Neoplasia Practice Questions

Q: A 15-year-old boy presents with pain and swelling in his right thigh. A biopsy of the mass demonstrates osteosarcoma. His mother was diagnosed with breast cancer one year ago, and his maternal grandmother died of breast cancer ten years ago. The child has three younger siblings. Siblings are at an increased risk of developing which of the following cancers?

Glioma. ### Explanation **Concept: Li-Fraumeni Syndrome (LFS)** The clinical presentation describes a classic case of **Li-Fraumeni Syndrome**. This is an autosomal dominant condition caused by a germline mutation in the **TP53 tumor suppressor gene** (located on chromosome 17p) [1]. The syndrome is characterized by a strong family history of early-onset cancers. **Why Glioma is Correct:** The "core" cancers associated with LFS are remembered by the mnemonic **SBLA**: **S**arcoma (Osteosarcoma/Soft tissue), **B**reast cancer, **L**eukemia, and **A**drenal cortical carcinoma. However, the spectrum also significantly includes **Brain tumors (specifically Gliomas)**. Since the siblings share the same genetic risk, they are at a high risk for these specific malignancies. **Why Other Options are Incorrect:** * **Wilms tumor (A):** Associated with WAGR syndrome, Denys-Drash, or Beckwith-Wiedemann syndrome (WT1/WT2 mutations), not typically TP53. * **Neuroblastoma (B):** Most common extracranial solid tumor in children; associated with N-MYC amplification, but not a core component of LFS. * **Hepatoblastoma (C):** Associated with Familial Adenomatous Polyposis (FAP) and Beckwith-Wiedemann syndrome, but not LFS. **High-Yield Clinical Pearls for NEET-PG:** * **TP53:** Known as the "Guardian of the Genome." It regulates the cell cycle at the G1-S checkpoint. * **LFS Criteria:** Proband diagnosed with sarcoma <45 years + First-degree relative with any cancer <45 years + Another first/second-degree relative with any cancer <45 years or sarcoma at any age. * **Most Common Cancer in LFS:** Breast cancer (females) and Sarcomas (males/children). * **Choroid Plexus Carcinoma:** In a child, this specific brain tumor is highly suggestive of a TP53 mutation. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 298-300.

Q: Which of the following functions is associated with the oncogenic MYC in lung cancer?

Nuclear binding protein. **Explanation:** **Why the correct answer is right:** The **MYC** gene (specifically *c-MYC*, *n-MYC*, and *l-MYC*) encodes a **nuclear transcription factor** [1] that plays a central role in cell cycle progression, metabolism, and apoptosis. Once synthesized, the MYC protein translocates to the nucleus, where it binds to specific DNA sequences (E-box sequences) via a basic helix-loop-helix leucine zipper domain. In lung cancer (particularly Small Cell Lung Cancer), *L-MYC* amplification leads to the constitutive expression of these nuclear proteins, driving uncontrolled cellular proliferation [1], [2]. **Why the other options are wrong:** * **A. Protein Kinase:** This function is characteristic of oncogenes like **ABL** (non-receptor tyrosine kinase) or **ERBB1/EGFR** (receptor tyrosine kinase) [1]. * **B. GTP Binding Protein:** This describes the **RAS** family of oncogenes (K-RAS, H-RAS, N-RAS). RAS proteins act as molecular switches by cycling between GDP-bound (inactive) and GTP-bound (active) states [2]. * **C. Growth Factor:** This refers to oncogenes like **PDGF-̢** (SIS oncogene), which act as extracellular signals to trigger cell growth. **High-Yield Clinical Pearls for NEET-PG:** * **MYC Family Associations:** * **c-MYC:** Burkitt Lymphoma (t[8;14]). * **N-MYC:** Neuroblastoma (Double minute chromosomes). * **L-MYC:** Small Cell Carcinoma of the Lung [2]. * **Mechanism:** MYC upregulates **Cyclin-Dependent Kinases (CDKs)** and downregulates CDK inhibitors, effectively "pushing" the cell through the G1/S checkpoint [2]. * **Warburg Effect:** MYC is a key mediator in reprogramming cell metabolism to aerobic glycolysis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 292-293. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 296-297.

