Neoplasia Practice Questions

Q: Which of the following is a marker for colorectal carcinoma?

CEA. ***CEA*** - **Carcinoembryonic antigen (CEA)** is a tumor marker commonly used for monitoring **colorectal carcinoma** recurrence and assessing treatment response. - Elevated CEA levels are often seen in patients with colorectal cancer, particularly in advanced stages or metastatic disease. *AFP* - **Alpha-fetoprotein (AFP)** is primarily a marker for **hepatocellular carcinoma** and germ cell tumors (e.g., testicular or ovarian tumors). - It is not routinely used as a marker for colorectal carcinoma. *CA-125* - **Cancer antigen 125 (CA-125)** is predominantly a marker for **ovarian cancer**. - While it can be elevated in other conditions, including some gastrointestinal malignancies, it is not the primary marker for colorectal carcinoma. *HCG* - **Human chorionic gonadotropin (HCG)** is a hormone primarily associated with **pregnancy** and is also used as a tumor marker for **germ cell tumors** (e.g., choriocarcinoma, testicular cancer). - It is not a marker for colorectal carcinoma.

Q: Which one of the following statements is true about cystosarcoma phylloides?

It is usually bulky and may fungate through the skin. ***It is usually bulky and may fungate through the skin*** - **Cystosarcoma phylloides** (also known as phyllodes tumor) are characterized by their rapid growth and tendency to become **very large**, often leading to the skin becoming stretched, thin, and potentially **ulcerated or fungating**. - Their rapid, expansive growth patterns contribute to their bulky appearance, which can be alarming to patients and clinicians. *It is a malignant tumour* - While it can be malignant, **the majority of phyllodes tumors are benign (60-75%)**; about 20-25% are borderline, and only 10-15% are frankly malignant. - Therefore, stating it "is a malignant tumor" is inaccurate, as it implies all tumors of this type are malignant. *It often metastasises to axillary nodes* - **Metastasis to regional lymph nodes, including axillary nodes, is rare** even in malignant phyllodes tumors [1]. - When metastasis occurs, it typically involves **hematogenous spread** to distant sites like the lungs, bone, and liver, rather than lymphatic spread [1], [2]. *It is treated by radical mastectomy* - **Radical mastectomy is generally not the primary treatment** for phyllodes tumors. The preferred treatment is **wide local excision** with clear margins due to the tumor's tendency for local recurrence [1]. - For very large or recurrent tumors, or those with significant suspicion of malignancy, a simple mastectomy may be performed, but **radical mastectomy is reserved for invasive breast cancer** and rarely indicated for phyllodes tumors [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1074. [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 type of thyroid carcinoma is least likely to exhibit lymph node metastasis?

Follicular Thyroid Carcinoma. **Follicular Thyroid Carcinoma** - This type predominantly spreads hematogenously, meaning via the **bloodstream**, to distant sites such as bone, lung, and brain, rather than through lymphatics [1]. - While local invasion can occur, **lymph node metastasis** is uncommon and less frequent compared to papillary and medullary thyroid carcinomas [1]. *Medullary Thyroid Carcinoma* - This is an aggressive neuroendocrine tumor that frequently metastasizes to regional **lymph nodes** early in its course [1]. - It often presents with **cervical lymphadenopathy** at the time of diagnosis, indicating widespread lymphatic involvement [1]. *Anaplastic Thyroid Carcinoma* - This is an undifferentiated and highly aggressive carcinoma with a very poor prognosis, characterized by rapid growth and extensive local invasion and early **distant metastasis** [1]. - Although it can involve lymph nodes, its aggressive nature more commonly leads to direct invasion of surrounding structures and widespread systemic dissemination, making **lymph node metastasis** a less defining feature compared to its overall aggressiveness and distant spread [1]. *Papillary Thyroid Carcinoma* - This is the most common type of thyroid cancer and is well-known for its propensity to spread via the **lymphatic system** to regional lymph nodes, sometimes even presenting with palpable nodes in the neck [1]. - **Lymph node involvement** is a common initial presentation and is a significant factor in prognosis and treatment planning [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 428-431.

Q: A 77-year-old man has a lesion on the right side of his face that has enlarged slowly over the past 5 years. On examination, the 3-cm lesion has irregular borders, irregular brown to black pigmentation, and a central 2-mm raised blue-black nodule. The lesion is resected and microscopically shows radial growth of large round malignant cells, some isolated and others in nests in the epidermis and superficial papillary dermis. The cells have prominent red nucleoli and dust-like cytoplasmic pigment. Which mutated gene is most likely to be present in the skin lesion of this man?

