Bio Behav Of Tumor Progres N Metastatsis
Questions and Answers
- 1.
A 15 year old man followed by his physician has had painless lymphadenopathy in the right cervical region for the past 5 months. A lymph node biopsy shows many lymphocytes that are large, with clumped chromatin and occasional mitoses. The characterization of this population of lymphocytes as a neoplasm is best accomplished by:
- A.
Immunohistochemical staining identifying leukocyte common antigen (LCA)
- B.
Gene rearrangement studies that demonstrate monoclonality
- C.
A differential white blood count showing a lymphocytosis
- D.
Demonstrating fibrosis within the mass by light microscopy
Correct Answer
B. Gene rearrangement studies that demonstrate monoclonalityExplanation
B. Correct. Monoclonality can be demonstrated by gene rearrangement studies or G6PD iso-enzyme studies.
Incorrect. Immunohistochemical staining identifying LCA indicates that the tumor cells are leukocytic in origin, but does not necessarily indicate a monocloncal cell population of proliferating cells.
C. Incorrect. Lymphocytosis can be seen in chronic bacterial infections, viral infections as well as neoplastic conditions.
D. Incorrect. Fibrosis under light microscopy can be seen in chronic inflammation as well as tumors; and is not limited to neoplasms.Rate this question:
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- 2.
Which of the following features is a definite microscopic feature of malignancy?
- A.
Coarse nuclear chromatin
- B.
High nuclear-cytoplasmic ratio
- C.
Irregular nuclear membrane
- D.
Atypical mitotic figures
- E.
Prominent nucleoli
Correct Answer
D. Atypical mitotic figuresExplanation
D. Correct. Atypical mitotic figures are a definite microscopic evidence of malignancy.
All other features can be seen in dysplasia as well as malignancy.Rate this question:
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- 3.
A 53-yr old woman feels a lump in her left breast. On examination, an irregular 3 cm mass seen fixed to the overlying skin, which is retracted. A mastectomy is performed; and the pathologist on sectioning the breast, finds a 3 x 3.5 cm ovoid mass that does not have discrete borders, but appears to infiltrate into surrounding stroma. The mass is firm, white and has a fibrous consistency. Which of the following features is most likely to be present on microscopic examination?
- A.
Anaplasia
- B.
Hyperplasia
- C.
Desmoplasia
- D.
Dysplasia
- E.
Metaplasia
Correct Answer
C. DesmoplasiaExplanation
C. Correct. Desmoplasia refers to the dense fibrous stroma within a tumor.
A. Incorrect. Anaplasia is a lack of differentiation within a tumor.
B. Incorrect. Hyperplasia is an increase in the number of cells as a result of an adaptive cellular change that may be physiological or pathological.
D. Incorrect. Dysplasia is a disordered growth that is a precursor to malignancy.
E. Incorrect. Metaplasia refers to the transformation of one adult epithelium to another.Rate this question:
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- 4.
The metastatic potential of a malignant tumor would be enhanced by upregulation of the gene for which of the following proteins?
- A.
Collagen type IV
- B.
Desmin
- C.
E-cadherin
- D.
Matrix metalloproteinase
Correct Answer
D. Matrix metalloproteinaseExplanation
D. Correct. Malignant cell elaborate proteases that degrade basement membrane components. Such enzymes include urokinase-type plasminogen activator (u-PA) and matrix metalloproteinase.
A. Incorrect. Collagen type IV expression is reduced in malignant tumor cells.
B. Incorrect. Desmin is found in tumors of mesenchyal origin.
C. Incorrect. E-cadherin expression is reduced in malignant tumor cells.Rate this question:
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- 5.
A 60-year-old woman develops a breast mass. A biopsy reveals a carcinoma. Immunoperoxidase stains for protease cathepsin D and matrix metalloproteinase-9 are markedly positive. Which of the following characteristics is most likely to be predicted by this finding
- A.
Angiogenesis
- B.
Invasion
- C.
Monoclonality
- D.
Aneuploidy
- E.
Differentiation
Correct Answer
B. InvasionExplanation
B. Correct. Cathepsin is a cysteine proteinase that cleaves substrates like fibronectin and laminin. High levels of this enzyme are associated with greater invasiveness.
A. Incorrect. Angiogenesis is mediated by bFGF and VEGF.
C. Incorrect. Monoclonality can be defined by Southern blot analysis for T-cell or B-cell receptor gene rearrangements
D. Incorrect. Aneuploidy is regulated by proto-oncogenes and tumor suppressor genes.
E. Incorrect. Differentiation is regulated by proto-oncogenes and tumor suppressor genes.Rate this question:
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- 6.
