Neoplasia — MCQs

Neoplasia Indian Medical PG Practice Questions and MCQs

Question 881: Which of the following has tumor promoting effect?

A. BRCA
B. RB
C. MYC (Correct Answer)
D. p16

Explanation: ***MYC*** - **MYC** is a well-known **oncogene** that promotes cell growth and proliferation, thus contributing to tumorigenesis [1,2,5]. - Its expression is often **dysregulated** in various tumors, leading to increased **cellular metabolism** and survival, facilitating cancer progression [1,4]. *BRAC* - Refers to **BRCA1 and BRCA2** genes, which are primarily associated with **tumor suppression** and repair of DNA double-strand breaks. - Mutations in these genes lead to a higher risk of cancers but do not directly promote tumor growth. *RB* - The **RB gene** encodes a protein that functions as a tumor suppressor by inhibiting cell cycle progression from G1 to S phase. - Its loss leads to **uncontrolled cell division**, but it does not promote tumors directly; rather, it prevents their formation. *p16* - **p16** is a cyclin-dependent kinase inhibitor that plays a critical role in regulating the cell cycle, thereby acting as a **tumor suppressor**. - Its loss or dysfunction is often implicated in cell cycle dysregulation but does not promote tumors itself. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 296-297. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, p. 292. [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. 228-229. [4] 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. 229-230. [5] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 292-293.

Question 882: Which chromosomal translocation is associated with follicular thyroid carcinoma?

A. PAX8 - PPARγ (Correct Answer)
B. ALK - NPM1
C. ETV6 - NTRK3
D. RET - PTC1

Explanation: ***PAX8 - PPARγ*** - The **PAX8-PPARγ fusion oncogene** is a well-established molecular marker directly associated with **follicular thyroid carcinoma (FTC)**. - This translocation leads to the expression of a fusion protein that contributes to **thyroid cell proliferation** and **tumorigenesis**. *ALK - NPM1* - The **ALK-NPM1 fusion** is primarily observed in some types of **anaplastic large cell lymphoma**, not thyroid cancers. - This translocation typically results in an **activated anaplastic lymphoma kinase (ALK)**, driving lymphoproliferation. *ETV6 - NTRK3* - The **ETV6-NTRK3 rearrangement** is characteristic of **secretory carcinoma** (formerly mammary analogue secretory carcinoma), often affecting salivary glands, and is not a common finding in thyroid malignancies. - This fusion leads to the activation of the **NTRK3 receptor tyrosine kinase**, involved in cell growth and survival. *RET - PTC1* - The **RET-PTC1 rearrangement (RET/papillary thyroid carcinoma 1)** is specifically associated with **papillary thyroid carcinoma (PTC)**, which is histologically distinct from follicular thyroid carcinoma. - This fusion activates the **RET proto-oncogene**, promoting cell proliferation and survival in papillary thyroid cancer.

Question 883: Which of the following is a good prognostic factor in neuroblastomas?

A. N-myc amplification
B. RAS oncogene
C. Hyperdiploidy (Correct Answer)
D. Translocations

Explanation: ***Hyperdiploidy*** - An increased number of chromosomes (hyperdiploidy) (more than diploid, typically triploid or tetraploid) is associated with a **favorable outcome** in neuroblastoma, particularly in infants [1]. - This chromosomal characteristic indicates a less aggressive tumor biology and often correlates with better response to treatment and **higher survival rates** [1]. *N-myc amplification* - Amplification of the **N-myc oncogene** is a strong indicator of **poor prognosis** in neuroblastoma, leading to rapid tumor progression and resistance to therapy [1]. - It is associated with **advanced disease stage** and is a key factor in risk stratification for treatment intensity [1]. *RAS oncogene* - While mutations in the **RAS oncogene** are found in various cancers, their specific prognostic significance in neuroblastoma is less consistently favorable than hyperdiploidy. - RAS mutations can sometimes be associated with **tumor resistance** to certain therapies. *Translocations* - **Chromosomal translocations** in general are often associated with oncogenesis and can have variable prognostic implications depending on the specific genes involved. - In neuroblastoma, specific translocations are generally not considered a good prognostic factor; instead, they can sometimes be linked to **aggressive disease** [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.

Question 884: Calcified pulmonary metastasis is seen in which carcinoma?

