Neoplasia — MCQs

Neoplasia Indian Medical PG Practice Questions and MCQs

Question 841: Which cancer is associated with the Cag A gene?

A. Hepatocellular carcinoma
B. Esophageal carcinoma
C. MALT lymphoma (Correct Answer)
D. Lung carcinoma

Explanation: ***MALT lymphoma*** - The Cag A gene is associated with **Helicobacter pylori**, which is a known risk factor for developing **MALT lymphoma** in the gastric mucosa [1]. - Its presence can lead to **chronic inflammation**, contributing to lymphoid tissue proliferation and the development of lymphoma [1]. *Lung carcinoma* - Lung carcinoma is primarily linked to **smoking** and other environmental factors, rather than the Cag A gene. - It does not have a direct association with **Helicobacter pylori** infection, contrasting with MALT lymphoma. *Hepatocellular carcinoma* - Hepatocellular carcinoma is predominantly caused by **chronic hepatitis B or C infections**, ethanol-related liver disease, and **aflatoxin exposure**. - The Cag A gene does not play a significant role in its pathogenesis or development. *Esophageal carcinoma* - Esophageal carcinoma is typically associated with **Barrett's esophagus**, **smoking**, or **alcohol use**, not the Cag A gene. - While chronic injury can lead to esophageal changes, **Helicobacter pylori** does not directly contribute to its etiology. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 356-357.

Question 842: Which of the following is considered a pre-malignant condition?

A. Hamartoma
B. Dysplasia (Correct Answer)
C. Anaplasia
D. Metaplasia

Explanation: ***Hamartoma*** - Hamartomas are benign growths made of an abnormal mixture of cells and tissues, not classified as **pre-malignant**. - They typically do not undergo malignant transformation or indicate an increased risk of cancer. *Anaplasia* - Anaplasia refers to a **loss of differentiation** in cells, frequently associated with malignant tumors, indicating a **pre-malignant** condition [2]. - Cells show extreme **abnormalities** and often point to a cancerous process in development [2]. *Metaplasia* - Metaplasia is the **reversal** of one differentiated cell type to another, often as a response to injury or irritation, and can be a precursor to malignancy [1]. - It often precedes dysplasia and is considered a **pre-malignant** condition due to its potential to progress to cancer [1]. *Dysplasia* - Dysplasia involves **abnormal cell growth** and changes in cell shape and organization, most often seen in association with pre-malignant lesions [1][3]. - It is typically considered a significant risk factor for the development of **malignant tumors** [3]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 278-280. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, p. 278. [3] 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. 210-211.

Question 843: Immunohistochemical marker for sentinel node biopsy in breast carcinoma?

A. Cytokeratin (Correct Answer)
B. Vimentin
C. Calretinin
D. CD45

Explanation: ***Cytokeratin*** - **Cytokeratin** is a specific marker for **epithelial cells**, including those of breast carcinoma, making it ideal for detecting micrometastases in lymph nodes. - Immunohistochemistry with cytokeratin antibodies can identify even small clusters of tumor cells not visible on routine hematoxylin and eosin (H&E) staining. *Vimentin* - **Vimentin** is a filament protein characteristic of **mesenchymal cells**, such as fibroblasts and endothelial cells, not epithelial carcinoma cells. - While some carcinomas can exhibit **epithelial-mesenchymal transition (EMT)** and express vimentin, it is not the primary or most specific marker for detecting breast carcinoma cells in lymph nodes. *Calretinin* - **Calretinin** is a marker typically used to identify **mesothelial cells** and is often employed in the diagnosis of **mesothelioma**. - It is not expressed by breast carcinoma cells and would not be useful for detecting metastatic disease in sentinel lymph nodes. *CD45* - **CD45** (Leukocyte Common Antigen) is a specific marker for **hematopoietic cells**, including lymphocytes, macrophages, and other immune cells. - It is used to identify and distinguish lymphoid infiltrates but is not expressed by breast carcinoma cells, making it unsuitable for this purpose.

Question 844: Carcinoma associated most commonly with upper one third of esophagus is?

