Neoplasia Practice Questions

Q: The incidence of bilaterality in a dermoid cyst is approximately

10%. ***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.

Q: All are true for pleomorphic adenoma except:

Always remains benign. ***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.

Q: 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?

Lymph gland spread is often encountered.. ***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.

Q: Rokitansky protuberances are seen in -

Teratoma. ***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.

Q: “Field carcinogenesis” is seen in

Head and neck carcinoma. ### 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.

Q: True about recurrent respiratory papillomatosis (multiple papillomatosis) -

HPV is causative agent. ***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.

Q: 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?

Colloid carcinoma of breast. ***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.

Question 1

What is an example of radiation-induced cancer?

Accepted Answer

Papillary carcinoma of thyroid

Answer

Hepatoma

Answer

Lymphoma

Answer

Follicular carcinoma of thyroid

Question 2

Knudson two-hit hypothesis is classically exemplified by

Accepted Answer

Retinoblastoma

Answer

Crohn disease

Answer

Ulcerative colitis

Answer

Melanoma

Question 3

The incidence of bilaterality in a dermoid cyst is approximately

Accepted Answer

10%

Answer

70%

Answer

30%

Answer

50%

Question 4

All are true for pleomorphic adenoma except:

Accepted Answer

Always remains benign

Answer

May turn into malignant

Answer

Minor salivary gland can be affected

Answer

Arises from parotid

Question 5

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?

Accepted Answer

Lymph gland spread is often encountered.

Answer

There is an excellent prognosis.

Answer

The tissue is well differentiated.

Answer

Lymphoid tissue is absent.

Question 6

Rokitansky protuberances are seen in -

Accepted Answer

Teratoma

Answer

Papillary carcinoma

Answer

Epidermoid cyst

Answer

Mucinous carcinoma

Question 7

“Field carcinogenesis” is seen in

Accepted Answer

Head and neck carcinoma

Answer

Breast carcinoma

Answer

Colon carcinoma

Answer

Brain tumour

Question 8

True about recurrent respiratory papillomatosis (multiple papillomatosis) -

Accepted Answer

HPV is causative agent

Answer

It is premalignant

Answer

Surgical excision is treatment of choice

Answer

It can occur at any age

Question 9

Absence of differentiation is known as:-

Accepted Answer

Anaplasia

Answer

Dysplasia

Answer

Metaplasia

Answer

Hyperplasia

Question 10

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?

Accepted Answer

Colloid carcinoma of breast

Answer

Tubular carcinoma of breast

Answer

Medullary carcinoma of breast

Answer

Papillary carcinoma of breast

Neoplasia — MCQs

Neoplasia — MCQs

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