Neoplasia — MCQs

Neoplasia Indian Medical PG Practice Questions and MCQs

Question 831: Which neoplasm is most strongly associated with asbestos exposure?

A. Lung adenocarcinoma
B. Mesothelioma (Correct Answer)
C. Squamous cell carcinoma
D. Lymphoma

Explanation: ***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.

Question 832: Which tumor marker is most commonly elevated in germ cell tumors?

A. AFP (Correct Answer)
B. CA-125
C. CEA
D. PSA

Explanation: ***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.

Question 833: 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?

A. Hilar lymph nodes (Correct Answer)
B. Cervical lymph nodes
C. Inguinal lymph nodes
D. Mesenteric lymph nodes

Explanation: ***Hilar lymph nodes*** - The **hilar lymph nodes** are located at the root of the lung, adjacent to the main bronchi. They are the **first regional lymph nodes** to receive lymphatic drainage from the lung parenchyma and central airways, making them the most likely site for initial metastasis from a bronchial tumor. [1] - Metastasis to these nodes indicates **N1 disease**, an important staging criterion for lung cancer. - The typical progression of lymphatic spread in lung cancer is: **Hilar nodes (N1) → Mediastinal nodes (N2) → Supraclavicular/cervical nodes (N3)**. [1] *Cervical lymph nodes* - **Cervical lymph nodes** (particularly supraclavicular nodes) are located in the neck. While lung cancer can metastasize to these nodes, it typically occurs after involvement of more proximal (hilar or mediastinal) lymph nodes, classifying it as **N3 disease**. [1] - Direct metastasis to cervical nodes as the *first* site is less common unless the tumor is in the apex of the lung (Pancoast tumor) or has already spread extensively. *Inguinal lymph nodes* - **Inguinal lymph nodes** are located in the groin. These nodes drain the lower extremities, perineum, and external genitalia. [2] - Metastasis to inguinal nodes from a primary lung cancer would indicate **distant metastasis (M1b disease)** and is not the first or primary site of regional spread. *Mesenteric lymph nodes* - **Mesenteric lymph nodes** are located in the mesentery, draining parts of the gastrointestinal tract. - Involvement of these nodes by lung cancer would represent **distant metastasis (M1b disease)** and is not a regional lymphatic spread pattern from a primary lung tumor. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 724-725. [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. 234-235.

Question 834: Which gene is commonly overexpressed in follicular lymphoma?

A. Bcl-1
B. Bcl-6
C. Bcl-2 (Correct Answer)
D. None of the options

Explanation: ***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.

Question 835: 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?

A. Locally invaded hepatocellular carcinoma
B. Colonic adenocarcinoma with metastasis (Correct Answer)
C. Angiosarcoma
D. Hepatic metastasis from primary lung adenocarcinoma

Explanation: ***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.

Question 836: What is the primary molecular defect in xeroderma pigmentosa?

A. DNA repair defect (Correct Answer)
B. Autosomal recessive
C. Poor long term prognosis
D. Pyrimidine dimers

Explanation: ***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.

Question 837: Which of the following statements about small intestinal tumors is true?

A. The risk of developing small bowel tumors correlates positively with colorectal cancer.
B. Adenomatous polyps are the most common small intestinal tumors.
C. Adenocarcinomas are the most common small intestinal tumors.
D. Carcinoids are more common in the ileum. (Correct Answer)

Explanation: ***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.

Question 838: Which histological type of breast carcinoma has the worst prognosis?

A. Tubular
B. Colloid
C. Papillary
D. Scirrhous (Correct Answer)

Explanation: ***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.

Question 839: Which of the following factors is associated with the best prognosis in breast carcinoma?

A. Tumor size <1 cm, lymph nodes negative, estrogen receptor negative, progesterone receptor negative, HER2 positive
B. Tumor size <2 cm, lymph nodes negative, estrogen receptor positive, progesterone receptor positive, HER2 negative
C. Tumor size <1 cm, lymph nodes negative, estrogen receptor positive, progesterone receptor positive, HER2 negative (Correct Answer)
D. Tumor size >2 cm, lymph nodes positive, estrogen receptor negative, progesterone receptor negative, HER2 positive

Explanation: ***Tumor size <1 cm, lymph nodes negative, estrogen receptor positive, progesterone receptor positive, HER2 negative*** * **Small tumor size** (<1 cm), **negative lymph nodes**, and **positive hormone receptors** (**ER/PR positive**) indicate a less aggressive tumor with a lower risk of metastasis, leading to a better prognosis [1]. * **HER2 negativity** is also a favorable prognostic factor in the context of hormone receptor-positive disease, as it avoids the more aggressive behavior often associated with HER2-positive tumors. *Tumor size <1 cm, lymph nodes negative, estrogen receptor negative, progesterone receptor negative, HER2 positive* * While **small tumor size** and **negative lymph nodes** are favorable [1], **estrogen receptor negative** and **progesterone receptor negative** status is associated with a more aggressive disease and poorer prognosis [1]. * **HER2 positivity**, in the absence of hormone receptor expression, often correlates with faster growth and spread, requiring targeted HER2 therapy. *Tumor size <2 cm, lymph nodes negative, estrogen receptor positive, progesterone receptor positive, HER2 negative* * Although exhibiting **positive hormone receptors** and **negative lymph nodes**, a tumor size up to **2 cm** is less favorable than a tumor smaller than 1 cm [1]. * While HER2 negative, the size is a less optimal prognostic indicator compared to the smaller tumor in the correct option [1]. *Tumor size >2 cm, lymph nodes positive, estrogen receptor negative, progesterone receptor negative, HER2 positive* * **Larger tumor size** (>2 cm) and **positive lymph nodes** are significant indicators of advanced disease and a **poorer prognosis** [1]. * **Hormone receptor-negative status** (ER-/PR-), combined with **HER2 positivity**, suggests an aggressive tumor subtype with limited hormone therapy options and requiring HER2-targeted therapy along with chemotherapy. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1064-1072.

Question 840: Retinoblastomas are characterized by which of the following features?

A. Necrosis
B. Small round cells
C. Retinal detachment
D. Flexner-Wintersteiner rosettes and Fleurettes (Correct Answer)

Explanation: ***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.

Practice by Chapter

Nomenclature and Classification of Tumors

Practice Questions

Characteristics of Benign and Malignant Neoplasms

Practice Questions

Molecular Basis of Cancer

Practice Questions

Carcinogenesis and Carcinogens

Practice Questions

Tumor Progression and Metastasis

Practice Questions

Tumor Markers

Practice Questions

Paraneoplastic Syndromes

Practice Questions

Genetic Basis of Cancer

Practice Questions

Tumor Immunity

Practice Questions

Cancer Epidemiology and Prevention

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free

Neoplasia — MCQs

Neoplasia — MCQs

On this page

Practice by Chapter

Want unlimited practice?