Neoplasia — MCQs

Neoplasia Indian Medical PG Practice Questions and MCQs

Question 941: Which immunohistochemical marker is primarily associated with glomus tumors?

A. Cytokeratin
B. S-100
C. CD-57
D. CD-34 (Correct Answer)

Explanation: ***CD-34*** (Marked answer, but controversial) - **IMPORTANT NOTE:** This association is **contested** in modern pathology literature. - Glomus tumors are derived from modified smooth muscle cells of the glomus body and typically show **smooth muscle actin (SMA)** and **vimentin positivity**. - **CD34** is an endothelial marker; while glomus tumors have prominent vascularity, the **neoplastic glomus cells themselves** are generally **CD34-negative**. - The correct positive markers are **SMA, vimentin, and caldesmon** - none of which are options here. - Among the given options, CD-34 may show positivity in the **vascular endothelium** within the tumor, but this does not represent the tumor cells. *CD-57* - **CD57** (HNK-1) is associated with neural differentiation, particularly in peripheral nerve sheath tumors like **schwannoma** or **neurofibroma**. - Glomus tumors lack neural differentiation and are **CD57-negative**. *Cytokeratin* - **Cytokeratin** is a marker for epithelial cells and carcinomas. - Glomus tumors are mesenchymal smooth muscle tumors and are **cytokeratin-negative**. *S-100* - **S-100** protein marks neural crest-derived cells, melanomas, and schwannomas. - Glomus tumors originate from modified smooth muscle cells, not neural crest, and are typically **S-100-negative** (though rare cases may show focal weak positivity).

Question 942: Which of the following conditions is not typically associated with an underlying malignancy?

A. Paget disease of vulva
B. Paget disease of anal region
C. Paget disease of bone (Correct Answer)
D. Paget disease of nipple

Explanation: ***Paget disease of bone*** - While Paget disease of bone can rarely undergo **malignant transformation** into **osteosarcoma**, it is itself a disorder of excessive bone remodeling and **not directly an underlying malignancy** like the other Paget diseases [2]. - The primary concern in Paget disease of bone is metabolic bone changes and potential complications like fractures, rather than being a superficial manifestation of internal cancer [2]. *Paget disease of nipple* - This condition is almost always associated with an **underlying ductal carcinoma in situ** or invasive adenocarcinoma of the breast [1]. - The epidermal changes are a manifestation of malignant cells migrating from the underlying breast tissue [1]. *Paget disease of vulva* - While it can occur as a primary intraepithelial neoplasm (adenocarcinoma in situ), approximately 20-30% of cases are associated with an **underlying invasive adenocarcinoma**, either vulvar or originating from other sites such as the colon, bladder, or urethra. - Its presence necessitates a thorough search for associated malignancies. *Paget disease of anal region* - Similar to vulvar Paget disease, it can be a primary intraepithelial adenocarcinoma, but it frequently is associated with an **underlying adenocarcinoma** of the colon, rectum, or anal glands. - Evaluation for an internal malignancy is crucial when this diagnosis is made. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1061-1062. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1191-1194.

Question 943: Which of the following is NOT a precancerous condition associated with bladder carcinoma?

A. Chronic ulcer
B. Aniline dyes (Correct Answer)
C. Schistosomiasis
D. Tuberculosis of the bladder

Explanation: ***Aniline dyes*** - **Aniline dyes** themselves are not direct precancerous conditions but rather contribute to the development of bladder carcinoma as **carcinogens** [1]. - Exposure to aromatic amines, historically used in dye industries, leads to DNA damage and genetic mutations over time, which can result in cancer [3]. *Tuberculosis of the bladder* - **Tuberculosis of the bladder** causes chronic inflammation and irritation, which can lead to metaplasia and dysplasia, increasing the risk of bladder cancer [5]. - While not as common as other risk factors, chronic inflammation from infections is a known pathway for malignant transformation in various organs [2]. *Schistosomiasis* - **Schistosomiasis**, particularly *Schistosoma haematobium* infection, is a significant risk factor for **squamous cell carcinoma of the bladder** [3]. - The chronic inflammation, irritation, and cellular damage caused by the parasite's eggs embedded in the bladder wall promote malignant change [3]. *Chronic ulcer* - **Chronic ulcers** in the bladder, resulting from persistent irritation or inflammation, can lead to cellular changes and repair mechanisms that increase the risk of malignant transformation [2], [4]. - Any long-standing inflammatory process with tissue damage and repair cycles can predispose to cancer development due to increased cell turnover and potential for mutations [2]. **References:** [1] 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. 217-218. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 286-287. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 968-970. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 966-967. [5] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 494-495.

Question 944: Which of the following is a benign tumor?

