NEET-PG 2012 - Pathology Practice Questions

Q: Glomus tumor is seen in -

Distal portion of digits. ***Distal portion of digits*** - **Glomus tumors** are most commonly found in the **distal extremities**, especially the **subungual region** (under the nail) of the fingers and toes. - This location accounts for over 75% of all glomus tumors, where they originate from specialized **neuromyoarterial glomus bodies** involved in thermoregulation. - The classic clinical triad includes **paroxysmal pain, point tenderness, and cold sensitivity**. *Rare locations such as retroperitoneum* - While glomus tumors can occur in unusual sites, the **retroperitoneum** is an exceptionally rare location for primary glomus tumors. - Extradigital glomus tumors account for approximately 25% of cases and can occur in various soft tissue sites. *Long bones and vertebrae* - Glomus tumors do not typically arise in **bone tissue** as they originate from glomus bodies in soft tissue. - Bone involvement, when present, is usually secondary due to pressure erosion from an adjacent soft tissue tumor rather than primary bone origin. *Proximal portion of digits (less common site)* - While glomus tumors can occasionally be found in less common digital locations, the **proximal portion of digits** is significantly less frequent than the distal, and particularly the subungual, region. - Their primary association remains with the **distal phalanx** and nail bed.

Q: Orphan Annie nuclei are characteristic of which of the following?

Papillary thyroid carcinoma. ***Papillary carcinoma thyroid***[1][2] - Characterized by **Orphan Annie nuclei**[1], which are large and round with a clear or empty appearance due to the presence of intranuclear cytoplasmic inclusions[1]. - Often associated with **thyroid follicular structures** and is the most common type of thyroid cancer[2]. *Meningioma* - Typically presents with **dural-based tumors** and does not exhibit Orphan Annie nuclei. - Histologically, it may demonstrate **whorled patterns** or calcifications instead. *Carcinoma pituitary* - Involves **adenomatous changes** in the pituitary gland but does not demonstrate the characteristic Orphan Annie nuclei. - More commonly shows **varied cellular morphology** depending on the type of secretory cells (e.g., prolactin, ACTH). *Paraganglioma* - Derived from **neuroendocrine cells**, and presents with **zellballen pattern** rather than Orphan Annie nuclei. - Often shows **chromaffin cells** and is typically associated with catecholamine secretion. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, p. 1099. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 429-430.

Q: Which of the following is the most likely proliferating breast mass?

Fibroadenoma. **Fibroadenoma** - A **fibroadenoma** is a benign **biphasic breast tumor** composed of both glandular and stromal tissue, making it a common proliferating mass [3]. - It is often seen in **young women** and typically presents as a firm, movable, non-tender lump [3]. *Duct ectasia* - **Duct ectasia** is a non-proliferative condition characterized by dilation of the **subareolar ducts**, often with inflammation and fibrosis. - It is more commonly associated with **nipple discharge** and **periductal inflammation** rather than being a primary proliferating mass. *Adenosis* - **Adenosis** refers to an increase in the number of **glands or lobules** within the breast parenchyma, which can be sclerosing or florid [2]. - While it involves increased glandular elements, it is generally considered a **benign proliferative change** and less likely to form a distinct, palpable mass compared to a fibroadenoma [1], [4]. *Papilloma* - A **papilloma** is a benign epithelial proliferation within a **duct**, characterized by a central fibrovascular core [2]. - It commonly presents with **nipple discharge**, often bloody, and is typically a smaller lesion within the ductal system rather than a large, palpable proliferating mass [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1052-1054. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 446-447. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 448-449. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1052.

Q: Most common site for medulloblastoma is-

Cerebellum. ***Cerebellum*** - **Medulloblastoma** is a highly malignant primary brain tumor that characteristically arises in the **cerebellum** [1]. - It is the most common malignant brain tumor in children, typically originating from the **roof of the fourth ventricle**. *Pituitary* - The **pituitary gland** is mostly associated with **adenomas**, which are benign tumors arising from anterior pituitary cells. - Tumors like **craniopharyngiomas** can also be found in the sellar region, but medulloblastomas do not originate here. *Cerebrum* - The **cerebrum** is the most common site for **gliomas** (e.g., glioblastoma multiforme) and metastatic tumors in adults. - Medulloblastoma specifically originates from primitive neuroectodermal cells in the posterior fossa [1]. *Pineal gland* - The **pineal gland** is associated with **pinealomas** (e.g., pineoblastoma, pineocytoma) and **germinomas** [2]. - These are distinct from medulloblastomas in their cellular origin and typical anatomical location.

