Neoplasia — MCQs

Neoplasia Indian Medical PG Practice Questions and MCQs

Question 881: Which substance plays a significant role in the tumor metastasis cascade?

A. TNF-alpha
B. CD99
C. NM23
D. MMP-2 (Matrix Metalloproteinase-2) (Correct Answer)

Explanation: ***Collagenase IV*** - Collagenase IV is involved in the **degradation of extracellular matrix**, facilitating tumor invasion and metastasis [1,2]. - It plays a crucial role in breaking down **type IV collagen**, a major component of the **basement membrane**, allowing cancer cells to migrate [2]. *TNF-alpha* - While TNF-alpha is a cytokine that can promote **tumor growth**, it is not directly involved in the **metastatic cascade** like collagenase IV [3,4]. - It primarily functions in **inflammation** and immune response, affecting tumor microenvironment rather than directly facilitating invasion. *NM23* - NM23 is noted for its potential role as a **tumor suppressor**, and lower levels are associated with metastasis. - However, it does not play a direct role in the *metastatic cascade* itself [3,4], as it primarily influences **tumor progression** rather than matrix degradation. *CD99* - CD99 is a cell adhesion molecule implicated in **cell migration**, but it is not a significant factor in the **enzymatic breakdown** of tissue during metastasis [1,2]. - Its expression has more to do with **cell adhesion characteristics**, rather than directly promoting invasive capabilities. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 315-316. [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. 232-233. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 314-315. [4] 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. 233-234.

Question 882: Which chromosomal translocation is associated with follicular thyroid carcinoma?

A. PAX8 - PPARγ (Correct Answer)
B. ALK - NPM1
C. ETV6 - NTRK3
D. RET - PTC1

Explanation: ***PAX8 - PPARγ*** - The **PAX8-PPARγ fusion oncogene** is a well-established molecular marker directly associated with **follicular thyroid carcinoma (FTC)**. - This translocation leads to the expression of a fusion protein that contributes to **thyroid cell proliferation** and **tumorigenesis**. *ALK - NPM1* - The **ALK-NPM1 fusion** is primarily observed in some types of **anaplastic large cell lymphoma**, not thyroid cancers. - This translocation typically results in an **activated anaplastic lymphoma kinase (ALK)**, driving lymphoproliferation. *ETV6 - NTRK3* - The **ETV6-NTRK3 rearrangement** is characteristic of **secretory carcinoma** (formerly mammary analogue secretory carcinoma), often affecting salivary glands, and is not a common finding in thyroid malignancies. - This fusion leads to the activation of the **NTRK3 receptor tyrosine kinase**, involved in cell growth and survival. *RET - PTC1* - The **RET-PTC1 rearrangement (RET/papillary thyroid carcinoma 1)** is specifically associated with **papillary thyroid carcinoma (PTC)**, which is histologically distinct from follicular thyroid carcinoma. - This fusion activates the **RET proto-oncogene**, promoting cell proliferation and survival in papillary thyroid cancer.

Question 883: Which of the following is a good prognostic factor in neuroblastomas?

A. N-myc amplification
B. RAS oncogene
C. Hyperdiploidy (Correct Answer)
D. Translocations

Explanation: ***Hyperdiploidy*** - An increased number of chromosomes (hyperdiploidy) (more than diploid, typically triploid or tetraploid) is associated with a **favorable outcome** in neuroblastoma, particularly in infants [1]. - This chromosomal characteristic indicates a less aggressive tumor biology and often correlates with better response to treatment and **higher survival rates** [1]. *N-myc amplification* - Amplification of the **N-myc oncogene** is a strong indicator of **poor prognosis** in neuroblastoma, leading to rapid tumor progression and resistance to therapy [1]. - It is associated with **advanced disease stage** and is a key factor in risk stratification for treatment intensity [1]. *RAS oncogene* - While mutations in the **RAS oncogene** are found in various cancers, their specific prognostic significance in neuroblastoma is less consistently favorable than hyperdiploidy. - RAS mutations can sometimes be associated with **tumor resistance** to certain therapies. *Translocations* - **Chromosomal translocations** in general are often associated with oncogenesis and can have variable prognostic implications depending on the specific genes involved. - In neuroblastoma, specific translocations are generally not considered a good prognostic factor; instead, they can sometimes be linked to **aggressive disease** [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 486-487.

Question 884: Which of the following is commonly associated with osteolytic metastasis?

