Neoplasia Practice Questions

Q: Which immunohistochemical marker is primarily associated with glomus tumors?

CD-34. ***CD-34*** (Marked answer, but controversial) - **IMPORTANT NOTE:** This association is **contested** in modern pathology literature. - Glomus tumors are derived from modified smooth muscle cells of the glomus body and typically show **smooth muscle actin (SMA)** and **vimentin positivity**. - **CD34** is an endothelial marker; while glomus tumors have prominent vascularity, the **neoplastic glomus cells themselves** are generally **CD34-negative**. - The correct positive markers are **SMA, vimentin, and caldesmon** - none of which are options here. - Among the given options, CD-34 may show positivity in the **vascular endothelium** within the tumor, but this does not represent the tumor cells. *CD-57* - **CD57** (HNK-1) is associated with neural differentiation, particularly in peripheral nerve sheath tumors like **schwannoma** or **neurofibroma**. - Glomus tumors lack neural differentiation and are **CD57-negative**. *Cytokeratin* - **Cytokeratin** is a marker for epithelial cells and carcinomas. - Glomus tumors are mesenchymal smooth muscle tumors and are **cytokeratin-negative**. *S-100* - **S-100** protein marks neural crest-derived cells, melanomas, and schwannomas. - Glomus tumors originate from modified smooth muscle cells, not neural crest, and are typically **S-100-negative** (though rare cases may show focal weak positivity).

Q: Which of the following conditions is not typically associated with an underlying malignancy?

Paget disease of bone. ***Paget disease of bone*** - While Paget disease of bone can rarely undergo **malignant transformation** into **osteosarcoma**, it is itself a disorder of excessive bone remodeling and **not directly an underlying malignancy** like the other Paget diseases [2]. - The primary concern in Paget disease of bone is metabolic bone changes and potential complications like fractures, rather than being a superficial manifestation of internal cancer [2]. *Paget disease of nipple* - This condition is almost always associated with an **underlying ductal carcinoma in situ** or invasive adenocarcinoma of the breast [1]. - The epidermal changes are a manifestation of malignant cells migrating from the underlying breast tissue [1]. *Paget disease of vulva* - While it can occur as a primary intraepithelial neoplasm (adenocarcinoma in situ), approximately 20-30% of cases are associated with an **underlying invasive adenocarcinoma**, either vulvar or originating from other sites such as the colon, bladder, or urethra. - Its presence necessitates a thorough search for associated malignancies. *Paget disease of anal region* - Similar to vulvar Paget disease, it can be a primary intraepithelial adenocarcinoma, but it frequently is associated with an **underlying adenocarcinoma** of the colon, rectum, or anal glands. - Evaluation for an internal malignancy is crucial when this diagnosis is made. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1061-1062. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1191-1194.

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

Epidermoid. ***Epidermoid*** - **Epidermoid carcinoma** (also known as squamous cell carcinoma) is the most prevalent type of anal cancer, accounting for about 80% of all cases. - This type of cancer originates from the **squamous cells** that line the anal canal. *Adenocarcinoma* - **Adenocarcinoma** of the anus arises from the glandular cells of the anal glands or columnar epithelium located in the upper anal canal or rectum. - It accounts for a much smaller percentage of anal cancers compared to epidermoid carcinoma. *Mixed carcinoma* - **Mixed carcinoma** is a less common subtype that contains features of both squamous and glandular differentiation or other histological types. - It represents a minor proportion of anal malignancies. *Melanoma* - **Anal melanoma** is a very rare and aggressive form of anal cancer, originating from melanocytes in the anal region. - It accounts for less than 1% of all anal neoplasms.

Q: Which of the following is a benign tumor?