A. Pancreatic carcinoma
B. Thyroid carcinoma (Correct Answer)
C. Endometrial carcinoma
D. None of the options

Explanation: ***Thyroid carcinoma*** - **Papillary** and **medullary thyroid carcinomas** can produce **calcified pulmonary metastases**. - In **papillary thyroid cancer**, calcification occurs due to **psammoma bodies** (concentrically laminated calcified structures). - In **medullary thyroid cancer**, calcification can occur through **dystrophic calcification** within the tumor tissue. - Other common causes of calcified lung metastases include **osteosarcoma** and **chondrosarcoma**. *Pancreatic carcinoma* - Pancreatic carcinoma rarely causes **calcified pulmonary metastases**; metastatic lesions are typically **non-calcified**. - Metastases are more commonly found in the **liver** and **peritoneum**. - Primary pancreatic tumors may show calcification, but metastases usually do not. *Endometrial carcinoma* - Endometrial carcinoma metastases to the lungs are usually **non-calcified** and appear as **soft tissue nodules**. - While it can metastasize to the lungs, **calcification** is not a typical feature of its pulmonary spread. *None of the options* - This option is incorrect because **thyroid carcinoma** (particularly papillary type) is a well-recognized cause of **calcified pulmonary metastases**. - Among epithelial malignancies, thyroid carcinoma is one of the classic causes of this finding.

Question 885: Which of the following is commonly associated with osteolytic metastasis?

A. Lung cancer
B. Renal cell carcinoma
C. Thyroid cancer
D. Breast cancer (Correct Answer)

Explanation: ### Breast cancer - **Breast cancer** is the **most common** primary malignancy causing osteolytic bone metastases in clinical practice due to its **high prevalence** and frequent bone tropism [1]. - Breast cancer metastases stimulate **osteoclast activity** leading to bone destruction and **purely lytic lesions** in approximately 80% of cases. - The high incidence of breast cancer makes it the **leading cause** of osteolytic metastases overall. *Renal cell carcinoma* - **Renal cell carcinoma (RCC)** characteristically produces **highly osteolytic, aggressive, and vascular** bone metastases [1]. - While RCC metastases are predominantly lytic, they are **less common** than breast cancer metastases due to lower disease prevalence. - RCC bone metastases often present with **expansile lesions** and high risk of pathological fractures. *Thyroid cancer* - **Thyroid cancer** (especially follicular subtype) produces predominantly **osteolytic metastases** that are often vascular [1]. - However, bone metastases from thyroid cancer are **relatively uncommon** compared to breast cancer due to the rarity of metastatic thyroid disease. *Lung cancer* - Lung cancer bone metastases are typically **mixed osteolytic-osteoblastic lesions** rather than purely lytic. - While common, lung cancer is **less characteristically associated with pure osteolytic lesions** compared to breast, renal, or thyroid cancers [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 671-672.

Question 886: Which of the following is a premalignant lesion for carcinoma of the rectum?

A. Juvenile polyposis
B. Adenomatous polyps (Correct Answer)
C. Familial adenomatous polyposis
D. Hyperplastic polyps

Explanation: ***Familial polyposis*** - Familial adenomatous polyposis (FAP) is characterized by numerous **adenomatous polyps** in the colon and rectum, which have a high risk of progressing to colorectal cancer [1]. - Individuals with FAP are at significant risk for developing **carcinoma rectum** at a young age if the condition is not managed properly [1]. *Juvenile polyp* - Juvenile polyps are generally **benign** and occur in children, with a very low risk of malignancy. - They do not contribute significantly to the risk of **carcinoma rectum** like adenomatous polyps do. *Adenomatous polyp* - While adenomatous polyps are indeed premalignant [1], the term **Familial polyposis** indicates a hereditary condition that specifically has a higher and more defined risk for rectal carcinoma. - Adenomatous polyps can occur sporadically and do not imply a genetic syndrome like familial polyposis. *FAP* - FAP refers specifically to **familial adenomatous polyposis** [1], which is the same concept as familial polyposis but less encompassed in terms of broad assessment in this context. - It is important to note that **familial polyposis** is a broader term that includes conditions like FAP and indicates a significant risk factor for rectal cancer [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 817, 821-822.

Question 887: The most common subtype of Non-Hodgkin's lymphoma in India is:

A. Diffuse small cell lymphocytic lymphoma
B. Diffuse large B cell lymphoma (Correct Answer)
C. Follicular lymphoma
D. Burkitt's lymphoma