A. Lung cancer
B. Renal cell carcinoma
C. Thyroid cancer
D. Breast cancer (Correct Answer)

Explanation: ### Breast cancer - **Breast cancer** is the **most common** primary malignancy causing osteolytic bone metastases in clinical practice due to its **high prevalence** and frequent bone tropism [1]. - Breast cancer metastases stimulate **osteoclast activity** leading to bone destruction and **purely lytic lesions** in approximately 80% of cases. - The high incidence of breast cancer makes it the **leading cause** of osteolytic metastases overall. *Renal cell carcinoma* - **Renal cell carcinoma (RCC)** characteristically produces **highly osteolytic, aggressive, and vascular** bone metastases [1]. - While RCC metastases are predominantly lytic, they are **less common** than breast cancer metastases due to lower disease prevalence. - RCC bone metastases often present with **expansile lesions** and high risk of pathological fractures. *Thyroid cancer* - **Thyroid cancer** (especially follicular subtype) produces predominantly **osteolytic metastases** that are often vascular [1]. - However, bone metastases from thyroid cancer are **relatively uncommon** compared to breast cancer due to the rarity of metastatic thyroid disease. *Lung cancer* - Lung cancer bone metastases are typically **mixed osteolytic-osteoblastic lesions** rather than purely lytic. - While common, lung cancer is **less characteristically associated with pure osteolytic lesions** compared to breast, renal, or thyroid cancers [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 671-672.

Question 885: Calcified pulmonary metastasis is seen in which carcinoma?

A. Pancreatic carcinoma
B. Thyroid carcinoma (Correct Answer)
C. Endometrial carcinoma
D. None of the options

Explanation: ***Thyroid carcinoma*** - **Papillary** and **medullary thyroid carcinomas** can produce **calcified pulmonary metastases**. - In **papillary thyroid cancer**, calcification occurs due to **psammoma bodies** (concentrically laminated calcified structures). - In **medullary thyroid cancer**, calcification can occur through **dystrophic calcification** within the tumor tissue. - Other common causes of calcified lung metastases include **osteosarcoma** and **chondrosarcoma**. *Pancreatic carcinoma* - Pancreatic carcinoma rarely causes **calcified pulmonary metastases**; metastatic lesions are typically **non-calcified**. - Metastases are more commonly found in the **liver** and **peritoneum**. - Primary pancreatic tumors may show calcification, but metastases usually do not. *Endometrial carcinoma* - Endometrial carcinoma metastases to the lungs are usually **non-calcified** and appear as **soft tissue nodules**. - While it can metastasize to the lungs, **calcification** is not a typical feature of its pulmonary spread. *None of the options* - This option is incorrect because **thyroid carcinoma** (particularly papillary type) is a well-recognized cause of **calcified pulmonary metastases**. - Among epithelial malignancies, thyroid carcinoma is one of the classic causes of this finding.

Question 886: Which of the following is a premalignant lesion for carcinoma of the rectum?

A. Juvenile polyposis
B. Adenomatous polyps (Correct Answer)
C. Familial adenomatous polyposis
D. Hyperplastic polyps

Explanation: ***Familial polyposis*** - Familial adenomatous polyposis (FAP) is characterized by numerous **adenomatous polyps** in the colon and rectum, which have a high risk of progressing to colorectal cancer [1]. - Individuals with FAP are at significant risk for developing **carcinoma rectum** at a young age if the condition is not managed properly [1]. *Juvenile polyp* - Juvenile polyps are generally **benign** and occur in children, with a very low risk of malignancy. - They do not contribute significantly to the risk of **carcinoma rectum** like adenomatous polyps do. *Adenomatous polyp* - While adenomatous polyps are indeed premalignant [1], the term **Familial polyposis** indicates a hereditary condition that specifically has a higher and more defined risk for rectal carcinoma. - Adenomatous polyps can occur sporadically and do not imply a genetic syndrome like familial polyposis. *FAP* - FAP refers specifically to **familial adenomatous polyposis** [1], which is the same concept as familial polyposis but less encompassed in terms of broad assessment in this context. - It is important to note that **familial polyposis** is a broader term that includes conditions like FAP and indicates a significant risk factor for rectal cancer [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 817, 821-822.

Question 887: The most common subtype of Non-Hodgkin's lymphoma in India is:

A. Diffuse small cell lymphocytic lymphoma
B. Diffuse large B cell lymphoma (Correct Answer)
C. Follicular lymphoma
D. Burkitt's lymphoma

Explanation: ***Diffuse large B cell lymphoma*** - It is the most common subtype of **Non-Hodgkin's lymphoma** observed in India, reflecting a higher prevalence in the population. - Characterized by **aggressive clinical behavior** [1] and typically presents as a rapidly enlarging mass, often involving lymph nodes or extranodal sites. *Burkitt's lymphoma* - This subtype is known for its **high proliferation rate** and is more common in specific demographics, such as children and immunocompromised individuals. - It typically presents with **jaw lesions** or abdominal masses, which is not typical in the broader Indian population. *Diffuse small cell lymphocytic lymphoma* - More accurately classified as **chronic lymphocytic leukemia** (CLL), it is not the most common subtype of Non-Hodgkin's lymphoma. - Characterized by a **milder clinical course** and presents with lymphocytosis in peripheral blood, lacking aggressive features. *Follicular lymphoma* - This is usually a **low-grade lymphoma** associated with **indolent behavior** and may not be the most commonly diagnosed subtype in India. - It typically involves multiple lymph nodes and is characterized by **nodular patterns on histology**, making it less prevalent than diffuse large B cell lymphoma. Follicular lymphoma is rare in Asian populations [2]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 563-564. [2] 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.

