Neoplasia — MCQs

Neoplasia Indian Medical PG Practice Questions and MCQs

Question 791: What is an example of radiation-induced cancer?

A. Hepatoma
B. Lymphoma
C. Follicular carcinoma of thyroid
D. Papillary carcinoma of thyroid (Correct Answer)

Explanation: ***Papillary carcinoma of thyroid*** - This is the most common form of thyroid cancer, and its incidence is significantly **increased following radiation exposure to the head and neck**, especially in childhood [1], [2]. - **Ionizing radiation** induces DNA damage, leading to genetic rearrangements and mutations that predispose to papillary carcinoma [1].*Hepatoma* - **Hepatoma (Hepatocellular carcinoma)** is primarily associated with **chronic viral hepatitis (Hepatitis B and C)** and **cirrhosis**, not typically radiation exposure. - While therapeutic radiation can cause liver injury, a direct link between external beam radiation and hepatoma in humans is not well-established.*Lymphoma* - **Lymphomas** are cancers of the lymphatic system, with various risk factors including **immunodeficiency**, certain **viral infections (e.g., EBV, HTLV-1)**, and **chemical exposures**. - Although high-dose radiation can suppress the immune system and secondary lymphomas can occur after radiation for other cancers, lymphoma is not a direct, classical radiation-induced cancer in the same way as papillary thyroid carcinoma.*Follicular carcinoma of thyroid* - While radiation exposure can increase the risk of all types of thyroid cancer, **papillary carcinoma** shows a much stronger and more direct association with radiation, particularly in younger populations [1], [2]. - Follicular carcinoma is less strongly linked to radiation, often associated with **iodine deficiency** and specific genetic mutations that are not primarily radiation-induced [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1098-1099. [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. 216-217.

Question 792: Knudson two-hit hypothesis is classically exemplified by

A. Crohn disease
B. Ulcerative colitis
C. Retinoblastoma (Correct Answer)
D. Melanoma

Explanation: ***Retinoblastoma*** - The **Knudson two-hit hypothesis** was **originally formulated** based on studies of **retinoblastoma** by Alfred Knudson in 1971 [1]. - It posits that **two separate mutational events** are required to inactivate **both alleles** of the **Rb tumor suppressor gene** in the same cell, leading to tumor formation [1], [2]. - This explains both **hereditary** (germline mutation + somatic mutation) and **sporadic** (two somatic mutations) forms of retinoblastoma [1], [2]. - Retinoblastoma remains the **paradigmatic example** of this hypothesis and tumor suppressor gene inactivation [2]. *Crohn disease* - This is an **inflammatory bowel disease**, not a neoplasm, with complex etiology involving genetic susceptibility, environmental factors, and immune dysregulation. - Its pathogenesis does **not follow the Knudson two-hit hypothesis**, which specifically relates to tumor suppressor gene inactivation in cancer. *Ulcerative colitis* - Similar to Crohn disease, **ulcerative colitis** is an **inflammatory bowel disease** with multifactorial etiology, not a neoplastic condition. - While chronic UC can increase colorectal cancer risk through accumulated mutations, the disease itself does **not represent the two-hit hypothesis model**. *Melanoma* - **Melanoma** is a skin cancer often linked to **UV radiation** and mutations in oncogenes like **BRAF** and tumor suppressors like **PTEN** and **CDKN2A**. [3] - While some familial melanomas involve tumor suppressor genes, melanoma is **not the classic example** used to illustrate the Knudson hypothesis—**retinoblastoma holds that distinction**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, p. 300. [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. 227-228. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 297-298.

Question 793: The incidence of bilaterality in a dermoid cyst is approximately

A. 70%
B. 30%
C. 10% (Correct Answer)
D. 50%

Explanation: ***Correct: 10%*** - **Dermoid cysts** (mature cystic teratomas) are the most common ovarian germ cell tumors, accounting for up to 40% of all ovarian neoplasms [1, 2]. - While predominantly **unilateral**, approximately **10-15% of cases** demonstrate bilateral involvement, affecting both ovaries [1]. - This relatively low incidence of bilaterality is an important clinical feature that distinguishes dermoid cysts from some other ovarian pathologies. - The term "dermoid" refers to the presence of mature ectodermal tissues (skin, hair, teeth), though these teratomas may contain all three germ layers [1, 2]. *Incorrect: 70%* - This percentage is far higher than the actual incidence of bilaterality for dermoid cysts. - A 70% bilateral rate would suggest that most cases are symmetric, which is not characteristic of mature cystic teratomas. - No reputable source supports such a high bilateral incidence for this condition. *Incorrect: 30%* - This percentage significantly overestimates the bilateral involvement of dermoid cysts. - While some variation exists in reported figures, 30% exceeds the accepted range of 10-15%. - This would imply nearly one-third of cases are bilateral, which is not clinically observed. *Incorrect: 50%* - A 50% incidence would incorrectly suggest that bilateral presentation is as common as unilateral presentation. - This contradicts established pathology literature and clinical experience. - Such a high rate of bilaterality is not characteristic of dermoid cysts. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1033-1034. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 480-481.

