Neoplasia Practice Questions

Q: A 59-year-old woman has discomfort in the posterior part of her tongue. A biopsy confirms that the lesion is a carcinoma. What is true in carcinoma of the posterior third of the tongue?

Lymph gland spread is often encountered.. ***Lymph gland spread is often encountered.*** - Carcinomas of the posterior third of the tongue (base of tongue) are typically aggressive and have a rich **lymphatic drainage** network, making early metastasis to **cervical lymph nodes** common. - This high rate of **lymphatic spread** significantly impacts prognosis and treatment planning. *There is an excellent prognosis.* - Carcinomas of the posterior third of the tongue generally have a **poor prognosis** due to their late presentation, aggressive nature, and high likelihood of regional lymph node metastasis. - The inaccessibility of the tumor often leads to diagnosis at an advanced stage, limiting treatment success compared to anterior tongue or lip cancers. *The tissue is well differentiated.* - Carcinomas of the posterior tongue are often **poorly differentiated** or undifferentiated, which correlates with more aggressive behavior and a higher potential for metastasis. - While some may be moderately differentiated, well-differentiated tumors are less common and usually associated with a better prognosis and less aggressive spread. *Lymphoid tissue is absent.* - The posterior third of the tongue, particularly the base of the tongue, is rich in **lymphoid tissue**, forming part of **Waldeyer's ring** (lingual tonsils) [1]. - This abundance of lymphoid tissue is a critical anatomical feature that facilitates lymphatic drainage and potentially contributes to early lymphatic spread in carcinomas of this region. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 744-745.

Q: Rokitansky protuberances are seen in -

Teratoma. ***Teratoma*** - **Rokitansky protuberance** (mural nodule or dermoid plug) is a raised solid area found within a **mature cystic teratoma**, particularly in the ovary [1]. - It often contains various tissues derived from the three germ layers such as **hair**, **sebaceous glands**, bone, and teeth [3]. *Papillary carcinoma* - Characterized by **papillary projections** formed by tumor cells, often seen in thyroid, kidney, or ovary. - While it can have protuberances, these are **composed of malignant cells** and lack the diverse tissue components of a Rokitansky protuberance. *Epidermoid cyst* - A benign cyst lined by **stratified squamous epithelium** and filled with keratin debris, typically located in the skin or skull. - These cysts do not form internal protuberances with heterogeneous tissue types like those seen in teratomas. *Mucinous carcinoma* - A malignant tumor characterized by the production of **mucin**, often affecting the ovary, colon, or breast [2]. - Lesions are typically filled with mucinous material or present as mucinous masses, and do not contain the specific solid Rokitansky protuberance. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, p. 1034. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1033-1034. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 480-481.

Q: “Field carcinogenesis” is seen in

Head and neck carcinoma. ### Head and neck carcinoma - **Field carcinogenesis (field cancerization)** is the classic example where chronic exposure to carcinogens (**tobacco, alcohol**) affects an entire mucosal field, leading to widespread epithelial changes [1]. - This results in **multiple independent primary tumors** or increased risk of recurrence after treatment. - First described by Slaughter et al. (1953) in oral cavity squamous cell carcinoma. - The entire aerodigestive tract epithelium is at risk due to continuous carcinogen exposure [1]. *Breast carcinoma* - Can be **multicentric** (multiple foci in same breast) or **bilateral**, but this is not field carcinogenesis. - Multiple tumors arise from **genetic predisposition** (e.g., BRCA mutations) rather than a field of carcinogen-exposed epithelium. *Colon carcinoma* - Multiple polyps/carcinomas can occur in **FAP** or **inflammatory bowel disease**, but this is termed a **"field defect"** based on genetic/inflammatory mechanisms. - Not the prototypical example of field carcinogenesis from chronic carcinogen exposure. *Brain tumour* - Arises from **glial cells or neurons** (non-epithelial), not susceptible to field carcinogenesis. - Multifocality typically reflects **incomplete resection** or spread of a single tumor, not independent primaries in a carcinogen-exposed field. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 720-721.

Q: Which is not a characteristic of Li-Fraumeni syndrome?

Autosomal recessive. ***Autosomal recessive*** - Li-Fraumeni syndrome is inherited in an **autosomal dominant** pattern, not autosomal recessive [1]. - This means only one copy of the altered gene in each cell is sufficient to cause the disorder. *p53 mutation* - Li-Fraumeni syndrome is directly caused by a **germline mutation** in the **TP53 tumor suppressor gene**, which codes for the p53 protein [2]. - The p53 protein normally plays a critical role in **cell cycle arrest**, DNA repair, and apoptosis, preventing tumor formation [2]. *Multiple primary tumors* - Individuals with Li-Fraumeni syndrome have a significantly increased risk of developing **multiple independent primary cancers** throughout their lifetime [1]. - These can include soft tissue sarcomas, osteosarcomas, brain tumors, adrenocortical carcinomas, and breast cancer. *Early onset cancers* - A hallmark of Li-Fraumeni syndrome is the development of **cancers at unusually young ages**, often in childhood or early adulthood. - This early onset is a key diagnostic criterion, differentiating it from sporadic cancers that typically appear later in life [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 298-300. [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. 227-228.

Q: Which of the following is not a tumor suppressor gene?

