Neoplasia — MCQs

Neoplasia Indian Medical PG Practice Questions and MCQs

Question 821: A biopsy shows tumor cells with an increased nuclear-to-cytoplasmic ratio, individual cell keratinization, and intercellular bridges. What is this characteristic of?

A. Lymphoma
B. Basal cell carcinoma
C. Melanoma
D. Squamous cell carcinoma (Correct Answer)

Explanation: ***Squamous cell carcinoma*** - **Increased nuclear-to-cytoplasmic ratio**, **individual cell keratinization (dyskeratosis)**, and **intercellular bridges** are pathognomonic histological features of squamous cell carcinoma [1]. - These findings indicate **squamous differentiation** with cellular atypia and loss of normal maturation, characteristic of this malignancy [2]. - Keratin pearl formation may also be present in well-differentiated tumors [1]. *Lymphoma* - Lymphoma typically presents with a proliferation of **monomorphic lymphoid cells**, often forming diffuse sheets or nodules. - While it can show an increased nuclear-to-cytoplasmic ratio, it lacks squamous differentiation features like keratinization and intercellular bridges. *Basal cell carcinoma* - Characterized by nests of **basaloid cells** with **peripheral palisading** and retraction artifact [3]. - It arises from the basal layer of the epidermis and does **not show squamous differentiation** such as keratinization or intercellular bridges [3]. *Melanoma* - Melanoma cells are typically large with prominent nuclei and nucleoli, often containing abundant cytoplasm and **melanin pigmentation**. - It represents a proliferation of melanocytes and does not exhibit squamous features like keratinization or intercellular bridges. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Disorders Involving Inflammatory And Haemopoietic Cells, pp. 643-645. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 723. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Disorders Involving Inflammatory And Haemopoietic Cells, pp. 643-644.

Question 822: A lacrimal gland mass is biopsied, revealing a slow-growing, well-circumscribed tumor. What is the most likely diagnosis?

A. Adenoid cystic carcinoma
B. Pleomorphic adenoma (Correct Answer)
C. Warthin’s tumor
D. Mucoepidermoid carcinoma

Explanation: ***Pleomorphic adenoma*** - This is the most common **benign epithelial tumor of the lacrimal gland**, often presenting as a slow-growing, **well-circumscribed mass** [1]. - Histologically, it's characterized by a mixture of **epithelial and mesenchymal components**, including ductal structures, myoepithelial cells, and various stromal elements [1]. *Adenoid cystic carcinoma* - This is a common malignant lacrimal gland tumor known for its aggressive nature, often with **perineural invasion** and a poor prognosis. - It typically presents with more rapid growth, **pain**, and can cause bony erosion, features not described here. *Warthin’s tumor* - Also known as **papillary cystadenoma lymphomatosum**, this is almost exclusively found in the **parotid gland**, not the lacrimal gland [1]. - It has characteristic histological features of **papillary cystic structures** lined by oncocytes and surrounded by lymphoid stroma. *Mucoepidermoid carcinoma* - While it can occur in salivary glands, it is a very **rare tumor** of the lacrimal gland. - It is characterized by a mixture of **mucus-secreting cells, epidermoid cells**, and intermediate cells, and is typically a malignant, not slow-growing, mass. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 751-753.

Question 823: A 55-year-old female presents with a rapidly enlarging neck mass and stridor. Fine needle aspiration reveals anaplastic cells. What is the most likely diagnosis?

