presence of fibrous tissue capsule

Answer

Overexpression of HER2/neu

Answer

Increase in N:C ratio

Question 3

Which of the following breast lesions characteristically shows central necrosis with calcification?

Accepted Answer

Comedo sub type of DCIS

Answer

Cribriform sub type of DCIS

Answer

Lobular carcinoma in situ

Answer

Colloid carcinoma

Question 4

Which of the following is true about Anaplasia?

Accepted Answer

Loss of differentiation

Answer

Benign and fully reversible

Answer

Loss of cohesion between cells

Answer

Change of epithelium type

Question 5

Which patient has the best prognosis in breast cancer?

Accepted Answer

Luminal A

Answer

Luminal B

Answer

Triple negative breast cancer

Answer

HER2-positive breast cancer

Question 6

AFP is a tumour marker for which of the following?

Accepted Answer

HCC

Answer

Chordoma

Answer

RCC

Answer

Oncocytoma

Question 7

Gleason's grading system is for -

Accepted Answer

Carcinoma prostate

Answer

Carcinoma colon

Answer

Carcinoma thyroid

Answer

Carcinoma testis

Question 8

Field carcinogenesis theory is commonly seen in

Accepted Answer

Head and neck cancer

Answer

Cervical cancer

Answer

Prostate cancer

Answer

Breast cancer

Question 9

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?

Accepted Answer

Amplification of N-myc gene

Answer

Advanced stage at diagnosis

Answer

Numerous ganglion cells

Answer

Cellular aneuploidy

Question 10

Which of the following statements about Von-Hippel Lindau syndrome is true:

Accepted Answer

Hemangioblastomas seen in craniospinal axis

Answer

Supratentorial lesions are uncommon

Answer

Tumors of Schwann cells are common

Answer

Predominantly supratentorial hemangioblastomas

Neoplasia — MCQs

Neoplasia — MCQs

On this page

Practice by Chapter

Want unlimited practice?