Neoplasia Practice Questions

Q: Which neoplasm is most strongly associated with asbestos exposure?

Mesothelioma. ***Mesothelioma*** - **Mesothelioma** is a malignancy specifically linked to **asbestos exposure**, primarily affecting the **pleura** [1]. - It has a long latency period, making it appear decades after exposure to asbestos fibers [1]. *Squamous cell carcinoma* - While **asbestos exposure** can contribute to lung cancers, it is **not specifically linked** to squamous cell carcinoma more than other environmental factors. - Often associated with **smoking** and chronic lung conditions rather than asbestos exclusively. *Lymphoma* - Lymphoma's pathogenesis is usually related to **immune system dysfunctions** and infections rather than asbestos exposure. - There is **no strong association** between lymphoma and asbestos exposure documented in literature. *Lung adenocarcinoma* - Like squamous cell carcinoma, lung adenocarcinoma is associated with **smoking** and various **toxic exposures**, but less so with asbestos. - **Asbestos exposure** is not a prominent risk factor for adenocarcinoma compared to other lung cancer types. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 339-340.

Q: Which tumor marker is most commonly elevated in germ cell tumors?

AFP. ***AFP*** - **Alpha-fetoprotein (AFP)** is a key tumor marker commonly elevated in germ cell tumors, particularly in **non-seminomatous types**. - It is associated with **yolk sac tumors** and can also be elevated in liver diseases, but its presence is significant in germ cell tumor diagnosis. *CEA* - **Carcinoembryonic antigen (CEA)** is primarily elevated in **colorectal cancers** and is not specific to germ cell tumors. - While it can be elevated in various malignancies, it lacks the association with germ cell tumors seen with AFP. *CA-125* - **CA-125** is mostly used as a marker for **ovarian cancer** and may be elevated in endometriosis and pelvic inflammatory disease. - It is not a reliable marker for germ cell tumors and does not share the same clinical relevance as AFP in this context. *PSA* - **Prostate-specific antigen (PSA)** is primarily used in the diagnosis and monitoring of **prostate cancer**. - It does not play a role in germ cell tumors and shows elevation in conditions related to the prostate rather than testicular malignancies. [1][2][3] **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. 980-982. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 510-512. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1034-1035.

Q: A woman presents with massive pulmonary thromboembolism. Which of the following, based on findings from a subsequent liver autopsy, is the most likely underlying cause of the pulmonary embolism?

Colonic adenocarcinoma with metastasis. ***Colonic adenocarcinoma with metastasis*** - The presentation of massive pulmonary thromboembolism can be associated with **malignancy** [3], particularly from **colonic sources**. - This diagnosis is consistent with **liver metastasis** [1][2], which often results in **pulmonary emboli** due to increased risk of thrombosis. *Locally invaded hepatocellular carcinoma* - Hepatocellular carcinoma usually presents with **liver dysfunction** and **weight loss**, not specifically massive PE. - While it can invade surrounding tissues, it does not typically lead to **pulmonary embolism** from liver pathology. *Metastasis from PE* - This option is misleading as **pulmonary embolism** itself does not cause **metastatic disease**; it often results from existing malignancies. - The concept of metastasis is associated with bloodstream transport of cancer cells [2], not the origin of PE. *Angiosarcoma* - Angiosarcoma is a rare vascular tumor that typically causes **massive bleeding** rather than thromboembolic events. - Its clinical presentation is distinct and not typically linked to **colonic malignancies** or massive PE. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 398-399. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, p. 282. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 705.

Q: Which gene is commonly overexpressed in follicular lymphoma?

Bcl-2. ***Bcl- 2*** - Follicular lymphoma is characteristically associated with the **overexpression of Bcl-2** [1][2], which prevents apoptosis and contributes to oncogenesis [1][3]. - It is a result of the **t(14;18)** translocation, leading to the fusion of the Bcl-2 gene with the immunoglobulin heavy chain locus [1][2][3]. *Bcl-6* - While Bcl-6 is involved in the pathogenesis of some lymphomas, including **diffuse large B-cell lymphoma** [4], it is not a defining feature of follicular lymphoma. - Its positivity in follicular lymphoma cases does not correlate with the diagnosis. *None of the above* - This option is incorrect as there is a clear association with **Bcl-2** [1][2], which is pivotal in the pathology of follicular lymphoma. - Saying "none of the above" overlooks the critical marker essential for diagnosis. *Bcl-1* - Bcl-1 is primarily linked to **mantle cell lymphoma**, not follicular lymphoma, making it an unsuitable choice. - It is associated with **t(11;14)** translocations and has a different role in lymphoid malignancies compared to Bcl-2. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 602-604. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 561-562. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 310-311. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 604.

