Neoplasia Practice Questions

Q: Most common benign tumor of the stomach is?

Leiomyoma. ***Leiomyoma*** - **Leiomyomas** are the most frequently encountered benign tumors of the stomach, originating from the **smooth muscle layer** (muscularis propria) of the gastric wall [1]. - They are typically asymptomatic but can present with symptoms like **bleeding** or abdominal pain if large or ulcerated. *Adenoma* - Gastric adenomas are less common than leiomyomas and are considered **premalignant lesions**, often arising in the setting of chronic gastritis or intestinal metaplasia [1]. - They are characterized by **glandular dysplasia** and carry a risk of progression to adenocarcinoma [1]. *Lipoma* - **Lipomas** are benign tumors composed of **adipose tissue** and are relatively rare in the stomach compared to other benign gastric tumors. - They usually grow in the submucosal layer and are often asymptomatic unless they become large enough to cause obstruction or bleeding. *Hamartoma* - Gastric **hamartomas** are uncommonly found in the stomach and represent a disorganized overgrowth of mature tissue components normally present in the stomach wall. - They are benign but can be associated with certain **syndromes** like Peutz-Jeghers syndrome. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 354-355.

Q: Which tumor is not associated with von Hippel-Lindau disease?

Cholangiocarcinoma. ***Cholangiocarcinoma*** - Cholangiocarcinoma is a **bile duct cancer** that is not typically associated with **von Hippel-Lindau (VHL) disease**. - While VHL disease affects various organs through abnormal blood vessel growth, the **bile ducts** are not common sites for VHL-related tumors. *Hemangioblastoma of Cerebellum* - **Hemangioblastomas**, particularly in the **cerebellum**, are characteristic benign tumors strongly associated with **VHL disease**. - These tumors are highly vascular and linked to mutations in the **VHL tumor suppressor gene** [2]. *Renal Cell Carcinoma* - **Clear cell renal cell carcinoma** is a major manifestation of VHL disease due to a mutated **VHL gene**, which affects oxygen sensing and leads to tumor formation [1]. - Patients with VHL disease have a significantly increased risk of developing **renal cysts** and these specific kidney cancers. *Pheochromocytoma* - **Pheochromocytomas**, which are neuroendocrine tumors of the **adrenal medulla**, are a well-documented feature of VHL disease. - They produce **catecholamines** and can lead to hypertension and other symptoms related to hormonal excess. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 958-959. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 306-307.

Q: A 12-year-old child presented with a maxillary mass, which on further investigation showed the presence of a "starry sky appearance" in the biopsy. All of the following statements are true except:

More commonly seen in adults. ***More commonly seen in adults*** - Burkitt lymphoma predominantly occurs in children and young adolescents, especially in endemic forms associated with malaria [1]. - While it can appear in adults, its incidence is significantly lower compared to pediatric populations [1]. *This condition is due to c-Myc gene activation* - Burkitt lymphoma is characteristically associated with translocations involving the **c-Myc gene**, primarily t(8;14). - This genetic alteration leads to **uncontrolled cell proliferation**, a hallmark of the disease. *This is non-Hodgkin lymphoma* - Burkitt lymphoma is indeed classified as a **non-Hodgkin lymphoma**, arising from B-lymphoid cells [1]. - It is known for its aggressive behavior and association with the **"starry sky appearance"** seen on biopsy [1]. *Burkitt lymphoma* - The **starry sky appearance** is a classic histopathological feature of Burkitt lymphoma, indicating high proliferation rates [1]. - It commonly presents as a maxillary or abdominal mass in children, confirming its diagnosis in this scenario [1]. **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. 605-606.

Q: A 67-year-old male smoker presents with haemoptysis and cough. Bronchoscopic biopsy revealed an undifferentiated tumour. The immunohistochemical marker that can be most helpful is:

Cytokeratin. ***Cytokeratin*** - **Cytokeratin** is a **intermediate filament protein** found in epithelial cells and is a key marker for carcinomas, which are the most common type of lung cancer [1]. - Given the patient's history (smoker, haemoptysis) and an undifferentiated tumor, a **carcinoma** is highly probable, making cytokeratin the most helpful marker for classification [2]. *Vimentin* - **Vimentin** is an intermediate filament protein typically expressed in **mesenchymal cells** (e.g., sarcomas, lymphomas, melanoma). - Its presence would suggest a non-epithelial tumor, which is less likely in this clinical context of a lung mass in a smoker. *GGT* - **Gamma-glutamyl transpeptidase (GGT)** is an enzyme primarily used as a marker for **liver function** and bile duct obstruction. - It is not a tumor marker and has no role in the immunohistochemical diagnosis of an undifferentiated lung tumor. *Calretinin* - **Calretinin** is a nuclear and cytoplasmic protein that is a useful marker for **mesothelioma** and some other neuroendocrine tumors. - While mesothelioma can occur in the lung, it is less common than carcinoma, and calretinin would only be considered if mesothelioma was specifically suspected. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 334-337. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 720-721.

