Neoplasia Practice Questions

Q: The image below shows the life cycle of a virus. Which of the proteins of the virus act as oncogenes?

E6, E7. ***E6, E7*** - The **E6** and **E7** proteins of high-risk human papillomaviruses (HPVs) are considered **oncogenes** because they interfere with critical tumor suppressor pathways [1][2]. - **E6** promotes the degradation of **p53**, a tumor suppressor protein, while **E7** inactivates **retinoblastoma protein (pRb)**, leading to uncontrolled cell proliferation and increased risk of malignant transformation [2]. *L1, L2* - **L1** and **L2** are **late proteins** (structural proteins) that form the **viral capsid** (outer shell) of the HPV virion. - They are essential for assembling new viral particles but do not directly contribute to the oncogenic process by disrupting host cell cycle regulation. *E1, E2, E5* - **E1** is involved in **viral DNA replication**, acting as a helicase and ATPase. - **E2** regulates **viral gene expression** and DNA replication, while **E5** is a small transmembrane protein that can contribute to cell growth but is generally considered less potent in oncogenesis than E6 and E7, and its exact role varies by HPV type. *E1, E2* - **E1** is critical for **viral DNA replication**, and **E2** regulates viral gene transcription and DNA replication. - While important for the viral life cycle, neither E1 nor E2 are the primary drivers of oncogenesis in the way E6 and E7 are, as they do not directly target key tumor suppressor proteins like p53 and pRb. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1007-1008. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 334-335.

Q: Which of the following conditions is associated with perineural invasion?

Adenoid cystic carcinoma. ***Adenoid cystic carcinoma*** - **Adenoid cystic carcinoma** is the **most notoriously characterized** by its strong propensity for **perineural invasion**, which contributes to its high recurrence rate and poor prognosis [1]. - This invasion allows the tumor cells to spread along nerve sheaths, extending beyond the visible tumor margins, often for considerable distances. - It is the **classic example** of perineural invasion among salivary gland tumors [1]. *Mucoepidermoid tumor* - While mucoepidermoid tumors can be locally aggressive, **perineural invasion** is not a characteristic feature that defines this tumor type. - They are more commonly associated with cystic degeneration and mucin production. *Pancreatic cancer* - **Pancreatic adenocarcinoma** does show **significant perineural invasion** (present in 70-90% of cases) and is an important feature contributing to its poor prognosis and pain symptoms. - However, in the context of this question, **adenoid cystic carcinoma** is considered the **most characteristic** or **prototypical** example of perineural invasion, particularly among head and neck neoplasms. - Both are associated with perineural invasion, but adenoid cystic carcinoma is the textbook example. *Pleomorphic adenoma* - A **pleomorphic adenoma** is a benign mixed tumor of the salivary glands and usually does not exhibit **perineural invasion** [2]. - Malignant transformation into a carcinoma ex pleomorphic adenoma can occur, but the benign form primarily grows as an encapsulated mass [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 753-755. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 751-753.

Q: What is the correct statement about thymoma?

Thymoma is the most common neoplasia of the thymus.. ***Thymoma is the most common neoplasia of the thymus.*** [1] - **Thymoma** is the most common primary tumor of the thymus, accounting for approximately **40-50% of anterior mediastinal masses** in adults. - It is a slow-growing tumor originating from the **epithelial cells** of the thymus [1]. *Chest X-ray is the investigation of choice for the diagnosis of thymoma.* - While a **chest X-ray** may show a widened mediastinum or an anterior mediastinal mass, it is not the investigation of choice for definitive diagnosis or staging [2]. - **CT scan** of the chest with contrast is the preferred imaging modality for evaluating thymomas, providing better anatomical detail and assessing invasiveness [2]. *Thymoma is typically asymptomatic and rarely causes any symptoms.* - Approximately **30-50% of patients with thymoma are asymptomatic** at diagnosis, with the tumor discovered incidentally on imaging [2]. - However, the remaining **50-70% of patients present with symptoms** related to **mass effect** (e.g., chest pain, dyspnea, cough) or **paraneoplastic syndromes** like myasthenia gravis, pure red cell aplasia, or hypogammaglobulinemia [2]. - Therefore, it is incorrect to say thymoma "rarely" causes symptoms. *Thymoma is primarily located in the posterior mediastinum.* - **Thymoma** is characteristically located in the **anterior mediastinum**, which is the most common site for thymic tissue. - Tumors primarily found in the posterior mediastinum are more commonly **neurogenic tumors**. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 571-574. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 572-574.

Q: Which of the following is NOT typically associated with chronic HPV infection?

