Oncology Practice Questions

Q: A 2-year-old boy presents with cough and breathlessness for last one month. On examination pallor is present and enlarged liver is palpable 3 cm below costal margin. CXR shows?

Mediastinal lymphadenopathy. ***Mediastinal lymphadenopathy*** - The CXR shows evidence of **significant widening of the mediastinum**, particularly in the hilar and paratracheal regions, consistent with enlarged lymph nodes. - In a 2-year-old with chronic cough, breathlessness, pallor, and hepatomegaly, a likely underlying cause could be a condition leading to extensive lymphadenopathy, such as **tuberculosis** or **lymphoma**, which can present with these findings. *Atypical pneumonia* - Atypical pneumonia typically presents with **interstitial infiltrates**, not prominent mediastinal widening. - While it can cause cough and breathlessness, it does not usually explain the **pallor** or **hepatomegaly** observed in this patient. *Pneumonia* - Typical bacterial pneumonia usually manifests as **lobar or segmental consolidation** on CXR, which is not seen here. - Although it causes cough and breathlessness, **hepatomegaly** and **pallor** are not primary features of uncomplicated pneumonia. *Mediastinal fibrosis* - Mediastinal fibrosis is a rare condition that involves diffuse scarring of the mediastinal contents, leading to **narrowing of airways or blood vessels**. - It would typically appear as a more **dense, irregular mass** or diffuse haziness with potential calcifications, often resulting in symptoms related to compression, rather than discrete, enlarged lymph node structures.

Q: A 4-year-old child with rapidly growing swelling of left eye with loss of vision over last 4 weeks. On examination hepatosplenomegaly is noted. CBC shows anemia, hyperleukocytosis with low platelets. Bone marrow aspiration was performed. Diagnosis is?

Chloroma. ***Chloroma*** - A rapidly growing orbital mass (often presenting as **proptosis** or periocular swelling) in a child, coupled with **hepatosplenomegaly** and CBC abnormalities (anemia, hyperleukocytosis, thrombocytopenia), are classic features of **acute myeloid leukemia** (AML) presenting as a chloroma. - A chloroma (also known as a **granulocytic sarcoma**) is an extramedullary manifestation of AML, consisting of leukemic cells infiltrating a tissue or organ, which can include the orbit. *Wilms tumor* - This is a common **kidney tumor** in children, typically presenting as an abdominal mass and sometimes hypertension or hematuria. - It does not typically present with orbital swelling or the described hematological abnormalities. *Hepatoblastoma* - This is the most common primary **malignant liver tumor** in children, presenting as an abdominal mass, elevated alpha-fetoprotein, and sometimes precocious puberty. - It does not cause orbital masses or the characteristic bone marrow findings of leukemia. *Non Hodgkin lymphoma* - While pediatric NHL can present with extranodal disease, including orbital involvement, the specific combination of rapidly growing orbital mass, prominent hepatosplenomegaly, and the **hyperleukocytosis with low platelets** usually points more strongly to an acute leukemia with extramedullary involvement, especially given a bone marrow aspiration would be performed to confirm. - In NHL, the bone marrow might be involved, but hyperleukocytosis with a severely deranged blood count (as seen in acute leukemia) is less characteristic as an initial presentation.

Q: An 8-year-old girl presents with swelling over right anterior chest wall. Which is the correct diagnosis?

Rhabdomyosarcoma. ***Rhabdomyosarcoma*** - This is a highly malignant tumor originating from **mesenchymal cells** that are committed to skeletal muscle differentiation. It is the **most common soft tissue sarcoma in children**, often presenting as a rapidly growing mass in areas like the head and neck, genitourinary tract, or extremities, but can also occur on the chest wall. - The imaging, particularly the CT scan showing a large, irregularly shaped mass on the anterior chest wall in an 8-year-old, is highly suggestive of a **malignant soft tissue tumor**, with rhabdomyosarcoma being the most probable given the age and presentation. *Fibroadenoma* - This is a **benign tumor of the breast**, typically occurring in adolescent and young adult women. - It is **rare in prepubertal girls** and would be located within breast tissue, not as a superficial chest wall mass as depicted in the image. *Lipoma* - A lipoma is a **benign fatty tumor** that usually presents as a soft, mobile, non-tender subcutaneous mass. - While it can occur on the chest wall, the presented mass appears relatively firm and infiltrative on imaging, and **lipomas are less common in young children** as the cause of such a prominent, rapidly growing anterior chest wall swelling. *Cystosarcoma Phyllodes* - Also known as a **phyllodes tumor**, this is a rare fibroepithelial tumor of the breast, typically found in women between 30 and 50 years of age. - Like fibroadenomas, these tumors are located within the breast and are **extremely rare in children**, making it an unlikely diagnosis for an 8-year-old girl with a chest wall mass.