A. Papillary thyroid carcinoma
B. Follicular thyroid carcinoma
C. Medullary thyroid carcinoma
D. Anaplastic thyroid carcinoma (Correct Answer)

Explanation: ***Anaplastic thyroid carcinoma*** - The rapid enlargement of the neck mass, presence of **stridor** (suggesting airway compression), and **anaplastic cells** on FNA are highly indicative of this aggressive thyroid malignancy [1]. - Anaplastic thyroid carcinoma is characterized by its very **poor prognosis** and rapid growth, often presenting with compressive symptoms [1], [2].*Papillary thyroid carcinoma* - This is the **most common type** but usually grows **slowly** and has an excellent prognosis, which does not fit the rapid enlargement and stridor [2]. - Histologically, it is characterized by **orphan Annie eye nuclei**, nuclear grooves, and intranuclear inclusions, not anaplastic cells [3].*Follicular thyroid carcinoma* - Typically presents as a **slow-growing mass** and is characterized by **vascular** or **capsular invasion**, which cannot be definitively diagnosed by FNA alone [2]. - It usually does not present with rapid growth and airway compromise like anaplastic carcinoma.*Medullary thyroid carcinoma* - Arises from **parafollicular C cells** and often produces **calcitonin**, but it usually has a more indolent course compared to anaplastic thyroid cancer [2]. - While it can be aggressive, the term "anaplastic cells" on FNA points specifically to the undifferentiated nature of anaplastic thyroid carcinoma [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1101-1102. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 429-430. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, p. 1099.

Question 824: A 50-year-old man presents with a painless, slow-growing mass in the parotid gland. Histology reveals a benign tumor with a mixture of epithelial and myoepithelial cells within a chondromyxoid stroma. What is the most likely diagnosis?

A. Pleomorphic adenoma (Correct Answer)
B. Warthin tumor
C. Mucoepidermoid carcinoma
D. Adenoid cystic carcinoma

Explanation: ***Pleomorphic adenoma*** - The tumor is characterized by a **benign mixture of epithelial and myoepithelial cells**, typical of pleomorphic adenoma, often referred to as a **benign mixed tumor** [3]. - The presence of a **chondromyxoid stroma** supports this diagnosis, as this tissue type is a hallmark of pleomorphic adenomas [3]. - These tumors present as **painless, slow-growing, mobile, discrete masses within the parotid** or submandibular areas [1]. *Mucoepidermoid carcinoma* - It usually presents as **malignant** with **mucoid and epidermoid components**, differing from the benign nature of the tumor in this case [2]. - Histology typically shows **variability in cell types** and is not characterized by the chondromyxoid stroma seen here. *Adenoid cystic carcinoma* - This is a **malignant tumor** often seen in salivary glands, characterized by **cylindrical and cribriform patterns**, not aligning with the benign findings here [2]. - It usually presents with **painful** masses and has a much more aggressive clinical course than pleomorphic adenoma. *Warthin tumor* - This tumor is most commonly associated with **lymphoid tissue** and is often seen in smokers, presenting with a **cystic and papillary architecture** rather than the chondromyxoid stroma. - It does not typically have the **epithelial and myoepithelial cell components** noted in the histology of pleomorphic adenoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 751-753. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 753-755. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 274-276.

Question 825: A 40-year-old man presents with a palpable breast mass. What is the most common type of breast cancer in men?

A. Intraductal papilloma
B. Lobular carcinoma
C. Invasive ductal carcinoma (Correct Answer)
D. Fibroadenoma

Explanation: ***Invasive ductal carcinoma*** - This is the **most common type of breast cancer** in men, accounting for the vast majority of male breast cancers. - It arises from the **lining of the milk ducts** and is characterized by its ability to invade surrounding breast tissue. *Intraductal papilloma* - While it can occur in men, it is a **benign (non-cancerous) tumor** of the milk ducts. - It usually presents with **nipple discharge**, which is often bloody, rather than a palpable mass as the primary concern. *Lobular carcinoma* - This type of breast cancer originates in the **milk-producing lobules of the breast**. - **Lobules are typically undeveloped in men**, making lobular carcinoma an extremely rare diagnosis in males. *Fibroadenoma* - Fibroadenomas are **benign tumors** composed of both glandular and stromal tissue. - They are very common in women, especially younger women, but are **exceptionally rare in men** due to the undeveloped nature of male breast glandular tissue.

