Neoplasia Practice Questions

Q: All are good prognostic factors in Neuroblastoma except

Trk B expression. ***Trk B expression*** - **Trk B expression** is associated with poor prognosis and increased tumor aggressiveness in neuroblastoma. - Neuroblastomas expressing Trk B often show **MYCN amplification** and are more likely to have advanced disease at diagnosis [1]. *Stage 2* - **Stage 2 neuroblastoma** generally represents a localized tumor with complete gross resection, and often indicates a favorable outcome. - It differs from Stages 3 and 4 which involve more extensive local invasion or metastatic disease. *Trk A expression* - **Trk A expression** is a well-established marker for favorable prognosis in neuroblastoma. - Tumors expressing TrkA often undergo spontaneous differentiation and have a higher likelihood of regression [2]. *Age of 1 year* - An **age less than 12-18 months** at diagnosis is a strong independent predictor of favorable prognosis in neuroblastoma [1]. - Younger patients often have less aggressive tumors and respond better to therapy. **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. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 483-484.

Q: Which of the following is the ovarian counterpart of testicular seminoma?

Dysgerminoma. ***Dysgerminoma*** - **Dysgerminoma** is the **ovarian counterpart of testicular seminoma**, both originating from **primordial germ cells** and having a similar histological appearance [1], [3]. - These tumors are typically highly sensitive to **radiation therapy and chemotherapy**, and often present with elevated **lactate dehydrogenase (LDH)** [1]. *Endodermal sinus tumor* - An **endodermal sinus tumor** (yolk sac tumor) is another type of **germ cell tumor** but is characterized by **elevated alpha-fetoprotein (AFP)** and specific Schiller-Duval bodies histologically [3]. - It is not the ovarian equivalent of seminoma; its testicular counterpart is the **yolk sac tumor** of the testis [3]. *Dermoid* - A **dermoid cyst** (mature cystic teratoma) is a common **benign germ cell tumor** containing mature tissues from all three germ layers, such as hair, teeth, and sebaceous material. - It does not have a direct testicular counterpart that is referred to as "seminoma," as seminoma is a malignant germ cell tumor [3]. *Brenner's tumor* - **Brenner's tumor** is a type of **surface epithelial-stromal tumor** of the ovary, characterized by nests of transitional cell epithelium resembling bladder urothelium within a fibrous stroma. - It is not a germ cell tumor and therefore bears no resemblance or direct counterpart to testicular seminoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1034-1035. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1140-1141. [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. 979-980.

Q: A 3-month-old boy is brought to the physician because his parents cannot find one of his testicles. Physical examination confirms the parents' observation. The patient develops a urogenital tumor 30 years later. An abdominal-pelvic CT scan reveals metastases to lumbar periaortic lymph nodes. Which of the following is the most likely pathologic diagnosis?

Seminoma. No explanation provided for the urogenital tumor type and its specific risk factors; however, patients with a history of **cryptorchidism** have a significantly increased risk of developing **testicular cancer**, with seminoma being the most common type [1]. **Seminomas** typically metastasize to **retroperitoneal (lumbar periaortic) lymph nodes**, which aligns with the CT findings. *Leydig cell tumor* - This is a **sex cord-stromal tumor** of the testis, which accounts for a small percentage of testicular tumors [2]. - While it can occur in undescended testes, **seminoma** is far more prevalent in cases of cryptorchidism leading to malignancy. *Renal cell carcinoma* - This is a kidney tumor, and while it does metastasize to lymph nodes, the primary tumor location would be the **kidney**, not a urogenital tumor arising from the absent testicle. - The history of **cryptorchidism** points directly to a testicular origin for the malignancy. *Malignant lymphoma* - Testicular lymphoma is more common in **older men** and usually presents as a diffuse enlargement of the testis [2]. - While it can metastasize to regional lymph nodes, there's no direct link to **cryptorchidism** as a risk factor for primary testicular lymphoma. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 508-509. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 513-514.

Q: Mesothelioma is caused by –

Asbestosis. ***Asbestosis*** - **Mesothelioma** is a rare and aggressive malignant tumor that primarily affects the **pleura** (lining of the lungs), **peritoneum** (abdominal lining), or **pericardium** (heart lining) [1]. - The primary causative agent is **asbestos fiber exposure**, typically occurring in occupational settings (shipbuilding, construction, asbestos mining) [1]. - **Asbestosis** refers to the chronic interstitial lung disease (pulmonary fibrosis) also caused by asbestos exposure. Both mesothelioma and asbestosis result from the same etiological agent—**asbestos fibers** [2]. - There is a long latency period (20-40 years) between asbestos exposure and development of mesothelioma [2]. *Bagassosis* - **Bagassosis** is a type of **hypersensitivity pneumonitis** caused by inhaling dust from **moldy sugarcane (bagasse)** [1]. - It causes allergic alveolitis with granuloma formation but is **not associated with mesothelioma**. *Silicosis* - **Silicosis** is a pneumoconiosis caused by inhaling **crystalline silica dust** (occupations: sandblasting, mining, stone cutting) [1]. - It causes nodular fibrosis and increases risk of tuberculosis and lung cancer, but is **not linked to mesothelioma**. *Anthracosis* - **Anthracosis** is caused by **carbon/coal dust** accumulation in the lungs, seen in coal miners and urban dwellers [1]. - It causes black pigmentation of lung tissue and is the mildest form of coal worker's pneumoconiosis, but **does not cause mesothelioma**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 695. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 339-340.

