Neoplasia — MCQs

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?

Q766

All of the following are small round blue cell tumours except

Q767

Mesothelioma is caused by –

Q768

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

Q769

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

Q770

Most common tumor of submandibular gland is -

Neoplasia Indian Medical PG Practice Questions and MCQs

Question 761: All are good prognostic factors in Neuroblastoma except

A. Trk B expression (Correct Answer)
B. Stage 2
C. Trk A expression
D. Age of 1 year

Explanation: ***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.

Question 762: Pseudohermaphroditism (Disorder of Sex Development - DSD) is most commonly seen with which tumor?

A. Adrenal adenoma
B. Leydig cell tumor
C. Granulosa cell tumor
D. Virilizing adrenal carcinoma (Correct Answer)

Explanation: ***Virilizing adrenal carcinoma*** - Virilizing adrenal carcinomas produce excessive **androgens**, leading to **46,XX DSD (female pseudohermaphroditism)** due to virilization of external genitalia in genetic females [1] - This results in **ambiguous genitalia** at birth or progressive virilization in childhood with clitoral enlargement, hirsutism, and development of male secondary sexual characteristics [2] - **Congenital adrenal hyperplasia (CAH)** is the most common cause, but virilizing adrenal carcinomas are important neoplastic causes [1] - The androgen excess causes masculinization while the internal Müllerian structures (uterus, fallopian tubes) remain intact *Adrenal adenoma* - While adrenal adenomas can be hormonally active (e.g., **Cushing syndrome, Conn syndrome**), they typically produce cortisol or aldosterone - Virilizing adenomas are **much less common** than virilizing carcinomas and rarely cause the degree of androgen excess needed for pseudohermaphroditism [1] - When adenomas do produce androgens, they cause milder virilization rather than ambiguous genitalia *Leydig cell tumor* - **Leydig cell tumors** produce androgens but occur in males (testicular) causing **precocious puberty** in boys or gynecomastia in adults - They do **not** cause pseudohermaphroditism since affected individuals are already genetically and phenotypically male - Ovarian Leydig cell tumors (extremely rare) can cause virilization in adult women but not congenital ambiguous genitalia [3] *Granulosa cell tumor* - **Granulosa cell tumors** are ovarian tumors that produce **estrogen**, causing feminization, not virilization - They lead to **precocious puberty** in prepubertal girls or postmenopausal bleeding in adults - These tumors would **not** cause pseudohermaphroditism, which requires androgen excess and virilization **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1130-1131. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1135-1137. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1037-1038.

Question 763: Which of the following is the ovarian counterpart of testicular seminoma?

A. Endodermal sinus tumor
B. Dermoid
C. Brenner's tumor
D. Dysgerminoma (Correct Answer)

Explanation: ***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.

Question 764: Radiosensitivity of tumour depends on:

A. Nucleus atypia
B. Histology (Correct Answer)
C. Blood supply
D. Number of cells

Explanation: ***Histology*** - The **histological type** of a tumor is the **PRIMARY and fundamental determinant** of its radiosensitivity, as different cell types have varying inherent responses to radiation based on their cellular characteristics and DNA repair mechanisms [1]. - For example, **lymphomas** and **seminomas** are typically highly radiosensitive, while **sarcomas** and **melanomas** are often radioresistant [1]. - This intrinsic property is determined by the cell of origin and tissue type, making histology the most important factor [1]. *Nucleus atypia* - While **nuclear atypia** indicates malignancy and often correlates with aggressive behavior, it does not directly determine radiosensitivity. - It reflects cellular morphology and differentiation status rather than the intrinsic ability to repair radiation-induced damage. *Blood supply* - **Blood supply** influences the delivery of oxygen to tumor cells, and well-oxygenated cells are generally more radiosensitive (**oxygen effect**). - However, blood supply is a **modifying factor** for radiosensitivity, not the fundamental determinant like histology. - It enhances or reduces the effectiveness of radiation but doesn't define the inherent sensitivity of the tumor type. *Number of cells* - The **number of cells** in a tumor affects the overall dose required for tumor control but is not a primary factor in the intrinsic radiosensitivity of individual cells or the tumor type itself. - A larger tumor burden might require higher total doses and potentially harbors more resistant clones, but this doesn't change the inherent radiobiological properties determined by histology. **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. 204-209.

Question 765: 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?

A. Leydig cell tumor
B. Renal cell carcinoma
C. Seminoma (Correct Answer)
D. Malignant lymphoma

Explanation: 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.

Question 766: All of the following are small round blue cell tumours except

A. Ewing's sarcoma
B. Rhabdomyosarcoma
C. Retinoblastoma
D. Wilms tumour (Correct Answer)

Explanation: ***Wilms tumour*** - **Wilms tumour** (nephroblastoma) is a **triphasic tumor** composed of blastemal, stromal, and epithelial elements [1], leading to a more varied histological appearance than mere small round blue cells. - While it can contain small, undifferentiated cells, its characteristic histology with **immature tubules** and mesenchymal elements differentiates it from classic small round blue cell tumors [1]. *Ewing's sarcoma* - **Ewing's sarcoma** is a classic example of a **small round blue cell tumor**, characterized by uniform, primitive cells with scant cytoplasm [2]. - It is classically associated with specific **chromosomal translocations**, particularly t(11;22). *Rhabdomyosarcoma* - **Rhabdomyosarcoma** is the most common soft tissue sarcoma in children and is also considered a **small round blue cell tumor** due to its primitive, undifferentiated cells [3]. - These tumors show evidence of **skeletal muscle differentiation**, which can be identified through immunohistochemistry (e.g., desmin, myogenin) [3]. *Retinoblastoma* - **Retinoblastoma** is a malignant tumor of the retina composed of primitive **neuroectodermal cells** that appear small, round, and blue [1]. - It classically forms characteristic **rosettes** (Flexner-Wintersteiner rosettes), which are a histological hallmark within its small round blue cell morphology [1]. **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. 211-212. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 671-672. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1224-1225.

Question 767: Mesothelioma is caused by –

A. Bagassosis
B. Silicosis
C. Anthracosis
D. Asbestosis (Correct Answer)

Explanation: ***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.

Question 768: All of the following statements about synovial sarcoma are true, except -

A. Usually seen in patients less than 50 years of age
B. Occur more often at extraarticular sites
C. Originate from synovial lining (Correct Answer)
D. Knee and foot are common sites involved

Explanation: ***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.

Question 769: Following is true about the incidence of tumors of salivary glands except -

A. Warthin's tumor - 5 - 10%
B. Mucoepidermoid carcinoma - 15%
C. Pleomorphic adenoma - 50%
D. Oncocytoma - 5% (Correct Answer)

Explanation: ***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.

Question 770: Most common tumor of submandibular gland is -

A. Oncocytoma
B. Pleomorphic adenoma (Correct Answer)
C. Adenolymphoma
D. Hemangioma

Explanation: ***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.

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Neoplasia — MCQs

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