Question 826: A 60-year-old male patient presents with abdominal pain and changes in bowel habits. Colonoscopy reveals a flat, erythematous lesion. Which colorectal precursor lesion is commonly associated with microsatellite instability?

A. Sessile serrated adenoma (Correct Answer)
B. Tubular adenoma
C. Villous adenoma
D. Hyperplastic polyp

Explanation: ***Sessile serrated adenoma*** - **Sessile serrated adenomas (SSAs)** are often found in the right colon and are characterized by a **microsatellite instability (MSI)** pathway, leading to colorectal cancer. - They progress via the **serrated pathway** involving CpG island methylator phenotype (CIMP) and often harbor **BRAF mutations**, resulting in **MSI-high** cancers. - Their flat, erythematous appearance on colonoscopy can be subtle, making them challenging to detect, but they are significant precursors to MSI-high cancers. *Tubular adenoma* - **Tubular adenomas** are the most common type of sporadic colorectal polyp, typically progressing to cancer via the **adenoma-carcinoma sequence** (chromosomal instability pathway). - They follow the traditional pathway involving **APC, KRAS, and p53 mutations**, not the **microsatellite instability (MSI)** pathway. *Villous adenoma* - **Villous adenomas** are characterized by their velvety or frond-like appearance and a higher risk of malignant transformation compared to tubular adenomas. - They mainly progress through the traditional **adenoma-carcinoma sequence** with **chromosomal instability (CIN)**, not **microsatellite instability (MSI)**. *Hyperplastic polyp* - **Hyperplastic polyps** are generally considered benign and have a very low malignant potential, especially small ones found in the distal colon. - While large or proximal hyperplastic polyps may rarely be associated with the **serrated pathway**, they lack the dysplastic features of sessile serrated adenomas and are not primarily linked to **MSI-high** cancers.

Question 827: A 30-year-old woman presents with a painless breast mass. A biopsy reveals tumor cells infiltrating the stroma in a single-file pattern. What is the most likely diagnosis?

A. Invasive ductal carcinoma
B. Invasive lobular carcinoma (Correct Answer)
C. Ductal carcinoma in situ
D. Fibroadenoma

Explanation: ***Invasive lobular carcinoma*** - Invasive lobular carcinoma is characterized by **ductal cells infiltrating the stroma in a single-file pattern** [1], which aligns with the biopsy findings. - This type of carcinoma often presents as a **painless breast mass** and may be bilateral; it has distinct growth patterns compared to ductal carcinomas [1]. *Fibroadenoma* - Fibroadenomas typically present as **well-circumscribed, painless masses** that are mobile, not infiltrative. - They do not show the **single-file pattern** of infiltration but rather a more solid or encapsulated growth on histology. *Ductal carcinoma in situ* - Ductal carcinoma in situ (DCIS) is restricted to the ducts and would not demonstrate the **invasive pattern** seen in the biopsy. - It often presents with calcifications on imaging rather than a palpable mass, and is not infiltrating the stroma. *Invasive ductal carcinoma* - Invasive ductal carcinoma usually presents with **irregular masses** and may have varied cellular morphology, but does not specifically infiltrate in the **single-file pattern** characteristic of lobular carcinoma [1]. - The presence of a **painless mass with specific infiltration patterns** suggests a different diagnosis than the typical presentation of invasive ductal carcinoma. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 454-455.

Question 828: A 34-year-old woman presents with a palpable breast lump. Core needle biopsy is performed. Which of the following findings in the biopsy is most concerning regarding malignant potential?

