Neoplasia Practice Questions

Q: Pro-apoptotic genes and anti-apoptotic genes belong to which gene family?

Bcl (B-cell lymphoma). ***Bcl*** [1] - Pro-apoptotic and anti-apoptotic genes are part of the **Bcl-2 gene family**, which regulates apoptosis [1,2]. - This family includes key **regulators** that either promote or inhibit cell death, thus playing a crucial role in cellular health [1,2]. *BRAF* - BRAF is primarily known as a **proto-oncogene** that plays a role in cell signaling related to **cell growth** and **division** rather than apoptosis. - While it is important in cancer biology, it does not directly regulate apoptotic pathways like Bcl does. *Rb* - The Rb gene is a **tumor suppressor** involved in cell cycle regulation but does not classify as a direct modulator of apoptosis. - Its primary function is to prevent excessive cell growth by inhibiting progression through the cell cycle. *p53* - Although p53 is involved in regulating the **cell cycle** and can induce apoptosis under stress conditions, it is not part of the Bcl-2 gene family [1]. - It acts primarily as a **guardian of the genome**, responding to DNA damage rather than being classified as a pro- or anti-apoptotic gene per se [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, pp. 65-67; Neoplasia, pp. 303-304, 310-311.

Q: Most common site of origin of pleomorphic adenoma is:

Parotid gland. ***Parotid gland*** - The **parotid gland** is the most frequent site for the development of **pleomorphic adenomas**, accounting for approximately 80% of all cases [1]. - This benign mixed tumor predominantly affects the parotid gland due to its large size and complex ductal system [1]. *Submandibular salivary gland* - While pleomorphic adenomas can occur in the **submandibular gland**, they are far less common than in the parotid, representing only 10% of salivary gland pleomorphic adenomas [1]. - Tumors in this gland have a slightly higher risk of malignancy compared to parotid tumors [1]. *Minor salivary glands of soft and hard palate* - Pleomorphic adenomas can arise from **minor salivary glands**, with the palate being a relatively common site among these. - However, their overall incidence in minor salivary glands is significantly lower than in the major salivary glands, particularly the parotid. *Minor salivary glands of lip* - The **minor salivary glands of the lip** can be a site for pleomorphic adenoma, especially the upper lip. - Nevertheless, the frequency of these tumors in the lip is much lower compared to their occurrence in the parotid gland. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 751-753.

Q: The following gene mutation protects tumor cells from apoptosis:

Bcl-2. ***bcl-2*** - The **bcl-2 gene** produces a protein that inhibits apoptosis, thereby allowing tumor cells to evade programmed cell death [1][2]. - Overexpression of **bcl-2** is associated with various cancers, making it pivotal in cancer biology [1]. *RB* - The **RB gene** is primarily a tumor suppressor, regulating the cell cycle, and does not directly prevent apoptosis. - Loss of RB function leads to unregulated cell division rather than inhibition of cell death. *TGFβ* - **TGFβ** acts as a tumor suppressor and can induce apoptosis in certain contexts, particularly in oncogenic processes. - Its primary role involves regulating cell growth and differentiation, not directly protecting against apoptosis. *BRCA* - **BRCA genes** (BRCA1 and BRCA2) are involved in DNA repair mechanisms; mutations increase cancer susceptibility but do not prevent apoptosis directly. - Dysfunction in BRCA proteins primarily impacts the repair of DNA damage, leading to genomic instability rather than apoptosis resistance. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 310-311. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, p. 310.

Q: Which tumor marker is associated with both colon carcinoma and pancreatic carcinoma?

CA-19-9. ***CA-19-9*** - This **glycoprotein** tumor marker is commonly elevated in both **pancreatic adenocarcinoma** and, to a lesser extent, in **colorectal carcinoma**. - Its primary utility is in monitoring treatment response and recurrence, rather than as a screening tool, given its **low sensitivity and specificity**. *CA-125* - **CA-125** is primarily associated with **ovarian cancer** and is often used for screening high-risk individuals, monitoring treatment, and detecting recurrence. - While it can be elevated in other conditions like **endometriosis** or certain benign pelvic masses, it is not a primary marker for colon or pancreatic carcinoma. *CA-15-3* - **CA-15-3** is predominantly used as a tumor marker for **breast cancer**, particularly for monitoring disease progression and recurrence in metastatic cases. - It has limited utility in the diagnosis or management of colon or pancreatic malignancies. *None of the options* - This option is incorrect because **CA-19-9** is indeed a tumor marker associated with both colon and pancreatic carcinoma, making it the correct answer.