Q: What is the primary molecular defect in xeroderma pigmentosa?

DNA repair defect. ***DNA repair defect*** - Xeroderma pigmentosum is characterized by a hereditary defect in **DNA repair mechanisms**, specifically **nucleotide excision repair (NER)** [1]. - This defect prevents the proper removal of **pyrimidine dimers** and other DNA damage caused by **ultraviolet (UV) light**, leading to an accumulation of mutations [1]. *Autosomal recessive* - While xeroderma pigmentosum is indeed inherited in an **autosomal recessive** pattern, this describes its inheritance rather than the fundamental molecular defect [1]. - The core pathophysiological issue is the inability to repair damaged DNA, which then manifests due to this recessive genetic trait. *Poor long term prognosis* - Patients with xeroderma pigmentosum do have a **poor long-term prognosis** due to a significantly increased risk of developing various cancers, especially **skin cancers** and potentially internal malignancies. - However, this is a consequence of the underlying molecular defect (DNA repair) rather than the primary mechanism itself. *Pyrimidine dimers* - **Pyrimidine dimers** (specifically **thymine dimers**) are indeed a key type of DNA damage that accumulates in xeroderma pigmentosum due to the defective repair mechanism [1]. - While their presence is central to the disease's pathology, the direct cause is the **failure to repair them**, which points to the underlying DNA repair defect. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 322-323, 332-333.

Q: Which histological type of breast carcinoma has the worst prognosis?

Scirrhous. ***Scirrhous*** - Scirrhous breast carcinoma, characterized by **desmoplastic stroma**, often exhibits **poor differentiation** and aggressive behavior, leading to a worse prognosis [2]. - It frequently presents with **poorly defined margins** and can metastasize earlier compared to other types. *Colloid* - Colloid carcinoma typically has a **better prognosis** due to its slower growth and less aggressive nature [2]. - It is characterized by **mucin production**, which can protect it from aggressive biological behavior. *Tubular* - Tubular carcinoma is considered a **low-grade** cancer with a favorable prognosis and often detected at an early stage [1]. - It usually demonstrates a well-circumscribed mass with **excellent survival rates** compared to more aggressive types [2]. *Papillary* - Papillary carcinoma also has a relatively **good prognosis**, particularly when compared to scirrhous types [1]. - Typically presents in older women and is often **non-invasive**, leading to favorable outcomes if treated early [2]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 458-459. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1069-1070.

Q: Which of the following statements about small intestinal tumors is true?

Carcinoids are more common in the ileum.. ***Carcinoids are more common in the ileum.*** - **Carcinoid tumors**, which are neuroendocrine tumors, are the most common primary malignant tumors of the small intestine, and their highest incidence is found in the **ileum**. - They often arise from enterochromaffin cells in the submucosa and can secrete vasoactive substances, leading to **carcinoid syndrome**. *Adenocarcinomas are the most common small intestinal tumors.* - While adenocarcinomas occur in the small intestine, they are not the most common type; **carcinoids** are more prevalent. - Small intestinal adenocarcinomas are typically found in the **duodenum**, unlike carcinoids which favor the ileum. *Adenomatous polyps are the most common small intestinal tumors.* - **Adenomatous polyps** are benign growths but are not the most common small intestinal tumors; **carcinoids** hold this distinction. - Though rare, they can undergo malignant transformation, particularly when associated with genetic syndromes like **Familial Adenomatous Polyposis (FAP)**. *The risk of developing small bowel tumors correlates positively with colorectal cancer.* - There is generally **no strong positive correlation** between the risk of developing typical small bowel tumors and colorectal cancer in the general population, although some genetic syndromes like **FAP** increase risks for both. - The etiologies and predominant tumor types for small bowel and colorectal cancers are largely distinct.

