Neoplasia — MCQs

Neoplasia Indian Medical PG Practice Questions and MCQs

Question 781: Esthesioneuroblastoma is a tumour arising from

A. Olfactory nasal mucosa (Correct Answer)
B. Arachnoid
C. Spinal cord
D. Pia mater

Explanation: ***Olfactory nasal mucosa*** - **Esthesioneuroblastoma**, also known as olfactory neuroblastoma, is a rare malignant tumor derived from the **olfactory neuroepithelial cells** within the nasal cavity. - These tumors arise from the basal layer of the **olfactory mucosa**, which includes the sustentacular cells, basal cells, and olfactory receptor neurons. *Arachnoid* - The **arachnoid mater** is one of the three **meningeal layers** that cover the brain and spinal cord, and tumors arising from this layer are typically **meningiomas** [1], [2]. - Meningiomas are usually benign and structurally distinct from esthesioneuroblastomas, which are neuroectodermal in origin [2]. *Spinal cord* - Tumors of the **spinal cord** can be intramedullary (within the cord tissue) or extramedullary (outside the cord but within the spinal column), such as gliomas or meningiomas [2]. - These tumors are distinct from esthesioneuroblastomas, which are characterized by their origin in the **nasal cavity** and differentiation towards olfactory neurons. *Pia mater* - The **pia mater** is the innermost layer of the **meninges**, closely investing the brain and spinal cord, and tumors arising directly from pial cells are extremely rare. - Tumors associated with the meninges usually originate from the arachnoid layer (meningiomas) and do not have the neural crest origin or location characteristic of esthesioneuroblastoma [2]. **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. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1319-1320.

Question 782: Commonest malignancy of bones is -

A. Multiple myeloma
B. Metastases (Correct Answer)
C. Osteogenic sarcoma
D. Ewing's sarcoma

Explanation: ***Metastases*** - **Metastatic tumors** are the most common malignancies found in bone, originating from primary cancers elsewhere in the body (e.g., breast, prostate, lung) [1], [3]. - While other options represent primary bone cancers, metastases significantly outnumber them due to the frequent spread of various carcinomas to bone [1], [3]. *Multiple myeloma* - This is a **primary bone marrow malignancy** involving plasma cells, but it is not a primary bone tumor in the strict sense. - While it causes extensive skeletal destruction, its overall incidence is less than that of metastatic bone disease from solid tumors [3]. *Ewing's sarcoma* - This is a **primary malignant bone tumor** that typically affects children and young adults [1]. - It is relatively rare compared to both metastatic disease and other primary bone tumors [1]. *Osteogenic sarcoma* - Also known as **osteosarcoma**, this is the most common primary malignant bone tumor, predominantly affecting adolescents and young adults [2]. - However, when considering all malignancies of bone, including metastatic disease, osteosarcoma's incidence is far lower than that of metastases [3]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 671-672. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1202. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1198-1200.

Question 783: Most common parotid gland tumour is

A. Monomorphic adenoma
B. Primary lymphoma
C. Pleomorphic adenoma (Correct Answer)
D. Adenocarcinoma

Explanation: ***Pleomorphic adenoma*** - This is the **most common benign tumor** of the salivary glands, accounting for approximately **60-70%** of all parotid gland tumors [1]. - It is characterized by its **mixed stromal and epithelial components**, giving it a pleomorphic (varied) appearance [1]. *Monomorphic adenoma* - This is a **less common benign epithelial tumor** of the salivary glands compared to pleomorphic adenoma. - It lacks the **stromal component** seen in pleomorphic adenoma and typically affects older individuals. *Adeno adenocarcinoma* - This is a type of **malignant epithelial tumor** of the salivary glands, which is much less common than benign pleomorphic adenoma [1]. - While it can occur in the parotid gland, it constitutes a **minority of parotid tumors**, typically presenting with more aggressive features. *Primary lymphoma* - **Lymphomas** can occur in the salivary glands but are **rare** as primary tumors of the parotid gland itself. - They typically arise from **lymphoid tissue** within or adjacent to the gland, often presenting as firm, non-tender masses. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 751-755.

Question 784: Ewing's sarcoma is a PNET (Primitive Neuroectodermal Tumor) that develops in the diaphysis of a long bone. A child with Ewing's sarcoma is on radiotherapy and chemotherapy. Which of the following is a poor prognostic factor in Ewing's sarcoma?