Question 794: All are true for pleomorphic adenoma except:

A. May turn into malignant
B. Minor salivary gland can be affected
C. Arises from parotid
D. Always remains benign (Correct Answer)

Explanation: ***Always remains benign*** - This statement is incorrect because **pleomorphic adenomas** have a recognized potential for **malignant transformation** into carcinoma ex pleomorphic adenoma. [1] - The risk of malignancy increases with the duration of the tumor and its size. [1] *May turn into malignant* - This is true; **pleomorphic adenomas** can undergo malignant transformation, leading to a more aggressive tumor known as **carcinoma ex pleomorphic adenoma**. [1] - The rate of malignant transformation is generally low but is a significant concern in the long-term management of these tumors. [1] *Minor salivary gland can be affected* - This is true; while often found in the parotid gland, **pleomorphic adenomas** can also arise in **minor salivary glands**, particularly those in the palate. - Tumors in minor salivary glands tend to have a higher malignant transformation rate and can present as asymptomatic masses. *Arises from parotid* - This is true; the **parotid gland** is the most common site for **pleomorphic adenomas**, accounting for approximately 80% of all cases. [1] - They typically present as a slow-growing, painless mass in the parotid region. [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 795: A 59-year-old woman has discomfort in the posterior part of her tongue. A biopsy confirms that the lesion is a carcinoma. What is true in carcinoma of the posterior third of the tongue?

A. Lymph gland spread is often encountered. (Correct Answer)
B. There is an excellent prognosis.
C. The tissue is well differentiated.
D. Lymphoid tissue is absent.

Explanation: ***Lymph gland spread is often encountered.*** - Carcinomas of the posterior third of the tongue (base of tongue) are typically aggressive and have a rich **lymphatic drainage** network, making early metastasis to **cervical lymph nodes** common. - This high rate of **lymphatic spread** significantly impacts prognosis and treatment planning. *There is an excellent prognosis.* - Carcinomas of the posterior third of the tongue generally have a **poor prognosis** due to their late presentation, aggressive nature, and high likelihood of regional lymph node metastasis. - The inaccessibility of the tumor often leads to diagnosis at an advanced stage, limiting treatment success compared to anterior tongue or lip cancers. *The tissue is well differentiated.* - Carcinomas of the posterior tongue are often **poorly differentiated** or undifferentiated, which correlates with more aggressive behavior and a higher potential for metastasis. - While some may be moderately differentiated, well-differentiated tumors are less common and usually associated with a better prognosis and less aggressive spread. *Lymphoid tissue is absent.* - The posterior third of the tongue, particularly the base of the tongue, is rich in **lymphoid tissue**, forming part of **Waldeyer's ring** (lingual tonsils) [1]. - This abundance of lymphoid tissue is a critical anatomical feature that facilitates lymphatic drainage and potentially contributes to early lymphatic spread in carcinomas of this region. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 744-745.

Question 796: Rokitansky protuberances are seen in -

A. Papillary carcinoma
B. Epidermoid cyst
C. Teratoma (Correct Answer)
D. Mucinous carcinoma

Explanation: ***Teratoma*** - **Rokitansky protuberance** (mural nodule or dermoid plug) is a raised solid area found within a **mature cystic teratoma**, particularly in the ovary [1]. - It often contains various tissues derived from the three germ layers such as **hair**, **sebaceous glands**, bone, and teeth [3]. *Papillary carcinoma* - Characterized by **papillary projections** formed by tumor cells, often seen in thyroid, kidney, or ovary. - While it can have protuberances, these are **composed of malignant cells** and lack the diverse tissue components of a Rokitansky protuberance. *Epidermoid cyst* - A benign cyst lined by **stratified squamous epithelium** and filled with keratin debris, typically located in the skin or skull. - These cysts do not form internal protuberances with heterogeneous tissue types like those seen in teratomas. *Mucinous carcinoma* - A malignant tumor characterized by the production of **mucin**, often affecting the ovary, colon, or breast [2]. - Lesions are typically filled with mucinous material or present as mucinous masses, and do not contain the specific solid Rokitansky protuberance. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, p. 1034. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1033-1034. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 480-481.

Question 797: “Field carcinogenesis” is seen in

A. Breast carcinoma
B. Colon carcinoma
C. Head and neck carcinoma (Correct Answer)
D. Brain tumour

Explanation: ### Head and neck carcinoma - **Field carcinogenesis (field cancerization)** is the classic example where chronic exposure to carcinogens (**tobacco, alcohol**) affects an entire mucosal field, leading to widespread epithelial changes [1]. - This results in **multiple independent primary tumors** or increased risk of recurrence after treatment. - First described by Slaughter et al. (1953) in oral cavity squamous cell carcinoma. - The entire aerodigestive tract epithelium is at risk due to continuous carcinogen exposure [1]. *Breast carcinoma* - Can be **multicentric** (multiple foci in same breast) or **bilateral**, but this is not field carcinogenesis. - Multiple tumors arise from **genetic predisposition** (e.g., BRCA mutations) rather than a field of carcinogen-exposed epithelium. *Colon carcinoma* - Multiple polyps/carcinomas can occur in **FAP** or **inflammatory bowel disease**, but this is termed a **"field defect"** based on genetic/inflammatory mechanisms. - Not the prototypical example of field carcinogenesis from chronic carcinogen exposure. *Brain tumour* - Arises from **glial cells or neurons** (non-epithelial), not susceptible to field carcinogenesis. - Multifocality typically reflects **incomplete resection** or spread of a single tumor, not independent primaries in a carcinogen-exposed field. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 720-721.