Q: One-year-old child presents with abdominal lump. All are true about the condition shown below except:

Gain of distal short arm of chromosome 1. ***Gain of distal short arm of chromosome 1*** - **Gain of distal short arm of chromosome 1 (1p duplication)** is not a characteristic genetic abnormality associated with neuroblastoma. - Instead, **deletion of the short arm of chromosome 1 (1p deletion)** is a common genetic alteration seen in neuroblastoma, indicating a poorer prognosis. *Dancing eyes and dancing feet* - This refers to **opsoclonus-myoclonus syndrome (OMS)**, a paraneoplastic syndrome associated with neuroblastoma, characterized by rapid, irregular eye movements (opsoclonus) and involuntary muscle jerks (myoclonus). - OMS is one of the classic paraneoplastic manifestations of neuroblastoma, seen in a small percentage of cases, especially those with tumors that spontaneously regress. *Homer Wright pseudo-Rosettes* - **Homer Wright pseudo-rosettes** are a characteristic histological feature of neuroblastoma, consisting of tumor cells arranged concentrically around a central area of neuropil. - This finding on histopathology is highly suggestive of neuroblastoma, a tumor of neural crest origin. *Horner syndrome* - **Horner syndrome** (ptosis, miosis, anhidrosis) can be caused by neuroblastoma arising in the neck or superior mediastinum, which infiltrates or compresses the **sympathetic chain**. - The image shows a child with proptosis and exophthalmos from likely orbital metastases, and another common site for neuroblastoma is the adrenal gland, but also sympathetic ganglia throughout the body.

Q: A 6-month-old infant with a progressively increasing abdominal lump. Investigations revealed a stage IVs neuroblastoma. All are correct about the condition except:

Most common stage of neuroblastoma. ***Most common stage of neuroblastoma*** - Stage IVs neuroblastoma is typically seen in infants under 1 year of age, but it is **not the most common stage** overall. - While it has distinct features, stage IV (disseminated disease with distant metastases) is generally considered the most common presentation of neuroblastoma at diagnosis across all age groups. *Favorable prognosis* - Stage IVs neuroblastoma generally has a **favorable prognosis** due to its unique biological behavior compared to other advanced stages. - This stage is characterized by **spontaneous regression** in many cases, contributing to better outcomes despite widespread disease. *Can regress spontaneously* - A hallmark of Stage IVs neuroblastoma is the potential for **spontaneous regression**, often without intensive therapy. - This characteristic is attributed to specific biological features of the tumor cells in this subset of patients. *Low dose cyclophosphamide* - For stage IVs neuroblastoma, particularly in symptomatic cases, **low-dose chemotherapy**, such as cyclophosphamide, is often used. - The goal is to manage symptoms and encourage regression rather than aggressive eradication, given the tumor's favorable biology.

Q: Comment on the diagnosis of this child, presenting with eye swelling. (Recent NEET Pattern 2016-17)

Neuroblastoma. ***Neuroblastoma*** - The image shows **periorbital ecchymosis** and **proptosis** in a child, which are classic signs of orbital metastatic neuroblastoma, often referred to as "raccoon eyes." - The abdominal scar suggests a prior surgery, possibly for removal of the primary tumor, which is typically found in the **adrenal gland** or **sympathetic ganglia**. *Chloroma* - **Chloromas** (also known as granulocytic sarcomas) are extramedullary manifestations of myeloid leukemia, presenting as solid tumors composed of myeloid blast cells. - While they can appear in the orbit and mimic proptosis, the presence of bilateral periorbital ecchymosis ("raccoon eyes") is more characteristic of neuroblastoma metastasis. *Wilms tumor* - **Wilms tumor** is a kidney cancer, typically presenting as an **abdominal mass** and occasionally with hypertension or hematuria. - Ocular manifestations, such as proptosis, are extremely **rare** and do not typically involve periorbital ecchymosis. *Ameloblastoma* - An **ameloblastoma** is a benign but locally aggressive tumor of odontogenic (tooth-forming) origin, primarily affecting the **jawbones**. - It does not metastasize to the orbit and would not present with periorbital swelling or ecchymosis.

