Neoplasia — MCQs

Neoplasia Indian Medical PG Practice Questions and MCQs

Question 841: Immunohistochemical marker for sentinel node biopsy in breast carcinoma?

A. Cytokeratin (Correct Answer)
B. Vimentin
C. Calretinin
D. CD45

Explanation: ***Cytokeratin*** - **Cytokeratin** is a specific marker for **epithelial cells**, including those of breast carcinoma, making it ideal for detecting micrometastases in lymph nodes. - Immunohistochemistry with cytokeratin antibodies can identify even small clusters of tumor cells not visible on routine hematoxylin and eosin (H&E) staining. *Vimentin* - **Vimentin** is a filament protein characteristic of **mesenchymal cells**, such as fibroblasts and endothelial cells, not epithelial carcinoma cells. - While some carcinomas can exhibit **epithelial-mesenchymal transition (EMT)** and express vimentin, it is not the primary or most specific marker for detecting breast carcinoma cells in lymph nodes. *Calretinin* - **Calretinin** is a marker typically used to identify **mesothelial cells** and is often employed in the diagnosis of **mesothelioma**. - It is not expressed by breast carcinoma cells and would not be useful for detecting metastatic disease in sentinel lymph nodes. *CD45* - **CD45** (Leukocyte Common Antigen) is a specific marker for **hematopoietic cells**, including lymphocytes, macrophages, and other immune cells. - It is used to identify and distinguish lymphoid infiltrates but is not expressed by breast carcinoma cells, making it unsuitable for this purpose.

Question 842: Which of the following is considered a pre-malignant condition?

A. Hamartoma
B. Dysplasia (Correct Answer)
C. Anaplasia
D. Metaplasia

Explanation: ***Hamartoma*** - Hamartomas are benign growths made of an abnormal mixture of cells and tissues, not classified as **pre-malignant**. - They typically do not undergo malignant transformation or indicate an increased risk of cancer. *Anaplasia* - Anaplasia refers to a **loss of differentiation** in cells, frequently associated with malignant tumors, indicating a **pre-malignant** condition [2]. - Cells show extreme **abnormalities** and often point to a cancerous process in development [2]. *Metaplasia* - Metaplasia is the **reversal** of one differentiated cell type to another, often as a response to injury or irritation, and can be a precursor to malignancy [1]. - It often precedes dysplasia and is considered a **pre-malignant** condition due to its potential to progress to cancer [1]. *Dysplasia* - Dysplasia involves **abnormal cell growth** and changes in cell shape and organization, most often seen in association with pre-malignant lesions [1][3]. - It is typically considered a significant risk factor for the development of **malignant tumors** [3]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 278-280. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, p. 278. [3] 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. 210-211.

Question 843: Which cancer is associated with the Cag A gene?

A. Hepatocellular carcinoma
B. Esophageal carcinoma
C. MALT lymphoma (Correct Answer)
D. Lung carcinoma

Explanation: ***MALT lymphoma*** - The Cag A gene is associated with **Helicobacter pylori**, which is a known risk factor for developing **MALT lymphoma** in the gastric mucosa [1]. - Its presence can lead to **chronic inflammation**, contributing to lymphoid tissue proliferation and the development of lymphoma [1]. *Lung carcinoma* - Lung carcinoma is primarily linked to **smoking** and other environmental factors, rather than the Cag A gene. - It does not have a direct association with **Helicobacter pylori** infection, contrasting with MALT lymphoma. *Hepatocellular carcinoma* - Hepatocellular carcinoma is predominantly caused by **chronic hepatitis B or C infections**, ethanol-related liver disease, and **aflatoxin exposure**. - The Cag A gene does not play a significant role in its pathogenesis or development. *Esophageal carcinoma* - Esophageal carcinoma is typically associated with **Barrett's esophagus**, **smoking**, or **alcohol use**, not the Cag A gene. - While chronic injury can lead to esophageal changes, **Helicobacter pylori** does not directly contribute to its etiology. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 356-357.

Question 844: What is the primary cancer associated with mutations in the APC gene?