Q: Which of the following is the most common tumor of the fetus and newborn?

Sacrococcygeal teratoma. **Explanation:** **Sacrococcygeal Teratoma (SCT)** is the most common tumor of the fetus and newborn [1], occurring in approximately 1 in 20,000 to 40,000 live births [1]. These tumors arise from the **totipotent cells** of the primitive streak (Hensen’s node) that fail to migrate or involute. They are more common in females (4:1 ratio) [1]. While most are benign (mature), the risk of malignancy increases with age at diagnosis. **Analysis of Incorrect Options:** * **Neuroblastoma:** This is the most common **extracranial solid tumor of childhood** and the most common malignancy in infants (under 1 year), but it is not more frequent than SCT in the immediate neonatal/fetal period. * **Wilms Tumor (Nephroblastoma):** This is the most common **primary renal tumor of childhood**, typically presenting between ages 2 and 5. It is rare in the neonatal period. * **Leukemia:** While leukemia is the most common childhood cancer overall, it is not the most common tumor at birth. Congenital leukemia is a rare entity. **High-Yield Clinical Pearls for NEET-PG:** * **Altman Classification:** Used for SCT based on the location (Type I is predominantly external; Type IV is entirely presacral/internal). * **Tumor Markers:** Elevated **Alpha-fetoprotein (AFP)** in a teratoma often suggests a yolk sac component (malignancy). * **Associated Complication:** Large fetal SCTs can cause **high-output cardiac failure** and hydrops fetalis due to significant vascular shunting (steal phenomenon). * **Most common malignancy in infants:** Neuroblastoma. * **Most common childhood cancer:** Acute Lymphoblastic Leukemia (ALL). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 482-483.

Q: Induration in the rectal pouch on a rectal examination in a 65-year-old woman with bilateral ovarian masses is an example of?

Seeding of tumor. **Explanation:** The clinical presentation describes a classic finding in advanced ovarian malignancy. The correct answer is **Seeding of tumor** (Option B), also known as transcoelomic spread. **Why it is correct:** Ovarian cancer most commonly spreads by the exfoliation of malignant cells into the peritoneal cavity. These cells are carried by physiological peritoneal fluid and tend to settle in dependent areas of the pelvis due to gravity. The **Pouch of Douglas (rectouterine/rectal pouch)** is the most dependent part of the female pelvis. When tumor cells implant and grow here, they form a firm, nodular sensation felt on rectal or vaginal examination, clinically referred to as a **"Blumer’s shelf"** or "rectal shelf." This is a hallmark of transcoelomic seeding. **Why other options are incorrect:** * **Lymphatic spread (A):** While ovarian cancer spreads to pelvic and para-aortic nodes, this typically presents as lymphadenopathy rather than a palpable shelf in the rectal pouch. * **Hematogenous spread (C):** This is less common in early/mid-stage ovarian cancer and usually involves distant organs like the liver parenchyma or lungs. * **Discontinuous spread (D):** This is a general term. "Seeding" is the specific pathological mechanism (transcoelomic) that describes how these "discontinuous" implants occur in the peritoneal cavity. **High-Yield NEET-PG Pearls:** * **Most common mode of spread:** Ovarian cancer spreads primarily via **transcoelomic seeding** (peritoneal surface involvement). * **Blumer’s Shelf:** A palpable nodularity in the Pouch of Douglas indicating drop metastases (commonly from Gastric [Krukenberg] or Ovarian primary). * **Sister Mary Joseph Nodule:** Metastatic implant at the umbilicus, also a result of peritoneal seeding. * **Staging:** The presence of these implants outside the pelvis but within the abdomen (up to 2cm) defines Stage IIIA2.

Q: Which electrolyte imbalance is characteristic of tumor lysis syndrome?