A. Age >15 years
B. Younger age
C. Large tumor size (>8cm) (Correct Answer)
D. Axial/pelvic location

Explanation: ***Large tumor size (>8cm)*** - Tumor size greater than 8 cm is **the most consistently validated and universally significant** independent poor prognostic factor across multiple large clinical trials and meta-analyses. - Large tumors are associated with **higher tumor burden**, **increased risk of micrometastatic disease**, and **reduced likelihood of complete surgical resection**. - The tumor size cutoff of 8-10 cm is used in **risk stratification protocols** (COG, EURO-EWING) to determine treatment intensity. - Studies show 5-year survival rates drop from ~70-75% for tumors <8cm to <50% for larger tumors. *Age >15 years* - Older age (>15-17 years) **is indeed a poor prognostic factor** in Ewing's sarcoma, with adolescents and young adults having worse outcomes than younger children. - However, age is often considered a **secondary prognostic factor** that is less consistently significant than tumor size when multivariate analysis is performed. - The prognostic impact of age may be partially related to larger tumor sizes at presentation in older patients and different tumor biology. *Younger age* - Younger age at diagnosis (particularly <10 years) is a **favorable prognostic factor**, associated with better treatment response and survival rates. - Children typically present with smaller tumors and show better tolerance to intensive multimodal therapy. *Axial/pelvic location* - Axial and pelvic locations **are established poor prognostic factors** due to difficulty in achieving wide surgical margins and higher risk of local recurrence [1]. - However, with modern multimodal therapy including high-dose chemotherapy and improved radiation techniques, the prognostic significance of tumor location has decreased somewhat compared to tumor size. - Tumor size remains the **dominant independent predictor** when both factors are present. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 671-674.

Question 785: Chimney sweeper's cancer is also known as

A. Carcinoma colon
B. Carcinoma penis
C. Carcinoma scrotum (Correct Answer)
D. Carcinoma lung

Explanation: ***Carcinoma scrotum*** - **Chimney Sweeper's cancer** is a historical term for **squamous cell carcinoma** of the scrotum, first described by Percivall Pott in 1775. - It was highly prevalent among chimney sweepers due to prolonged occupational exposure to **soot** (coal tar), which contains **polycyclic aromatic hydrocarbons (PAHs)**. *Carcinoma colon* - This cancer affects the **large intestine** and is linked to polyps, genetic factors, and lifestyle, not specifically soot exposure to external skin. - While PAHs can be ingested and metabolized, the direct association with "Chimney Sweeper's cancer" is specific to external skin carcinogenicity [1]. *Carcinoma penis* - This is a rare cancer associated with **HPV infection**, poor hygiene, and phimosis, primarily affecting the penile shaft or glans [2]. - It is not historically linked to occupational soot exposure in the way scrotal cancer is. *Carcinoma lung* - **Lung cancer** is strongly associated with **smoking** and exposure to airborne carcinogens like asbestos and radon, or general air pollution [1]. - While chimney sweepers might inhale soot, the term "Chimney Sweeper's cancer" specifically refers to the external **scrotal carcinoma** due to direct skin contact. **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. 217-218. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 975-976.

Question 786: Alpha-fetoprotein is a marker of

A. Yolk sac carcinoma (Correct Answer)
B. Choriocarcinoma
C. Embryonal carcinoma
D. Dysgerminoma

Explanation: ***Yolk sac carcinoma*** - **Alpha-fetoprotein (AFP)** is a **glycoprotein** normally produced by the fetal liver and yolk sac. - In adults, elevated AFP levels are a key tumor marker for **yolk sac tumors (endodermal sinus tumors)**, hepatocellular carcinoma, and some germ cell tumors [1]. *Choriocarcinoma* - **Choriocarcinoma** is primarily associated with elevated levels of **human chorionic gonadotropin (hCG)**, not AFP [2]. - hCG is a hormone produced by the placenta and is a marker for various germ cell tumors, especially those with syncytiotrophoblastic differentiation [3]. *Embryonal carcinoma* - **Embryonal carcinoma** can produce various tumor markers, including **hCG** and sometimes **AFP**, but it is generally less consistently associated with high AFP compared to yolk sac tumors [2]. - Its histological features are more primitive and undifferentiated than yolk sac carcinoma [1]. *Dysgerminoma* - **Dysgerminoma** is associated with elevated levels of **lactate dehydrogenase (LDH)** and, occasionally, mildly elevated hCG. - It is histologically analogous to seminoma in males and typically does not produce AFP [4]. **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. 979-980. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1035-1036. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 512-513. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1140-1141.

Question 787: Triphasic Cells seen in Wilm's tumour are

A. Stromal Cells, Epithelial Cells, Embryonal Cells
B. Mesenchymal Cells, Stromal Cells, Embryonal Cells
C. Epithelial Cells
D. Stromal Cells, Blastemal Cells, Epithelial Cells (Correct Answer)

Explanation: ***Stromal Cells, Blastemal Cells, Epithelial Cells*** - Wilms' tumor (nephroblastoma) is classically characterized by a **triphasic histology** representing arrested kidney development [2]. - The three components are **blastemal cells** (undifferentiated small round blue cells), **stromal cells** (spindle-shaped connective tissue), and **epithelial cells** (forming tubules or glomeruli) [2]. *Stromal Cells, Epithelial Cells, Embryonal Cells* - While stromal and epithelial cells are correct components, the term "embryonal cells" is too broad and less precise than **blastemal cells** for the primitive mesenchyme [2]. - **Blastemal cells** are specifically the undifferentiated primitive cells that give rise to the other components [1]. *Mesenchymal Cells, Stromal Cells, Embryonal Cells* - **Mesenchymal cells** are a type of stromal cell but are not one of the three distinct components. Instead, **blastemal cells** are a key feature [2]. - Again, "embryonal cells" is a less specific term than **blastemal cells** in this context. *Epithelial Cells* - While **epithelial cells** are one of the three components, Wilms' tumor is defined by a characteristic **triphasic** pattern, not exclusively by epithelial cells [2]. - This option misses the critical blastemal and stromal components. **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] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 488-490.

