Neoplasia Practice Questions

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

Vascular invasion. ***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.

Q: The most common site of metastasis in neuroblastoma is?

Bone marrow. ***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.

Q: Which of the following does not have a viral etiology?

Breast ductal carcinoma. ***Hodgkin's lymphoma*** - Hodgkin's lymphoma is primarily associated with **genetic factors** and environmental triggers instead of a viral cause [1][2]. - It can arise from **Reed-Sternberg cells**, which are not related to viral infections [1][2]. - EBV is not associated with certain subtypes of Hodgkin lymphoma [3]. *Nasopharyngeal carcinoma* - Strongly linked to **Epstein-Barr virus (EBV)**, which plays a significant role in its pathogenesis. - It is characterized by **nasal obstruction** and symptoms related to tumor invasion, with a clear viral etiology. *Hepatocellular carcinoma* - Often associated with **hepatitis B and C viruses**, which are well-known risk factors for liver cancer. - Chronic infection leads to **cirrhosis**, predisposing individuals to carcinoma development. *Burkitt's lymphoma* - Associated with **EBV**, particularly in endemic forms in Africa, affecting the jaw or abdomen [4]. - It involves **aggressive B-cell proliferation**, strongly linked to viral infection [4]. **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. 556-557. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 614-616. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 618. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 335-336.

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

Expression of Trk A receptor. ***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.

Q: Paget's disease of the nipple is

associated with underlying breast cancer. ***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.

Q: Which enzymatic activity is primarily responsible for the immortality of cancer cells?

Telomerase. ***Telomerase*** - **Telomerase** is an enzyme that adds repetitive nucleotide sequences to the ends of chromosomes (**telomeres**), preventing their shortening during DNA replication [1]. - In normal somatic cells, **telomerase** activity is low or absent, leading to progressive telomere shortening and eventual cellular senescence or apoptosis; however, in cancer cells, **telomerase** is highly active, maintaining telomere length and enabling indefinite cell division, contributing to their **immortality** [1]. *DNA reverse transcriptase* - **DNA reverse transcriptase** synthesizes DNA from an RNA template, a process characteristic of retroviruses (e.g., HIV) and not typically involved in the immortality of human cancer cells. - While some endogenous retroelements exist in the human genome, this enzyme's primary role is not in maintaining the replicative potential of cancer cells. *RNA polymerase* - **RNA polymerase** is responsible for synthesizing RNA from a DNA template (**transcription**), a fundamental process in gene expression. - While critical for cell growth and division, **RNA polymerase** does not directly prevent telomere shortening or contribute to cellular immortality. *DNA polymerase* - **DNA polymerase** is involved in DNA replication and repair, synthesizing new DNA strands and ensuring genetic fidelity. - While essential for cell proliferation, it does not directly address the issue of **telomere shortening**, which is key to cellular aging and immortality. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 311-312.

Q: CA-19-9 is typically elevated in all of the following cancers except:

Breast carcinoma. ***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**.

Q: Which of the following tumors is known for its potential for spontaneous regression?

Malignant melanoma. ***Osteogenic sarcoma*** - Osteogenic sarcoma, or **osteosarcoma**, is a **malignant bone tumor** that typically does not resolve spontaneously and often requires aggressive treatment [1]. - It commonly presents with **pain and swelling** in long bones, and its prognosis is poor without intervention. *Retinoblastoma* - Retinoblastoma can exhibit **spontaneous regression**, especially in bilateral cases, where the tumor may shrink without treatment over time. - It primarily affects the **retina** in children, ideally diagnosed early to preserve vision and life. *Cholangio carcinoma* - Cholangio carcinoma is an aggressive form of **bile duct cancer** that does not resolve spontaneously and usually has a poor prognosis. - Symptoms typically include **jaundice** and bile duct obstruction, requiring surgical intervention. *Malignant melanoma* - Malignant melanoma is a highly aggressive skin cancer that does not undergo spontaneous resolution and often metastasizes quickly. - Early recognition is crucial for treatment, as it is associated with significant **morbidity and mortality**. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 673-674.

Question 1

Sun damage causes malignant transformation of the skin by:

Accepted Answer

Induction of pyrimidine dimers

Answer

Direct DNA damage

Answer

Free radical formation

Answer

Mutation of p53 due to UV exposure

Question 2

Which of the following is the most critical factor in the tumor metastasis cascade?

Accepted Answer

E-Cadherin

Answer

Type IV collagenase

Answer

Tyrosine kinase

Answer

Fibronectin

Question 3

Which histological feature is most commonly associated with malignant pheochromocytoma?

Accepted Answer

Vascular invasion

Answer

Presence of necrosis

Answer

Capsular invasion

Answer

High mitotic rate

Question 4

The most common site of metastasis in neuroblastoma is?

Accepted Answer

Bone marrow

Answer

Lung

Answer

Liver

Answer

Lymph nodes

Question 5

Which of the following does not have a viral etiology?

Accepted Answer

Breast ductal carcinoma

Answer

Hepatocellular carcinoma

Answer

Nasopharyngeal carcinoma

Answer

Colorectal adenocarcinoma

Question 6

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

Accepted Answer

Expression of Trk A receptor

Answer

Normal chromosome number (diploidy)

Answer

Amplification of the N-myc gene

Answer

Loss of genetic material on chromosome 1p

Question 7

Paget's disease of the nipple is

Accepted Answer

associated with underlying breast cancer

Answer

primarily an infectious condition

Answer

a benign dermatological condition

Answer

characterized by decreased skin pigmentation

Question 8

Which enzymatic activity is primarily responsible for the immortality of cancer cells?

Accepted Answer

Telomerase

Answer

RNA polymerase

Answer

DNA polymerase

Answer

DNA reverse transcriptase

Question 9

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

Accepted Answer

Breast carcinoma

Answer

Ovarian carcinoma

Answer

Colonic carcinoma

Answer

Pancreatic carcinoma

Question 10

Which of the following tumors is known for its potential for spontaneous regression?

Accepted Answer

Malignant melanoma

Answer

Osteogenic sarcoma

Answer

Retinoblastoma

Answer

Cholangiocarcinoma

Neoplasia — MCQs

Neoplasia — MCQs

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