Increased p53 activity. ***Increased p53 activity*** - Chronic **HPV infection**, particularly by high-risk types, leads to the expression of the viral **E6 protein**, which targets **p53 for degradation**. [3] - Therefore, chronic HPV infection is typically associated with **decreased p53 activity**, not increased, as E6's role is to neutralize this tumor suppressor. [2] *Integration into host genome* - This is a hallmark of transforming infections by high-risk **HPVs**, allowing for stable expression of **viral oncogenes** like E6 and E7. - This integration is crucial for the development of HPV-associated malignancies, as it ensures persistent expression of viral proteins that disrupt **cell cycle control**. [1] *Expression of E6 and E7 proteins* - **E6 and E7** are the main viral oncogenes expressed during persistent **high-risk HPV infection**. - **E6 targets p53** for degradation, and **E7 inactivates retinoblastoma protein (pRb)**, leading to uncontrolled cell proliferation. [2] *Cellular proliferation* - The effects of **E6 and E7** on **p53 and pRb** remove the checks and balances on cell growth, promoting **uncontrolled cellular proliferation**. [1] - This excessive proliferation is a key step in the development of **HPV-associated neoplasia and cancer**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1007-1008. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 334-335. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 739-741.

Q: A 70-year-old man comes to the physician because of a 4-month history of epigastric pain, nausea, and weakness. He has smoked one pack of cigarettes daily for 50 years and drinks one alcoholic beverage daily. He appears emaciated. He is 175 cm (5 ft 9 in) tall and weighs 47 kg (103 lb); BMI is 15 kg/m2. He is diagnosed with gastric cancer. Which of the following cytokines is the most likely direct cause of this patient’s examination findings?

IL-6. **IL-6** - **Interleukin-6 (IL-6)** plays a significant role in **cachexia** associated with cancer, leading to features like **anorexia**, muscle wasting, and fatigue. - Its elevated levels in cancer patients contribute to systemic inflammation and metabolic changes that result in the patient's **emaciated appearance** and weight loss. *IL-2* - **Interleukin-2 (IL-2)** is primarily involved in the **proliferation and differentiation of T cells** and natural killer cells, often used in cancer immunotherapy. [1] - It is not directly implicated as a primary cause of **cancer-associated cachexia** or the systemic symptoms described. *TGF-β* - **Transforming Growth Factor-beta (TGF-β)** is a cytokine that generally **inhibits immune responses** and regulates cell growth, differentiation, and apoptosis. - While it can be involved in tumor progression and metastasis, it is not recognized as a direct cause of the **cachectic syndrome** seen in this patient. *TNF-β* - **Tumor Necrosis Factor-beta (TNF-β)**, also known as **lymphotoxin-alpha (LT-α)**, shares some functions with TNF-α, but its role in **cancer cachexia** is less direct and prominent than TNF-α or IL-6. [2] - It is primarily involved in immune surveillance and inflammation, but not the leading cause of the patient's systemic wasting. *IFN-α* - **Interferon-alpha (IFN-α)** is a cytokine primarily known for its **antiviral and anti-proliferative effects** and its role in immune modulation. [1] - It is used in the treatment of certain cancers but is **not a primary mediator** of cancer-related cachexia or the specific constitutional symptoms of weight loss and emaciation.

Q: Which of the following is true about Anaplasia?

Loss of differentiation. ***Loss of differentiation*** - **Anaplasia** is defined as the loss of structural and functional differentiation in cells, indicating a reversal to a more primitive state [1]. - It is a hallmark feature of **malignancy** and is associated with increased proliferative capacity and aggressiveness of tumors [1]. *Benign and fully reversible* - **Anaplasia** is a characteristic of **malignant tumors** and is generally not reversible without treatment [1]. - Benign cellular changes are typically reversible and maintain their differentiation features [1]. *Loss of cohesion between cells* - While loss of cohesion can occur in some aggressive tumors, it is more specifically related to changes in cell adhesion molecules and is not the primary definition of **anaplasia**. - **Anaplasia** refers to the loss of differentiation, not solely the physical separation of cells [1]. *Change of epithelium type* - This description refers to **metaplasia**, which is the reversible change of one differentiated cell type to another differentiated cell type [1]. - **Anaplasia** involves a loss of differentiation, not merely a change to a different, still differentiated, cell type [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 276-280.

Q: A newborn child is noted to have a bulky abdominal tumor. CT scans reveal that the mass involves the right abdomen and retroperitoneum. The tumor is resected, revealing ganglion cells and primitive, small, round cells occasionally organized in rosettes, embedded in a fibrillary pink matrix. Special studies confirm the likely diagnosis. Which of the following features of this tumor is associated with a poorer prognosis?