BRAF. ***BRAF*** - The presence of **irregular pigmentation** and characteristics of melanoma suggest an association with mutations, particularly in the **BRAF gene**, often seen in **cutaneous melanoma** [1,2]. - BRAF mutations are commonly involved in **cell proliferation** and survival pathways that contribute to the malignant behavior of melanoma cells [1]. *TYR* - TYR (tyrosinase) is primarily involved in **melanin synthesis** and is not directly implicated in melanoma pathogenesis. - Although mutations may affect pigmentation, they do not correlate with increased tumorigenicity seen in melanoma. *ATM* - ATM (Ataxia Telangiectasia Mutated) is related to **DNA repair mechanisms** and is more associated with predisposition to **other cancers** rather than directly involved with melanoma. - It does not account for the specific features of **BRAF mutation** in melanoma progression. *NF1* - NF1 (Neurofibromatosis type 1) mutations are associated with neurofibromas and possibly with a predisposition to certain types of **malignancies**, but not primarily to **melanomas**. - The clinical presentation does not support an NF1 mutation considering the distinct features of the lesion described. **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. The Skin, pp. 1152-1153.

Q: Renal cell carcinoma is characterized by which of the following histopathological features?

Clear cell morphology with abundant cytoplasm. ***Invades Renal Vein*** - **Renal cell carcinoma** is known for **venous invasion**, particularly involving the renal vein, which can lead to **thrombus formation** [1][2]. - This feature is significant for staging and prognosis, often indicating **advanced disease** [2]. *Hematuria usually absent* - **Hematuria** is often present in renal cell carcinoma, contrary to this assertion. - The presence of **blood in urine** is a common symptom that can raise suspicion for malignancy. *Arises from proximal convoluted tubule* - While renal cell carcinoma originates from the **epithelial cells**, it primarily arises from the **proximal tubule**, but this option lacks the specificity related to its histopathology. - More accurately, the clear cell type is the most common variant associated with this tumor [1]. *More common in females* - Renal cell carcinoma is actually more prevalent in **males**, contradicting this statement. - The male-to-female ratio is approximately **2:1**, making it less common in females. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 959-961. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 492-493.

Q: Which of the following tumors is most commonly associated with perineural spread?

Adenoid cystic carcinoma. ***All of the above*** - Perineural spread is associated with multiple tumor types, including **adenoid cystic carcinoma** and **mucoepidermoid carcinoma**, confirming each can exhibit this feature [1]. - This spread presents significant clinical implications, as tumors that migrate along nerve sheaths tend to show **aggressive behavior** and increased risk of recurrence. *Adenoid cystic carcinoma* - While it is known to have perineural invasion as a feature, it is not the only tumor associated with this mechanism [1]. - This carcinoma often presents with **slow-growing masses** and a characteristic **cribriform pattern** histologically, but does not encompass all cases. *Keratoacanthoma* - Typically presents as a **rapidly growing squamous cell carcinoma** variant with a **central keratin plug** and does not commonly exhibit perineural invasion. - It shows a benign course compared to tumors associated with perineural spread. *Mucoepidermoid carcinoma* - This tumor also can demonstrate **perineural invasion**, but it is just one of several tumor types known for this characteristic [1]. - Its risk of perineural spread highlights its **diverse histological features**, yet it is not representative of all cases. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 753-755.

Q: What does the term 'Stage M' indicate in colon cancer according to the TNM staging system?

Distant metastasis to the liver.. ***Local extension to serosa and lymph nodes.*** - Stage M in colon cancer indicates **involvement beyond the primary tumor**, typically affecting the **serosa** and nearby **lymph nodes**. - This stage represents **regional spread** rather than distant metastases, making it a critical point in cancer staging [1]. *Local extension to mucosa.* - This refers to early disease confined to the **innermost layer** of the colon and does not denote advanced disease like Stage M. - It reflects the **initial stages** of colon cancer, not involving lymphatic or serosal spread. *Local extension to serosa.* - While it indicates some **local progression**, it does not encompass the involvement of **lymph nodes**, which is essential for Stage M. - It misses a critical component of the classification, as it is not just about serosal involvement alone. *Metastasis to the liver.* - This describes **distant metastatic spread**, which is categorized beyond local extension and is indicative of a more advanced stage than M. - Stage M specifically refers to local disease rather than **distant metastasis**, such as to the liver. **References:** [1] 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. 236-237.

Q: Commonest primary site of Krukenberg tumour is:

Stomach. ***Stomach*** - The **stomach** is the most frequent primary site for the metastatic adenocarcinoma that gives rise to a **Krukenberg tumor** in the ovary [1]. - Gastric adenocarcinomas, particularly **diffuse-type gastric cancer** (including signet ring cell carcinoma), often spread to the ovaries via the peritoneal cavity or lymphatic routes [1]. *Breast* - While breast cancer can metastasize to the ovaries, it is a **less common primary source** for Krukenberg tumors compared to gastric cancer. - Breast carcinoma metastases to the ovary generally do not have the classic **signet-ring cell morphology** characteristic of Krukenberg tumors. *Colon* - **Colorectal cancer** is another potential primary source, but it accounts for a **smaller percentage** of Krukenberg tumors than gastric cancer. - Ovarian metastases from colonic carcinoma might have different histological features than the typical signet ring cells. *Small intestine* - Metastatic tumors to the ovary from the **small intestine** are **rare**, making it an unlikely primary site for a Krukenberg tumor. - Primary adenocarcinomas of the small intestine are themselves uncommon compared to those of the colon or stomach. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 779.

Q: Which HPV oncoprotein initiates cervical carcinogenesis primarily by inactivating the p53 tumor suppressor?

