Neoplasia — MCQs
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Schwannoma arises most frequently from:
Neuroblastoma originates from –
Late effects of radiation therapy include:
Which of the following is a precancerous lesion?
Most common malignant tumor of minor salivary glands
Which of the following is not a characteristic of malignant lesions?
Leisegang rings are found in:
An 80-year-old man has increasing jaundice with abdominal pain for the past 2 weeks. He has lost 4 kg over the past 5 months. On physical examination, there is tenderness with palpable gallbladder in the right upper quadrant. An abdominal CT scan shows gallbladder and common bile duct dilation, along with a 3-cm mass in the head of the pancreas. Which of the following lesions is the most likely precursor to this mass?
Tumor NOT commonly seen in first decade of life?
Chordoma can occur over all the following sites, except -
Neoplasia Indian Medical PG Practice Questions and MCQs
Question 771: Schwannoma arises most frequently from:
- A. Trigeminal nerve
- B. Facial Nerve
- C. Vestibular Nerve (Correct Answer)
- D. Cochlear Nerve
Explanation: ***Vestibular Nerve*** - Schwannomas, particularly **vestibular schwannomas** (also known as acoustic neuromas), arise most frequently from the Schwann cells of the vestibular portion of the eighth cranial nerve [1]. - These are benign tumors that grow slowly and can cause hearing loss, tinnitus, and balance problems [1]. *Trigeminal nerve* - Schwannomas can occur on the trigeminal nerve, but they are **less common** than vestibular schwannomas [1]. - Trigeminal schwannomas can present with facial pain, numbness, or weakness. *Facial Nerve* - Schwannomas of the facial nerve are **rare** and often present with facial paralysis or involuntary twitching. - They are significantly less frequent compared to those originating from the vestibular nerve. *Cochlear Nerve* - While the cochlear nerve is part of the vestibulocochlear nerve (cranial nerve VIII), schwannomas predominantly arise from the **vestibular branch** rather than the cochlear branch itself [1]. - Therefore, primary cochlear nerve schwannomas are relatively uncommon compared to vestibular schwannomas. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 727-728.
Question 772: Neuroblastoma originates from –
- A. Mediastinum
- B. Adrenals
- C. Neck
- D. All of these (Correct Answer)
Explanation: ***All of these*** - **Neuroblastoma** arises from primitive **sympathetic neural crest cells** and can originate from **any location** where these cells exist during development [1]. - The tumor can develop in the **adrenal medulla**, **sympathetic ganglia** along the paravertebral sympathetic chain (abdomen, chest, neck, pelvis), making all the listed options correct sites of origin [1], [2]. - The anatomical distribution reflects the **embryological migration pattern** of neural crest cells. **Adrenal Glands (Most Common)** - The **adrenal medulla** is the most frequent primary site, accounting for approximately **40-50%** of all neuroblastomas [1]. - This is because the adrenal medulla is derived from sympathetic neural crest cells. - Abdominal neuroblastomas (adrenal and extra-adrenal) together comprise about **65%** of cases. **Mediastinum (Posterior)** - Approximately **15-20%** of neuroblastomas originate in the **posterior mediastinum** from sympathetic ganglia. - These are the **second most common site** and typically present as posterior mediastinal masses on chest imaging. - Often discovered incidentally on chest X-rays. **Neck (Cervical)** - **Cervical neuroblastoma** arises from sympathetic ganglia in the neck region. - This accounts for about **1-5%** of cases and is relatively uncommon. - May present as a palpable neck mass or Horner syndrome if the cervical sympathetic chain is involved. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 483-484. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 419-420.