Hyperkalemia. **Explanation:** **Tumor Lysis Syndrome (TLS)** is an oncologic emergency caused by the rapid destruction of a large number of metabolically active tumor cells (most commonly in high-grade lymphomas and leukemias) following chemotherapy [1]. When these cells rupture, they release their intracellular contents into the systemic circulation. **Why Hyperkalemia is Correct:** Potassium is the primary intracellular cation. The massive lysis of tumor cells leads to an immediate release of potassium into the bloodstream, resulting in **Hyperkalemia**. This is the most dangerous component of TLS as it can lead to lethal cardiac arrhythmias. **Analysis of Incorrect Options:** * **Hypercalcemia:** In TLS, **Hypocalcemia** occurs, not hypercalcemia. This happens because the release of intracellular phosphorus leads to hyperphosphatemia; the excess phosphate binds to serum calcium, causing it to precipitate as calcium phosphate crystals. * **Hypokalemia:** This is the opposite of what occurs in TLS. Potassium levels rise due to cellular rupture. * **Increased serum sodium:** Sodium is primarily an extracellular ion; its levels are not characteristically elevated by the release of intracellular contents in TLS. **High-Yield Clinical Pearls for NEET-PG:** * **The Metabolic Tetrad of TLS:** 1. **Hyperkalemia** (Risk of arrhythmias) 2. **Hyperphosphatemia** (From breakdown of intracellular proteins) 3. **Hyperuricemia** (From catabolism of purines/nucleic acids) [1] 4. **Hypocalcemia** (Secondary to hyperphosphatemia) * **Renal Failure:** Hyperuricemia and calcium phosphate crystals can lead to acute kidney injury (AKI) [1]. * **Prophylaxis:** Aggressive hydration and **Allopurinol** (xanthine oxidase inhibitor) or **Rasburicase** (recombinant urate oxidase) are used to manage uric acid levels. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 941-942.

Question 1

Sacrococcygeal teratoma tumor cells consist of cells from which germ layer(s)?

Accepted Answer

All of the above

Answer

Ectoderm

Answer

Endoderm

Answer

Mesoderm

Question 2

Oncogenes can be best studied by which of the following methods?

Accepted Answer

Transfection

Answer

Transduction

Answer

Transformation

Answer

Conjugation

Question 3

A 15-year-old boy presents with pain and swelling in his right thigh. A biopsy of the mass demonstrates osteosarcoma. His mother was diagnosed with breast cancer one year ago, and his maternal grandmother died of breast cancer ten years ago. The child has three younger siblings. Siblings are at an increased risk of developing which of the following cancers?

Accepted Answer

Glioma

Answer

Wilms tumor

Answer

Neuroblastoma

Answer

Hepatoblastoma

Question 4

Which of the following functions is associated with the oncogenic MYC in lung cancer?

Accepted Answer

Nuclear binding protein

Answer

Protein kinase

Answer

GTP binding protein

Answer

Growth factor

Question 5

Some cells release messengers locally and possess cell surface receptors for the same messengers, enabling those cells to respond to their own secreted products. This has been implicated in the growth of certain cancers. Which of the following is an important example of this phenomenon?

Accepted Answer

Colorectal cancer

Answer

Pancreatic malignancy

Answer

Lymphoma

Answer

Gastric maltoma

Question 6

Malignancies associated with BRCA 1 and 2 include all of the following except?

Accepted Answer

Mesothelioma

Answer

Breast cancer

Answer

Prostate cancer

Answer

Papillary serous carcinoma of peritoneum

Question 7

Which of the following is the most common tumor of the fetus and newborn?

Accepted Answer

Sacrococcygeal teratoma

Answer

Neuroblastoma

Answer

Wilm's tumor

Answer

Leukemia

Question 8

Induration in the rectal pouch on a rectal examination in a 65-year-old woman with bilateral ovarian masses is an example of?

Accepted Answer

Seeding of tumor

Answer

Lymphatic spread of tumor

Answer

Hematogenous spread of tumor

Answer

Discontinuous spread of tumor

Question 9

Which of the following genetic changes is commonly observed in cancers?

Accepted Answer

Methylation of tumor suppressor genes

Answer

Hypomethylation of oncogenes

Answer

Loss of heterozygosity

Answer

Mutation of introns

Question 10

Which electrolyte imbalance is characteristic of tumor lysis syndrome?

Accepted Answer

Hyperkalemia

Answer

Hypercalcemia

Answer

Hypokalemia

Answer

Increased serum sodium

Neoplasia — MCQs

Neoplasia — MCQs

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