Neoplasia Practice Questions

Q: What is the primary cause of Mesothelioma?

Asbestos exposure. ***Asbestosis*** - Mesothelioma is primarily caused by **exposure to asbestos**, which leads to malignant changes in the mesothelial cells [1][2][3]. - Asbestosis results in **lung scarring** and is a well-established risk factor for the development of mesothelioma. *Silicosis* - Caused by inhalation of **silica dust**, primarily affecting individuals in construction or mining [1][4]. - While it can cause lung diseases, it does not lead to mesothelioma specifically. *Anthracosis* - Results from **coal dust exposure**, leading to the accumulation of carbon in the lungs [1]. - It is associated with chronic bronchitis and other respiratory issues but not with mesothelioma. *Baggasosis* - Caused by exposure to **bagasse** (sugarcane residue), mainly leading to lung inflammation [1]. - It does not have a recognized link to mesothelioma and largely affects the respiratory system differently. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 695. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 339-340. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 697-698. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 697.

Q: Which histological feature is most commonly associated with malignant pheochromocytoma?

Vascular invasion. ***Vascular invasion*** - **Vascular invasion** is the most definitive histological feature indicating malignancy in pheochromocytomas, as it demonstrates the tumor's ability to spread beyond its primary site through blood vessels. - The presence of tumor cells within identifiable vascular channels outside the primary tumor capsule is a strong microscopic indicator of potential metastasis and is considered the single most reliable histological criterion for malignancy. - While definitive diagnosis of malignant pheochromocytoma requires demonstration of metastasis, vascular invasion is the histological feature most strongly associated with malignant behavior. *Presence of necrosis* - While **necrosis** can be seen in malignant tumors due to rapid growth and insufficient blood supply, it is not a specific feature for diagnosing malignancy in pheochromocytomas, as it can occasionally be seen in benign variants or as a result of tumor degeneration. - Necrosis alone does not offer the same definitive evidence of metastatic potential as vascular invasion. *Capsular invasion* - **Capsular invasion**, though suggestive of aggressive behavior, is not as definitive for malignancy as vascular invasion because tumor cells can remain localized even after capsular breach, whereas vascular invasion indicates the potential for distant spread. - Benign pheochromocytomas can sometimes show areas of limited capsular penetration without being malignant. *High mitotic rate* - While **high mitotic rate** can suggest increased cellular proliferation and is part of the PASS (Pheochromocytoma of the Adrenal gland Scaled Score), it is less specific than vascular invasion for predicting malignant behavior. - Mitotic activity must be interpreted in context with other histological features and does not independently establish malignancy.

Q: Which of the following statements about pleomorphic adenoma is false?

Has a tendency to invade perineural space. ***Has a tendency to invade perineural space*** - Pleomorphic adenoma typically shows **benign behavior** and does not usually invade surrounding tissues [1]. - It is characterized by **well-defined margins**, making perineural invasion uncommon compared to malignant tumors. *Most common tumor of salivary glands* - This statement is true; pleomorphic adenoma is indeed the **most common benign tumor** of the salivary glands. - It primarily occurs in the **parotid gland**, comprising about 60-70% of all salivary gland tumors [1]. *It is also called a mixed tumor* - This statement is correct as pleomorphic adenoma is frequently referred to as a **mixed tumor**, reflecting its composition of both epithelial and mesenchymal elements [2]. - The term emphasizes its **epithelial and stromal components**, which vary significantly. *Most commonly involves the parotid gland* - This is a true statement, as the parotid gland is the most commonly affected site for pleomorphic adenoma [1]. - It can also appear in minor salivary glands, but the **parotid gland** accounts for the majority of cases. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 751-753. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 274-276.

Q: Which of the following is a characteristic of bronchoalveolar carcinoma?