Question 773: Late effects of radiation therapy include:
- A. Mucositis, Enteritis, Nausea and vomiting, Pneumonitis
- B. Enteritis, Nausea and vomiting, Pneumonitis, Somatic mutations
- C. Mucositis, Nausea and vomiting, Pneumonitis, Somatic mutations
- D. Mucositis, Enteritis, Pneumonitis, Somatic mutations (Correct Answer)
Explanation: ***Mucositis, Enteritis, Pneumonitis, Somatic mutations*** - **Somatic mutations** leading to **secondary malignancies** are a classic late effect of radiation (occurs years after exposure due to DNA damage) [1] - **Radiation pneumonitis** progressing to **pulmonary fibrosis** is a well-recognized late complication (typically 1-3 months to years post-treatment) [1] - **Chronic radiation enteritis** with fibrosis and vascular damage can occur months to years after abdominal/pelvic radiation [1] - **Chronic mucositis** with fibrosis can persist as a late effect, though mucositis is more commonly acute - This option represents the **most comprehensive list of late effects** among the choices *Mucositis, Enteritis, Nausea and vomiting, Pneumonitis* - **Nausea and vomiting** are predominantly **acute side effects** occurring during or immediately after radiation therapy, not late effects - While mucositis and enteritis can have chronic forms, including nausea/vomiting makes this option incorrect *Enteritis, Nausea and vomiting, Pneumonitis, Somatic mutations* - Incorrectly includes **nausea and vomiting** as a late effect - Though it includes somatic mutations (correct late effect), the presence of an acute symptom invalidates this choice *Mucositis, Nausea and vomiting, Pneumonitis, Somatic mutations* - Incorrectly includes **nausea and vomiting** as a late effect - Omits enteritis, which can manifest as chronic radiation enteritis with fibrosis and strictures **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Central Nervous System Synapse, pp. 437-439.
Question 774: Which of the following is a precancerous lesion?
- A. Keratosis of larynx (Correct Answer)
- B. Laryngitis sicca
- C. Scleroma larynx
- D. Pachydermia of larynx
Explanation: ***Keratosis of larynx*** - **Keratosis of the larynx**, particularly with **dysplasia**, is considered a **precancerous lesion** due to the potential for malignant transformation into squamous cell carcinoma [1]. - It involves abnormal thickening and keratinization of the laryngeal mucosa, often linked to irritants like **smoking** and **alcohol** [1]. *Laryngitis sicca* - This condition involves **dryness and crusting of the laryngeal mucosa**, typically due to environmental factors or systemic drying conditions. - While uncomfortable, it is generally an **inflammatory** condition and not considered precancerous. *Scleroma larynx* - **Laryngeal scleroma** is a chronic inflammatory condition caused by infection with **Klebsiella rhinoscleromatis**, leading to granulomatous changes and fibrosis. - It results in progressive airway obstruction but is a bacterial infection and **not a precancerous lesion**. *Pachydermia of larynx* - **Pachydermia of the larynx** refers to a benign thickening of the laryngeal mucosa, often in the interarytenoid region, typically due to **chronic irritation** or reflux. - Although it indicates chronic inflammation and hyperkeratosis, it is generally considered a **benign reactive change** rather than a true precancerous condition, unless significant dysplasia is also present (which would classify it under keratosis). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 746-747.
Question 775: Most common malignant tumor of minor salivary glands
- A. Pleomorphic adenoma
- B. Adenoid cystic carcinoma (Correct Answer)
- C. Squamous cell carcinoma
- D. Mucoepidermoid carcinoma
Explanation: ***Adenoid cystic carcinoma*** - This is the **most common malignant tumor** originating from the minor salivary glands [1]. - It is characterized by **perineural invasion**, which contributes to its aggressive nature and predisposition to local recurrence and distant metastasis. *Pleomorphic adenoma* - This is the **most common benign tumor** of both major and minor salivary glands, not malignant. - It has a potential for malignant transformation, but in its primary form, it is benign. *Squamous cell carcinoma* - While squamous cell carcinoma can occur in the head and neck region, it is **rarely a primary tumor of salivary glands**. - It typically arises from surface epithelium, not glandular tissue. *Mucoepidermoid carcinoma* - This is the **most common malignant tumor of major salivary glands**, specifically the parotid gland, but not the most common for minor salivary glands [1]. - It is composed of mucin-producing cells, epidermoid cells, and intermediate cells. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 753-755.
