Neoplasia Practice Questions

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

Familial polyposis. ***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.

Q: Commonest histological type of germ cell tumor of the testis is:

Seminoma. ***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.

Q: What is the most common site of lymphangiosarcoma?

Post-mastectomy lymphedema of the arm. ***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.

Q: The most common type of rhabdomyosarcoma is

Embryonal. ***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.

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

Adenocarcinoma. ***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.

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

M phase. ***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.

Q: About Langerhans cell histiocytosis, all are true EXCEPT:

Gonadal involvement occurs. ***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.

Q: The most important prognostic factor for carcinoma of the breast is:

Stage. ***Stage*** - **Tumor stage** (TNM staging system) is the most critical prognostic factor for breast carcinoma because it directly reflects the extent of disease spread at diagnosis, including tumor size, nodal involvement, and distant metastases [1]. - Patients with **early-stage disease** (localized) generally have a much better prognosis than those with **late-stage disease** (regional or metastatic) [1]. *Tumor DNA content* - **Tumor DNA content**, specifically **aneuploidy**, can be an indicator of a more aggressive tumor phenotype. - While it has prognostic value, it is less important than pathological stage in clinical decision-making. *Histological subtype* - The **histological subtype** (e.g., invasive ductal carcinoma, invasive lobular carcinoma) affects prognosis, with some subtypes having more aggressive behavior [2]. - However, the overall stage, particularly lymph node involvement, overrides the prognostic impact of the specific subtype [1]. *Tumor grade* - **Tumor grade**, based on the degree of cellular differentiation, nuclear pleomorphism, and mitotic activity, is an important prognostic factor [2]. - Higher-grade tumors are generally more aggressive, but its prognostic significance is secondary to that of tumor stage, especially when considering the complete clinical picture [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1070-1072. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 457-458.

Q: Retinoblastoma is associated with:

Osteosarcoma. ***Osteosarcoma*** - Retinoblastoma is associated with **increased risk** of secondary malignancies, particularly **osteosarcoma**. - The relationship is due to **genetic predisposition** via alterations in the RB1 gene [1]. *Hepatocellular* - Hepatocellular carcinoma is primarily linked to **risk factors** like hepatitis infection and is not directly associated with retinoblastoma. - It does not share a **common genetic pathway** with retinoblastoma, making this option incorrect. *Osteoclastoma* - Osteoclastoma (giant cell tumor of bone) typically occurs in the **metaphysis of long bones** and does not relate to retinoblastoma. - There are no documented links between **genetic mutations** in retinoblastoma and osteoclastoma development. *SCC* - Squamous cell carcinoma (SCC) is more associated with **sun exposure** and certain viral infections, rather than retinoblastoma. - It lacks any **genetic relationship** or increased incidence linked to retinoblastoma, ruling this option out. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 298-300.

Question 1

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

Accepted Answer

Familial polyposis

Answer

Juvenile polyps

Answer

Hyperplastic polyps

Answer

Hamartomatous polyps

Question 2

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

Accepted Answer

Seminoma

Answer

Teratoma

Answer

Yolk sac tumour

Answer

Choriocarcinoma

Question 3

What is the most common site of lymphangiosarcoma?

Accepted Answer

Post-mastectomy lymphedema of the arm

Answer

Liver

Answer

Spleen

Answer

Retroperitoneum

Question 4

The most common type of rhabdomyosarcoma is

Accepted Answer

Embryonal

Answer

Alveolar

Answer

Pleomorphic

Answer

Spindle cell

Question 5

Which of the following best describes a teratoma?

Accepted Answer

A tumor containing tissues from all three germ layers: ectoderm, mesoderm, and endoderm.

Answer

Occurs most commonly in gonadal regions and along the midline.

Answer

Can originate from any of the three germ layers.

Answer

Often asymptomatic, but may cause discomfort depending on size.

Question 6

The lung carcinoma most common in non-smokers is?

Accepted Answer

Adenocarcinoma

Answer

Large cell

Answer

Small cell carcinoma

Answer

Squamous cell carcinoma

Question 7

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

Accepted Answer

M phase

Answer

G1 phase

Answer

S phase

Answer

G2 phase

Question 8

About Langerhans cell histiocytosis, all are true EXCEPT:

Accepted Answer

Gonadal involvement occurs

Answer

Peak incidence less than 3 years of age

Answer

Diffuse form is known as Letterer-Siwe disease

Answer

Radiosensitive

Question 9

The most important prognostic factor for carcinoma of the breast is:

Accepted Answer

Stage

Answer

Tumor DNA content

Answer

Histological subtype

Answer

Tumor grade

Question 10

Retinoblastoma is associated with:

Accepted Answer

Osteosarcoma

Answer

Hepatocellular carcinoma

Answer

Squamous cell carcinoma

Answer

Giant cell tumor

Neoplasia — MCQs

Neoplasia — MCQs

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