Question 788: Skeletal metastasis is common in:

A. Hepatoma
B. Cancer stomach
C. Cancer pancreas
D. Cancer breast (Correct Answer)

Explanation: ***Cancer breast*** - **Breast cancer** is one of the most common primary malignancies that metastasize to bones (part of the classic **"osteophilic pentad"**: breast, prostate, lung, kidney, and thyroid) [1]. - Preferentially metastasizes to **axial skeleton** including the **spine**, **pelvis**, and **ribs**. - Bone metastases from breast cancer can be **osteolytic**, **osteoblastic**, or mixed, often causing pain and **pathological fractures**. - Approximately **70% of patients with advanced breast cancer** develop bone metastases. *Hepatoma* - **Hepatocellular carcinoma (HCC)**, or hepatoma, commonly metastasizes to the **lungs** and regional lymph nodes via hematogenous spread [2]. - While bone metastases can occur, they are **uncommon** (occurs in <5% of cases), much less frequent than with breast, prostate, or lung cancers [1]. - Bone involvement often indicates advanced disease. *Cancer stomach* - **Gastric cancer** primarily metastasizes to nearby **lymph nodes**, the **liver**, and the **peritoneum** (Krukenberg tumor to ovaries, Sister Mary Joseph nodule). - Bone metastases from gastric cancer are **relatively rare**, occurring in less than 10-15% of cases, and represent a poor prognostic sign. - Not among the common cancers with bone tropism [1]. *Cancer pancreas* - **Pancreatic cancer** frequently metastasizes to the **liver** (most common), **peritoneum**, and **lungs**. - Bone metastases are **uncommon** in pancreatic cancer (<5% of cases), typically indicating widespread disease and a very poor prognosis. - Not part of the osteophilic group of cancers [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 671-672. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, p. 282.

Question 789: Which of the following is true about bone metastasis?

A. Most common secondary tumor in females is from breast (Correct Answer)
B. Higher serum levels of alkaline phosphatase
C. Bone metastases are often symptomatic
D. Prostate cancer produces only lytic lesions

Explanation: ***Most common secondary tumor in females is from breast*** - **Breast cancer** is the most common cause of skeletal metastases in women, frequently affecting the **axial skeleton** (spine, pelvis, ribs) [1]. - These metastases can be **osteolytic**, **osteoblastic**, or mixed, often leading to bone pain and pathological fractures. *Higher serum levels of alkaline phosphatase* - While **elevated alkaline phosphatase** can be seen in bone metastasis due to increased osteoblastic activity [2], it is not universally true for *all* bone metastases. - Many bone metastases, especially purely **lytic lesions**, may not significantly elevate alkaline phosphatase; instead, they might raise calcium levels. *Bone metastases are often symptomatic* - Bone metastases can be **asymptomatic** for extended periods, especially early in their development [2], only becoming symptomatic when significant bone destruction or nerve compression occurs [1]. - While pain is the most common symptom, **pathological fractures** and **spinal cord compression** can also be initial presentations [2]. *Prostate cancer produces only lytic lesions* - **Prostate cancer** characteristically produces **osteoblastic (bone-forming) metastases**, which appear as sclerotic lesions on imaging [2],[3]. - While rarely some lytic components can be present, the predominant feature is increased bone density. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 671-672. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 501-502. [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. 993-994.

Question 790: What is the average time interval between radiation exposure and genesis of post-radiation osteosarcoma?

A. 16 yrs (Correct Answer)
B. 4 yrs
C. 8 yrs
D. 2 yrs

Explanation: ***16 yrs*** - The latency period for **radiation-induced osteosarcomas** is typically long, often exceeding a decade. - Studies have shown the average interval between therapeutic radiation and the development of osteosarcoma to be around **10-20 years**, with 16 years being a well-supported average. *4 yrs* - A 4-year interval is generally too short for the development of a **secondary osteosarcoma** after radiation exposure. - While other radiation-induced pathologies might manifest earlier, the transformation to osteosarcoma requires a sustained period of genetic damage and cellular changes. *8 yrs* - An 8-year latency period is still relatively short for most radiation-induced osteosarcomas to develop. - While some cases might occur within this timeframe, the average and modal latency periods are typically longer, reflecting the multi-step process of **carcinogenesis**. *2 yrs* - A 2-year interval is exceptionally rare for the development of a **radiation-induced osteosarcoma**. - This short period does not align with the known biological mechanisms and latency associated with radiation-induced bone malignancies.

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Neoplasia — MCQs

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