Q: What is the most common initial site for the spread of cancers?

Lymph Nodes. ***LN*** - Lymph nodes (LN) are the **primary site for metastatic spread** due to their role in filtering lymphatic fluid, making them a common initial site for cancer spread. - The presence of cancer cells in lymph nodes can indicate **lymphatic dissemination**, often correlating with advanced disease stages. *Brain* - While the **brain** can be affected by metastases, it is not the **commonest site** for initial spread of cancers compared to lymph nodes. - Metastasis to the brain typically occurs later in the disease process and is more common with certain cancers like melanoma or lung cancer. *Lungs* - The **lungs** are often involved in metastatic disease, but they are generally not the initial site of spread; rather, they serve as a common final destination for metastatic lesions [1]. - Lung involvement is usually detected in advanced cancer stages when multiple sites of metastasis have occurred. *Liver* - The **liver** is a common site for metastasis due to its extensive blood supply and involvement in circulation; however, it is not the first site where cancers typically spread [1]. - Liver metastases often arise later in the course of a malignancy and are usually a result of dissemination from other primary sites. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, p. 282.

Q: Which of the following statements about Psammoma bodies is false?

Seen in teratoma. ***Seen in teratoma*** - **Psammoma bodies** are not typically found in teratomas; they are more commonly associated with other tumors such as meningiomas and papillary thyroid carcinoma. - Teratomas usually consist of differentiated tissues from all three germ layers, and do not exhibit the characteristic **laminated** appearance of psammoma bodies. *Seen in meningioma* - **Meningiomas** are indeed associated with psammoma bodies, which appear as laminated calcified structures [1]. - These bodies signify **calcium deposition** and are a pathological feature of certain tumors, particularly **meningeal** tumors [1]. *Contains Calcium deposits* - Psammoma bodies are known for their **calcium deposits**, characterized by their laminated structure [1]. - They represent focal areas of calcification within tumors, particularly in conditions like **meningiomas** and **thyroid papillary carcinoma**. *Concentric whorled appearance* - Psammoma bodies display a **concentric** laminated appearance, often described as **whorled layers**. - This histopathological feature is a distinguishing characteristic of psammoma bodies in confirmed tumors. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1316-1317.

Q: Which of the following is the strongest predisposing factor for testicular germ cell tumors?

Previous testicular germ cell tumor. ***Previous testicular germ cell tumor*** - A previous diagnosis of a **testicular germ cell tumor** is the strongest risk factor for developing a new, contralateral tumor. - This risk is significantly higher than that associated with other predisposing factors. *Testicular feminization syndrome* - While **gonadal dysgenesis** conditions like **androgen insensitivity syndrome** (sometimes referred to as testicular feminization syndrome) can increase the risk of gonadal tumors, it is not the strongest factor compared to a prior cancer history. - The risk is related to the presence of **undescended testes** or dysgenetic gonads within these syndromes. *Family history of testicular cancer* - A **family history** of testicular cancer does increase the risk, suggesting a genetic predisposition. - However, this risk is generally lower than the risk associated with having already had one testicular germ cell tumor. *Cryptorchidism* - **Cryptorchidism** (undescended testis) is a well-established risk factor for testicular germ cell tumors, with the risk increasing the higher the position of the testis [1], [2]. - Despite this, the risk associated with a history of cryptorchidism is still less potent than having a prior testicular cancer [1]. **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. 508-509. [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. 976-977.

Q: What is the most common site of esophageal cancer?

