Neoplasia Practice Questions

Q: A biopsy from a breast lump shows small, uniform cells that are estrogen receptor positive. This finding is most consistent with which type of breast cancer?

Lobular carcinoma. ***Lobular carcinoma*** - Characterized by **small, uniform cells** that are often estrogen receptor positive, aligning with the biopsy findings [1]. - Typically, **invasive lobular carcinoma** may present with subtle features and often leads to bilateral involvement. *Triple-negative breast cancer* - Defined by the absence of **estrogen receptors**, **progesterone receptors**, and **HER2/neu**, which contradicts the positive estrogen receptor finding. - Often associated with **high histological grade** and a more aggressive behavior compared to other types. *Ductal carcinoma in situ* - Although it can show **positive estrogen receptors**, it is primarily characterized by **ductal involvement** without invasion into surrounding tissue. - Typically presents with **calcifications** on mammography rather than the solid tumor appearance noted in this biopsy. *Inflammatory breast cancer* - Features **cutaneous changes** and **lymphedema** rather than small, uniform cells; it causes a more aggressive and diffuse breast distortion. - Rarely presents with estrogen receptor positivity, particularly when compared to lobular carcinoma's characteristics. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1068-1069.

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

Pleomorphic adenoma. ***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.

Q: 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?

Anaplastic thyroid carcinoma. ***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.

Q: 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?

Pleomorphic adenoma. ***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.

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

Invasive ductal carcinoma. ***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.

Q: 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?

Invasive lobular carcinoma. ***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.

Q: 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?

Sessile serrated adenoma. ***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.

Q: 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?

Atypical hyperplasia. ***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.

Q: 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?

Chromogranin and synaptophysin. ***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 1

A biopsy from a breast lump shows small, uniform cells that are estrogen receptor positive. This finding is most consistent with which type of breast cancer?

Accepted Answer

Lobular carcinoma

Answer

Ductal carcinoma in situ

Answer

Inflammatory breast cancer

Answer

Triple-negative breast cancer

Question 2

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

Accepted Answer

Pleomorphic adenoma

Answer

Adenoid cystic carcinoma

Answer

Warthin’s tumor

Answer

Mucoepidermoid carcinoma

Question 3

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?

Accepted Answer

Anaplastic thyroid carcinoma

Answer

Papillary thyroid carcinoma

Answer

Follicular thyroid carcinoma

Answer

Medullary thyroid carcinoma

Question 4

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?

Accepted Answer

Pleomorphic adenoma

Answer

Warthin tumor

Answer

Mucoepidermoid carcinoma

Answer

Adenoid cystic carcinoma

Question 5

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

Accepted Answer

Invasive ductal carcinoma

Answer

Intraductal papilloma

Answer

Lobular carcinoma

Answer

Fibroadenoma

Question 6

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?

Accepted Answer

Invasive lobular carcinoma

Answer

Invasive ductal carcinoma

Answer

Ductal carcinoma in situ

Answer

Fibroadenoma

Question 7

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?

Accepted Answer

Sessile serrated adenoma

Answer

Tubular adenoma

Answer

Villous adenoma

Answer

Hyperplastic polyp

Question 8

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?

Accepted Answer

Atypical hyperplasia

Answer

Fibroadenoma

Answer

Ductal hyperplasia

Answer

Fat necrosis

Question 9

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?

Accepted Answer

Chromogranin and synaptophysin

Answer

TTF-1 and Napsin A

Answer

CD56 and CK7

Answer

PD-L1 and EGFR

Question 10

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?

Accepted Answer

Neuroblastoma

Answer

Wilms tumor

Answer

Rhabdomyosarcoma

Answer

Hepatoblastoma

Neoplasia — MCQs

Neoplasia — MCQs

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