Neoplasia Practice Questions

Q: Gastric carcinoma is associated with all of the following EXCEPT:

Activation of RAS. ***Activation of RAS*** - **RAS mutations** are relatively uncommon in gastric carcinoma compared to other gastrointestinal malignancies. While KRAS mutations can occur in approximately 10-15% of gastric cancers (particularly intestinal type), they are **far less frequent** than in **pancreatic adenocarcinoma** (~90%) or **colorectal carcinoma** (~40%). - In the context of gastric carcinoma, RAS pathway alterations are **not considered a major oncogenic driver** compared to the other molecular changes listed, making this the **LEAST characteristically associated** alteration. *Inactivation of p53* - **Inactivation of the p53 tumor suppressor gene** is one of the most frequent molecular events in gastric carcinoma, occurring in approximately **50-60% of cases**. - Loss of p53 function leads to genomic instability, uncontrolled cell proliferation, and resistance to apoptosis, contributing significantly to **tumorigenesis** and **poor prognosis**. *Over expression of C-met* - **Overexpression of C-MET**, a receptor tyrosine kinase for hepatocyte growth factor (HGF), is commonly observed in gastric carcinoma (30-40% of cases) and is strongly linked to **tumor growth**, **invasion**, and **metastasis**. - C-MET amplification and overexpression promote cell proliferation, survival, migration, and angiogenesis, making it an important **therapeutic target** in advanced gastric cancer. *Over expression of C-erb* - **Overexpression of C-erbB-2 (HER2/neu)** is found in approximately **10-20% of gastric adenocarcinomas**, particularly the intestinal type. - HER2 amplification or overexpression is a significant **prognostic and predictive biomarker**, and is specifically targeted by **trastuzumab** (Herceptin) therapy in HER2-positive advanced gastric cancer, improving survival outcomes.

Q: What is the most common type of mediastinal tumor?

Thymoma. ***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.

Q: Linitis plastica is a type of ?

Manifestation of gastric cancer. ***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.

Q: Localized Langerhans cell histiocytosis affecting head and neck is?

Eosinophilic granuloma. ***Eosinophilic granuloma*** - This is a localized form of **Langerhans cell histiocytosis** that typically presents in the head and neck region, often affecting areas like the skull and mandible [1]. - Characterized by **bone lesions** and may present with **pain or swelling** in the affected area, making it a prominent form in children and young adults. *Pulmonary langerhans cell histiocytosis* - Primarily affects the **lungs** and is associated with **cough, dyspnea**, and pulmonary nodules, not the head and neck region. - Occurs predominantly in **smokers** and involves interstitial lung disease patterns on imaging studies. *Hand-schuller-christian disease* - This condition is a systemic form of Langerhans cell histiocytosis that affects multiple systems rather than being localized, commonly presenting with **diabetes insipidus** and bone lesions. - It is often associated with **exophthalmos** and may involve lymphadenopathy, affecting older children and adults, not localized head and neck involvement. *Letterer-siwe disease* - This represents the acute, disseminated form of Langerhans cell histiocytosis, affecting infants, and is marked by systemic symptoms like **fever**, **rash**, and **hepatosplenomegaly** [1]. - Typically presents with serious manifestations and not specifically localized in the **head and neck area** as seen in eosinophilic granuloma. **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, p. 630.

Q: Flexner-Wintersteiner rosette is seen in-

Retinoblastoma. ***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.

Q: All are growth promoting oncogenes except ?

TGF-β. ***TGF-p*** - **TGF-p (Transforming Growth Factor beta)** is primarily known as a **growth inhibitory** factor rather than a promoting oncogene. - It plays a crucial role in **cell differentiation**, **apoptosis**, and inhibits cell proliferation, counteracting the effects of other oncogenes. *TGF-a* - **TGF-a (Transforming Growth Factor alpha)** is a **growth factor** that stimulates cell proliferation and is involved in various cancers [1][2]. - It binds to the **EGF receptor**, promoting growth and tumor development. *PDGF* - **PDGF (Platelet-Derived Growth Factor)** acts as a potent **mitogen** for connective tissue cells and is involved in wound healing and tumor growth [2][4]. - It plays a central role in promoting cell proliferation and migration, contributing to cancer progression [4]. *FGF* - **FGF (Fibroblast Growth Factor)** promotes mitosis and is crucial in **angiogenesis**, wound healing, and several developmental processes [2]. - Its overexpression is linked to various tumors, making it a significant oncogenic growth promoter [2][3]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. With Illustrations By, pp. 30-31. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, p. 292. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 292-293. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. With Illustrations By, pp. 31-32.

Q: Which of the following is the most common type of tongue cancer?

Squamous cell carcinoma. ***Adenocarcinoma most common*** - The most common type of tongue cancer is **squamous cell carcinoma (SCC)**, not adenocarcinoma [1]. - Adenocarcinomas are less frequently associated with the tongue compared to SCC, which constitutes the majority of cases. *Tobacco is the cause* - Tobacco use is indeed a **significant risk factor** for various head and neck cancers, including tongue cancer [1]. - Smoking and smokeless tobacco are linked to increased incidence and severity of **squamous cell carcinoma** on the tongue [1]. *Deep cervical lymph nodes not involved* - Tongue cancers often metastasize to **deep cervical lymph nodes**, particularly in advanced stages. - Involvement of lymph nodes is a common feature that can affect prognosis and treatment strategies. *Lateral surface involved* - The **lateral surface** of the tongue is a common site for cancerous lesions, especially in cases related to tobacco use. - Tumors might also arise from other surfaces, but lateral involvement is characteristic of **squamous cell carcinoma**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 738-739.