Q: Retinoblastomas are characterized by which of the following features?

Flexner-Wintersteiner rosettes and Fleurettes. ***None*** - Retinoblastomas exhibit **various histopathological features** including necrosis, small round cells, and pseudorosettes. - The statement "all of the following" implies the other options are present, hence "none" fits as the correct answer because it negates the presence of any aberrant features. *Necrosis* - Retinoblastomas typically show areas of **necrosis** due to rapid cell proliferation outpacing blood supply [1]. - The presence of necrosis is a common association in many cancer types, including retinoblastoma. *Small round cells* - The tumor is characterized by **small round blue cells** on histological examination, which is a hallmark feature of retinoblastomas. - This cytological appearance helps differentiate retinoblastoma from other retinal tumors. *Pseudorosettes and Fleurettes* - Pseudorosettes and **fleurettes** are indicative of **certain neuroectodermal tumors** but are not diagnostic features of retinoblastoma. - These structures are more associated with other tumors like medulloblastoma rather than retinoblastoma. Retinoblastomas characteristically show Flexner-Wintersteiner rosettes instead [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Eye, p. 1342.

Question 1

Which neoplasm is most strongly associated with asbestos exposure?

Accepted Answer

Mesothelioma

Answer

Lung adenocarcinoma

Answer

Squamous cell carcinoma

Answer

Lymphoma

Question 2

Which tumor marker is most commonly elevated in germ cell tumors?

Accepted Answer

AFP

Answer

CA-125

Answer

CEA

Answer

PSA

Question 3

A 60-year-old male presents with chronic cough and hemoptysis. Bronchoscopy reveals a mass obstructing the left main bronchus. Which lymph nodes are most likely to show metastasis first?

Accepted Answer

Hilar lymph nodes

Answer

Cervical lymph nodes

Answer

Inguinal lymph nodes

Answer

Mesenteric lymph nodes

Question 4

A woman presents with massive pulmonary thromboembolism. Which of the following, based on findings from a subsequent liver autopsy, is the most likely underlying cause of the pulmonary embolism?

Accepted Answer

Colonic adenocarcinoma with metastasis

Answer

Locally invaded hepatocellular carcinoma

Answer

Angiosarcoma

Answer

Hepatic metastasis from primary lung adenocarcinoma

Question 5

Which gene is commonly overexpressed in follicular lymphoma?

Accepted Answer

Bcl-2

Answer

Bcl-1

Answer

Bcl-6

Answer

None of the options

Question 6

What is the primary molecular defect in xeroderma pigmentosa?

Accepted Answer

DNA repair defect

Answer

Autosomal recessive

Answer

Poor long term prognosis

Answer

Pyrimidine dimers

Question 7

Which histological type of breast carcinoma has the worst prognosis?

Accepted Answer

Scirrhous

Answer

Tubular

Answer

Colloid

Answer

Papillary

Question 8

Which of the following statements about small intestinal tumors is true?

Accepted Answer

Carcinoids are more common in the ileum.

Answer

The risk of developing small bowel tumors correlates positively with colorectal cancer.

Answer

Adenomatous polyps are the most common small intestinal tumors.

Answer

Adenocarcinomas are the most common small intestinal tumors.

Question 9

Which of the following factors is associated with the best prognosis in breast carcinoma?

Accepted Answer

Tumor size <1 cm, lymph nodes negative, estrogen receptor positive, progesterone receptor positive, HER2 negative

Answer

Tumor size <1 cm, lymph nodes negative, estrogen receptor negative, progesterone receptor negative, HER2 positive

Answer

Tumor size <2 cm, lymph nodes negative, estrogen receptor positive, progesterone receptor positive, HER2 negative

Answer

Tumor size >2 cm, lymph nodes positive, estrogen receptor negative, progesterone receptor negative, HER2 positive

Question 10

Retinoblastomas are characterized by which of the following features?

Accepted Answer

Flexner-Wintersteiner rosettes and Fleurettes

Answer

Necrosis

Answer

Small round cells

Answer

Retinal detachment

Neoplasia — MCQs

Neoplasia — MCQs

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