Q: Which of the following germ cell tumors is benign?

Dermoid cyst. ***Seminoma*** - Seminomas are well-known malignant **germ cell tumors**, primarily affecting young males [2]. - They are associated with elevated **human chorionic gonadotropin (hCG)** and can spread to lymph nodes [3]. *Leydig cell tumor* - These tumors are usually **benign** and arise from Leydig cells in the testes. - While they can produce **testosterone**, they do not typically exhibit malignancy. *Sertoli cell tumor* - Sertoli cell tumors are also generally **benign** and arise from Sertoli cells in the testes. - They lack the malignant behavior seen in seminomas and have a low rate of metastasis [1]. *Dermoid cyst* - Dermoid cysts are **benign** mature teratomas, commonly found in the ovaries or testicles. - They can contain different tissue types (like hair, fat, and teeth) but are not malignant. **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. 512-513. [2] 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. [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. 980-982.

Q: Ewing's sarcoma arises from which type of cells?

Primitive neuroectodermal cells. ***Primitive neuroectodermal cells*** - **Ewing's sarcoma** is a malignant small round blue cell tumor largely believed to arise from **primitive neuroectodermal cells**. - This cellular origin explains why it's often grouped under the term **PNET (Primitive Neuroectodermal Tumor)**. *G cells* - **G cells** are specialized **enteroendocrine cells** found in the stomach and duodenum that secrete **gastrin**. - They are involved in regulating gastric acid secretion and have no association with Ewing's sarcoma. *Totipotent cells* - **Totipotent cells** have the ability to differentiate into **any type of cell**, including embryonic and extraembryonic tissues. - While all cancers originate from cellular changes, Ewing's sarcoma originates from a more specific, committed cell lineage, not totipotent stem cells. *Neurons* - **Neurons** are the basic functional units of the nervous system, responsible for transmitting electrical and chemical signals. - While Ewing's sarcoma has neuroectodermal characteristics, it does not arise from fully differentiated neurons but rather from more **primitive precursors**.

Q: Which of the following translocations is not associated with Down syndrome?

t(11;14). ***t (11: 14)*** - The **t(11;14) translocation** is commonly associated with **mantle cell lymphoma**, a B-cell non-Hodgkin lymphoma, and is not a cause of Down syndrome. - This translocation leads to the overexpression of the **cyclin D1 gene**, located on chromosome 11, which promotes cell growth and proliferation. *t (14; 21)* - This is a common **Robertsonian translocation** involving chromosomes 14 and 21, which results in an extra copy of chromosome 21 material [1]. - Individuals with this translocation can have **Down syndrome** because their cells end up with the equivalent of three copies of chromosome 21 [1]. *t (21; 21)* - This translocation is another type of **Robertsonian translocation** where two chromosome 21s fuse. - This specific translocation is rare and results in an extra copy of chromosome 21, leading to **Down syndrome** with a high recurrence risk in offspring. *t (15: 21)* - This is a **Robertsonian translocation** involving chromosomes 15 and 21, resulting in an extra copy of chromosome 21 material. - This translocation is a known cause of **Down syndrome** due to the dosage imbalance of genes on chromosome 21 [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 169-172.

Q: Which of the following diseases is NOT associated with Anti-Neutrophil Cytoplasmic Antibodies (ANCA)?

Henoch schonlein purpura. ***Henoch schonlein purpura*** - **Henoch-Schönlein purpura (HSP)** is not associated with **ANCA**; it primarily involves IgA deposition [1]. - Commonly presents with **purpura**, **abdominal pain**, and **glomerulonephritis**, differentiating it from ANCA-associated vasculitides [1]. *Wegener's granulomatosis* - **Wegener's granulomatosis**, now known as **Granulomatosis with polyangiitis**, is strongly associated with **c-ANCA** and anti-PR3 antibodies. - It typically presents with **respiratory** and **renal symptoms** due to vasculitis [2]. *Microscopic PAN* - **Microscopic polyangiitis (PAN)** is associated with **p-ANCA** and myeloperoxidase (MPO) antibodies. - It leads to **glomerulonephritis** and **pulmonary hemorrhage**, indicating its vasculitic nature. *Churg Strauss syndrome* - **Churg-Strauss syndrome**, or **Eosinophilic Granulomatosis with Polyangiitis**, is associated with **p-ANCA** and perinuclear staining [1]. - Often presents with **asthma**, **eosinophilia**, and systemic vasculitis affecting multiple organs [1].

