Neoplasia Practice Questions

Q: Molecular classification of breast cancer is based on which of the following?

Gene expression profiling. ### Explanation **Correct Answer: A. Gene Expression Profiling** The molecular classification of breast cancer (Perou-Sørlie classification) is fundamentally based on **Gene Expression Profiling** using DNA microarrays [1]. This technique measures the activity of thousands of genes simultaneously to categorize tumors into distinct biological subtypes: **Luminal A, Luminal B, HER2-enriched, and Basal-like.** [1] This classification is superior to traditional methods because it reflects the underlying biology, clinical behavior, and prognosis of the tumor. **Analysis of Incorrect Options:** * **B. Expression of hormone receptors (ER, PR, HER-2):** While these markers are used in daily clinical practice as **surrogates** (surrogate subtyping) to approximate the molecular class, the *true* molecular classification is defined by the genetic signature, not immunohistochemistry (IHC) alone [1]. * **C. Histology:** Histological classification (e.g., Invasive Ductal vs. Lobular carcinoma) is based on morphology and architecture under a microscope, which does not always correlate with the molecular driver of the tumor. * **D. Response to chemotherapy:** This is a clinical outcome or a criterion for choosing treatment, not a basis for the classification itself. **High-Yield Clinical Pearls for NEET-PG:** * **Luminal A:** Most common subtype; ER/PR positive, HER2 negative, low Ki-67. Has the **best prognosis**. * **Basal-like:** Usually "Triple Negative" (ER-/PR-/HER2-); expresses cytokeratins 5/6. Associated with **BRCA1 mutations** and has a poor prognosis [1]. * **HER2-enriched:** Characterized by *ERBB2* gene amplification; treated with Trastuzumab. * **Ki-67 Index:** A proliferation marker used to differentiate Luminal A (low Ki-67) from Luminal B (high Ki-67). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1059-1068.

Q: Which tumor marker is elevated in both hepatocellular carcinoma and testicular cancer?

AFP. **Explanation:** **AFP (Alpha-Fetoprotein)** is the correct answer because it is a glycoprotein normally produced by the fetal liver and yolk sac. In adults, its elevation is a hallmark of two specific conditions: 1. **Hepatocellular Carcinoma (HCC):** It serves as a primary screening and diagnostic marker [1]. 2. **Germ Cell Tumors (GCTs):** Specifically, it is elevated in **Yolk Sac Tumors** (Endodermal sinus tumors) and **Non-seminomatous germ cell tumors (NSGCTs)** of the testis. Note that AFP is *never* elevated in pure seminomas. **Analysis of Incorrect Options:** * **CEA (Carcinoembryonic Antigen):** Primarily used for monitoring **Colorectal Carcinoma**. It can also be elevated in pancreatic, gastric, and breast cancers, but it is not a specific marker for HCC or testicular GCTs. * **hCG (human Chorionic Gonadotropin):** This is the marker for **Choriocarcinoma** and is also elevated in some Seminomas (syncytiotrophoblastic components). While relevant to testicular cancer, it is not associated with HCC. * **CA 19-9:** This is the highly specific marker for **Pancreatic Adenocarcinoma** and **Cholangiocarcinoma**. **High-Yield Clinical Pearls for NEET-PG:** * **The "Rule of 500":** In a patient with cirrhosis, an AFP level >500 ng/mL is highly suggestive of HCC [1]. * **Yolk Sac Tumors:** AFP is the definitive marker; look for **Schiller-Duval bodies** on histology. * **Mixed GCTs:** If a testicular biopsy shows "Seminoma" but serum AFP is elevated, the diagnosis must be revised to a **Mixed Germ Cell Tumor**, as pure seminomas do not produce AFP. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 399-400.

Question 1

All of the following are considered hallmarks of cancer except?

Accepted Answer

None of the above

Answer

Limitless replicative potential

Answer

Insensitivity to growth-inhibitory signals

Answer

Self-sufficiency in growth signals

Question 2

What is the term for excessive fibrosis in a tumor?

Accepted Answer

Desmoplasia

Answer

Anaplasia

Answer

Metaplasia

Answer

Dysplasia

Question 3

Which of the following is NOT a tumor suppressor gene?

Accepted Answer

RAS

Answer

WT-1

Answer

RB

Answer

P53

Question 4

Ebstein Barr virus has been implicated in the following malignancies except?

Accepted Answer

Multiple myeloma

Answer

Hodgkin's disease

Answer

B-cell lymphoma

Answer

Nasopharyngeal carcinoma

Question 5

Molecular classification of breast cancer is based on which of the following?

Accepted Answer

Gene expression profiling

Answer

Expression of hormone receptors like ER, PR, and HER-2 neu

Answer

Histology

Answer

Response to chemotherapy

Question 6

A 50-year-old woman undergoes screening colonoscopy. An isolated 1-cm pedunculated polyp is found in the sigmoid colon. The excised polyp histologically shows well-differentiated glands with no invasion of the stalk. Which of the following investigational research procedures can distinguish most clearly whether the polyp represents hyperplasia of the colonic mucosa or a tubular adenoma?

Accepted Answer

Molecular marker of clonality

Answer

Flow cytometry to quantitate cells in the S phase

Answer

Histochemical staining for mucin

Answer

Immunohistochemical staining for keratin

Question 7

Regarding oncogenesis, which of the following is false?

Accepted Answer

An increase in telomerase activity promotes anti-tumor effects.

Answer

Proto-oncogenes can be activated by chromosomal translocation.

Answer

Malignant transformation involves the accumulation of mutations in proto-oncogenes and tumor suppressor genes.

Answer

Point mutations can occur in somatic cells.

Question 8

Carcinoembryonic antigen is raised in which of the following non-neoplastic conditions?

Accepted Answer

Pancreatitis

Answer

Hepatitis

Answer

Hemolytic anemia

Answer

Ulcerative colitis

Question 9

Homer Wright rosettes are seen in which of the following neoplasms?

Accepted Answer

Neuroblastoma

Answer

Nephroblastoma

Answer

Ependymoma

Answer

Rhabdomyosarcoma

Question 10

Which tumor marker is elevated in both hepatocellular carcinoma and testicular cancer?

Accepted Answer

AFP

Answer

CEA

Answer

HCG

Answer

CA-19

Neoplasia — MCQs

Neoplasia — MCQs

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