Neoplasia Practice Questions

Q: Which cancer is associated with the Cag A gene?

MALT lymphoma. ***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.

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

Squamous cell carcinoma (SCC). ***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.

Q: Inhibin is a tumor marker associated with which of the following tumors?

Granulosa cell tumor. ***Granulosa cell tumor (a type of ovarian tumor)*** - **Inhibin** is a polypeptide hormone primarily produced by the **granulosa cells** of the ovary and Sertoli cells of the testis [1]. - Granulosa cell tumors, being composed of granulosa cells, often **overproduce inhibin**, making it a valuable tumor marker for diagnosis, monitoring recurrence, and treatment response [1]. *Serous cystadenoma (a type of ovarian epithelial tumor)* - While serous cystadenomas are common ovarian tumors, they are of **epithelial origin** and typically do not produce inhibin. - Markers like **CA-125** are more commonly associated with epithelial ovarian cancers, though not typically with benign serous cystadenomas. *Krukenberg tumor (a metastatic ovarian tumor)* - Krukenberg tumors are **metastatic neoplasms to the ovary**, most commonly originating from the gastrointestinal tract (especially the stomach). - Their marker profile reflects the primary tumor, and **inhibin is not a typical marker** for these metastatic lesions. *Dysgerminoma (a type of ovarian germ cell tumor)* - Dysgerminomas are **germ cell tumors** of the ovary, analogous to seminomas in males. - Tumor markers associated with dysgerminomas include **lactate dehydrogenase (LDH)**, and sometimes **beta-hCG**, but not inhibin. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1036-1037.

Q: What is the most common type of anal canal carcinoma?

Squamous cell carcinoma. ***Squamous cell carcinoma*** - This is the most prevalent type of anal canal carcinoma, accounting for over **80% of all anal cancers**. - It arises from the **squamous epithelial cells** lining the anal canal, often linked to **HPV infection**. *Adenocarcinoma* - This type of cancer originates from the **glandular cells** in the upper part of the anal canal or from **anal glands**. - It is a much rarer form of anal cancer compared to squamous cell carcinoma. *Adenoacanthoma* - This is a rare variant of **adenocarcinoma** that also contains foci of benign or malignant squamous differentiation. - It is not the most common type and represents a specific histological subtype. *Papillary carcinoma* - This term describes a **growth pattern** of various carcinomas characterized by finger-like projections or papillae. - It is not a distinct primary type of anal canal carcinoma, but rather a descriptive feature that can be found in some adeno- or squamous cell carcinomas.

Q: Which type of breast cancer is most commonly associated with bilateral breast carcinoma?

Invasive lobular carcinoma. ***Invasive lobular carcinoma*** - **Invasive lobular carcinoma (ILC)** is the type of breast cancer most frequently associated with **bilateral disease**. [1], [2] This is due to its growth pattern, which often involves the widespread infiltration of cells that can occur in both breasts. [2] - ILC cells tend to grow in single-file strands, making them less likely to form a palpable mass or be detected by mammography, leading to a higher chance of multifocal or bilateral involvement. [1] *Ductal carcinoma in situ* - **Ductal carcinoma in situ (DCIS)** is a non-invasive lesion, meaning the cancerous cells are confined to the breast ducts and have not spread into surrounding breast tissue. - While DCIS can be multifocal within the same breast, it is less commonly associated with bilateral synchronous or metachronous disease compared to invasive lobular carcinoma. *Invasive ductal carcinoma* - **Invasive ductal carcinoma (IDC)** is the most common type of invasive breast cancer overall, accounting for 70-80% of all invasive breast cancers. - While IDC can be bilateral, it is less frequently associated with bilateral presentation than invasive lobular carcinoma. Its growth pattern typically forms a distinct mass that is more readily detected. *None of the options* - This option is incorrect because **invasive lobular carcinoma** is indeed a type of breast cancer with a well-established association with bilateral disease. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 454-455. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1068-1069.

Q: In breast carcinoma, prognosis depends best upon -

Axillary lymph node status. ***Axillary lymphnode status*** - The presence and number of **positive axillary lymph nodes** are the **most significant prognostic factor** in breast carcinoma, as they directly indicate the extent of regional spread [1]. - Involvement of axillary lymph nodes is strongly predictive of a **higher risk of distant metastasis** and generally a poorer prognosis [2]. *Estrogen receptor status* - **Estrogen receptor (ER) status** is an important **predictive marker** for response to hormonal therapy, but it is not the best single indicator of overall prognosis in metastatic disease [2]. - While ER-positive tumors generally have a better prognosis and respond to endocrine therapy, the presence of metastasis itself dictates much of the prognosis. *Size of tumour* - **Tumor size** is a significant prognostic factor for **primary breast cancer**, with larger tumors generally having a worse prognosis [1]. - However, in the context of **metastasis**, the spread to lymph nodes or distant sites becomes a more critical determinant of overall prognosis than the original tumor size. *Site of tumour* - The **site of the primary tumor within the breast** generally has **little independent prognostic value** once metastasis has occurred or is being evaluated. - While certain locations might be associated with variations in lymph node drainage, the actual **lymph node status** is what directly reflects metastatic spread and prognosis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1070-1072. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 458-459.

Q: Which of the following is included in the Modified Bloom Richardson criteria for Carcinoma Breast?