Q: All of the following statements about synovial sarcoma are true, except -

Originate from synovial lining. ***Originate from synovial lining*** - This statement is **false**. While named "synovial sarcoma" due to its histological resemblance to synovium, it **does not originate from synovial cells** [1]. - Its origin is believed to be from **primitive mesenchymal cells** that can differentiate along various cell lines, not directly from the synovial lining of joints. *Usually seen in patients less than 50 years of age* - This statement is **true**. Synovial sarcoma predominantly affects **adolescents and young adults**, with a median age of diagnosis typically in the 3rd or 4th decade of life [1]. - It is one of the more common soft tissue sarcomas in this younger age group. *Occur more often at extraarticular sites* - This statement is **true**. Despite its name, synovial sarcoma most frequently occurs in **extra-articular locations**, often near large joints but not within the joint capsule itself [1]. - Common sites include the deep soft tissues of the extremities, especially the **thigh and knee**, and less often the trunk or head and neck. *Knee and foot are common sites involved* - This statement is **true**. The **knee** (particularly the thigh region around the knee) and **foot/ankle** are indeed among the most frequent locations for synovial sarcoma [1]. - These tumors often present as a deep-seated mass in these areas. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1225-1226.

Q: Following is true about the incidence of tumors of salivary glands except -

Oncocytoma - 5%. ***Oncocytoma - 5%*** - Oncocytomas are relatively rare, accounting for **less than 1%** of all salivary gland tumors, making 5% an overestimation. - While benign, they are much less common than other benign salivary gland neoplasms such as pleomorphic adenoma and Warthin's tumor. *Warthin's tumor - 5 - 10%* - Warthin's tumor is the **second most common benign salivary gland tumor** and typically accounts for 5-10% of all salivary gland neoplasms. - This incidence rate is generally considered accurate in various epidemiological studies. *Mucoepidermoid carcinoma - 15%* - **Mucoepidermoid carcinoma** is the most common malignant salivary gland tumor, representing approximately 10-15% of all salivary gland tumors [1]. - This percentage falls within the expected range for its incidence. *Pleomorphic adenoma - 50%* - **Pleomorphic adenoma** is the most common benign salivary gland tumor, accounting for approximately 50-60% of all salivary gland tumors [1]. - The stated incidence of 50% is well within the accepted range for this type of tumor [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 751-753.

Q: Most common tumor of submandibular gland is -

Pleomorphic adenoma. ***Pleomorphic adenoma*** - **Pleomorphic adenoma** is the most common tumor of **all salivary glands**, including the submandibular gland, accounting for **50-60% of submandibular tumors** [1]. - It is a **mixed tumor** containing epithelial and mesenchymal components [3]. - Overall, it represents 60-70% of parotid tumors and 40-60% of submandibular tumors [1]. *Oncocytoma* - **Oncocytomas** are rare benign tumors of salivary glands composed of oncocytes (cells with abundant eosinophilic, granular cytoplasm due to numerous mitochondria). - They are much less common than pleomorphic adenomas and predominantly occur in the parotid gland. *Adenolymphoma* - **Adenolymphoma**, also known as **Warthin's tumor**, is the second most common benign salivary tumor but is **almost exclusively found in the parotid gland** (>95% cases) [2]. - It is rarely seen in the submandibular gland. *Hemangioma* - **Hemangiomas** are benign vascular tumors that are more common in children and usually occur in the parotid gland. - While they can occur in the submandibular region, they are not the most common tumor type and are relatively rare overall in salivary glands. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 751-753. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, p. 753. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 274-276.

Question 1

All are good prognostic factors in Neuroblastoma except

Accepted Answer

Trk B expression

Answer

Stage 2

Answer

Trk A expression

Answer

Age of 1 year

Question 2

Pseudohermaphroditism (Disorder of Sex Development - DSD) is most commonly seen with which tumor?

Accepted Answer

Virilizing adrenal carcinoma

Answer

Adrenal adenoma

Answer

Leydig cell tumor

Answer

Granulosa cell tumor

Question 3

Which of the following is the ovarian counterpart of testicular seminoma?

Accepted Answer

Dysgerminoma

Answer

Endodermal sinus tumor

Answer

Dermoid

Answer

Brenner's tumor

Question 4

Radiosensitivity of tumour depends on:

Accepted Answer

Histology

Answer

Nucleus atypia

Answer

Blood supply

Answer

Number of cells

Question 5

A 3-month-old boy is brought to the physician because his parents cannot find one of his testicles. Physical examination confirms the parents' observation. The patient develops a urogenital tumor 30 years later. An abdominal-pelvic CT scan reveals metastases to lumbar periaortic lymph nodes. Which of the following is the most likely pathologic diagnosis?

Accepted Answer

Seminoma

Answer

Leydig cell tumor

Answer

Renal cell carcinoma

Answer

Malignant lymphoma

Question 6

All of the following are small round blue cell tumours except

Accepted Answer

Wilms tumour

Answer

Ewing's sarcoma

Answer

Rhabdomyosarcoma

Answer

Retinoblastoma

Question 7

Mesothelioma is caused by –

Accepted Answer

Asbestosis

Answer

Bagassosis

Answer

Silicosis

Answer

Anthracosis

Question 8

All of the following statements about synovial sarcoma are true, except -

Accepted Answer

Originate from synovial lining

Answer

Usually seen in patients less than 50 years of age

Answer

Occur more often at extraarticular sites

Answer

Knee and foot are common sites involved

Question 9

Following is true about the incidence of tumors of salivary glands except -

Accepted Answer

Oncocytoma - 5%

Answer

Warthin's tumor - 5 - 10%

Answer

Mucoepidermoid carcinoma - 15%

Answer

Pleomorphic adenoma - 50%

Question 10

Most common tumor of submandibular gland is -

Accepted Answer

Pleomorphic adenoma

Answer

Oncocytoma

Answer

Adenolymphoma

Answer

Hemangioma

Neoplasia — MCQs

Neoplasia — MCQs

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