Middle 1/3rd. ***Lower 1/3rd*** - The most common site for **esophageal cancer** is indeed the **lower third** of the esophagus, often correlating with the gastroesophageal junction [1]. - This area is associated with **risk factors** such as **gastroesophageal reflux disease (GERD)** and **Barrett's esophagus**, which can lead to adenocarcinoma [1]. *Middle 1/3 rd* - While esophageal cancer can occur here, it is significantly **less common** than in the lower third. - Typically, squamous cell carcinoma is more prevalent in the middle third [2], but not as frequent as adenocarcinoma in the lower third. *Upper 1/3 rd* - Similar to the middle third, it has a **lower incidence** of esophageal cancer compared to the lower segment. - This section is more frequently affected by **squamous cell carcinoma**, especially associated with factors like tobacco and alcohol use. *Lower end of esophagus* - While it may seem specific, it does not highlight the **most common site** as comprehensively as "lower 1/3rd," which encompasses adenocarcinoma risk factors. - This phrasing may confuse with the **anatomical definition**, as it doesn't clearly denote a region but rather a terminological description. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 765-766. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 766-767.

Q: Signet ring cells are characteristically seen in which ovarian tumor?

Krukenberg tumor. ***Krukenberg tumor*** - The **signet ring appearance** is classically associated with Krukenberg tumors, which are metastatic tumors of the ovary often arising from gastric cancer [1]. - These tumors contain **mucin-filled cells** that resemble signet rings when viewed histologically [1]. *Teratoma* - Teratomas contain **multiple cell types** and may have various appearances, but they do not typically exhibit a signet ring configuration [3]. - More characteristic findings include **dermoid cysts** or tissue types from all three embryonic layers [3]. *Granulosa cell tumor* - Granulosa cell tumors are primarily characterized by **hormonal activity**, producing estrogen, and do not display signet ring cells. - Histologically, they are defined by **Call-Exner bodies** and small follicles rather than signet ring morphology. *Dysgerminoma* - Dysgerminomas, a type of germ cell tumor, typically show **solid sheets of uniform cells** without the signet ring feature [2]. - They are more associated with **lymphocytic infiltration** and often elevate serum levels of **LDH** [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 779. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1034-1035. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 480-481.

Question 1

Most common benign tumor of the stomach is?

Accepted Answer

Leiomyoma

Answer

Lipoma

Answer

Hamartoma

Answer

Adenoma

Question 2

Which tumor is not associated with von Hippel-Lindau disease?

Accepted Answer

Cholangiocarcinoma

Answer

Renal Cell Carcinoma

Answer

Pheochromocytoma

Answer

Hemangioblastoma of Cerebellum

Question 3

Familial retinoblastoma is characterized by which of the following statements?

Accepted Answer

Has autosomal dominant inheritance

Answer

Due to mutations in the RB1 gene

Answer

Less common than sporadic retinoblastoma

Answer

More commonly bilateral

Question 4

A 12-year-old child presented with a maxillary mass, which on further investigation showed the presence of a "starry sky appearance" in the biopsy. All of the following statements are true except:

Accepted Answer

More commonly seen in adults

Answer

This is non-Hodgkin lymphoma

Answer

This condition is due to c-Myc gene activation

Answer

This is Burkitt lymphoma

Question 5

A 67-year-old male smoker presents with haemoptysis and cough. Bronchoscopic biopsy revealed an undifferentiated tumour. The immunohistochemical marker that can be most helpful is:

Accepted Answer

Cytokeratin

Answer

Vimentin

Answer

GGT

Answer

Calretinin

Question 6

What is the most common initial site for the spread of cancers?

Accepted Answer

Lymph Nodes

Answer

Liver

Answer

Lungs

Answer

Brain

Question 7

Which of the following statements about Psammoma bodies is false?

Accepted Answer

Seen in teratoma

Answer

Contains Calcium deposits

Answer

Concentric whorled appearance

Answer

Seen in meningioma

Question 8

Which of the following is the strongest predisposing factor for testicular germ cell tumors?

Accepted Answer

Previous testicular germ cell tumor

Answer

Testicular feminization syndrome

Answer

Family history of testicular cancer

Answer

Cryptorchidism

Question 9

What is the most common site of esophageal cancer?

Accepted Answer

Middle 1/3rd

Answer

Entire Esophagus

Answer

Lower 1/3rd

Answer

Upper 1/3rd

Question 10

Signet ring cells are characteristically seen in which ovarian tumor?

Accepted Answer

Krukenberg tumor

Answer

Dysgerminoma

Answer

Granulosa cell tumor

Answer

Teratoma

Neoplasia — MCQs

Neoplasia — MCQs

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