Q: What is the most common malignant tumor of the parotid gland?

Mucoepidermoid carcinoma. ***Mucoepidermoid carcinoma*** - This is the **most common malignant tumor** of the **major and minor salivary glands**, including the parotid gland [1]. - It arises from **ductal and myoepithelial cells** and presents with a wide range of histological grades (low, intermediate, high). *Oncocytoma* - This is a **rare, benign tumor** composed of oncocytes, which are large epithelial cells with abundant granular eosinophilic cytoplasm. - It is **not malignant** and does not represent the most common parotid malignancy. *Warthin's tumor* - Also known as papillary cystadenoma lymphomatosum, this is the **second most common benign parotid tumor** [1] after pleomorphic adenoma. - It is **benign** and primarily affects older men, often smokers. *Adenoid cystic carcinoma* - While a **malignant tumor**, it is **less common** than mucoepidermoid carcinoma in the parotid gland [1]. - It is known for its characteristic **perineural invasion** and a high propensity for distant metastases, even years after resection [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 753-755.

Q: Which of the following cancers is associated with osteolytic metastases?

All of the options. ***All of the options*** - **Lung**, **kidney**, and **thyroid** cancers are all known to frequently produce **osteolytic bone metastases** [1]. - These cancers release factors that stimulate **osteoclast activity**, leading to bone destruction rather than new bone formation. *Lung* - **Non-small cell lung cancer** often metastasizes to bone and commonly causes **osteolytic lesions** [2]. - Bone metastases are a frequent complication, particularly in advanced stages, and are associated with **pain** and **pathological fractures**. *Kidney* - **Renal cell carcinoma** is notorious for causing highly vascularized and often **osteolytic metastases** in bone [1]. - These lesions can be aggressive, leading to significant **bone destruction** and **hypercalcemia**. *Thyroid* - **Follicular thyroid carcinoma** and, less commonly, **papillary thyroid carcinoma** are known to cause **osteolytic bone metastases** [1]. - Thyroid cancer metastases in bone can be slow-growing but are typically **destructive** and may cause **pain** or **fractures**. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 671-672. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 724-725.

Q: Krukenberg tumors originate from:

Stomach. ***Stomach*** - **Krukenberg tumors** are **metastatic signet-ring cell adenocarcinomas** of the ovary. - The **stomach** is the **most common primary site** (70-80% of cases), particularly **gastric adenocarcinoma** [1]. - These tumors typically involve **both ovaries bilaterally** and are characterized by **mucin-producing signet-ring cells** [1]. - Metastasis occurs via **lymphatic or hematogenous spread** [2] or by **direct transperitoneal seeding**. *Liver* - The liver is a common site of metastasis for many GI malignancies, but it is **not the primary origin** of Krukenberg tumors. - **Hepatocellular carcinoma** has a different metastatic pattern and histology (not signet-ring cells). *Ovary* - The ovary is the **site of metastasis**, not the primary origin. - **Primary ovarian malignancies** have different histological features (serous, mucinous, endometrioid) and lack the characteristic signet-ring cell morphology from GI primaries. *Gallbladder* - Gallbladder adenocarcinoma can rarely metastasize to the ovaries, but is an **uncommon source** compared to gastric primaries. - **Gallbladder cancer** typically spreads to liver and regional lymph nodes rather than ovaries. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 779. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 355-356.

Q: Inflammatory carcinoma of the breast is classified under which category?

T4d. ***T4d*** - **Inflammatory carcinoma of the breast** is specifically classified as **T4d** in the TNM staging system, regardless of tumor size. - This classification reflects its unique clinical presentation with **diffuse erythema, edema, and peau d'orange** (orange peel skin) due to lymphatic invasion [1]. *T4b* - **T4b** refers to breast cancer with clinically evident **edema, ulceration of the skin of the breast**, or satellite skin nodules in the same breast [2]. - While inflammatory carcinoma might have edema, the hallmark features of widespread erythema and lymphatic involvement distinguish T4d. *T4c* - **T4c** is used when a tumor exhibits **both T4a and T4b features**. - **T4a** involves chest wall fixation, and T4b involves skin edema/ulceration; neither specifically defines inflammatory breast cancer [2]. *T3* - **T3** classifies breast tumors larger than **5 cm in greatest dimension** but without features of T4. - Inflammatory breast cancer is defined by its characteristic skin changes and lymphatic involvement, not solely by tumor size. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 453-454. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1068.