Lepidic growth with preservation of alveolar structure. ***Adenocarcinoma*** - Bronchoalveolar carcinoma is classified as a subtype of **adenocarcinoma**, specifically presenting as non-small cell lung cancer (NSCLC) [1]. - It is characterized by **lepidic growth pattern** in the alveolar structures, which preserves the architecture of the lung parenchyma. *Stromal invasion with desmoplasia* - Typically, bronchoalveolar carcinoma shows **minimal invasion**, contrasting with the extensive desmoplastic reaction seen in other types of lung cancer. - This type is more about growth patterns than typical invasive features associated with stromal changes. *Grows along pre-existing anatomical structures* - While some lung tumors may grow along bronchi, bronchoalveolar carcinoma primarily **grows along alveolar surfaces** rather than conforming to anatomical structures. - This growth pattern leads to its distinct histological features, differing from the infiltrative patterns of other cancers. *Preservation of Alveolar structure* - Although bronchoalveolar carcinoma does preserve some architecture, stating it relies solely on this aspect is misleading as this does not comprehensively define the tumor. - Its distinction lies in its subtype classification as an **adenocarcinoma** rather than merely structural preservation [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 335-336.

Q: To which of the following events is a "good" outcome in neuroblastoma associated?

Expression of Trk A receptor. ***Trk A expression*** - The presence of **Trk A expression** in neuroblastoma is associated with **better prognosis**, indicating differentiated tumors that respond well to treatment. - Trk A is a **neurotrophic receptor** that is implicated in promoting differentiation and survival of the tumors. *N-myc amplification* - **N-myc amplification** is often linked to **poor prognosis** and aggressive disease behavior in neuroblastoma [1]. - Generally associated with advanced stage disease and worse clinical outcomes. *Chromosome 1 p deletion* - **Chromosome 1p deletion** is associated with a higher risk of **poor outcomes** in neuroblastoma, particularly in high-risk cases. - Its presence indicates a chromosomal aberration linked to aggressive tumor behavior. *Diploidy* - **Diploidy** is generally associated with an **intermediate prognosis**, but not as good as the expression of Trk A. - In contrast, **hyperdiploidy** is often more favorable than diploidy, especially in younger patients [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 486-487.

Q: The most common site of metastasis in neuroblastoma is?

Bone marrow. ***Bone marrow*** - **Bone marrow** is the most common site of metastasis in neuroblastoma, occurring in more than half of all patients and being a primary determinant of prognosis. - Metastasis to the bone marrow often leads to **anemia**, **thrombocytopenia**, and sometimes **bone pain**. *Lung* - While possible, lung metastases are relatively **uncommon** in neuroblastoma, especially when compared to bone marrow involvement. - Lung metastases tend to occur in **later stages** or with specific genetic subtypes. *Liver* - Liver metastases, though seen, are more prevalent in **infants** with **Stage 4S neuroblastoma**, where the liver can be massively enlarged [1]. - This specific stage often has a **better prognosis** than other metastatic forms [1]. *Lymph nodes* - **Regional lymph node** involvement is common at diagnosis, but distant lymph node metastasis is less frequent than bone marrow involvement. - Involvement of regional lymph nodes does contribute to staging but is not the most frequent site of **distant metastasis**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, p. 486.

Q: Malignancy in pheochromocytoma is indicated by:

Metastasis. ***Metastasis*** - The definitive criterion for diagnosing **malignancy in pheochromocytoma** is the presence of **metastatic disease**, meaning tumor cells have spread to sites where chromaffin tissue is not normally found. - The distinction between benign and malignant pheochromocytomas often cannot be made based on histological features alone. *Mitotic figures* - While increased **mitotic activity** can be a feature indicating aggressive tumor behavior, it is not a standalone definitive criterion for malignancy in pheochromocytoma. - Benign pheochromocytomas can occasionally show mitotic figures, and their presence alone does not confirm malignancy. *Capsular invasion* - **Capsular invasion** suggests an aggressive tumor but is not a definitive indicator of malignancy in pheochromocytoma. - Tumors that exhibit capsular invasion without distant spread are still considered to have uncertain malignant potential rather than overt malignancy. *Vascular invasion* - Similar to capsular invasion, **vascular invasion** indicates an increased risk of metastasis but is not a conclusive sign of malignancy. - The presence of tumor cells within blood vessels raises suspicion, but true malignancy is only confirmed by the presence of distant metastases.