A. Liposarcoma
B. Askin's tumor
C. Chloroma
D. Fibromatosis (Correct Answer)

Explanation: ***Fibromatosis*** - Fibromatosis is classified as a **benign fibrous tumor** [1][3], meaning it does not have the potential to metastasize. - It involves **proliferation of fibroblasts** [1] and is primarily characterized by local invasiveness rather than malignancy. *Askin's tumor* - Also known as **primitive neuroectodermal tumor (PNET)**, it is recognized as a **malignant tumor** commonly affecting the chest wall. - Associated with strong **aggressive behavior** and metastatic potential, particularly in pediatric populations. *Liposarcoma* - Liposarcoma is a malignant tumor arising from **adipose tissue** [2][3], exhibiting aggressive growth and potential for metastasis. - It is classified as a **soft tissue sarcoma** [2], with various subtypes depending on histological features [2]. *Chloroma* - Chloroma, or **myeloid sarcoma**, is a malignant tumor of **myeloid lineage cells** typically associated with acute myeloid leukemia (AML). - Characterized by the **extramedullary infiltration** of myeloid cells, leading to clinical aggressiveness. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1223-1224. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1222-1223. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1222.

Question 945: What is the most common type of anal carcinoma?

A. Epidermoid (Correct Answer)
B. Adenocarcinoma
C. Mixed carcinoma
D. Melanoma

Explanation: ***Epidermoid*** - **Epidermoid carcinoma** (also known as squamous cell carcinoma) is the most prevalent type of anal cancer, accounting for about 80% of all cases. - This type of cancer originates from the **squamous cells** that line the anal canal. *Adenocarcinoma* - **Adenocarcinoma** of the anus arises from the glandular cells of the anal glands or columnar epithelium located in the upper anal canal or rectum. - It accounts for a much smaller percentage of anal cancers compared to epidermoid carcinoma. *Mixed carcinoma* - **Mixed carcinoma** is a less common subtype that contains features of both squamous and glandular differentiation or other histological types. - It represents a minor proportion of anal malignancies. *Melanoma* - **Anal melanoma** is a very rare and aggressive form of anal cancer, originating from melanocytes in the anal region. - It accounts for less than 1% of all anal neoplasms.

Question 946: Somatic mutation of PTEN is seen in:

A. Endometrial carcinoma (Correct Answer)
B. Osteosarcoma
C. Carcinoma breast
D. Retinoblastoma

Explanation: ***Endometrial carcinoma*** - Somatic mutations of the **PTEN gene** are frequently associated with endometrial carcinoma, particularly in **type I endometrial cancers** [1]. - These mutations lead to **dysregulation of cellular pathways**, contributing to the development and progression of the tumor [1]. *Carcinoma breast* - While breast cancer can exhibit various mutations, including in genes like **BRCA1/2**, PTEN mutations are **not commonly associated**. - Breast cancers typically have a different **molecular profile**, including hormone receptor status that is not linked to PTEN. *Osteosarcoma* - Osteosarcoma's genetic alterations mainly involve **RB gene** and **TP53 mutations**, rather than changes in the PTEN gene. - The typical pathology does not involve the **loss of PTEN function**, making it an unlikely association with this mutation. *Retinoblastoma* - Retinoblastoma is primarily associated with mutations in the **RB1 gene**, not PTEN, and is linked to **hereditary patterns**. - PTEN mutations do not play a significant role in the pathogenesis of retinoblastoma, differentiating its genetic basis from that of endometrial carcinoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1015-1018.

Question 947: Thorium-induced tumor is which of the following?

A. Angiosarcoma of liver (Correct Answer)
B. Lymphoma
C. Renal cell carcinoma
D. Astrocytoma

Explanation: ***Angiosarcoma of liver*** - Thorium exposure is specifically linked to the development of **angiosarcoma of the liver**, often seen in individuals with a history of thorium dioxide injection [1]. - This type of tumor arises from **vascular endothelial cells** and is highly aggressive, often leading to significant morbidity. *Lymphoma* - Lymphoma is associated with **immune system factors** and typically arises from lymphoid tissues, which do not correlate with thorium exposure. - **Hematological malignancies** such as lymphoma do not have a documented direct association with thorium as a causative agent. *Astrocytoma* - Astrocytomas originate from **glial cells** in the brain and are primarily influenced by genetic predispositions rather than environmental carcinogens like thorium. - There is no established relationship between **thorium exposure** and the incidence of brain tumors such as astrocytomas. *Renal cell carcinoma* - Renal cell carcinoma is commonly linked to **smoking, obesity**, and genetic factors rather than thorium exposure. - It does not have a recognized connection to thorium, which is more specifically associated with liver tumors. **References:** [1] 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. 216-217.

Question 948: In which of the following locations is a carcinoid tumor most common?

