NEOPLASIA TAGMEE3AT

Part 1: General Principles

Question 1

Lymphatic spread occurs early in:

a) Rhabdomyosarcoma

b) Breast carcinoma

c) Liposarcoma

d) Leiomyosarcoma

e) Osteosarcoma

REVEAL ANSWER & EXPLANATION

Question 2

Adenoma is a benign tumour of:

a) Surface epithelial cells

b) Mesenchymal cells

c) Glandular epithelial cells

d) Germ cells

e) White blood cells

REVEAL ANSWER & EXPLANATION

Question 3

One of the following is a tumour suppressor gene:

a) p53

b) Her2/neu

c) RAS gene

d) TGF alpha

e) BCL2

REVEAL ANSWER & EXPLANATION

Question 4

A cervical biopsy showing dysplastic squamous epithelial cells occupying the entire thickness
of epithelium with no evidence of epithelial maturation and with an intact basement membrane
is diagnosed as:

a) Atypical hyperplasia

b) Mild Dysplasia

c) Moderate Dysplasia

d) Carcinoma in situ

e) Carcinomatosis

REVEAL ANSWER & EXPLANATION

Question 5

A 35-year-old female who has been taking oral contraceptive pills for many years presents with acute
abdominal pain and fullness. Ultrasound revealed a 6 cm mass in the liver that was subsequently resected.

Histopathologic examination of the resected mass would most likely reveal which of the
following?

a) Intrahepatic cholangiocarcinoma

b) Angiosarcoma

c) Hepatocellular carcinoma

d) Hepatic adenoma

e) Focal nodular hyperplasia

REVEAL ANSWER & EXPLANATION

Question 6

A 23-year-old woman presents to her physician with a lump in her left breast. She has no family history of
cancer. On examination she has a 2-cm rubbery, round, freely mobile mass. Core needle biopsy was done
and was reported as a fibroadenoma.

Which of the following characteristics was most likely seen in the sample?

a) Anaplastic cells

b) High nucleus to cytoplasm ratio

c) High fraction of cells with mitotic figures

d) Glandular and stromal proliferation

e) Extensive necrosis

REVEAL ANSWER & EXPLANATION

Question 7

Benign cystic teratoma show:

a) Small round blue embryonal cells with poor differentiation and cystic degeneration

b) Disorganized mature tissue normally present in the organ affected with cleft like cystic spaces

c) Mixed mature tissues with a cyst lined by stratified squamous epithelium

d) Immature fetal type tissues that behave in a malignant manner

e) Mixed mature well differentiated tissues with small foci squamous cell carcinoma

REVEAL ANSWER & EXPLANATION

Question 8

Which of the following conditions is most likely to be related to development of malignancy?

a) Essential hypertension

b) Ulcerative colitis

c) Coronary artery diseases

d) Uterine leiomyoma

e) Acute abscess

REVEAL ANSWER & EXPLANATION

Question 9

Which of the following markers could be most important in diagnosis of carcinoma?

a) S100

b) Desmin

c) Calcitonin

d) Cytokeratin

e) Vimentin

REVEAL ANSWER & EXPLANATION

Question 10

Which of the following markers could be most important in diagnosis of sarcoma?

a) S100

b) Desmin

c) Calcitonin

d) Cytokeratin

e) Vimentin

REVEAL ANSWER & EXPLANATION

Question 11

A true statement about hamartomas:

a) In-situ tumor

b) Locally malignant tumor

c) Normal tissue is present in abnormal site

d) Benign tumor with disorganized tissue

e) Type of granuloma

REVEAL ANSWER & EXPLANATION

Question 12

APC is an example of:

a) Growth factors

b) Growth receptors

c) DNA repair proteins

d) Tumor suppressor genes

e) Apoptotic gene

REVEAL ANSWER & EXPLANATION

Question 13

Which of the following pairs matches a malignancy with its possible causative carcinogenic
agent?

a) Gastric carcinoid tumor / Helicobacter bacilli

b) Hepatocellular carcinoma / Hepatitis A virus

c) B-cell lymphoma / Epstein Barr virus

d) Bronchogenic carcinoma and mesothelioma / Aflatoxin

e) Laryngeal squamous cell carcinoma / Sunlight

REVEAL ANSWER & EXPLANATION

Question 14

Which of the following genes is considered as guardian of the genome?

a) P53

b) APC

c) Retinoblastoma

d) RAS

e) C-MYC

REVEAL ANSWER & EXPLANATION

Question 15

A 60-year-old male, with a history of chronic viral hepatitis, developed progressive weight loss. CT scan
revealed a nodular liver with a mass 10 cm in the right liver lobe.

Elevation of which of the following is most likely to occur in this patient?

a) Alpha fetoprotein

b) Carcinoembryonic antigen

c) CA 19-9

d) Calcitonin

REVEAL ANSWER & EXPLANATION

Question 16

Benign tumours usually show:

a) Lymphatic invasion

b) Mature cell population

c) Extensive necrosis

d) Many mitotic figures

e) Stromal infiltration

REVEAL ANSWER & EXPLANATION

Question 17

Laryngeal biopsy showed dysplastic squamous epithelial cells in the lower one-third of
epithelium with an intact basement membrane. This is diagnosed as:

a) Atypical hyperplasia

b) Mild Dysplasia

c) Moderate Dysplasia

d) Carcinoma in situ

REVEAL ANSWER & EXPLANATION

Question 24

A 68-year-old man has a long history of prostate cancer that was metastatic at the time of diagnosis. Over
the past two months, he has had significant weight loss, loss of appetite, and loss of energy.