Question 888: Flexner-Wintersteiner rosette is seen in-

A. Retinoblastoma (Correct Answer)
B. Hepatoblastoma
C. Nephroblastoma
D. Neuroblastoma

Explanation: ***Retinoblastoma*** - Flexner-Wintersteiner rosettes are **characteristic histological features** seen in retinoblastoma, indicating retinal differentiation [1]. - These rosettes reflect the **presence of photoreceptor-like structures**, which are specific to this type of tumor [1]. *Hepatoblastoma* - Histologically, hepatoblastoma shows **primitive epithelial cells** and **mixed patterns**, not Flexner-Wintersteiner rosettes. - It is primarily associated with **liver** and does not present with retinal differentiation. *Nephroblastoma* - Nephroblastoma, or Wilms tumor, typically exhibits **triphasic histology** (epithelial, stromal, and blastemal components) without rosette formation. - It primarily affects the **kidney** and does not involve the retina. *Neuroblastoma* - Neuroblastoma is characterized by **small round blue cells** and **neuroid differentiation** but lacks Flexner-Wintersteiner rosettes. - This tumor usually arises in the **adrenal glands** or sympathetic nervous system, not in retinal tissue. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Eye, p. 1342.

Question 889: What is the most common type of mediastinal tumor?

A. Lymphoma
B. Thymoma (Correct Answer)
C. Teratoma
D. Neurogenic tumor

Explanation: ***Thymoma*** - **Thymoma** is the most common **primary tumor** of the mediastinum in **adults**, particularly in the **anterior mediastinum** [1]. - It typically occurs in adults aged **40-60 years** and is often associated with **paraneoplastic syndromes** such as **myasthenia gravis** (30-50% of cases), pure red cell aplasia, and hypogammaglobulinemia [1]. - Presents as an **anterior mediastinal mass** on chest imaging, often detected incidentally or due to mass effect symptoms [1]. *Lymphoma* - **Lymphoma** (both Hodgkin and non-Hodgkin) is a common cause of mediastinal masses, especially in **younger patients** and adolescents [1]. - However, mediastinal lymphoma often represents **secondary involvement** or systemic disease rather than a primary mediastinal tumor. - In pediatric populations, lymphomas are among the most common mediastinal masses. *Neurogenic tumor* - **Neurogenic tumors** (schwannomas, neurofibromas, ganglioneuromas) are the most common tumors of the **posterior mediastinum** across all age groups. - They arise from **nerve sheaths** or **sympathetic ganglia** and are the most common mediastinal tumor in **children**. - In the posterior compartment specifically, they predominate, but overall thymoma is more common in adults. *Teratoma* - **Teratomas** are **germ cell tumors** containing tissues from all three germ layers (ectoderm, mesoderm, endoderm), which may include hair, teeth, cartilage, and bone [1]. - They are the most common germ cell tumor of the mediastinum and typically occur in the **anterior mediastinum** [1]. - More common in younger patients but less frequent overall than thymomas in the adult population. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 571-574.

Question 890: Linitis plastica is a type of ?

A. Benign ulcer
B. GIST
C. Manifestation of gastric cancer (Correct Answer)
D. Plastic-like appearance of stomach lining

Explanation: ***Diffuse carcinoma of stomach*** - Linitis plastica is a specific type of **gastric cancer** characterized by **thickening of the stomach wall**, leading to a rigid, non-distensible abdomen [1]. - It often presents with **significant weight loss** and **early satiety**, distinguishing it from other stomach conditions. *Benign ulcer* - Benign ulcers do not cause the **extensive wall thickening** or **desmoplastic response** seen in linitis plastica [1]. - They typically heal with treatment and are associated with typical ulcer symptoms, unlike the progressive nature of linitis plastica. *Plastic like lining of stomach* - While linitis plastica describes a **plastic-like appearance**, it is not classified as a mere lining change but rather a sign of underlying **malignancy** [1]. - This option misrepresents it as a benign condition rather than a serious **stomach adenocarcinoma**. *GIST* - Gastrointestinal stromal tumors (GIST) are **soft tissue tumors** of mesenchymal origin, differing fundamentally from the **invasive** characteristics of linitis plastica [2]. - GISTs typically present with **mass lesions** in the GI tract, not the diffuse rigidity seen in linitis plastica [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 779-780. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 779.

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Neoplasia — MCQs

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