A. Appendix
B. Esophagus
C. Small bowel (Correct Answer)
D. Stomach

Explanation: ***Small bowel*** - The **small intestine**, particularly the **ileum**, is the **most common site** for carcinoid tumors (neuroendocrine tumors) in current medical literature [1]. - Small bowel carcinoids account for approximately **40-45%** of all gastrointestinal neuroendocrine tumors [1]. - These tumors can be associated with **carcinoid syndrome** when they metastasize to the liver, causing symptoms like flushing, diarrhea, and bronchospasm [3]. - Small bowel carcinoids tend to be **more aggressive** than appendiceal carcinoids and have a higher metastatic potential [2]. *Appendix* - Historically, the appendix was considered the most common site based on incidental findings during appendectomy. - Currently accounts for approximately **15-20%** of gastrointestinal neuroendocrine tumors. - Appendiceal carcinoids are usually **small, localized, and benign** with an excellent prognosis when discovered early [2]. *Stomach* - Gastric carcinoids account for approximately **7-8%** of gastrointestinal neuroendocrine tumors. - Often associated with **hypergastrinemia**, **chronic atrophic gastritis**, or **multiple endocrine neoplasia type 1 (MEN1)** syndrome [1]. - Can be classified into three types based on pathogenesis and clinical behavior. *Esophagus* - **Esophageal carcinoid tumors** are extremely rare, accounting for less than **1%** of gastrointestinal neuroendocrine tumors. - The esophagus is primarily associated with **squamous cell carcinoma** and **adenocarcinoma** rather than carcinoids. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 780-781. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 375-376. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 781-782.

Question 949: In the context of solid tumors, which is the most common site of metastasis?

A. Lung (Correct Answer)
B. Bone
C. Liver
D. Brain

Explanation: ***Lung*** - The **lungs** are the most common site of metastasis for solid tumors overall due to their unique position in receiving 100% of the systemic venous return via the pulmonary circulation. - This makes the lungs the **first capillary bed** encountered by tumor cells entering the venous system from most primary sites. - Common primary tumors metastasizing to lung include **breast, colon, kidney, sarcomas, melanoma, head and neck, and thyroid cancers** [2]. - Found in approximately **30-40% of all cancer deaths** at autopsy. *Liver* - The **liver** is the **second most common** site for metastasis, particularly for gastrointestinal malignancies [1]. - Its dual blood supply (hepatic artery and portal vein) makes it highly susceptible, especially for tumors draining via the **portal circulation** (colon, pancreas, stomach). - Also a common site for breast, lung, and melanoma metastases. - Found in approximately 30-35% of cancer deaths at autopsy. *Bone* - **Bone metastases** are common with specific tumor types: breast, prostate, lung, kidney, and thyroid [3]. - While causing significant morbidity (pain, fractures, hypercalcemia), bone is **less frequent overall** compared to lung or liver when considering all solid tumors. *Brain* - **Brain metastases** occur primarily with lung cancer, breast cancer, melanoma, and renal cell carcinoma [1]. - The **blood-brain barrier** provides some protection, making brain a less common site overall. - Significant clinical impact but lower overall frequency compared to lung and liver. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 724-725. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 338-339. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 671-672.

Question 950: Patient diagnosed with squamous cell intraepithelial lesion, which of the following has the highest risk for progression to carcinoma?

A. Low grade squamous intraepithelial neoplasia
B. High grade squamous intraepithelial neoplasia (Correct Answer)
C. Squamous intraepithelial neoplasia associated with HIV
D. Squamous intraepithelial neoplasia associated with HPV 16

Explanation: ***High grade squamous intraepithelial neoplasia*** - **High-grade squamous intraepithelial neoplasia (HSIL)** represents more severe dysplastic changes, involving a greater thickness of the epithelium, and thus carries a **significantly higher risk of progression to invasive carcinoma** compared to low-grade lesions [1]. - These lesions reflect persistent infection and dysregulation of cell growth and differentiation, often requiring more aggressive management [1]. *Low grade squamous intraepithelial neoplasia* - **Low-grade squamous intraepithelial neoplasia (LSIL)** involves only milder dysplastic changes, typically limited to the lower third of the epithelium [1]. - LSIL lesions have a **high rate of spontaneous regression** and a much lower risk of progressing to invasive carcinoma compared to HSIL [1]. *Squamous intraepithelial neoplasia associated with HIV* - While HIV infection is a risk factor for more persistent and progressive HPV infections and squamous intraepithelial lesions due to **immunosuppression**, the specific grade of the lesion (e.g., HSIL) is a more direct indicator of immediate progression risk than HIV status alone. - HIV-positive individuals frequently have **multifocal or recurrent lesions**, but the *cellular changes themselves* (high-grade vs. low-grade) are the primary determinant of progression risk. *Squamous intraepithelial neoplasia associated with HPV 16* - **HPV 16** is a **high-risk HPV type** strongly associated with squamous intraepithelial lesions and cervical cancer [1]. However, the *grade* of the lesion (HSIL vs. LSIL) indicates the extent of cellular transformation already present. - While HPV 16 is a major etiologic factor, the morphological classification of the lesion (HSIL) directly reflects the present cellular atypia and thus the immediate risk of progression to carcinoma, regardless of whether it's HPV 16-positive or not [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1006-1010.

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