HER2. ***HER2*** - **HER2** (**Human Epidermal growth factor Receptor 2**) is an **oncogene**, meaning it promotes cell growth and division when overexpressed [1]. - It is a **receptor tyrosine kinase** that, when activated, signals cells to grow and divide, and its amplification is associated with aggressive forms of breast cancer [1]. *p53* - **p53** is a well-known **tumor suppressor gene** that plays a critical role in cell cycle control and apoptosis. - It detects DNA damage and can halt cell division or initiate programmed cell death to prevent the proliferation of damaged cells. *BRCA1* - **BRCA1** (**BReast CAncer gene 1**) is a **tumor suppressor gene** involved in DNA repair. - Mutations in BRCA1 are strongly associated with increased risk of hereditary breast and ovarian cancers due to compromised DNA damage repair mechanisms. *RB* - The **retinoblastoma protein (RB)** is a classic example of a **tumor suppressor gene**. - It acts as a gatekeeper for cell cycle progression from G1 to S phase, preventing uncontrolled cell division by binding to and inactivating E2F transcription factors. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 291-294.

Q: Which is an intranuclear immunohistochemistry marker for neuroendocrine tumors?

INSM. ***INSM*** - **INSM1 (Insulinoma-associated protein 1)** is a highly sensitive and specific **transcription factor** expressed in neuroendocrine cells. - It exhibits **intranuclear staining** in immunohistochemistry, making it a reliable marker for neuroendocrine differentiation in tumors. *NCAM1/CD56* - **NCAM1/CD56** is a **cell surface adhesion molecule** - It shows **membranous or cytoplasmic staining** in immunohistochemistry, not intranuclear. *Chromogranin* - **Chromogranin A** is a **storage protein** found in dense core granules of neuroendocrine cells. [1] - It demonstrates **cytoplasmic staining** in immunohistochemistry and is a general neuroendocrine marker. [1] *Synaptophysin* - **Synaptophysin** is a **transmembrane glycoprotein** associated with synaptic vesicles. - It exhibits **cytoplasmic or membranous staining** in immunohistochemistry and is also a general neuroendocrine marker. [2] **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 419-420. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 780-781.

Q: A lacrimal gland mass is biopsied, revealing a slow-growing, well-circumscribed tumor. What is the most likely diagnosis?

Pleomorphic adenoma. ***Pleomorphic adenoma*** - This is the most common **benign epithelial tumor of the lacrimal gland**, often presenting as a slow-growing, **well-circumscribed mass** [1]. - Histologically, it's characterized by a mixture of **epithelial and mesenchymal components**, including ductal structures, myoepithelial cells, and various stromal elements [1]. *Adenoid cystic carcinoma* - This is a common malignant lacrimal gland tumor known for its aggressive nature, often with **perineural invasion** and a poor prognosis. - It typically presents with more rapid growth, **pain**, and can cause bony erosion, features not described here. *Warthin’s tumor* - Also known as **papillary cystadenoma lymphomatosum**, this is almost exclusively found in the **parotid gland**, not the lacrimal gland [1]. - It has characteristic histological features of **papillary cystic structures** lined by oncocytes and surrounded by lymphoid stroma. *Mucoepidermoid carcinoma* - While it can occur in salivary glands, it is a very **rare tumor** of the lacrimal gland. - It is characterized by a mixture of **mucus-secreting cells, epidermoid cells**, and intermediate cells, and is typically a malignant, not slow-growing, mass. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 751-753.

Question 1

Knudson two-hit hypothesis is classically exemplified by

Accepted Answer

Retinoblastoma

Answer

Crohn disease

Answer

Ulcerative colitis

Answer

Melanoma

Question 2

A 59-year-old woman has discomfort in the posterior part of her tongue. A biopsy confirms that the lesion is a carcinoma. What is true in carcinoma of the posterior third of the tongue?

Accepted Answer

Lymph gland spread is often encountered.

Answer

There is an excellent prognosis.

Answer

The tissue is well differentiated.

Answer

Lymphoid tissue is absent.

Question 3

Rokitansky protuberances are seen in -

Accepted Answer

Teratoma

Answer

Papillary carcinoma

Answer

Epidermoid cyst

Answer

Mucinous carcinoma

Question 4

“Field carcinogenesis” is seen in

Accepted Answer

Head and neck carcinoma

Answer

Breast carcinoma

Answer

Colon carcinoma

Answer

Brain tumour

Question 5

Absence of differentiation is known as:-

Accepted Answer

Anaplasia

Answer

Dysplasia

Answer

Metaplasia

Answer

Hyperplasia

Question 6

Which is not a characteristic of Li-Fraumeni syndrome?

Accepted Answer

Autosomal recessive

Answer

p53 mutation

Answer

Multiple primary tumors

Answer

Early onset cancers

Question 7

A patient with gastric cancer shows positive CEA. What is its significance?

Accepted Answer

Prognostic

Answer

Diagnostic

Answer

Therapeutic

Answer

Screening

Question 8

Which of the following is not a tumor suppressor gene?

Accepted Answer

HER2

Answer

p53

Answer

RB

Answer

BRCA1

Question 9

Which is an intranuclear immunohistochemistry marker for neuroendocrine tumors?

Accepted Answer

INSM

Answer

NCAM1/CD56

Answer

Chromogranin

Answer

Synaptophysin

Question 10

A lacrimal gland mass is biopsied, revealing a slow-growing, well-circumscribed tumor. What is the most likely diagnosis?

Accepted Answer

Pleomorphic adenoma

Answer

Adenoid cystic carcinoma

Answer

Warthin’s tumor

Answer

Mucoepidermoid carcinoma

Neoplasia — MCQs

Neoplasia — MCQs

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