E6. ***E6*** - **E6 oncoprotein is the HPV protein that specifically targets and degrades p53** through ubiquitin-mediated proteolysis [2]. - **p53 degradation** prevents apoptosis and allows cells with damaged DNA to survive and proliferate, a critical early step in malignant transformation [3]. - E6 works synergistically with E7 in cervical carcinogenesis, but **E6 is uniquely responsible for p53 inactivation** [1]. *E3* - HPV does not have a clinically significant E3 oncoprotein in the context of cervical cancer pathogenesis. - This is not a major viral oncoprotein involved in malignant transformation. *E5* - **E5 oncoprotein** plays a minor role in early infection by enhancing growth factor receptor signaling. - It does **not target p53** and is often lost during viral integration, making it less critical for malignant progression. *E7* - **E7 oncoprotein targets the retinoblastoma protein (Rb)**, not p53 [1]. - Rb inactivation releases E2F transcription factors, driving cell cycle progression [1]. - E7 and E6 work together, but **E7's specific target is Rb, not p53** [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 334-335. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1006-1007. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 303-304.

Q: Which of the following is a characteristic feature of endodermal sinus tumor?

Presence of Schiller-Duval bodies. **Presence of Schiller-Duval bodies** - **Schiller-Duval bodies** are pathognomonic histological structures found in **yolk sac tumors (endodermal sinus tumors)**. - They consist of a central capillary surrounded by tumor cells within a space, resembling a glomerulus. *Presence of Call-Exner bodies* - **Call-Exner bodies** are characteristic of **granulosa cell tumors** of the ovary. - They are small, follicle-like structures with a central eosinophilic fluid and granulosa cells arranged peripherally. *Presence of Homer-Wright rosettes* - **Homer-Wright rosettes** are typically seen in **neuroblastoma** and **medulloblastoma**. - These rosettes are characterized by a central fibrous space surrounded by tumor cells with surrounding nuclei, but without a lumen. *Presence of Psammoma bodies* - **Psammoma bodies** are concentric, lamellated calcified structures found in various tumors, including **papillary thyroid carcinoma**, **meningioma**, and **serous papillary ovarian carcinoma**. - Their presence indicates a neoplastic process but is not specific to endodermal sinus tumors.

Question 1

Which of the following is a marker for colorectal carcinoma?

Accepted Answer

CEA

Answer

AFP

Answer

CA-125

Answer

HCG

Question 2

Which one of the following statements is true about cystosarcoma phylloides?

Accepted Answer

It is usually bulky and may fungate through the skin

Answer

It is a malignant tumour

Answer

It often metastasises to axillary nodes

Answer

It is treated by radical mastectomy

Question 3

Which type of thyroid carcinoma is least likely to exhibit lymph node metastasis?

Accepted Answer

Follicular Thyroid Carcinoma

Answer

Anaplastic Thyroid Carcinoma

Answer

Medullary Thyroid Carcinoma

Answer

Papillary Thyroid Carcinoma

Question 4

A 77-year-old man has a lesion on the right side of his face that has enlarged slowly over the past 5 years. On examination, the 3-cm lesion has irregular borders, irregular brown to black pigmentation, and a central 2-mm raised blue-black nodule. The lesion is resected and microscopically shows radial growth of large round malignant cells, some isolated and others in nests in the epidermis and superficial papillary dermis. The cells have prominent red nucleoli and dust-like cytoplasmic pigment. Which mutated gene is most likely to be present in the skin lesion of this man?

Accepted Answer

BRAF

Answer

ATM

Answer

NF1

Answer

TYR

Question 5

Renal cell carcinoma is characterized by which of the following histopathological features?

Accepted Answer

Clear cell morphology with abundant cytoplasm

Answer

Nested/alveolar growth pattern

Answer

High nuclear grade with prominent nucleoli

Answer

Rich capillary network

Question 6

Which of the following tumors is most commonly associated with perineural spread?

Accepted Answer

Adenoid cystic carcinoma

Answer

Mucoepidermoid carcinoma

Answer

Keratoacanthoma

Answer

Basal cell carcinoma

Question 7

What does the term 'Stage M' indicate in colon cancer according to the TNM staging system?

Accepted Answer

Distant metastasis to the liver.

Answer

Local extension to serosa and lymph nodes.

Answer

Local extension to serosa only.

Answer

Local extension to mucosa.

Question 8

Commonest primary site of Krukenberg tumour is:

Accepted Answer

Stomach

Answer

Breast

Answer

Colon

Answer

Small intestine

Question 9

Which HPV oncoprotein initiates cervical carcinogenesis primarily by inactivating the p53 tumor suppressor?

Accepted Answer

E6

Answer

E3

Answer

E5

Answer

E7

Question 10

Which of the following is a characteristic feature of endodermal sinus tumor?

Accepted Answer

Presence of Schiller-Duval bodies

Answer

Presence of Call-Exner bodies

Answer

Presence of Homer-Wright rosettes

Answer

Presence of Psammoma bodies

Neoplasia — MCQs

Neoplasia — MCQs

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