A. Colorectal carcinoma (Correct Answer)
B. Gastric carcinoma
C. Gastric lymphoma
D. Esophageal adenocarcinoma

Explanation: ***Colorectal carcinoma*** - The **APC gene** is a tumor suppressor gene that, when mutated, is associated with the development of **familial adenomatous polyposis (FAP)** [3] and sporadic colorectal cancer [2]. - Loss of APC function leads to **upregulation of beta-catenin** [1], promoting cell proliferation in the colon [1]. *Esophageal adenocarcinoma* - Primarily linked to **Barrett's esophagus** and chronic gastroesophageal reflux disease (GERD), not directly related to APC mutation. - Genetic alterations in this cancer typically involve **TP53** and **CDKN2A** rather than APC. *Gastric lymphoma* - Gastric lymphoma is often associated with **H. pylori infection**, and while certain genes are implicated, APC is not among the key contributors. - Typically arises from gastric mucosa-associated lymphoid tissue (MALT) rather than direct APC mutations. *Gastric carcinoma* - Although gastric carcinoma can involve various genetic changes, it's mainly associated with **hereditary diffuse gastric cancer syndromes** linked to mutations in the **CDH1** gene. - APC is primarily implicated in colorectal malignancies, not gastric cancer, though FAP patients with germline APC mutations do have increased risk of intestinal-type gastric cancer [4]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 304-305. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 819. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 817. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 778-779.

Question 845: In a histopathological examination, a tumor shows a hobnail appearance. Which of the following tumors is most likely associated with this finding?

A. Clear cell carcinoma (Correct Answer)
B. Endodermal sinus tumor
C. HCC
D. Choriocarcinoma

Explanation: ***Clear cell carcinoma*** - The **hobnail appearance** describes tumor cells that protrude into the lumen, resembling a hobnail, which is a characteristic feature of **clear cell carcinoma** in various organs like the kidney, ovary, and uterus. - These cells often have **clear cytoplasm** and prominent apical nuclei, contributing to their distinct appearance. *Endodermal sinus tumor* - This tumor is known for forming **Schiller-Duval bodies**, which are pathognomonic glomeruloid structures, not a hobnail appearance. - It typically contains regions of a reticular pattern and often stains positive for **alpha-fetoprotein (AFP)**. *HCC* - **Hepatocellular carcinoma (HCC)** is characterized by cells resembling hepatocytes, forming trabecular, solid, or pseudoglandular patterns. - It does not typically exhibit the **hobnail cell morphology** described. *Choriocarcinoma* - **Choriocarcinoma** is composed of cytotrophoblasts and syncytiotrophoblasts, which are often arranged in a haphazard fashion without distinct hobnail features. - This tumor is characterized by high levels of **human chorionic gonadotropin (hCG)**.

Question 846: In which type of lung carcinoma is the p53 mutation most commonly observed?

A. Adenocarcinoma
B. Squamous cell carcinoma (SCC) (Correct Answer)
C. Large cell carcinoma
D. Small cell carcinoma

Explanation: ***Small cell carcinoma*** - **Small cell lung carcinoma (SCLC)** has the highest frequency of **p53 mutations**, occurring in approximately **90-95%** of cases. - These mutations are associated with the **aggressive nature** and **poor prognosis** of SCLC, contributing to its rapid growth and early metastasis. *Adenocarcinoma* - **Adenocarcinoma** has p53 mutations in approximately **50-60%** of cases, which is less frequent than SCLC. - This subtype is more commonly associated with **EGFR mutations** and **ALK rearrangements**, particularly in non-smokers. *Squamous cell carcinoma (SCC)* - **Squamous cell carcinoma** shows p53 mutations in about **70-80%** of cases, but still lower than SCLC. - It is more strongly associated with **smoking** and often displays mutations in **CDKN2A** and **PIK3CA** pathways. *Large cell carcinoma* - **Large cell carcinoma** has variable p53 mutation rates, typically **40-60%** of cases. - This subtype is less well-characterized molecularly and represents a **diagnosis of exclusion** among lung cancers.

Question 847: Carcinoma associated most commonly with upper one third of esophagus is?

A. Adenocarcinoma
B. Adeno-squamous Carcinoma
C. Leiomyosarcoma
D. Squamous Cell Carcinoma (Correct Answer)

Explanation: **Squamous Cell Carcinoma** - **Squamous cell carcinoma** is the predominant type of esophageal cancer in the **upper and middle thirds** of the esophagus. - This type is strongly associated with risk factors such as **smoking** and **alcohol consumption**. *Adenocarcinoma* - **Adenocarcinoma** is most commonly found in the **distal esophagus** and **gastroesophageal junction**. - It is often associated with **Barrett's esophagus**, a metaplastic change due to chronic gastroesophageal reflux disease (GERD). *Adeno-squamous Carcinoma* - **Adeno-squamous carcinoma** is a rare mixed tumor with both glandular and squamous differentiation. - It can occur in any part of the esophagus, but is less common overall than either adenocarcinoma or squamous cell carcinoma alone. *Leiomyosarcoma* - **Leiomyosarcoma** is a malignant tumor arising from the **smooth muscle** lining the esophagus. - It is an extremely rare form of esophageal cancer, far less common than epithelial carcinomas.