Question 798: True about recurrent respiratory papillomatosis (multiple papillomatosis) -

A. HPV is causative agent (Correct Answer)
B. It is premalignant
C. Surgical excision is treatment of choice
D. It can occur at any age

Explanation: ***HPV is causative agent*** - **Human papillomavirus (HPV)** is the primary etiologic agent for recurrent respiratory papillomatosis (RRP), also known as laryngeal papillomatosis. - HPV types **6** and **11** are most commonly associated with RRP (>90% of cases), leading to benign, wart-like growths in the respiratory tract. - This is the most fundamental and defining characteristic of RRP. *It is premalignant* - RRP is a **benign** condition, not a premalignant lesion. - Malignant transformation is extremely rare (<1%), typically associated with HPV types **16** and **18**, radiation exposure, or chronic inflammation [1]. - The vast majority of cases remain benign throughout, so classifying RRP as "premalignant" is incorrect. *Surgical excision is treatment of choice* - While **surgical excision** (laser surgery, microdebrider) is indeed the primary/mainstay treatment for RRP to debulk lesions and maintain airway patency, this statement is technically true. - However, in the context of identifying the "most characteristic" feature, HPV etiology is more fundamental than treatment modality. - Adjuvant therapies like **bevacizumab**, **cidofovir**, or **interferon** may be used for recurrent cases but are not first-line. *It can occur at any age* - This is technically true - RRP exhibits a **bimodal age distribution** with juvenile-onset RRP (JORRP, peak before age 5) and adult-onset RRP (AORRP, peak 20-40 years). - However, the bimodal pattern means it has specific age predilections rather than uniform distribution across all ages. - HPV etiology remains the more definitive characteristic. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 746-747.

Question 799: Absence of differentiation is known as:-

A. Dysplasia
B. Anaplasia (Correct Answer)
C. Metaplasia
D. Hyperplasia

Explanation: ***Anaplasia*** - **Anaplasia** refers to the **lack of differentiation** in cells, meaning they lose the morphological and functional characteristics of mature cells [1]. - It is a hallmark of **malignancy** and often associated with aggressive tumors. - Key features include pleomorphism, abnormal nuclear morphology, increased mitotic activity, and loss of polarity [2]. *Dysplasia* - **Dysplasia** involves **disordered growth** and maturation of cells, often characterized by pleomorphism, loss of polarity, and increased mitotic figures. - While it can be a precursor to cancer, it represents an **abnormal development** rather than a complete absence of differentiation [3]. - Dysplastic cells retain some degree of differentiation but show architectural and cytological abnormalities. *Metaplasia* - **Metaplasia** is the **reversible change** of one adult differentiated cell type to another adult differentiated cell type [3]. - This adaptation usually occurs in response to chronic irritation or stress, for example, columnar to squamous epithelium in the respiratory tract of smokers. - Both cell types involved are fully differentiated, just different types. *Hyperplasia* - **Hyperplasia** is an **increase in the number of cells** in an organ or tissue, leading to increased volume [4]. - This is an adaptive response to stimuli, such as hormonal stimulation (e.g., endometrial hyperplasia) or increased functional demand. - The cells remain well-differentiated and maintain normal architecture. **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. 278. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 278-280. [4] 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. 85-87.

Question 800: A middle-aged female presented with a 4cm mass in the upper outer quadrant of the breast. Biopsy showed densely packed cells within large extracellular spaces. Which of the following is the most likely diagnosis of this patient?

A. Tubular carcinoma of breast
B. Medullary carcinoma of breast
C. Colloid carcinoma of breast (Correct Answer)
D. Papillary carcinoma of breast

Explanation: ***Colloid carcinoma of breast*** - This type of carcinoma is characterized by **malignant cells floating in abundant extracellular mucin (colloid)**, which aligns with the description "densely packed cells within large extracellular spaces." - It often presents as a **well-circumscribed mass** and has a generally **good prognosis**. *Tubular carcinoma of breast* - Characterized by **well-differentiated tubules** with open lumens and a single layer of epithelial cells. - It does not typically feature large extracellular spaces filled with mucin. *Medullary carcinoma of breast* - This typically presents as a **soft, fleshy tumor** with syncytial sheets of large anaplastic cells and a prominent lymphoid infiltrate [1]. - It does not involve significant extracellular mucin or large extracellular spaces. *Papillary carcinoma of breast* - This carcinoma is defined by **papillary growth patterns** with fibrovascular cores lined by epithelial cells. - While it can be associated with cystic spaces, these are not typically described as "large extracellular spaces" filled with mucinous material. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 455-456.

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Neoplasia — MCQs

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