Neoplasia — MCQs

Neoplasia Indian Medical PG Practice Questions and MCQs

Question 981: Which of the following has the minimal chance of causing mesothelioma?

A. Amphibole
B. Amosite
C. Tremolite
D. Chrysotile (Correct Answer)

Explanation: ***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 982: Which of the following is the most critical factor in the tumor metastasis cascade?

A. E-Cadherin (Correct Answer)
B. Type IV collagenase
C. Tyrosine kinase
D. Fibronectin

Explanation: ***E-Cadherin*** - E-Cadherin plays a crucial role in **cell-cell adhesion**, maintaining the integrity of epithelial tissues, and is notably downregulated during epithelial-mesenchymal transition (EMT) in tumor metastasis [1][3]. - Loss of E-Cadherin promotes **invasiveness** and the ability of cancer cells to enter the bloodstream for metastasis [1][3]. *Fibronectin* - While involved in the **extracellular matrix**, it mainly supports cell adhesion and migration but is not specifically tied to the cascade of tumor metastasis [2]. - It does not directly influence the **cellular changes** needed for metastasis like EMT does. *Type IV collagenase* - Type IV collagenase is important for **degrading basement membranes**, but is not as directly involved in the initial stages of **tumor cell dissemination** as E-Cadherin [2][3]. - Its role is more supportive in the context of **tissue remodeling** rather than in the metastatic cascade itself [2]. *Tyrosine kinase* - Tyrosine kinases are involved in **signal transduction** and cellular communication but are not a structural component in the metastasis cascade [2]. - While they may modulate pathways that affect metastasis, they do not directly facilitate cell adhesion or detachment processes essential for initial metastasis [3]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 317-318. [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. 233-234. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 314-316.

Question 983: Which histological feature is most commonly associated with malignant pheochromocytoma?

A. Vascular invasion (Correct Answer)
B. Presence of necrosis
C. Capsular invasion
D. High mitotic rate

Explanation: ***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.

Question 984: Which of the following statements about pleomorphic adenoma is false?

A. Most commonly involves the parotid gland
B. It is also called a mixed tumor
C. Has a tendency to invade perineural space (Correct Answer)
D. Most common tumor of salivary glands

Explanation: ***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.

Question 985: Which of the following is a characteristic of bronchoalveolar carcinoma?

A. Stromal invasion with desmoplasia
B. Grows along existing anatomical structures
C. Adenocarcinoma
D. Lepidic growth with preservation of alveolar structure (Correct Answer)

Explanation: ***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.

Question 986: Malignancy in pheochromocytoma is indicated by:

A. Mitotic figures
B. Capsular invasion
C. Metastasis (Correct Answer)
D. Vascular invasion

Explanation: ***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.

Question 987: To which of the following events is a "good" outcome in neuroblastoma associated?

A. Normal chromosome number (diploidy)
B. Amplification of the N-myc gene
C. Loss of genetic material on chromosome 1p
D. Expression of Trk A receptor (Correct Answer)

Explanation: ***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.

Question 988: The most common site of metastasis in neuroblastoma is?

A. Lung
B. Liver
C. Lymph nodes
D. Bone marrow (Correct Answer)

Explanation: ***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.

Question 989: Paget's disease of the nipple is

A. primarily an infectious condition
B. a benign dermatological condition
C. characterized by decreased skin pigmentation
D. associated with underlying breast cancer (Correct Answer)

Explanation: ***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 990: CA-19-9 is typically elevated in all of the following cancers except:

A. Breast carcinoma (Correct Answer)
B. Ovarian carcinoma
C. Colonic carcinoma
D. Pancreatic carcinoma

Explanation: ***Breast carcinoma*** - CA-19-9 is a **tumor marker** primarily associated with **gastrointestinal cancers** and is not typically elevated in breast carcinoma. - While other markers like **CA 15-3** or **CA 27.29** are used for monitoring breast cancer, CA-19-9 is not clinically useful in this context. *Ovarian carcinoma* - Although **CA-125** is the primary marker for ovarian cancer, CA-19-9 can be elevated in a subset of cases, particularly with **mucinous ovarian tumors**. - Its presence can indicate a **different histological subtype** or more advanced disease, but it's not the primary diagnostic marker. *Colonic carcinoma* - CA-19-9 can be elevated in **colorectal cancer**, although **CEA (carcinoembryonic antigen)** is more commonly used for monitoring this type of cancer. - High levels of CA-19-9 in colorectal cancer may suggest **advanced disease** or specific tumor characteristics. *Pancreatic carcinoma* - CA-19-9 is the **most widely used and validated tumor marker** for **pancreatic adenocarcinoma**, helping in diagnosis, prognosis, and monitoring treatment response. - Elevated levels are found in a majority of patients with pancreatic cancer and correlate with **tumor burden** and **disease progression**.

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Neoplasia — MCQs

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