Fibromatosis. ***Fibromatosis*** - Fibromatosis is classified as a **benign fibrous tumor** [1][3], meaning it does not have the potential to metastasize. - It involves **proliferation of fibroblasts** [1] and is primarily characterized by local invasiveness rather than malignancy. *Askin's tumor* - Also known as **primitive neuroectodermal tumor (PNET)**, it is recognized as a **malignant tumor** commonly affecting the chest wall. - Associated with strong **aggressive behavior** and metastatic potential, particularly in pediatric populations. *Liposarcoma* - Liposarcoma is a malignant tumor arising from **adipose tissue** [2][3], exhibiting aggressive growth and potential for metastasis. - It is classified as a **soft tissue sarcoma** [2], with various subtypes depending on histological features [2]. *Chloroma* - Chloroma, or **myeloid sarcoma**, is a malignant tumor of **myeloid lineage cells** typically associated with acute myeloid leukemia (AML). - Characterized by the **extramedullary infiltration** of myeloid cells, leading to clinical aggressiveness. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1223-1224. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1222-1223. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1222.

Q: In which of the following locations is a carcinoid tumor most common?

Small bowel. ***Small bowel*** - The **small intestine**, particularly the **ileum**, is the **most common site** for carcinoid tumors (neuroendocrine tumors) in current medical literature [1]. - Small bowel carcinoids account for approximately **40-45%** of all gastrointestinal neuroendocrine tumors [1]. - These tumors can be associated with **carcinoid syndrome** when they metastasize to the liver, causing symptoms like flushing, diarrhea, and bronchospasm [3]. - Small bowel carcinoids tend to be **more aggressive** than appendiceal carcinoids and have a higher metastatic potential [2]. *Appendix* - Historically, the appendix was considered the most common site based on incidental findings during appendectomy. - Currently accounts for approximately **15-20%** of gastrointestinal neuroendocrine tumors. - Appendiceal carcinoids are usually **small, localized, and benign** with an excellent prognosis when discovered early [2]. *Stomach* - Gastric carcinoids account for approximately **7-8%** of gastrointestinal neuroendocrine tumors. - Often associated with **hypergastrinemia**, **chronic atrophic gastritis**, or **multiple endocrine neoplasia type 1 (MEN1)** syndrome [1]. - Can be classified into three types based on pathogenesis and clinical behavior. *Esophagus* - **Esophageal carcinoid tumors** are extremely rare, accounting for less than **1%** of gastrointestinal neuroendocrine tumors. - The esophagus is primarily associated with **squamous cell carcinoma** and **adenocarcinoma** rather than carcinoids. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 780-781. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 375-376. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 781-782.

Q: Somatic mutation of PTEN is seen in:

Endometrial carcinoma. ***Endometrial carcinoma*** - Somatic mutations of the **PTEN gene** are frequently associated with endometrial carcinoma, particularly in **type I endometrial cancers** [1]. - These mutations lead to **dysregulation of cellular pathways**, contributing to the development and progression of the tumor [1]. *Carcinoma breast* - While breast cancer can exhibit various mutations, including in genes like **BRCA1/2**, PTEN mutations are **not commonly associated**. - Breast cancers typically have a different **molecular profile**, including hormone receptor status that is not linked to PTEN. *Osteosarcoma* - Osteosarcoma's genetic alterations mainly involve **RB gene** and **TP53 mutations**, rather than changes in the PTEN gene. - The typical pathology does not involve the **loss of PTEN function**, making it an unlikely association with this mutation. *Retinoblastoma* - Retinoblastoma is primarily associated with mutations in the **RB1 gene**, not PTEN, and is linked to **hereditary patterns**. - PTEN mutations do not play a significant role in the pathogenesis of retinoblastoma, differentiating its genetic basis from that of endometrial carcinoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1015-1018.

Q: Thorium-induced tumor is which of the following?

Angiosarcoma of liver. ***Angiosarcoma of liver*** - Thorium exposure is specifically linked to the development of **angiosarcoma of the liver**, often seen in individuals with a history of thorium dioxide injection [1]. - This type of tumor arises from **vascular endothelial cells** and is highly aggressive, often leading to significant morbidity. *Lymphoma* - Lymphoma is associated with **immune system factors** and typically arises from lymphoid tissues, which do not correlate with thorium exposure. - **Hematological malignancies** such as lymphoma do not have a documented direct association with thorium as a causative agent. *Astrocytoma* - Astrocytomas originate from **glial cells** in the brain and are primarily influenced by genetic predispositions rather than environmental carcinogens like thorium. - There is no established relationship between **thorium exposure** and the incidence of brain tumors such as astrocytomas. *Renal cell carcinoma* - Renal cell carcinoma is commonly linked to **smoking, obesity**, and genetic factors rather than thorium exposure. - It does not have a recognized connection to thorium, which is more specifically associated with liver tumors. **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. 216-217.