A. Fibroadenoma
B. Ductal hyperplasia
C. Atypical hyperplasia (Correct Answer)
D. Fat necrosis

Explanation: ***Atypical hyperplasia*** - **Atypical hyperplasia** signifies abnormal cellular proliferation with some, but not all, features of carcinoma in situ, representing a **premalignant lesion** with a significantly increased risk of developing invasive breast cancer [1]. [2] - While not cancer itself, it is a **marker of increased risk** in both breasts and warrants close surveillance and often prophylactic measures. *Fibroadenoma* - **Fibroadenomas** are common **benign breast tumors** composed of both glandular and stromal tissue, typically presenting as mobile, rubbery masses [4]. - They do not inherently increase the risk of breast cancer unless associated with **complex features** or atypical hyperplasia within the fibroadenoma [4]. *Ductal hyperplasia* - **Ductal hyperplasia** (or usual ductal hyperplasia) is a benign condition characterized by an increase in the number of epithelial cells lining the breast ducts [3]. - It confers only a **mildly increased risk** of subsequent breast cancer, which is significantly lower than that associated with atypical hyperplasia [2]. *Fat necrosis* - **Fat necrosis** occurs when breast fat cells are damaged, often due to trauma, surgery, or radiation, leading to inflammation and scar tissue formation. - It is a **benign condition** and does not increase the risk of breast cancer. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1054-1056. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1052. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 446-447. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 448-449.

Question 829: In a 60-year-old female with a smoking history presenting with chronic cough, hemoptysis, and weight loss, how can immunohistochemical markers be used to differentiate between squamous cell carcinoma and small cell lung cancer?

A. Chromogranin and synaptophysin (Correct Answer)
B. TTF-1 and Napsin A
C. CD56 and CK7
D. PD-L1 and EGFR

Explanation: ***Chromogranin and synaptophysin*** - Both **Chromogranin** and **synaptophysin** are **neuroendocrine markers** that are typically positive in small cell lung cancer (SCLC) [1]. - These markers help differentiate SCLC from squamous cell carcinoma, which generally does not express these neuroendocrine markers. *CD56 and CK7* - **CD56** is a neuroendocrine marker present in many tumors, including SCLC, but is not specific for diagnosis. - **CK7** is expressed in various lung cancers but is also found in non-lung tumors, making it insufficient for differentiation between SCLC and squamous cell carcinoma. *PD-L1 and EGFR* - **PD-L1** is associated with immune checkpoint inhibition but does not distinguish between squamous cell carcinoma and small cell lung cancer. - **EGFR** mutations are relatively more common in adenocarcinomas rather than squamous cell carcinoma or SCLC, limiting its utility in this context. *TTF-1 and Napsin A* - **TTF-1** is typically positive in adenocarcinoma and SCLC but not specifically in squamous cell carcinoma. - **Napsin A** is also primarily a marker for adenocarcinoma, thus not helpful for differentiating between SCLC and squamous cell carcinoma. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 337-338.

Question 830: A 5-year-old child presents with a large abdominal mass and hypertension. Histology reveals small round blue cells and Homer-Wright rosettes. What is the most likely diagnosis?

A. Neuroblastoma (Correct Answer)
B. Wilms tumor
C. Rhabdomyosarcoma
D. Hepatoblastoma

Explanation: ***Neuroblastoma*** - The presence of **small round blue cells** and **Homer-Wright rosettes** on histology is characteristic of neuroblastoma [2], which often presents with an abdominal mass in children [1]. - Commonly associated with **hypertension** [3] and typically found in the **adrenal glands** or sympathetic ganglia [1,4]. *Hepatoblastoma* - Generally shows **different histological features**, primarily consisting of **primitive epithelial cells** rather than small blue cells or rosettes. - Associated with **elevated alpha-fetoprotein** (AFP), which is not indicated in this case. *Wilms tumor* - Generally presents with a **palpable abdominal mass** but lacks the specific **Homer-Wright rosettes** associated with neuroblastoma. - Histologically, involves **blastema, epithelium, and stroma**, distinct from the findings here. *Rhabdomyosarcoma* - Primarily arises in **soft tissues** and is characterized by **rhabdomyoblasts**; the **histology** does not show Homer-Wright rosettes. - More common in the head and neck region than the abdomen, diverging from this clinical scenario. **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] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 484-485. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, p. 486. [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. 211-212.

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Neoplasia — MCQs

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