Q: Paget's disease of the nipple is

associated with underlying breast cancer. ***Neoplasia*** - Paget's disease of the nipple is strongly associated with **underlying breast malignancy**, particularly **ductal carcinoma** [1][2]. - Clinical features typically include **nipple discharge**, ulceration, and **eczematous changes**, pointing towards a neoplastic process rather than benign conditions [2]. - The malignant cells (Paget cells) are derived from the adjacent breast carcinomas and can be detected by nipple biopsy [1][2]. *Dermatitis* - While dermatitis can appear similar, it often presents with **itching and scaling**, lacking the **associated cancer symptoms** of Paget's disease. - Dermatitis generally responds well to **topical treatments**, unlike Paget's which requires further oncological evaluation. *Hypopigmentation* - Hypopigmentation does not correlate with the typical clinical features of Paget's disease, which may include **hyperpigmented or crusted lesions**. - It is also not indicative of a **malignant process**, while Paget's is a clear marker for neoplastic conditions [1][2]. *Infection* - Although infections can occur, they typically present with **localized redness and possible discharge**, differing from the eczematous changes seen in Paget's disease. - This does not precisely represent the **high risk of cancer** associated with Paget's, making it an unlikely diagnosis [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 456-457. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1061-1062.

Question 1

What is the primary cause of Mesothelioma?

Accepted Answer

Asbestos exposure

Answer

Silicosis

Answer

Baggasosis

Answer

Anthracosis

Question 2

Which of the following is the most critical factor in the tumor metastasis cascade?

Accepted Answer

E-Cadherin

Answer

Type IV collagenase

Answer

Tyrosine kinase

Answer

Fibronectin

Question 3

Which histological feature is most commonly associated with malignant pheochromocytoma?

Accepted Answer

Vascular invasion

Answer

Presence of necrosis

Answer

Capsular invasion

Answer

High mitotic rate

Question 4

Which of the following statements about pleomorphic adenoma is false?

Accepted Answer

Has a tendency to invade perineural space

Answer

Most commonly involves the parotid gland

Answer

It is also called a mixed tumor

Answer

Most common tumor of salivary glands

Question 5

Which of the following is a characteristic of bronchoalveolar carcinoma?

Accepted Answer

Lepidic growth with preservation of alveolar structure

Answer

Stromal invasion with desmoplasia

Answer

Grows along existing anatomical structures

Answer

Adenocarcinoma

Question 6

To which of the following events is a "good" outcome in neuroblastoma associated?

Accepted Answer

Expression of Trk A receptor

Answer

Normal chromosome number (diploidy)

Answer

Amplification of the N-myc gene

Answer

Loss of genetic material on chromosome 1p

Question 7

The most common site of metastasis in neuroblastoma is?

Accepted Answer

Bone marrow

Answer

Lung

Answer

Liver

Answer

Lymph nodes

Question 8

Malignancy in pheochromocytoma is indicated by:

Accepted Answer

Metastasis

Answer

Mitotic figures

Answer

Capsular invasion

Answer

Vascular invasion

Question 9

Paget's disease of the nipple is

Accepted Answer

associated with underlying breast cancer

Answer

primarily an infectious condition

Answer

a benign dermatological condition

Answer

characterized by decreased skin pigmentation

Question 10

All the following statements about thyroid carcinoma are true, except which one?

Accepted Answer

Papillary carcinoma primarily spreads via hematogenous routes.

Answer

Medullary ca is associated with MEN2a

Answer

Follicular carcinoma primarily spreads via hematogenous routes.

Answer

Thyroid lymphoma is often associated with Hashimoto's thyroiditis

Neoplasia — MCQs

Neoplasia — MCQs

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