Q: In the context of solid tumors, which is the most common site of metastasis?

Lung. ***Lung*** - The **lungs** are the most common site of metastasis for solid tumors overall due to their unique position in receiving 100% of the systemic venous return via the pulmonary circulation. - This makes the lungs the **first capillary bed** encountered by tumor cells entering the venous system from most primary sites. - Common primary tumors metastasizing to lung include **breast, colon, kidney, sarcomas, melanoma, head and neck, and thyroid cancers** [2]. - Found in approximately **30-40% of all cancer deaths** at autopsy. *Liver* - The **liver** is the **second most common** site for metastasis, particularly for gastrointestinal malignancies [1]. - Its dual blood supply (hepatic artery and portal vein) makes it highly susceptible, especially for tumors draining via the **portal circulation** (colon, pancreas, stomach). - Also a common site for breast, lung, and melanoma metastases. - Found in approximately 30-35% of cancer deaths at autopsy. *Bone* - **Bone metastases** are common with specific tumor types: breast, prostate, lung, kidney, and thyroid [3]. - While causing significant morbidity (pain, fractures, hypercalcemia), bone is **less frequent overall** compared to lung or liver when considering all solid tumors. *Brain* - **Brain metastases** occur primarily with lung cancer, breast cancer, melanoma, and renal cell carcinoma [1]. - The **blood-brain barrier** provides some protection, making brain a less common site overall. - Significant clinical impact but lower overall frequency compared to lung and liver. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 724-725. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 338-339. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 671-672.

Question 1

Which immunohistochemical marker is primarily associated with glomus tumors?

Accepted Answer

CD-34

Answer

Cytokeratin

Answer

S-100

Answer

CD-57

Question 2

Which of the following conditions is not typically associated with an underlying malignancy?

Accepted Answer

Paget disease of bone

Answer

Paget disease of vulva

Answer

Paget disease of anal region

Answer

Paget disease of nipple

Question 3

Which of the following is NOT a precancerous condition associated with bladder carcinoma?

Accepted Answer

Aniline dyes

Answer

Chronic ulcer

Answer

Schistosomiasis

Answer

Tuberculosis of the bladder

Question 4

What is the most common type of anal carcinoma?

Accepted Answer

Epidermoid

Answer

Adenocarcinoma

Answer

Mixed carcinoma

Answer

Melanoma

Question 5

Which of the following is a benign tumor?

Accepted Answer

Fibromatosis

Answer

Liposarcoma

Answer

Askin's tumor

Answer

Chloroma

Question 6

In which of the following locations is a carcinoid tumor most common?

Accepted Answer

Small bowel

Answer

Appendix

Answer

Esophagus

Answer

Stomach

Question 7

Somatic mutation of PTEN is seen in:

Accepted Answer

Endometrial carcinoma

Answer

Osteosarcoma

Answer

Carcinoma breast

Answer

Retinoblastoma

Question 8

Thorium-induced tumor is which of the following?

Accepted Answer

Angiosarcoma of liver

Answer

Lymphoma

Answer

Renal cell carcinoma

Answer

Astrocytoma

Question 9

In the context of solid tumors, which is the most common site of metastasis?

Accepted Answer

Lung

Answer

Bone

Answer

Liver

Answer

Brain

Question 10

Patient diagnosed with squamous cell intraepithelial lesion, which of the following has the highest risk for progression to carcinoma?

Accepted Answer

High grade squamous intraepithelial neoplasia

Answer

Low grade squamous intraepithelial neoplasia

Answer

Squamous intraepithelial neoplasia associated with HIV

Answer

Squamous intraepithelial neoplasia associated with HPV 16

Neoplasia — MCQs

Neoplasia — MCQs

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