Question 848: Which of the following tumors is associated with elevated levels of Alpha-fetoprotein (AFP)?

A. Teratoma
B. Yolk sac tumor (Correct Answer)
C. Seminoma
D. None of the options

Explanation: ***a and c*** - **Alpha-fetoprotein (AFP)** is commonly elevated in certain germ cell tumors, specifically **non-seminomatous tumors** [1]. - This correctly includes conditions associated with raised AFP, indicating its relevance in testicular tumors beyond **seminoma**. *Seminoma* - Typically associated with elevated **beta-hCG** but not significantly with **AFP** levels; only very rarely can it show a slight increase. - It mainly presents as a **solid testicular mass** and is classified under germ cell tumors that do not usually raise AFP [1]. *Teratoma* - Teratomas can be associated with elevated AFP but predominantly in **mixed germ cell tumors** rather than pure teratomas [1]. - They may require surgical intervention and can produce a variety of germ cell components, complicating tumor markers interpretation. *Yolk sac tumor* - Specifically associated with significantly elevated **AFP** and is a common cause of raised levels in children and some adults [1]. - However, this does not adequately cover other conditions that may also elevate AFP levels, hence it's incomplete in the context of the question. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 979-980.

Question 849: Metastasis to lungs comes most commonly from

A. Melanoma
B. Primary brain tumor
C. Primary bone tumor
D. Breast carcinoma (Correct Answer)

Explanation: ***Breast carcinoma*** - **Breast cancer** is one of the most common sources of pulmonary metastases, spreading via **hematogenous** [3] or lymphatic routes. [1] - The lungs are a frequent site for distant metastasis, and breast cancer accounts for a significant proportion due to its **high prevalence** and rich vascular supply. [1] - Other common sources include colorectal, renal, thyroid, and prostate carcinomas. [1] *Primary brain tumor* - **Primary brain tumors** (gliomas, medulloblastomas) rarely metastasize outside the central nervous system. - They typically lack the ability to penetrate the **dura mater** and enter systemic circulation effectively. - While they can spread via CSF within the CNS, distant metastasis to lungs is **extremely rare**. *Primary bone tumor* - **Primary bone tumors** are typically **sarcomas** (osteosarcoma, Ewing sarcoma), not carcinomas. [2] - While osteosarcoma does metastasize to lungs frequently, these tumors are much **less common** overall than breast cancer. [2] - In terms of absolute numbers, breast cancer is a more frequent source of lung metastases. *Melanoma* - Melanoma has aggressive metastatic potential and can spread to virtually any organ, including the lungs. [1] - However, due to the **higher incidence** of breast cancer, breast remains a more common source of pulmonary metastases in clinical practice. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 338-339. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 671-672. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 456-457.

Question 850: What is the most common tumor suppressor gene involved in carcinogenesis?

A. p53 (Correct Answer)
B. Retinoblastoma (Rb)
C. Tumor protein p73 (p73)
D. Cyclin-dependent kinase inhibitor 2A (p16)

Explanation: ***p53*** [1][2] - The **p53 gene** is widely recognized as the most common tumor suppressor gene associated with various cancers, particularly due to its role in apoptosis and cell cycle regulation [1][2]. - Mutations in **p53** are found in over **50%** of human tumors, highlighting its critical role in cancer genesis [2]. *Rb* - While the **Rb gene** is significant in preventing retinoblastoma and other cancers, it is less commonly mutated overall compared to p53 [1]. - Rb primarily regulates the **cell cycle**, particularly the transition from G1 to S phase, but its involvement in cancer is more limited in scope [2]. *p16* - **p16** acts as an inhibitor of cyclin-dependent kinases but is primarily associated with specific cancers such as melanoma, not broadly across all cancers. - It serves as a cell cycle checkpoint but is not as ubiquitous a tumor suppressor as p53. *p73* - Although **p73** shares structural similarities with p53 and has roles in apoptosis, it is not as frequently implicated in cancer development. - Its functions are more related to developmental processes and it does not have the same high mutation rates seen in tumors as p53. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 297-298, 302-304. [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.

Practice by Chapter

Nomenclature and Classification of Tumors

Practice Questions

Characteristics of Benign and Malignant Neoplasms

Practice Questions

Molecular Basis of Cancer

Practice Questions

Carcinogenesis and Carcinogens

Practice Questions

Tumor Progression and Metastasis

Practice Questions

Tumor Markers

Practice Questions

Paraneoplastic Syndromes

Practice Questions

Genetic Basis of Cancer

Practice Questions

Tumor Immunity

Practice Questions

Cancer Epidemiology and Prevention

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free

Neoplasia — MCQs

Neoplasia — MCQs

On this page

Practice by Chapter

Want unlimited practice?