Explanation: ***Diffuse large B cell lymphoma*** - It is the most common subtype of **Non-Hodgkin's lymphoma** observed in India, reflecting a higher prevalence in the population. - Characterized by **aggressive clinical behavior** [1] and typically presents as a rapidly enlarging mass, often involving lymph nodes or extranodal sites. *Burkitt's lymphoma* - This subtype is known for its **high proliferation rate** and is more common in specific demographics, such as children and immunocompromised individuals. - It typically presents with **jaw lesions** or abdominal masses, which is not typical in the broader Indian population. *Diffuse small cell lymphocytic lymphoma* - More accurately classified as **chronic lymphocytic leukemia** (CLL), it is not the most common subtype of Non-Hodgkin's lymphoma. - Characterized by a **milder clinical course** and presents with lymphocytosis in peripheral blood, lacking aggressive features. *Follicular lymphoma* - This is usually a **low-grade lymphoma** associated with **indolent behavior** and may not be the most commonly diagnosed subtype in India. - It typically involves multiple lymph nodes and is characterized by **nodular patterns on histology**, making it less prevalent than diffuse large B cell lymphoma. Follicular lymphoma is rare in Asian populations [2]. **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. 563-564. [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. 602-604.

Question 888: Localized Langerhans cell histiocytosis affecting head and neck is?

A. Eosinophilic granuloma (Correct Answer)
B. Letterer-siwe disease
C. Pulmonary Langerhans cell histiocytosis
D. Hand-Schuller-Christian disease

Explanation: ***Eosinophilic granuloma*** - This is a localized form of **Langerhans cell histiocytosis** that typically presents in the head and neck region, often affecting areas like the skull and mandible [1]. - Characterized by **bone lesions** and may present with **pain or swelling** in the affected area, making it a prominent form in children and young adults. *Pulmonary langerhans cell histiocytosis* - Primarily affects the **lungs** and is associated with **cough, dyspnea**, and pulmonary nodules, not the head and neck region. - Occurs predominantly in **smokers** and involves interstitial lung disease patterns on imaging studies. *Hand-schuller-christian disease* - This condition is a systemic form of Langerhans cell histiocytosis that affects multiple systems rather than being localized, commonly presenting with **diabetes insipidus** and bone lesions. - It is often associated with **exophthalmos** and may involve lymphadenopathy, affecting older children and adults, not localized head and neck involvement. *Letterer-siwe disease* - This represents the acute, disseminated form of Langerhans cell histiocytosis, affecting infants, and is marked by systemic symptoms like **fever**, **rash**, and **hepatosplenomegaly** [1]. - Typically presents with serious manifestations and not specifically localized in the **head and neck area** as seen in eosinophilic granuloma. **References:** [1] 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. 630.

Question 889: What is a hamartoma?

A. Malignant tumor
B. Metastatic tissue
C. Hemorrhage in vessel
D. Developmental malformation (Correct Answer)

Explanation: ***Development malformation*** - A **hamartoma** is a type of **benign tumor** that consists of an overgrowth of mature cells, representing a **developmental malformation** [1]. - It is formed from tissues that are normally present in the affected organ but are disorganized, leading to a characteristic appearance. *Malignant tumor* - Hamartomas are classified as **benign tumors** [1], not malignant, as they do not invade surrounding tissues or metastasize. - Despite being a growth, they do not exhibit the aggressive characteristics of malignant tumors. *Hemorrhage in vessel* - Hemorrhage refers to bleeding within a vessel and is unrelated to the definition or nature of a **hamartoma**. - Hamartomas do not consist of blood or bleeding; instead, they involve disorganized tissue growth. *Metastatic tissue* - Metastatic tissue refers to cancerous cells that have spread from their original site, which contrasts with the **non-cancerous** nature of hamartomas [1]. - Hamartomas do not involve the spread of cancer cells, but rather a **local abnormality** in tissue arrangement. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 481-482.

Question 890: Which of the following is a primary pleural tumor?

A. Mesothelioma (Correct Answer)
B. Myxoma
C. Lipoma
D. None of the options

Explanation: ***Mesothelioma*** - Mesothelioma is a **primary malignant tumor** of the pleura [1], commonly associated with **asbestos exposure** [2]. - It typically presents with symptoms like **pleuritic chest pain**, dyspnea, and pleural effusion. *Myxoma* - Myxoma is a **benign tumor** primarily found in the **heart**, particularly in the left atrium, not in the pleura. - It does not arise from pleural tissue and lacks the **malignant characteristics** of mesothelioma. *All* - This option suggests that multiple tumors can be primary pleural tumors, which is incorrect as only mesothelioma is recognized as such. - Other tumors like myxoma and lipoma do not originate in the pleura and thus cannot be classified as primary pleural tumors. *Lipoma* - Lipoma is a **benign tumor** made up of adipose tissue [3] and is typically found in *subcutaneous tissue*, not the pleural cavity. - It does not have the malignant potential or association with pleural disease that characterizes mesothelioma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 728-729. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 339-340. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1222.

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