NEOPLASIA TAGMEE3AT

Part 1: General Principles

Question 1

Lymphatic spread occurs early in:

a) Rhabdomyosarcoma

b) Breast carcinoma

c) Liposarcoma

d) Leiomyosarcoma

e) Osteosarcoma

EXPLANATION

Carcinomas (epithelial malignancies like breast carcinoma) preferentially spread via the lymphatic system first.
Mesenchymal malignancies (sarcomas) preferentially spread via the hematogenous (blood) route.

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

EXPLANATION

Benign epithelial tumors derived from glandular epithelium are classified as adenomas, whereas benign surface
epithelial tumors are designated as papillomas.

Question 3

One of the following is a tumour suppressor gene:

a) p53

b) Her2/neu

c) RAS gene

d) TGF alpha

e) BCL2

EXPLANATION

The p53 gene acts as the "Guardian of the Genome," functioning as an anti-proliferative tumor suppressor gene
that arrests the cell cycle. Her2/neu and RAS are proto-oncogenes, while BCL2 is an apoptosis regulatory gene.

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

EXPLANATION

Dysplasia that involves the whole epithelial thickness without breaching or invading the basement membrane is
termed Carcinoma in situ.

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

EXPLANATION

Long-standing exposure to oral contraceptive pills (OCPs) is a strong predisposing environmental factor for the
development of a benign hepatic adenoma.

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

EXPLANATION

A fibroadenoma of the breast is characterized by a mixed microscopic pattern, displaying concurrent proliferation
of both epithelial (glandular) and mesenchymal (stromal) components.

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

EXPLANATION

Benign (mature) teratomas originate from totipotent cells and consist of fully differentiated, mature tissues from
multiple germ layers. In the ovary, they frequently present as a cyst lined by stratified squamous epithelium
containing hair or sebaceous structures.

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

EXPLANATION

Chronic ulcerative colitis is an acquired preneoplastic disorder. Long-standing cases carry a significantly
increased risk of transforming into colon cancer.

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

EXPLANATION

Cytokeratin is the specific immunohistochemical marker utilized to confirm an epithelial origin, making it positive
in carcinomas.

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

EXPLANATION

Vimentin is the immunohistochemical marker that confirms a mesenchymal (connective tissue) origin, making it
positive in sarcomas.

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

EXPLANATION

A hamartoma is technically not a true tumor; rather, it presents as a localized mass of disorganized but mature
tissues that are native to that specific organ site.

Question 12

APC is an example of:

a) Growth factors

b) Growth receptors

c) DNA repair proteins

d) Tumor suppressor genes

e) Apoptotic gene

EXPLANATION

The APC gene is a tumor suppressor gene that exerts an anti-proliferative action by regulating the destruction of
beta-catenin.

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

EXPLANATION

The Epstein-Barr Virus (EBV) is a DNA oncogenic virus directly implicated in the pathogenesis of B-cell
lymphoma, Burkitt lymphoma, and nasopharyngeal carcinoma.

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

EXPLANATION

The p53 gene is known as the Guardian of the Genome due to its role in arresting the cell cycle to allow for DNA
repair or triggering apoptosis following non-fatal genetic damage.

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

EXPLANATION

Chronic viral hepatitis (HBV/HCV) predisposes patients to cirrhosis and hepatocellular carcinoma. Alpha-
fetoprotein is the specific biochemical tumor marker elevated in hepatocellular carcinoma.

Question 16

Benign tumours usually show:

a) Lymphatic invasion

b) Mature cell population

c) Extensive necrosis

d) Many mitotic figures

e) Stromal infiltration

EXPLANATION

Benign tumors are consistently well-differentiated, composed of a uniform population of mature cells that closely
resemble their normal counterparts.

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

EXPLANATION

Dysplastic changes confined strictly to the lower 1/3 of the epithelial thickness are categorized as mild dysplasia.

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

EXPLANATION

This presentation describes cancer cachexia. The progressive wasting of skeletal muscle and fat is driven by the
release of cytokines, primarily TNF-alpha and IL-1, from tumor cells or macrophages.