Mitotic rate. ***Mitotic rate*** - The **Modified Bloom-Richardson (Nottingham) criteria** for breast carcinoma grading includes three components: **tubular/glandular formation**, **nuclear pleomorphism**, and **mitotic rate**. - **Mitotic rate** assesses the frequency of cell division and is scored based on the number of mitoses per 10 high-power fields. - A higher mitotic rate indicates more aggressive tumor growth and contributes to a higher histological grade. *Desmoplasia* - **Desmoplasia** refers to the fibrous stromal reaction surrounding a tumor and is a common feature of invasive carcinomas. - While it is associated with tumor invasion, it is **not one of the three specific criteria** used in the Modified Bloom-Richardson grading system. - The MBR system focuses on cellular morphology and proliferative activity, not stromal response. *Lymphovascular invasion* - **Lymphovascular invasion** (LVI) indicates the presence of tumor cells within lymphatic or blood vessels, signifying higher metastatic potential. - While LVI is an important **prognostic factor** in breast cancer staging and treatment planning, it is **not part of the MBR histological grading criteria**. - The MBR system evaluates only tubular formation, nuclear features, and mitotic activity. *Nuclear pleomorphism* - **Nuclear pleomorphism** (nuclear grade/nuclear atypia) is actually **one of the three components** of the Modified Bloom-Richardson criteria. - It assesses variation in nuclear size, shape, and chromatin pattern within tumor cells. - Both mitotic rate and nuclear pleomorphism are correct components of the MBR system; however, if forced to choose one answer, mitotic rate is more distinctly quantifiable and is often emphasized in teaching contexts.

Q: In which condition is Calretinin primarily used as a diagnostic marker?

Malignant Mesothelioma. ***Mesothelioma*** - **Calretinin** is a sensitive marker used specifically for diagnosing **mesothelioma**, particularly in differentiating it from adenocarcinomas [1]. - It is expressed in **mesothelial cells**, making it a crucial tool in immunohistochemical staining for tumor identification [1]. *Hamartoma* - **Hamartomas** typically do not express **calretinin**, and their diagnosis requires different markers based on the tissue type involved. - They are benign and can occur in various organs but do not show mesothelial characteristics. *Chordoma* - **Chordomas** are malignant tumors originating from notochordal remnants, and they are not associated with **calretinin** positivity. - They are usually **mucins-positive** and identified using other specific markers, such as **brachyury**. *Choristoma* - **Choristomas** are benign lesions of ectopic tissue, and like hamartomas, they do not express **calretinin**. - These tumors are often diagnosed based on the specific type of tissue they contain rather than immunohistochemistry. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 731.

Q: In which type of cancer is K-ras mutation most commonly observed?

Pancreatic cancer. ***Pancreatic carcinoma*** - K-ras mutations are found in **over 90%** of pancreatic adenocarcinomas, making it a hallmark of this cancer type [1]. - These mutations are involved in the **initiation and progression** of pancreatic tumors [1]. *Hepatic carcinoma* - Hepatic carcinoma is more associated with mutations in **TP53** and **CTNNB1**, rather than K-ras mutations. - K-ras mutations are not a primary driver in the context of liver cancer development. *Prostate carcinoma* - Prostate carcinoma typically involves mutations in **PTEN** and **TMPRSS2-ERG** fusion genes, not K-ras. - K-ras mutations are not a significant feature in the pathogenesis of prostate cancer. *Gastric carcinoma* - Gastric carcinoma can have mutation involvement often related to **CDH1** and **TP53**, with variable K-ras mutation presence. - K-ras mutations are less frequent when compared to other mutations seen in gastric tumorigenesis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Pancreas, pp. 897-898.

Question 1

Which cancer is associated with the Cag A gene?

Accepted Answer

MALT lymphoma

Answer

Hepatocellular carcinoma

Answer

Esophageal carcinoma

Answer

Lung carcinoma

Question 2

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

Accepted Answer

Squamous cell carcinoma (SCC)

Answer

Adenocarcinoma

Answer

Large cell carcinoma

Answer

Small cell carcinoma

Question 3

Inhibin is a tumor marker associated with which of the following tumors?

Accepted Answer

Granulosa cell tumor

Answer

Krukenberg tumor

Answer

Dysgerminoma

Answer

Serous cystadenoma

Question 4

What is the best assessment for the tendency of colonic carcinoma to metastasize?

Accepted Answer

Depth of penetration of bowel wall (T stage)

Answer

Size of tumor

Answer

Carcinoembryonic antigen (CEA) levels

Answer

Histological grade of the tumor

Question 5

What is the most common type of anal canal carcinoma?

Accepted Answer

Squamous cell carcinoma

Answer

Adenocarcinoma

Answer

Adenoacanthoma

Answer

Papillary carcinoma

Question 6

Which type of breast cancer is most commonly associated with bilateral breast carcinoma?

Accepted Answer

Invasive lobular carcinoma

Answer

Ductal carcinoma in situ

Answer

Invasive ductal carcinoma

Answer

None of the options

Question 7

In breast carcinoma, prognosis depends best upon -

Accepted Answer

Axillary lymph node status

Answer

Size of tumour

Answer

Site of tumour

Answer

Estrogen receptor status

Question 8

Which of the following is included in the Modified Bloom Richardson criteria for Carcinoma Breast?

Accepted Answer

Mitotic rate

Answer

Desmoplasia

Answer

Lymphovascular invasion

Answer

Nuclear pleomorphism

Question 9

In which condition is Calretinin primarily used as a diagnostic marker?

Accepted Answer

Malignant Mesothelioma

Answer

Benign Hamartoma

Answer

Choristoma

Answer

Chordoma

Question 10

In which type of cancer is K-ras mutation most commonly observed?

Accepted Answer

Pancreatic cancer

Answer

Prostate cancer

Answer

Gastric cancer

Answer

Liver cancer

Neoplasia — MCQs

Neoplasia — MCQs

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