Q: A mother notices a swelling in the abdomen of her 3-year-old child while bathing him. He had a history of hematuria two weeks back, which resolved spontaneously. On examination, a right-sided reniform ballotable mass was found. What is the most appropriate initial investigative approach?

Ultrasound, CT scan with contrast, and CBC. ***Ultrasound, CT scan with contrast, and CBC*** - This combination allows for comprehensive **assessment of the kidney mass**, its extent, and helps differentiate it from other abdominal masses, while a CBC checks for paraneoplastic anemia or polycythemia. - **Ultrasound** is typically the initial imaging modality due to its non-invasiveness and ability to characterize the mass as solid or cystic, followed by a **CT scan with contrast** for detailed anatomical information and staging. *Ultrasound, CT scan with contrast, CBC, and Bone marrow biopsy* - While ultrasound, CT scan with contrast, and CBC are appropriate, a **bone marrow biopsy** is usually reserved for suspected metastasis or specific types of tumors like neuroblastoma, not as an initial step for a primary renal mass presentation in a 3-year-old child. - The initial focus is on characterizing the renal mass and systemic workup, and bone marrow biopsy would be considered later if there's evidence or high suspicion of metastatic disease to the bone marrow. *Ultrasound and CT scan with contrast* - While these imaging studies are crucial for diagnosing and staging the renal mass, neglecting a **complete blood count (CBC)** would be an oversight. - A CBC can reveal important information such as anemia (common with renal tumors), thrombocytosis, or other hematological abnormalities that might influence treatment decisions or indicate prognosis. *CT scan with contrast and Bone marrow biopsy* - Relying solely on a **CT scan with contrast** as the initial imaging can be less efficient than starting with ultrasound, especially in children, and lacks the preliminary information provided by a CBC. - A **bone marrow biopsy** is not typically part of the initial workup for a suspected Wilms' tumor unless there is specific concern for bone marrow involvement or to rule out a neuroblastoma.

Q: Which of the following malignant diseases of children has the best prognosis -

Wilms tumor. ***Wilms tumor*** - **Wilms tumor**, also known as **nephroblastoma**, has one of the best prognoses among childhood malignancies, with a **survival rate exceeding 90%** for localized disease. - Its high curability is attributed to its **chemosensitivity**, surgical resectability, and advancements in multimodal therapy. *Primitive neuroectodermal tumor* - **Primitive neuroectodermal tumors (PNETs)** are highly aggressive and often associated with a **poor prognosis**, particularly when they are large or metastatic. - These tumors arise from neuroectoderm and can occur in the central nervous system (e.g., medulloblastoma) or peripherally, making treatment challenging due to their infiltrative nature. *Neuroblastoma* - **Neuroblastoma** is a common extracranial solid tumor in children, originating from neural crest cells, and its prognosis varies widely based on age, stage, and biological features, but it often has a **guarded prognosis**, especially in older children or with unfavorable genetic markers. - High-risk neuroblastomas frequently exhibit **amplification of the MYCN oncogene** and often require intensive, multi-modal treatment, still leading to significant mortality. *Rhabdomyosarcoma* - **Rhabdomyosarcoma** is a malignant tumor of mesenchymal origin with skeletal muscle differentiation, and its prognosis depends heavily on site, histology (e.g., alveolar vs. embryonal), and resectability, with **overall survival rates lower than Wilms tumor**, especially for unfavorable subtypes or metastatic disease. - Aggressive treatment including chemotherapy, radiation, and surgery is often necessary, but recurrence rates can be high.

Q: Abdominal Ultrasonography in a 3 year old boy shows a solid circumscribed hypoechoic renal mass. Most likely diagnosis is-

Wilms tumor. ***Wilms tumor*** - **Wilms tumor** is the most common renal malignancy in children aged 2-5 years, often presenting as a **palpable abdominal mass** or an incidental finding on imaging. - The ultrasound finding of a **solid, circumscribed, hypoechoic renal mass** in a 3-year-old boy is highly characteristic of Wilms tumor. *Mesoblastic nephroma* - This is typically diagnosed in infants, usually before **6 months of age**, making it less likely in a 3-year-old. - While it is a solid renal mass, its incidence is significantly lower than Wilms tumor in this age group. *Renal cell carcinoma* - **Renal cell carcinoma (RCC)** is extremely rare in young children, predominantly affecting adults. - While RCC can present as a solid renal mass, the age of the patient (3 years old) makes this diagnosis highly improbable. *Oncocytoma* - **Renal oncocytoma** is a benign renal tumor that is almost exclusively seen in adults, typically older than 50 years. - Its occurrence in a 3-year-old child is virtually unheard of.