Question 776: Which of the following is not a characteristic of malignant lesions?
- A. Absence of encapsulation
- B. Ulcerated borders
- C. Pear-shaped (Correct Answer)
- D. Ill-defined borders
Explanation: ***Pear-shaped*** - A **pear-shaped** morphology is not a typical characteristic of malignant lesions; they usually present with irregular, ill-defined, or infiltrative shapes [1] - This shape is often associated with benign lesions (e.g., fibroadenoma) or specific types of cysts [2] - Malignant tumors characteristically have **irregular, asymmetric, or spiculated** contours [3] *Absence of encapsulation* - Malignant lesions typically lack a well-defined fibrous capsule, allowing them to **invade surrounding tissues** [1] - This characteristic distinguishes them from most benign tumors, which are often encapsulated [2] - The absence of encapsulation is a hallmark feature of malignant behavior *Ulcerated borders* - Ulceration is a common feature of advanced malignant lesions, indicating rapid growth and tissue destruction [3] - This occurs as the tumor outgrows its blood supply or invades superficial layers, leading to tissue breakdown - Surface ulceration is particularly seen in malignant tumors of skin, GI tract, and mucosal surfaces *Ill-defined borders* - Malignant lesions frequently have **irregular or ill-defined borders** due to their invasive and infiltrative growth patterns [2] - This lack of clear demarcation makes complete surgical removal challenging - On imaging and gross examination, poorly defined margins are a key indicator of malignancy **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 276-278. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, p. 280. [3] 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. 204-206.
Question 777: Leisegang rings are found in:
- A. Odontoma
- B. Calcifying epithelial odontogenic tumor (Correct Answer)
- C. Calcifying epithelial odontogenic cyst
- D. Primordial cyst
Explanation: ***Calcifying epithelial odontogenic tumor*** - **Leisegang rings** are pathognomonic for **Calcifying Epithelial Odontogenic Tumor (CEOT)**, also known as Pindborg tumor. These rings represent **concentric rings of calcification**. - Histologically, CEOT features polyhedral epithelial cells within a fibrous stroma, often forming amyloid-like deposits that then calcify to form the characteristic rings. *Odontoma* - An **odontoma** is a benign odontogenic tumor composed of well-differentiated dental tissues (enamel, dentin, cementum, pulp) [1]. - It does not exhibit **Leisegang rings** but rather organized or disorganized masses of tooth-like structures. *Calcifying epithelial odontogenic cyst* - This is not a recognized entity; the correct term for a calcifying odontogenic lesion with cystic features is a **calcifying cystic odontogenic tumor (CCOT)**, formerly known as Gorlin cyst. - CCOT is characterized by ghost cells and dysplastic dentin, not **Leisegang rings**. *Primordial cyst* - A **primordial cyst** is an outdated term, typically referring to a **keratocystic odontogenic tumor (KCOT)** or sometimes a **dentigerous cyst**. - These cysts are characterized by a lining of stratified squamous epithelium and do not contain **Leisegang rings**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 741-742.
Question 778: An 80-year-old man has increasing jaundice with abdominal pain for the past 2 weeks. He has lost 4 kg over the past 5 months. On physical examination, there is tenderness with palpable gallbladder in the right upper quadrant. An abdominal CT scan shows gallbladder and common bile duct dilation, along with a 3-cm mass in the head of the pancreas. Which of the following lesions is the most likely precursor to this mass?
