Neoplasia Practice Questions

Q: Schwannoma arises most frequently from:

Vestibular Nerve. ***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.

Q: Neuroblastoma originates from –

All of these. ***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.

Q: Late effects of radiation therapy include:

Mucositis, Enteritis, Pneumonitis, Somatic mutations. ***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.

Q: Which of the following is a precancerous lesion?

Keratosis of larynx. ***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.

Q: Most common malignant tumor of minor salivary glands

Adenoid cystic carcinoma. ***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.

Q: Leisegang rings are found in:

Calcifying epithelial odontogenic tumor. ***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.

Q: Tumor NOT commonly seen in first decade of life?

Ameloblastoma. ***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.

Q: Chordoma can occur over all the following sites, except -

Rib. ***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.

Question 1

Schwannoma arises most frequently from:

Accepted Answer

Vestibular Nerve

Answer

Trigeminal nerve

Answer

Facial Nerve

Answer

Cochlear Nerve

Question 2

Neuroblastoma originates from –

Accepted Answer

All of these

Answer

Mediastinum

Answer

Adrenals

Answer

Neck

Question 3

Late effects of radiation therapy include:

Accepted Answer

Mucositis, Enteritis, Pneumonitis, Somatic mutations

Answer

Mucositis, Enteritis, Nausea and vomiting, Pneumonitis

Answer

Enteritis, Nausea and vomiting, Pneumonitis, Somatic mutations

Answer

Mucositis, Nausea and vomiting, Pneumonitis, Somatic mutations

Question 4

Which of the following is a precancerous lesion?

Accepted Answer

Keratosis of larynx

Answer

Laryngitis sicca

Answer

Scleroma larynx

Answer

Pachydermia of larynx

Question 5

Most common malignant tumor of minor salivary glands

Accepted Answer

Adenoid cystic carcinoma

Answer

Pleomorphic adenoma

Answer

Squamous cell carcinoma

Answer

Mucoepidermoid carcinoma

Question 6

Which of the following is not a characteristic of malignant lesions?

Accepted Answer

Pear-shaped

Answer

Absence of encapsulation

Answer

Ulcerated borders

Answer

Ill-defined borders

Question 7

Leisegang rings are found in:

Accepted Answer

Calcifying epithelial odontogenic tumor

Answer

Odontoma

Answer

Calcifying epithelial odontogenic cyst

Answer

Primordial cyst

Question 8

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?

Accepted Answer

Pancreatic intraepithelial neoplasia

Answer

Duodenal adenocarcinoma

Answer

Colonic neuroendocrine carcinoma

Answer

Neuroendocrine tumor

Question 9

Tumor NOT commonly seen in first decade of life?

Accepted Answer

Ameloblastoma

Answer

Neuroblastoma

Answer

Wilm’s tumor

Answer

Retinoblastoma

Question 10

Chordoma can occur over all the following sites, except -

Accepted Answer

Rib

Answer

Vertebral body

Answer

Clivus

Answer

Sacrum

Neoplasia — MCQs

Neoplasia — MCQs

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