Q: Most common tumor in the part of the brain shown (arrow) among children is

Astrocytoma. ***Astrocytoma*** - The image shows a **brainstem lesion**, which is a common location for astrocytomas in children. - **Pilocytic astrocytoma** is the most common brain tumor in children, often presenting in the cerebellum, brainstem, or optic pathways. *DNET (Dysembryoplastic Neuroepithelial Tumor)* - DNETs are typically found in the **temporal lobe** and are associated with a history of seizures. - While benign, their characteristic location and symptoms do not align with a brainstem mass as the primary finding. *Ependymoma* - Ependymomas frequently arise in the **fourth ventricle** in children, often causing hydrocephalus. - Although they can occur in the brainstem, astrocytomas are generally more common in this specific region in pediatric cases. *Medulloblastoma* - Medulloblastomas are nearly always located in the **cerebellum** (infratentorial region) and are known for their aggressive nature and propensity for CSF dissemination. - The lesion shown appears to be within the brainstem, making medulloblastoma less likely given its typical cerebellar location.

Question 1

A 2-year-old boy presents with cough and breathlessness for last one month. On examination pallor is present and enlarged liver is palpable 3 cm below costal margin. CXR shows?

Accepted Answer

Mediastinal lymphadenopathy

Answer

Atypical pneumonia

Answer

Pneumonia

Answer

Mediastinal fibrosis

Question 2

A 4-year-old child with rapidly growing swelling of left eye with loss of vision over last 4 weeks. On examination hepatosplenomegaly is noted. CBC shows anemia, hyperleukocytosis with low platelets. Bone marrow aspiration was performed. Diagnosis is?

Accepted Answer

Chloroma

Answer

Wilms tumor

Answer

Hepatoblastoma

Answer

Non Hodgkin lymphoma

Question 3

An 8-year-old girl presents with swelling over right anterior chest wall. Which is the correct diagnosis?

Accepted Answer

Rhabdomyosarcoma

Answer

Fibroadenoma

Answer

Lipoma

Answer

Cystosarcoma Phyllodes

Question 4

One-year-old child presents with abdominal lump. All are true about the condition shown below except:

Accepted Answer

Gain of distal short arm of chromosome 1

Answer

Dancing eyes and dancing feet

Answer

Homer Wright pseudo-Rosettes

Answer

Horner syndrome

Question 5

A 6-month-old infant with a progressively increasing abdominal lump. Investigations revealed a stage IVs neuroblastoma. All are correct about the condition except:

Accepted Answer

Most common stage of neuroblastoma

Answer

Favorable prognosis

Answer

Can regress spontaneously

Answer

Low dose cyclophosphamide

Question 6

Comment on the diagnosis of this child, presenting with eye swelling. (Recent NEET Pattern 2016-17)

Accepted Answer

Neuroblastoma

Answer

Chloroma

Answer

Wilms tumor

Answer

Ameloblastoma

Question 7

A mother notices a swelling in the abdomen of her 3-year-old child while bathing him. He had a history of hematuria two weeks back, which resolved spontaneously. On examination, a right-sided reniform ballotable mass was found. What is the most appropriate initial investigative approach?

Accepted Answer

Ultrasound, CT scan with contrast, and CBC

Answer

Ultrasound, CT scan with contrast, CBC, and Bone marrow biopsy

Answer

Ultrasound and CT scan with contrast

Answer

CT scan with contrast and Bone marrow biopsy

Question 8

Which of the following malignant diseases of children has the best prognosis -

Accepted Answer

Wilms tumor

Answer

Primitive neuroectodermal tumor

Answer

Neuroblastoma

Answer

Rhabdomyosarcoma

Question 9

Abdominal Ultrasonography in a 3 year old boy shows a solid circumscribed hypoechoic renal mass. Most likely diagnosis is-

Accepted Answer

Wilms tumor

Answer

Mesoblastic nephroma

Answer

Renal cell carcinoma

Answer

Oncocytoma

Question 10

Most common tumor in the part of the brain shown (arrow) among children is

Accepted Answer

Astrocytoma

Answer

DNET

Answer

Ependymoma

Answer

Medulloblastoma

Oncology — MCQs

Oncology — MCQs

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