Neoplasia — MCQs

Neoplasia Indian Medical PG Practice Questions and MCQs

Question 951: Commonest histological type of germ cell tumor of the testis is:

A. Teratoma
B. Yolk sac tumour
C. Seminoma (Correct Answer)
D. Choriocarcinoma

Explanation: ***Seminoma*** - Seminomas are the most common type of testicular cancer, accounting for approximately **30-50%** of cases in adults [1]. - They are typically sensitive to **radiation therapy**, making treatment effective [1]. *Yolk sac tumour* - This type is more common in **children** and is less frequently seen in adults with testicular cancer [1]. - While aggressive, it represents a **distinct histological type** among germ cell tumors, but not the most common. *Teratoma* - Teratomas can be found in testicular cancers, but are less common as the **sole histological type** in adults [1]. - They often contain multiple germ layers and may present later than seminomas, which are typically diagnosed earlier. *Choriocarcinoma* - This is a rare and aggressive form of testicular cancer often associated with other germ cell tumors, making it less common overall [2]. - Characterized by **elevated beta-hCG levels**, it generally does not present as the primary histological type [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 979-982. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 510-512.

Question 952: What is the most precancerous condition associated with an increased risk of carcinoma of the colon?

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

Explanation: ***Familial polyposis*** - This condition, more accurately known as **Familial Adenomatous Polyposis (FAP)**, is characterized by hundreds to thousands of adenomatous polyps in the colon. [1] - The risk of developing **colorectal carcinoma** in FAP patients approaches 100% by age 30-40 if left untreated, making it the most significant pre-cancerous condition. [1] *Hamartomatous polyps* - These polyps are malformations of normal tissue components, not neoplastic growths, and generally have a **low malignant potential**. - While certain hamartomatous polyposis syndromes (e.g., Peutz-Jeghers syndrome) carry an increased cancer risk, solitary hamartomatous polyps rarely transform into carcinoma. [2] *Juvenile polyps* - These are a type of **hamartomatous polyp** found predominantly in children, often presenting with rectal bleeding. [2] - They are typically benign and have a **very low malignant potential**, especially when solitary. [2] *Hyperplastic polyps* - These are common, small, and usually located in the rectosigmoid colon, composed of well-differentiated epithelial cells with a "saw-tooth" appearance. - They are generally considered **benign** and do not carry a significant risk of malignant transformation. [1] **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 821-822. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 814-815.

Question 953: What is the most common site of lymphangiosarcoma?

A. Liver
B. Spleen
C. Post-mastectomy lymphedema of the arm (Correct Answer)
D. Retroperitoneum

Explanation: ***Post-mastectomy lymphedema of the arm*** - Lymphangiosarcoma is a rare, aggressive malignancy that most commonly arises in the setting of **chronic lymphedema**, particularly following **radical mastectomy** for breast cancer [1]. - The chronic lymphedema, often in the arm, creates a microenvironment conducive to the development of this vascular malignancy, known as **Stewart-Treves syndrome**. *Liver* - While the liver can be a site of various primary and metastatic cancers, it is not the most common location for **lymphangiosarcoma**. - Primary liver cancers are typically **hepatocellular carcinoma** or **cholangiocarcinoma**. *Spleen* - The spleen is rarely a primary site for any sarcoma and is not typically associated with the development of **lymphangiosarcoma**. - Splenic involvement usually indicates metastatic disease or a primary **lymphoid malignancy**. *Retroperitoneum* - The retroperitoneum can be a site for various soft tissue sarcomas, such as **liposarcoma** or **leiomyosarcoma** [2]. - However, it is not the most common primary site for **lymphangiosarcoma**, which has a strong predilection for areas of chronic lymphedema. **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. 125-126. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1222.