His current spectrum can be attributed to which of the following?

a) TNF (Tumor necrosis factor) alpha

b) VEGF

c) VHL Gene

d) Cathepsin D

REVEAL ANSWER & EXPLANATION

Question 25

Oxidative Irradiation on the neck may predispose to:

a) Papillary thyroid cancer

b) Hepatic adenoma

c) Breast carcinoma

d) Chondrosarcoma

REVEAL ANSWER & EXPLANATION

Question 26

Teratoma originates from:

a) Pluripotent cells

b) Totipotent cells

c) Multipotent cells

d) Oligopotent cells

REVEAL ANSWER & EXPLANATION

Question 27

Grading of malignant tumors is determined through:

a) Mitotic figures on microscopic examination

b) Blood metastasis

c) Lymphatic metastasis

d) Tumor size

REVEAL ANSWER & EXPLANATION

Question 28

Leukoplakia is a premalignant condition that can develop into:

a) SCC (squamous cell carcinoma)

b) Transitional carcinoma

c) Adenocarcinoma

d) None of the above

REVEAL ANSWER & EXPLANATION

Question 29

The Xeroderma pigmentosa gene is considered a:

a) Tumor suppressor gene

b) DNA repair gene

c) Proto-oncogene

REVEAL ANSWER & EXPLANATION

Question 30

Oropharyngeal carcinoma or cervical carcinoma is predisposed by:

a) HPV

b) HTLV

c) Epstein Barr virus

d) Hepatitis B virus

REVEAL ANSWER & EXPLANATION

Question 31

Virchow's LN may be the presenting sign of:

a) Gastric carcinoma

b) Cancer breast

c) Osteosarcoma

d) Cancer ovary

REVEAL ANSWER & EXPLANATION

Question 32

Epithelial Disorderly cell proliferation:

a) Metaplasia

b) Hyperplasia

c) Neoplasia

d) Dysplasia

REVEAL ANSWER & EXPLANATION

Part 2: Clinical Scenarios

Clinical Scenario 1

A 60-year-old male with a history of smoking presents with a lung mass. Biopsy reveals malignant epithelial
cells arranged in nests and cords. The tumor spreads initially to regional lymph nodes.

This pattern of spread is characteristic of which type of tumor?

a) Sarcoma

b) Carcinoma

c) Lymphoma

d) Melanoma

e) Mesothelioma

REVEAL ANSWER & EXPLANATION

Clinical Scenario 2

A breast biopsy from a 50-year-old female shows malignant cells with features suspicious for cancer.

To confirm the epithelial origin of the tumor and differentiate it from sarcoma or lymphoma,
which of the following diagnostic methods is most appropriate?

a) Routine hematoxylin and eosin staining

b) Immunohistochemical staining for cytokeratin

c) Electron microscopy

d) Fine needle aspiration cytology

e) Frozen section examination

REVEAL ANSWER & EXPLANATION

Clinical Scenario 3

During surgery for a suspected malignant breast lump, the surgeon needs immediate confirmation of the
nature of the lesion before proceeding with axillary lymph node dissection.

Which of the following techniques is most appropriate for intraoperative histopathologic

a) Paraffin-embedded section

b) Frozen section technique

c) Fine needle aspiration cytology

d) Immunohistochemistry

e) Molecular testing

REVEAL ANSWER & EXPLANATION

Clinical Scenario 4

A 55-year-old female presents with bilateral ovarian masses. She has a history of gastric cancer diagnosed
2 years ago. Biopsy of the ovarian masses shows signet ring cells.

Which of the following is the most likely primary tumor?

a) Ovarian carcinoma

b) Breast carcinoma

c) Gastric carcinoma

d) Colon carcinoma

e) Pancreatic carcinoma

REVEAL ANSWER & EXPLANATION

Clinical Scenario 5

A 25-year-old woman is concerned about a small, pigmented, well-demarcated papule on her face that has
been present since childhood. The lesion is non-tender, non-ulcerated, and stable in size.

Which of the following is the most likely diagnosis?

a) Malignant melanoma

b) Basal cell carcinoma

c) Benign melanocytic tumor (Nevus)

d) Seborrheic keratosis

e) Lentigo

REVEAL ANSWER & EXPLANATION

Clinical Scenario 6

A biopsy from a skin lesion reveals irregular nests of malignant squamous epithelial cells. Few keratin
pearls are identified in less than 25% of the tumor masses.

Based on Broder's grading system, this tumor is classified as:

a) Well-differentiated squamous cell carcinoma

b) Moderately differentiated squamous cell carcinoma

c) Poorly differentiated squamous cell carcinoma

d) Undifferentiated squamous cell carcinoma

e) Basal cell carcinoma

REVEAL ANSWER & EXPLANATION

Clinical Scenario 7

A patient with ductal carcinoma in situ of the breast shows spread of malignant cells along the epithelium of
the ducts into the lobules, or to the skin of the nipple (Paget's disease) without invading the basement
membrane.

This pattern of spread is best described as:

a) Hematogenous spread

b) Lymphatic spread

c) Intra-epithelial spread

d) Transcoelomic spread

e) Perineural spread

REVEAL ANSWER & EXPLANATION

Clinical Scenario 8

A pathological examination of a tumor biopsy reveals cells with enlarged, hyperchromatic nuclei, increased
nucleocytoplasmic ratio, and numerous abnormal mitotic figures.

These features collectively are known as:

a) Differentiation

b) Metaplasia

c) Criteria of malignancy (anaplasia)

d) Dysplasia

e) Hyperplasia

REVEAL ANSWER & EXPLANATION