Question 25

Oxidative Irradiation on the neck may predispose to:

a) Papillary thyroid cancer

b) Hepatic adenoma

c) Breast carcinoma

d) Chondrosarcoma

EXPLANATION

Therapeutic irradiation applied to the head and neck region is a recognized carcinogen that can induce the
development of papillary thyroid cancers years after exposure.

Question 26

Teratoma originates from:

a) Pluripotent cells

b) Totipotent cells

c) Multipotent cells

d) Oligopotent cells

EXPLANATION

Teratomas originate from totipotent germ cells (located in the ovary or testis) or from sequestered embryonic
rests, possessing the capacity to differentiate into tissues representative of all three germ layers.

Question 27

Grading of malignant tumors is determined through:

a) Mitotic figures on microscopic examination

b) Blood metastasis

c) Lymphatic metastasis

d) Tumor size

EXPLANATION

Tumor grading relies on microscopic parameters, primarily the degree of cytologic differentiation, architectural
features, and the number of mitoses. In contrast, size and metastasis are evaluated during clinical staging.

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

EXPLANATION

Oral or vulvar leukoplakia is a hyperplastic and dysplastic proliferation functioning as a preneoplastic syndrome
with a risk of transformation into squamous cell carcinoma.

Question 29

The Xeroderma pigmentosa gene is considered a:

a) Tumor suppressor gene

b) DNA repair gene

c) Proto-oncogene

EXPLANATION

Xeroderma pigmentosa is an inherited autosomal recessive syndrome caused by defective DNA repair genes,
which prevents the correction of UV damage and leads to sunlight-induced skin cancers.

Question 30

Oropharyngeal carcinoma or cervical carcinoma is predisposed by:

a) HPV

b) HTLV

c) Epstein Barr virus

d) Hepatitis B virus

EXPLANATION

High-risk strains of Human Papillomavirus (HPV types 16 and 18) are directly implicated in the genesis of both
cervical and oropharyngeal squamous cell carcinomas.

Question 31

Virchow's LN may be the presenting sign of:

a) Gastric carcinoma

b) Cancer breast

c) Osteosarcoma

d) Cancer ovary

EXPLANATION

Lymphatic obstruction by tumor cells can force retrograde spread. This mechanism is responsible for the
metastasis of gastric, colon, or prostate carcinomas to the left supraclavicular node (Virchow's LN).

Question 32

Epithelial Disorderly cell proliferation:

a) Metaplasia

b) Hyperplasia

c) Neoplasia

d) Dysplasia

EXPLANATION

Dysplasia is defined as disordered cellular proliferation accompanied by a loss of individual cell polarity and
architectural orientation.

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

EXPLANATION

Carcinomas (malignant tumors of epithelial origin) typically exhibit early metastatic spread via lymphatic
pathways to regional lymph nodes.

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

EXPLANATION

In immunohistochemical profiling, cytokeratin serves as the definitive marker to confirm that an undifferentiated
tumor is of epithelial origin (a carcinoma).

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

EXPLANATION

The frozen section technique provides rapid histological evaluation while the patient is still in the operating room,
allowing for real-time adjustments to the surgical management plan.

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

EXPLANATION

Bilateral metastasis to the ovaries featuring intracellular mucin-producing signet-ring cells identifies a Krukenberg
tumor, which typically originates from a primary gastric or colon carcinoma.

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

EXPLANATION

A nevus is categorized as a benign tumor of melanocytes that classically presents as a well-demarcated, stable
colored papule or macule.

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

EXPLANATION

According to Broder's system, a squamous cell carcinoma where less than 25% of the tumor masses form
mature cell nests or keratin pearls is classified as Grade III (Poorly-differentiated).

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

EXPLANATION

The migration of malignant cells entirely within the epithelial boundaries (such as from breast ducts to the nipple
skin) without breaching the basement membrane is precisely defined as intra-epithelial spread.

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

EXPLANATION

Enlarged, hyperchromatic nuclei, an elevated nucleocytoplasmic (N:C) ratio, pleomorphism, and abnormal mitotic
figures are the structural changes collectively defined as the criteria of malignancy (anaplasia).