Question 954: The most common type of rhabdomyosarcoma is

A. Embryonal (Correct Answer)
B. Alveolar
C. Pleomorphic
D. Spindle cell

Explanation: ***Embryonal*** - The most common type of **rhabdomyosarcoma**, primarily affecting **children**, presenting with symptoms based on its site of origin. - Typically associated with a **better prognosis** compared to other types [1], commonly found in the **head and neck**, urinary tract, or retroperitoneum. *Inflammatory* - Inflammatory rhabdomyosarcoma is a rare variant and not considered common, often involving **inflammatory reactions** rather than pure sarcoma features. - This type generally does not match the typical presentation or histology associated with **rhabdomyosarcoma**. *Pleomorphic* - Pleomorphic rhabdomyosarcoma is characterized by a **diverse morphological appearance**, typically observed in adults, making it less common in the pediatric population. - This variant is associated with a **poor prognosis** [1] and is rarely the most common type in the demographic affected. *Alveolar* - Alveolar rhabdomyosarcoma usually presents in adolescents [2] and is characterized by **alveolar structures**; it is not the most prevalent type among rhabdomyosarcomas. - This type is associated with a more aggressive behavior and poorer outcomes, distinguishing it from the more common embryonal form. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1224-1225. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1222.

Question 955: Which of the following best describes a teratoma?

A. Occurs most commonly in gonadal regions and along the midline.
B. Can originate from any of the three germ layers.
C. Often asymptomatic, but may cause discomfort depending on size.
D. A tumor containing tissues from all three germ layers: ectoderm, mesoderm, and endoderm. (Correct Answer)

Explanation: ***Hamartous developmental manifestation consisting of three different layers*** - Teratomas are indeed tumors that originate from **all three germ layers**: ectoderm, mesoderm, and endoderm, leading to a complex tissue composition [1][2]. - They can contain a variety of differentiated tissues, including **hair, teeth, and muscle**, reflecting their pluripotent nature [1]. *Can originate from any of the three germ layers.* - While teratomas involve all three germ layers [1], they **do not originate** from just one of them; they are a combination rather than a singular origin. - This option misinterprets the **nature** of teratomas as merely arising from a specific layer. *Occurs most commonly in gonadal and midline locations.* - Although teratomas are indeed found in the **gonads**, especially in young adults, this statement inaccurately emphasizes location over the tumor's core defining feature. - The defining characteristic of teratomas is their **complex tissue composition** [1], not their location. *Often asymptomatic, but can be associated with pain in some cases.* - While some teratomas can be asymptomatic, the statement fails to define them properly as tumors containing **multiple tissue types**. - The potential for associated pain does not capture the essential **histological nature** of teratomas, which is their origin from all germ layers [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 480-481. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1033-1034.

Question 956: Which phase of the cell cycle is most sensitive to radiotherapy?

A. M phase (Correct Answer)
B. G1 phase
C. S phase
D. G2 phase

Explanation: ***M phase*** - Cells in the **M phase** (mitosis) are generally the most sensitive to radiation-induced damage due to their condensed chromosomes and active processes of chromosome segregation [2]. - DNA in the M phase is highly accessible and vulnerable to breaks, making it difficult for the cell to repair damage before division. *G1 phase* - The **G1 phase** is relatively radioresistant because the cell has ample time to repair DNA damage before DNA replication [1]. - Cells are actively growing and performing normal functions, with chromosomes in a decondensed state. *S phase* - The **S phase**, during which DNA synthesis occurs, is intermediate in terms of radiosensitivity. - While DNA is being replicated, there are active repair mechanisms, making it more resistant than M phase but less than G1. *G2 phase* - The **G2 phase** is generally considered the second most radiosensitive phase, as DNA has been replicated but the cell is preparing for mitosis and has less time for repair before division. - Radiation damage during G2 can disrupt the fidelity of chromosome distribution in the upcoming M phase. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 302-303. [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. 112-113.

Question 957: The lung carcinoma most common in non-smokers is?

A. Large cell
B. Adenocarcinoma (Correct Answer)
C. Small cell carcinoma
D. Squamous cell carcinoma

Explanation: ***Adenocarcinoma*** - **Adenocarcinoma** is the most common lung cancer histology type found in non-smokers, often associated with **female gender** and **younger age** demographics. - Frequently linked to **environmental factors** like exposure to radon and air pollution, rather than smoking. *Large cell* - This type is generally associated with **poor differentiation** and higher rates of metastasis, but not specifically prevalent in non-smokers. - Often arises in **smokers**, reflecting a different epidemiological profile compared to adenocarcinoma. *Squamous cell carcinoma* - Strongly correlated with **cigarette smoking** [1] and typically originates from the **central airways**. - Commonly associated with **keratinization**, making it less frequent in the non-smoking population. *Small cell carcinoma* - Most commonly seen in **heavy smokers**, characterized by **rapid growth** and **early metastasis**. - It does not represent the predominant type in non-smokers, further supporting adenocarcinoma as the most common in that group. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 336-337.