Q: Serum lactate dehydrogenase (LDH) increased with normal alpha-fetoprotein (AFP) is seen with:

Dysgerminoma. ***Dysgerminoma*** - Dysgerminoma is associated with **increased serum lactate dehydrogenase (LDH)** levels due to high cellular turnover [1]. - It typically presents with a **normal alpha-fetoprotein (AFP)** level, which helps distinguish it from other germ cell tumors [1]. *Mucinous cystodenocarcinoma* - This tumor typically elevates **CA-125** rather than LDH, and serum AFP is not relevant. - It primarily arises from **epithelial ovarian tissue**, which does not correlate with LDH elevation. *Yolk sac tumor* - Yolk sac tumors typically show **elevated AFP** levels, not just LDH, which is a contrasting feature. - They are germ cell tumors that are associated with **high AFP** and low LDH. *Brenner's* - Brenner tumor usually does not have significant changes in **LDH** and is associated with **normal tumor markers** like AFP. - It is classified as a **benign or low malignant potential ovarian tumor**, not typically linked with elevated LDH. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1034-1035.

Q: Which of the following has the minimal chance of causing mesothelioma?

Chrysotile. ***Crysolite*** - Crysolite, also known as **chrysotile**, has a significantly lower carcinogenic potential compared to other asbestos types like amphibole asbestos. - It is the most commonly used asbestos type but is associated with a **minimal risk of mesothelioma** [1]. *Amesolite* - Amesolite is an **amphibole asbestos** known to have a higher associated risk for mesothelioma due to its fiber structure [1]. - It has been implicated in **asbestosis** and lung cancer, making it a stronger carcinogen compared to crysolite. *Tremolite* - Tremolite is another type of **amphibole asbestos** that is highly toxic and strongly associated with mesothelioma [1]. - The **risk of malignant pleural mesothelioma** is significantly increased with exposure to tremolite fibers. *Ampholite* - Ampholite is a group of amphibole asbestos which has a high risk for both **lung cancers** and **mesothelioma** due to its fibrous nature [1]. - Similar to other amphibole types, it poses a greater carcinogenic risk than crysolite. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 697-698.

Question 1

Pro-apoptotic genes and anti-apoptotic genes belong to which gene family?

Accepted Answer

Bcl (B-cell lymphoma)

Answer

p53 (Tumor Suppressor Gene)

Answer

Rb (Retinoblastoma protein)

Answer

BRAF (B-Raf proto-oncogene)

Question 2

Most common site of origin of pleomorphic adenoma is:

Accepted Answer

Parotid gland

Answer

Submandibular salivary gland

Answer

Minor salivary glands of soft and hard palate

Answer

Minor salivary glands of lip

Question 3

The following gene mutation protects tumor cells from apoptosis:

Accepted Answer

Bcl-2

Answer

BRCA

Answer

RB

Answer

TGFβ

Question 4

Which tumor marker is associated with both colon carcinoma and pancreatic carcinoma?

Accepted Answer

CA-19-9

Answer

CA-125

Answer

CA-15-3

Answer

None of the options

Question 5

What is the most common malignant tumor of the parotid gland?

Accepted Answer

Mucoepidermoid carcinoma

Answer

Oncocytoma

Answer

Adenoid cystic carcinoma

Answer

Warthin's tumor

Question 6

Which of the following cancers is associated with osteolytic metastases?

Accepted Answer

All of the options

Answer

Lung

Answer

Kidney

Answer

Thyroid

Question 7

Krukenberg tumors originate from:

Accepted Answer

Stomach

Answer

Liver

Answer

Ovary

Answer

Gallbladder

Question 8

Inflammatory carcinoma of the breast is classified under which category?

Accepted Answer

T4d

Answer

T4b

Answer

T4c

Answer

T3

Question 9

Serum lactate dehydrogenase (LDH) increased with normal alpha-fetoprotein (AFP) is seen with:

Accepted Answer

Dysgerminoma

Answer

Yolk sac tumor

Answer

Brenner's tumor

Answer

Mucinous cystadenocarcinoma

Question 10

Which of the following has the minimal chance of causing mesothelioma?

Accepted Answer

Chrysotile

Answer

Amphibole

Answer

Amosite

Answer

Tremolite

Neoplasia — MCQs

Neoplasia — MCQs

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