Amplification of N-myc gene. ***Amplification of N-myc gene*** - **N-myc (MYCN) gene amplification** is the most critical adverse prognostic factor in **neuroblastoma**, indicating a more aggressive tumor with rapid growth and poor response to therapy [1]. - Its presence is associated with **increased likelihood of metastasis**, treatment failure, and poor survival regardless of stage [1]. - MYCN amplification is found in ~20-25% of neuroblastomas and is an independent predictor of poor outcome. *Advanced stage at diagnosis* - While advanced stage (stage 3 or 4) generally correlates with a poorer prognosis, **N-myc amplification** is an independent molecular marker that is a stronger predictor of outcome [1]. - Tumors with MYCN amplification can have an aggressive course even at lower stages, and conversely, some high-stage tumors without MYCN amplification may have a better outcome. *Numerous ganglion cells* - The presence of numerous **ganglion cells** indicates a more differentiated tumor type, such as a **ganglioneuroma** or **ganglioneuroblastoma** (intermixed type). - Increased differentiation is generally associated with a **better prognosis** in neuroblastic tumors, representing favorable histology. *Cellular aneuploidy* - In neuroblastoma, **hyperdiploidy** (DNA index >1, with more than the diploid number of chromosomes) is associated with a **favorable prognosis**, particularly in infants [1]. - In contrast, **diploid tumors** (DNA index = 1) tend to have a worse prognosis [1]. - The term "cellular aneuploidy" alone is ambiguous; the prognostic significance depends on whether it refers to hyperdiploidy (favorable) or diploidy (unfavorable). **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 1

A patient has a cerebellar mass, renal tumor, and a family history of similar conditions. Which of the following mutations is most likely present in the family?

Accepted Answer

VHL

Answer

Neurofibromatosis (NF1)

Answer

Tuberous Sclerosis Complex (TSC)

Answer

Li-Fraumeni syndrome

Question 2

The image below shows the life cycle of a virus. Which of the proteins of the virus act as oncogenes?

Accepted Answer

E6, E7

Answer

L1, L2

Answer

E1, E2, E5

Answer

E1, E2

Question 3

Which of the following conditions is associated with perineural invasion?

Accepted Answer

Adenoid cystic carcinoma

Answer

Mucoepidermoid tumor

Answer

Pancreatic cancer

Answer

Pleomorphic adenoma

Question 4

What is the correct statement about thymoma?

Accepted Answer

Thymoma is the most common neoplasia of the thymus.

Answer

Chest X-ray is the investigation of choice for the diagnosis of thymoma.

Answer

Thymoma is primarily located in the posterior mediastinum.

Answer

Thymoma is usually asymptomatic and only occasionally causes symptoms.

Question 5

Which of the following is NOT typically associated with chronic HPV infection?

Accepted Answer

Increased p53 activity

Answer

Integration into host genome

Answer

Expression of E6 and E7 proteins

Answer

Cellular proliferation

Question 6

A researcher is studying the ability of breast cancer cells to metastasize. Neoplastic cells obtained from 30 patients with stage IV ductal carcinoma of the breast are tagged with a fluorescent antibody. The cells are then inserted into a medium resembling normal human tissue. After 2 weeks, all samples show in vitro hematogenous invasion and migration away from the original site of insertion. Which of the following properties is most likely responsible for the ability of these neoplastic cells to metastasize?

Accepted Answer

Release of matrix metalloproteinase

Answer

Loss of cellular polarity

Answer

Presence of fibrous tissue capsule

Answer

Overexpression of HER2/neu

Answer

Increase in N:C ratio

Question 7

A 70-year-old man comes to the physician because of a 4-month history of epigastric pain, nausea, and weakness. He has smoked one pack of cigarettes daily for 50 years and drinks one alcoholic beverage daily. He appears emaciated. He is 175 cm (5 ft 9 in) tall and weighs 47 kg (103 lb); BMI is 15 kg/m2. He is diagnosed with gastric cancer. Which of the following cytokines is the most likely direct cause of this patient’s examination findings?

Accepted Answer

IL-6

Answer

IL-2

Answer

TGF-β

Answer

TNF-β

Answer

IFN-α

Question 8

Which of the following is true about Anaplasia?

Accepted Answer

Loss of differentiation

Answer

Benign and fully reversible

Answer

Loss of cohesion between cells

Answer

Change of epithelium type

Question 9

Field carcinogenesis theory is commonly seen in

Accepted Answer

Head and neck cancer

Answer

Cervical cancer

Answer

Prostate cancer

Answer

Breast cancer

Question 10

A newborn child is noted to have a bulky abdominal tumor. CT scans reveal that the mass involves the right abdomen and retroperitoneum. The tumor is resected, revealing ganglion cells and primitive, small, round cells occasionally organized in rosettes, embedded in a fibrillary pink matrix. Special studies confirm the likely diagnosis. Which of the following features of this tumor is associated with a poorer prognosis?

Accepted Answer

Amplification of N-myc gene

Answer

Advanced stage at diagnosis

Answer

Numerous ganglion cells

Answer

Cellular aneuploidy

Neoplasia — MCQs

Neoplasia — MCQs

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