A. Adenocarcinoma
B. Adeno-squamous Carcinoma
C. Leiomyosarcoma
D. Squamous Cell Carcinoma (Correct Answer)

Explanation: **Squamous Cell Carcinoma** - **Squamous cell carcinoma** is the predominant type of esophageal cancer in the **upper and middle thirds** of the esophagus. - This type is strongly associated with risk factors such as **smoking** and **alcohol consumption**. *Adenocarcinoma* - **Adenocarcinoma** is most commonly found in the **distal esophagus** and **gastroesophageal junction**. - It is often associated with **Barrett's esophagus**, a metaplastic change due to chronic gastroesophageal reflux disease (GERD). *Adeno-squamous Carcinoma* - **Adeno-squamous carcinoma** is a rare mixed tumor with both glandular and squamous differentiation. - It can occur in any part of the esophagus, but is less common overall than either adenocarcinoma or squamous cell carcinoma alone. *Leiomyosarcoma* - **Leiomyosarcoma** is a malignant tumor arising from the **smooth muscle** lining the esophagus. - It is an extremely rare form of esophageal cancer, far less common than epithelial carcinomas.

Question 845: What is the primary cancer associated with mutations in the APC gene?

A. Colorectal carcinoma (Correct Answer)
B. Gastric carcinoma
C. Gastric lymphoma
D. Esophageal adenocarcinoma

Explanation: ***Colorectal carcinoma*** - The **APC gene** is a tumor suppressor gene that, when mutated, is associated with the development of **familial adenomatous polyposis (FAP)** [3] and sporadic colorectal cancer [2]. - Loss of APC function leads to **upregulation of beta-catenin** [1], promoting cell proliferation in the colon [1]. *Esophageal adenocarcinoma* - Primarily linked to **Barrett's esophagus** and chronic gastroesophageal reflux disease (GERD), not directly related to APC mutation. - Genetic alterations in this cancer typically involve **TP53** and **CDKN2A** rather than APC. *Gastric lymphoma* - Gastric lymphoma is often associated with **H. pylori infection**, and while certain genes are implicated, APC is not among the key contributors. - Typically arises from gastric mucosa-associated lymphoid tissue (MALT) rather than direct APC mutations. *Gastric carcinoma* - Although gastric carcinoma can involve various genetic changes, it's mainly associated with **hereditary diffuse gastric cancer syndromes** linked to mutations in the **CDH1** gene. - APC is primarily implicated in colorectal malignancies, not gastric cancer, though FAP patients with germline APC mutations do have increased risk of intestinal-type gastric cancer [4]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 304-305. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 819. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 817. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 778-779.

Question 846: Which type of breast carcinoma exhibits the least desmoplastic reaction?

A. Ductal
B. Tubular
C. Medullary
D. Lobular (Correct Answer)

Explanation: ***Lobular*** - **Lobular carcinoma** tends to be less desmoplastic than other types, characterized by **small, non-cohesive cells** that invade the stroma with minimal reaction [1]. - It is frequently bilateral and can have a subtle histological presentation, making it less likely to elicit a strong desmoplastic response. *Medullary* - **Medullary carcinoma** is associated with a prominent **lymphocytic infiltrate** and notable desmoplastic stromal reaction [1]. - It presents with a large, well-circumscribed mass and often has a more aggressive nature, which contradicts the characteristics of desmoplastic carcinoma. *Tubular* - **Tubular carcinoma** shows abundant desmoplastic stroma, resulting in a firm consistency [2], contrary to the nature of least desmoplastic carcinoma. - It features distinctive tubular structures and is generally considered a subtype with a more significant desmoplastic reaction. *Ductal* - **Ductal carcinoma**, particularly infiltrating ductal carcinoma, often has a strong desmoplastic reaction, leading to significant stromal fibrosis. - This type frequently presents as a hard mass due to the involved desmoplastic response, differing from the lobular type's characteristics. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 454-456. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 453-454.

Question 847: What is the most common tumor suppressor gene involved in carcinogenesis?

A. p53 (Correct Answer)
B. Retinoblastoma (Rb)
C. Tumor protein p73 (p73)
D. Cyclin-dependent kinase inhibitor 2A (p16)

Explanation: ***p53*** [1][2] - The **p53 gene** is widely recognized as the most common tumor suppressor gene associated with various cancers, particularly due to its role in apoptosis and cell cycle regulation [1][2]. - Mutations in **p53** are found in over **50%** of human tumors, highlighting its critical role in cancer genesis [2]. *Rb* - While the **Rb gene** is significant in preventing retinoblastoma and other cancers, it is less commonly mutated overall compared to p53 [1]. - Rb primarily regulates the **cell cycle**, particularly the transition from G1 to S phase, but its involvement in cancer is more limited in scope [2]. *p16* - **p16** acts as an inhibitor of cyclin-dependent kinases but is primarily associated with specific cancers such as melanoma, not broadly across all cancers. - It serves as a cell cycle checkpoint but is not as ubiquitous a tumor suppressor as p53. *p73* - Although **p73** shares structural similarities with p53 and has roles in apoptosis, it is not as frequently implicated in cancer development. - Its functions are more related to developmental processes and it does not have the same high mutation rates seen in tumors as p53. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 297-298, 302-304. [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. 227-228.