- A. Pancreatic intraepithelial neoplasia (Correct Answer)
- B. Duodenal adenocarcinoma
- C. Colonic neuroendocrine carcinoma
- D. Neuroendocrine tumor
Explanation: ***Pancreatic intraepithelial neoplasia (PanIN)*** - **PanIN is the most common precursor lesion** to pancreatic ductal adenocarcinoma (PDAC), which accounts for over 90% of pancreatic malignancies [1] - The clinical presentation with **jaundice, weight loss, abdominal pain, palpable gallbladder (Courvoisier's sign)**, and a **pancreatic head mass on CT** is classic for PDAC [1] - **PanIN lesions progress through grades** (PanIN-1, PanIN-2, PanIN-3) with accumulating genetic mutations (KRAS, p16, TP53, SMAD4) leading to invasive carcinoma [1] - Other precursor lesions include **intraductal papillary mucinous neoplasms (IPMN)** and **mucinous cystic neoplasms (MCN)**, but PanIN is the most frequent pathway [1] *Duodenal adenocarcinoma* - This is a **separate malignancy arising from duodenal mucosa**, not a precursor to pancreatic cancer - While periampullary duodenal cancers can cause similar obstructive jaundice, the CT clearly shows a **pancreatic parenchymal mass**, not a duodenal wall lesion - Duodenal adenocarcinoma would show **duodenal wall thickening** rather than a discrete pancreatic head mass *Colonic neuroendocrine carcinoma* - This is a **distinct malignancy from colonic origin**, not a precursor to pancreatic adenocarcinoma - Colonic neuroendocrine tumors typically present with **GI bleeding, bowel obstruction**, or distant metastases, not as a primary pancreatic mass - This option has no pathophysiologic relationship to pancreatic ductal adenocarcinoma *Neuroendocrine tumor* - **Pancreatic neuroendocrine tumors (PNETs)** are a different tumor lineage arising from islet cells, not ductal epithelium - PNETs are **not precursors to PDAC**; they are separate entities with distinct molecular profiles, behavior, and prognosis - While PNETs can present as pancreatic masses, they typically have **better prognosis** and different imaging characteristics (hypervascular vs hypovascular) **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Pancreas, pp. 897-900.
Question 779: Tumor NOT commonly seen in first decade of life?
- A. Neuroblastoma
- B. Wilm’s tumor
- C. Retinoblastoma
- D. Ameloblastoma (Correct Answer)
Explanation: ***Ameloblastoma*** - Ameloblastomas are **odontogenic tumors** that typically affect adults between the **third and seventh decades of life**, making them uncommon in the first decade. - Symptoms include **painless swelling** in the jaw, facial asymmetry, and malocclusion, usually presenting much later in life. *Neuroblastoma* - **Neuroblastoma** is a common tumor of early childhood, with the majority of diagnoses occurring before the **age of 5** [1], [2]. - It originates from **neural crest cells** and can arise in the adrenal glands, abdomen, chest, or neck [1], [2]. *Wilm’s tumor* - **Wilm's tumor (nephroblastoma)** is a kidney cancer that most commonly affects children between the **ages of 3 and 4**, making it prevalent in the first decade of life [1], [2]. - It often presents as an **abdominal mass**, abdominal pain, or hematuria. *Retinoblastoma* - **Retinoblastoma** is a malignant tumor of the retina that almost exclusively affects young children, typically diagnosed before the **age of 5** [1], [2]. - Key signs include **leukocoria** (white pupillary reflex) and strabismus [3]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 483-484. [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. 211-212. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 737-738.
Question 780: Chordoma can occur over all the following sites, except -
- A. Rib (Correct Answer)
- B. Vertebral body
- C. Clivus
- D. Sacrum
Explanation: ***Rib*** - **Chordomas** originate from remnants of the **notochord**, which is primarily found along the **midline axial skeleton**. - Although the ribs are part of the axial skeleton, they develop from **somites and lateral plate mesoderm**, not from notochord remnants, making them an extremely unlikely site for chordoma. *Vertebral body* - The **vertebral bodies** are common sites for **chordomas** as they develop from notochordal remnants along the axial skeleton. - Approximately 15% of all chordomas occur in the mobile spine (cervical, thoracic, and lumbar vertebrae). *Clivus* - The **clivus**, located at the base of the skull, is a frequent site for **chordomas** due to the presence of notochordal tissue in this region. - **Clival chordomas** represent about 30-35% of all chordoma cases. *Sacrum* - The **sacrum** is the **most common site** for chordomas, accounting for over 50% of cases. - This is due to the significant presence of **notochordal remnants** in the sacrococcygeal region.
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