Question 958: About Langerhans cell histiocytosis, all are true EXCEPT:

A. Gonadal involvement occurs (Correct Answer)
B. Peak incidence less than 3 years of age
C. Diffuse form is known as Letterer-Siwe disease
D. Radiosensitive

Explanation: ***Gonadal involvement occurs*** - **Gonadal involvement is not characteristic** of Langerhans cell histiocytosis, which primarily affects bones, skin, and organs like the liver and lungs. - The condition typically presents with lesions in areas such as the skull, vertebrae, and lungs, rather than the gonads. *Diffuse form is known as litter-sewe-disease* - The diffuse form of Langerhans cell histiocytosis is indeed known as **Letterer-Siwe disease**, but this option is misleading as it uses an incorrect term. - Letterer-Siwe disease is a severe variant occurring in infants, presenting with systemic symptoms, which is distinct from gonadal involvement. *Peak incidence less than 3 years of age* - Langerhans cell histiocytosis does peak in incidence in **young children**, typically under the age of 3, making this statement true for the condition. - Common manifestations include **bone pain**, skin lesions, and lymphadenopathy in this age group. *Radiosensitive* - This condition is not considered **radiosensitive**; it usually requires chemotherapy for treatment rather than radiation. - Treatment effectiveness does not primarily depend on radiation therapy, as the lesions are often resistant to radiation. [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, p. 630.

Question 959: Which one of the following is an important tumor marker in the diagnosis of endodermal sinus tumor?

A. Alpha-fetoprotein (Correct Answer)
B. HCG
C. CA-125
D. LDH

Explanation: ***Alpha-fetoprotein*** - **Alpha-fetoprotein (AFP)** is consistently elevated in patients with **endodermal sinus tumor (yolk sac tumor)**, making it a crucial diagnostic marker. - The tumor cells produce AFP, reflecting their differentiation towards embryonic yolk sac structures. *HCG* - **Human chorionic gonadotropin (HCG)** is primarily associated with **choriocarcinoma** and other germ cell tumors like mixed germ cell tumors containing choriocarcinoma components [1],[2]. - While some germ cell tumors can co-express HCG and AFP, AFP is the dominant and most specific marker for endodermal sinus tumors. *CA-125* - **CA-125** is a widely used tumor marker for **epithelial ovarian cancer**. - It is not typically elevated in germ cell tumors such as endodermal sinus tumors. *LDH* - **Lactate dehydrogenase (LDH)** can be elevated in various cancers, including some germ cell tumors, reflecting high tumor burden and rapid cell turnover. - However, LDH is a **non-specific marker** and not as specific for endodermal sinus tumor as AFP. **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 Female Genital Tract, pp. 1035-1036.

Question 960: Regarding anaplastic thyroid carcinoma, which of the following statements is true?

A. Common in young
B. Radiotherapy cures
C. Associated with p53 mutation (Correct Answer)
D. Surrounding neck tissue is usually free

Explanation: ***Associated with p53 mutation*** - **Anaplastic thyroid carcinoma** is a highly aggressive cancer frequently characterized by **p53 tumor suppressor gene mutations**. - These mutations contribute to its rapid growth, dedifferentiation, and resistance to therapy. *Common in young* - **Anaplastic thyroid carcinoma (ATC)** is a rare and highly aggressive malignancy that primarily affects **older adults**, typically those over 60 years of age. - It is one of the least differentiated forms of thyroid cancer and has a poor prognosis. [1] *Surrounding neck tissue is usually free* - ATC is characterized by **rapid growth** and **aggressive local invasion**, often involving surrounding neck tissues such as the trachea, esophagus, and great vessels. [1] - This extensive local involvement contributes to symptoms like dysphagia, dyspnea, and hoarseness, and makes surgical resection difficult or impossible. *Radiotherapy cures* - **ATC is largely refractory to conventional therapies**, including surgery, radiotherapy, and chemotherapy, due to its aggressive biology and common presence of dedifferentiated cells. - While radiation therapy may be used for **palliative management** of local symptoms, it very rarely achieves a cure; the prognosis remains extremely poor, with median survival measured in months. [1] **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1101-1102.

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