Q: Which of the following germ cell tumors is benign?

Dermoid cyst. ***Seminoma*** - Seminomas are well-known malignant **germ cell tumors**, primarily affecting young males [2]. - They are associated with elevated **human chorionic gonadotropin (hCG)** and can spread to lymph nodes [3]. *Leydig cell tumor* - These tumors are usually **benign** and arise from Leydig cells in the testes. - While they can produce **testosterone**, they do not typically exhibit malignancy. *Sertoli cell tumor* - Sertoli cell tumors are also generally **benign** and arise from Sertoli cells in the testes. - They lack the malignant behavior seen in seminomas and have a low rate of metastasis [1]. *Dermoid cyst* - Dermoid cysts are **benign** mature teratomas, commonly found in the ovaries or testicles. - They can contain different tissue types (like hair, fat, and teeth) but are not malignant. **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. 512-513. [2] 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. [3] 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.

Q: Which gene mutation is commonly associated with malignant melanoma?

CDKN2A. ***CDK2A*** - CDK2A mutations are implicated in malignant melanoma as they disrupt the **cell cycle regulation**, contributing to uncontrolled cell growth [1]. - Loss of CDK2A function leads to reduced **p16INK4A**, a crucial inhibitor of cyclin-dependent kinases involved in **G1/S phase transition** [1,3]. - Germline mutations of p16 (CDKN2A) are present in 25% of melanoma-prone kindreds [2], and germline mutations in CDKN2A are associated with familial forms of melanoma [3]. *RET* - RET mutations are primarily associated with **medullary thyroid carcinoma** and **multiple endocrine neoplasia type 2**, not melanoma. - It is involved in the signaling pathways but does not have a direct link to melanoma pathogenesis. *None* - Suggesting "none" misrepresents the reality that specific mutations do occur in malignant melanoma, including **CDK2A** and **BRAF**. - This option fails to recognize the importance of genetic alterations in cancer development and progression. *N-myc* - N-myc mutations are primarily associated with **neuroblastoma** and not typically linked to malignant melanoma. - In melanoma, mutations of this gene do not play a significant role in its pathophysiology compared to another tumor suppressor gene like **CDK2A**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, pp. 1150-1151. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 297-298. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 305-306.

Q: ER positive status in carcinoma breast indicates?

Prognosis. ***Prognosis*** - **ER positive status** in breast cancer indicates a better prognosis, as these tumors often respond well to hormone therapy [1][2]. - Patients with **ER positive** breast cancer usually have a lower risk of metastasis compared to **ER negative** tumors, making the outcome more favorable [1]. *Site* - ER status does not provide information regarding the **anatomical location** of the breast cancer, as it can be present in different sites of the breast. - It primarily focuses on the **biologic characteristics** of the tumor rather than its site of occurrence [1]. *None* - Selecting 'None' suggests that ER positive status has no relevance, which is incorrect as it is significant for treatment and prognosis [1]. - It is a crucial indicator for deciding on **endocrine therapy**, impacting management strategies in breast cancer patients [1]. *Etiology* - ER positive status does not directly indicate the **cause** of breast cancer, as various genetic and environmental factors contribute to its development. - It mainly reflects tumor behavior and response to therapies, not the **underlying factors** that lead to the disease [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1056. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1064-1066.

Question 1

Gastric carcinoma is associated with all of the following EXCEPT:

Accepted Answer

Activation of RAS

Answer

Over expression of C-met

Answer

Inactivation of p53

Answer

Over expression of C-erb

Question 2

What is the most common type of mediastinal tumor?

Accepted Answer

Thymoma

Answer

Lymphoma

Answer

Teratoma

Answer

Neurogenic tumor

Question 3

Linitis plastica is a type of ?

Accepted Answer

Manifestation of gastric cancer

Answer

Benign ulcer

Answer

GIST

Answer

Plastic-like appearance of stomach lining

Question 4

Localized Langerhans cell histiocytosis affecting head and neck is?

Accepted Answer

Eosinophilic granuloma

Answer

Letterer-siwe disease

Answer

Pulmonary Langerhans cell histiocytosis

Answer

Hand-Schuller-Christian disease

Question 5

Flexner-Wintersteiner rosette is seen in-

Accepted Answer

Retinoblastoma

Answer

Hepatoblastoma

Answer

Nephroblastoma

Answer

Neuroblastoma

Question 6

All are growth promoting oncogenes except ?

Accepted Answer

TGF-β

Answer

FGF

Answer

PDGF

Answer

TGF-α

Question 7

Which of the following is the most common type of tongue cancer?

Accepted Answer

Squamous cell carcinoma

Answer

Lymphoma

Answer

Adenocarcinoma

Answer

Basal cell carcinoma

Question 8

Which of the following germ cell tumors is benign?

Accepted Answer

Dermoid cyst

Answer

Seminoma

Answer

Embryonal carcinoma

Answer

Yolk sac tumor

Question 9

Which gene mutation is commonly associated with malignant melanoma?

Accepted Answer

CDKN2A

Answer

MYCN

Answer

RET

Answer

BRAF

Question 10

ER positive status in carcinoma breast indicates?

Accepted Answer

Prognosis

Answer

Etiology

Answer

Site

Answer

None of the options

Neoplasia — MCQs

Neoplasia — MCQs

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