Question 848: In which type of lung carcinoma is the p53 mutation most commonly observed?

A. Adenocarcinoma
B. Squamous cell carcinoma (SCC) (Correct Answer)
C. Large cell carcinoma
D. Small cell carcinoma

Explanation: ***Small cell carcinoma*** - **Small cell lung carcinoma (SCLC)** has the highest frequency of **p53 mutations**, occurring in approximately **90-95%** of cases. - These mutations are associated with the **aggressive nature** and **poor prognosis** of SCLC, contributing to its rapid growth and early metastasis. *Adenocarcinoma* - **Adenocarcinoma** has p53 mutations in approximately **50-60%** of cases, which is less frequent than SCLC. - This subtype is more commonly associated with **EGFR mutations** and **ALK rearrangements**, particularly in non-smokers. *Squamous cell carcinoma (SCC)* - **Squamous cell carcinoma** shows p53 mutations in about **70-80%** of cases, but still lower than SCLC. - It is more strongly associated with **smoking** and often displays mutations in **CDKN2A** and **PIK3CA** pathways. *Large cell carcinoma* - **Large cell carcinoma** has variable p53 mutation rates, typically **40-60%** of cases. - This subtype is less well-characterized molecularly and represents a **diagnosis of exclusion** among lung cancers.

Question 849: Which of the following tumors is associated with elevated levels of Alpha-fetoprotein (AFP)?

A. Teratoma
B. Yolk sac tumor (Correct Answer)
C. Seminoma
D. None of the options

Explanation: ***a and c*** - **Alpha-fetoprotein (AFP)** is commonly elevated in certain germ cell tumors, specifically **non-seminomatous tumors** [1]. - This correctly includes conditions associated with raised AFP, indicating its relevance in testicular tumors beyond **seminoma**. *Seminoma* - Typically associated with elevated **beta-hCG** but not significantly with **AFP** levels; only very rarely can it show a slight increase. - It mainly presents as a **solid testicular mass** and is classified under germ cell tumors that do not usually raise AFP [1]. *Teratoma* - Teratomas can be associated with elevated AFP but predominantly in **mixed germ cell tumors** rather than pure teratomas [1]. - They may require surgical intervention and can produce a variety of germ cell components, complicating tumor markers interpretation. *Yolk sac tumor* - Specifically associated with significantly elevated **AFP** and is a common cause of raised levels in children and some adults [1]. - However, this does not adequately cover other conditions that may also elevate AFP levels, hence it's incomplete in the context of the question. **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. 979-980.

Question 850: Metastasis to lungs comes most commonly from

A. Melanoma
B. Primary brain tumor
C. Primary bone tumor
D. Breast carcinoma (Correct Answer)

Explanation: ***Breast carcinoma*** - **Breast cancer** is one of the most common sources of pulmonary metastases, spreading via **hematogenous** [3] or lymphatic routes. [1] - The lungs are a frequent site for distant metastasis, and breast cancer accounts for a significant proportion due to its **high prevalence** and rich vascular supply. [1] - Other common sources include colorectal, renal, thyroid, and prostate carcinomas. [1] *Primary brain tumor* - **Primary brain tumors** (gliomas, medulloblastomas) rarely metastasize outside the central nervous system. - They typically lack the ability to penetrate the **dura mater** and enter systemic circulation effectively. - While they can spread via CSF within the CNS, distant metastasis to lungs is **extremely rare**. *Primary bone tumor* - **Primary bone tumors** are typically **sarcomas** (osteosarcoma, Ewing sarcoma), not carcinomas. [2] - While osteosarcoma does metastasize to lungs frequently, these tumors are much **less common** overall than breast cancer. [2] - In terms of absolute numbers, breast cancer is a more frequent source of lung metastases. *Melanoma* - Melanoma has aggressive metastatic potential and can spread to virtually any organ, including the lungs. [1] - However, due to the **higher incidence** of breast cancer, breast remains a more common source of pulmonary metastases in clinical practice. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 338-339. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 671-672. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 456-457.

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Neoplasia — MCQs

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