Q: Which of the following is the most common type of tongue cancer?

Squamous cell carcinoma. ***Adenocarcinoma most common*** - The most common type of tongue cancer is **squamous cell carcinoma (SCC)**, not adenocarcinoma [1]. - Adenocarcinomas are less frequently associated with the tongue compared to SCC, which constitutes the majority of cases. *Tobacco is the cause* - Tobacco use is indeed a **significant risk factor** for various head and neck cancers, including tongue cancer [1]. - Smoking and smokeless tobacco are linked to increased incidence and severity of **squamous cell carcinoma** on the tongue [1]. *Deep cervical lymph nodes not involved* - Tongue cancers often metastasize to **deep cervical lymph nodes**, particularly in advanced stages. - Involvement of lymph nodes is a common feature that can affect prognosis and treatment strategies. *Lateral surface involved* - The **lateral surface** of the tongue is a common site for cancerous lesions, especially in cases related to tobacco use. - Tumors might also arise from other surfaces, but lateral involvement is characteristic of **squamous cell carcinoma**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 738-739.

Q: Which of the following statements BEST characterizes the clinical significance of Barrett's esophagus?

Barrett's esophagus is a precancerous condition. ***Predisposes to SCC*** - Barrett's esophagus primarily predisposes individuals to **adenocarcinoma**, not squamous cell carcinoma (SCC) [2][3]. - SCC is associated with other conditions, such as **smoking** and **chronic irritation**, not Barrett's [3]. *Intestinal type is the most common type* - The intestinal type is indeed **common** in Barrett's esophagus, but it's not the only type present [2]. - Barrett's esophagus can also have a **gastric** type, but the intestinal type predominates in adenocarcinoma risk. *Metaplasia of cells* - This condition is defined by **intestinal metaplasia**, where squamous epithelium is replaced by columnar epithelium [2]. - Metaplasia is a **hallmark** of Barrett's esophagus and crucial for its diagnosis [2]. *Precancerous condition* - Barrett's esophagus is considered a **precancerous condition** because it increases the risk of transitioning to esophageal adenocarcinoma [1][2]. - The progression from Barrett's to cancer is well-documented in medical literature [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 764-765. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 348-349. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 766-767.

Question 1

Glomus tumor is seen in -

Accepted Answer

Distal portion of digits

Answer

Rare locations such as retroperitoneum

Answer

Long bones and vertebrae

Answer

Proximal portion of digits (less common site)

Question 2

Orphan Annie nuclei are characteristic of which of the following?

Accepted Answer

Papillary thyroid carcinoma

Answer

Paraganglioma with Zellballen pattern

Answer

Meningioma with psammoma bodies

Answer

Pituitary adenoma with atypical nuclei

Question 3

Which of the following is the most likely proliferating breast mass?

Accepted Answer

Fibroadenoma

Answer

Duct ectasia

Answer

Adenosis

Answer

Papilloma

Question 4

Most common site for medulloblastoma is-

Accepted Answer

Cerebellum

Answer

Pituitary

Answer

Cerebrum

Answer

Pineal gland

Question 5

Which of the following germ cell tumors is benign?

Accepted Answer

Dermoid cyst

Answer

Seminoma

Answer

Embryonal carcinoma

Answer

Yolk sac tumor

Question 6

Ewing's sarcoma arises from which type of cells?

Accepted Answer

Primitive neuroectodermal cells

Answer

G cells

Answer

Totipotent cells

Answer

Neurons

Question 7

Which of the following translocations is not associated with Down syndrome?

Accepted Answer

t(11;14)

Answer

t(21;21)

Answer

t(14;21)

Answer

t(15;21)

Question 8

Which of the following diseases is NOT associated with Anti-Neutrophil Cytoplasmic Antibodies (ANCA)?

Accepted Answer

Henoch schonlein purpura

Answer

Wegener's granulomatosis

Answer

Microscopic PAN

Answer

Churg Strauss syndrome

Question 9

Which of the following is the most common type of tongue cancer?

Accepted Answer

Squamous cell carcinoma

Answer

Lymphoma

Answer

Adenocarcinoma

Answer

Basal cell carcinoma

Question 10

Which of the following statements BEST characterizes the clinical significance of Barrett's esophagus?

Accepted Answer

Barrett's esophagus is a precancerous condition

Answer

Barrett's esophagus involves metaplasia of esophageal cells

Answer

Intestinal type is the most common type

Answer

It does not predispose to SCC but to adenocarcinoma

NEET-PG 2012 — Pathology