A 66-year-old man has a routine physical examination and a stool sample proves positive for the presence of occult blood. He undergoes colonoscopy and a 5 cm sessile mass is present in the sigmoid. Biopsy of the mass yields a diagnosis of adenocarcinoma. Presence of which of the following is most likely to explain finding a mass of the cells from this neoplasm in the lung:
- A.
Presence of vimentin in tumor cells
- B.
Presence of keratin in tumor cells
- C.
Increased laminin receptors on tumor cells
- D.
Diminished apoptosis
- E.
Tumor cell monoclonality
Correct Answer
C. Increased laminin receptors on tumor cellsExplanation
(C) Laminin receptors allow neoplastic cells to attach more readily to basement membranes and hence metastasize.
A.) Incorrect. Vimentin positivity of tumor cells indicates a mesenchymal origin of the tumor and does not play any role in invasion and metastasis.
B.) Incorrect. Keratin positivity of tumor cells indicates an epithelial origin of the tumor and does not play any role in invasion and metastasis.
(D) Incorrect. Diminished apoptosis implies accumulation of cells proliferating in the body that results in a tumor mass, but has no role in invasion and metastasis
(E) Incorrect. Monoclonality of a tumor implies the origin of the tumor from a single precursor cell, invasion and metastasisRate this question:
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- 7.
A 60-year-old man who is a chronic smoker has had a chronic cough for the past 10 yrs. He has begun to lose weight during the past year. A chest x-ray shows a right hilar mass. Lung biopsy shows a tumor comprising of malignant squamous cells. What is the most common initial pathway of spread of this lesion?
- A.
Bloodstream
- B.
Pleural cavity
- C.
Contiguous spread to chest wall
- D.
Lymphatics
- E.
Seeding of body cavity
Correct Answer
D. LymphaticsExplanation
D. Correct. The lung biopsy describes a squamous cell carcinoma of lung. The initial mode of spread of carcinomas is via the lymphatic route.
A. Incorrect. The initial mode of spread of sarcomas is via the hematogenous route.
B. Incorrect. Spread into pleural cavity can occur via seeding of malignant cells from a lung cancer.
C. Incorrect.
E. Incorrect.Rate this question:
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- 8.
A 45-year-old woman presents to her physician with altered bowel habits. has an enlarged, non-tender lymph node that on biopsy reveals a metastatic neoplasm. Which of the following is the most likely primary neoplasm:
- A.
Cerebral glioma
- B.
Adenocarcinoma of colon
- C.
Fibroadenoma of breast
- D.
Liposarcoma of retroperitoneum
- E.
Laryngeal papilloma
Correct Answer
B. Adenocarcinoma of colonExplanation
B. Correct. Carcinomas spread initially to lymph nodes.
A. Incorrect. Gliomas spread via local invasion
C. Incorrect. Fibroadenomas are benign tumors that do not metastasize.
D. Incorrect. Sarcomas spread initially via the hematogenous route.
E. Incorrect. Laryngeal papilloma is a benign tumor that does not metastasize.Rate this question:
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- 9.
A 55-yr old man dies after a year-long illness. At autopsy, the liver contains multiple tumor masses 2-5 cm in size, firm and tan and that grossly resemble umbilication with central necrosis. Which of the following is most appropriate?
- A.
There is multicentric origin of a benign neoplasm
- B.
The neoplasm has a high grade
- C.
A carcinogen was the underlying cause for the neoplasm.
- D.
The neoplasm has an advanced stage
Correct Answer
D. The neoplasm has an advanced stageExplanation
D. Correct. Multiple tumor masses with areas of umbilication with central necrosis is typical of metastatic cancers in advanced stages.
A. Incorrect. Multiple leiomyomas within the uterus represents a multicentric origin of a benign neoplasm.
B. Incorrect. High grade of tumors can be discerned only under the microscope.
C. Incorrect. Gross appearance of tumors due to carcinogens is not distinguishable from tumors due to other causes.Rate this question:
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- 10.
An autopsy is performed on a 56-year-old female with ascites, who was diagnosed with papillary serous cystadenocarcinoma of the ovary 3 years ago. The peritoneum is studded with small tumors and massive ascites is noted. Which of the following routes of tumor metastasis accounts for the autopsy findings?
- A.
Direct tumor extension
- B.
Hematogenous spread
- C.
Lymphatic spread
- D.
Seeding of body cavity
- E.
Venous spread
Correct Answer
D. Seeding of body cavityExplanation
D. Correct. The image shows a loop of small bowel and mesentery studded with small nodules of metastatic cancer. Malignant tumors that arise in organs adjacent to body cavities (eg. Ovaries, GIT, lung) may shed malignant cells into these spaces. Tumor cells in these sites grow in masses and often produce fluid (i.e. ascites of pleural fluid), sometimes in massive amounts.
Other options provide routes of metastatic spread, but do not lead to peritoneal carcinomatosis in patients with ovarian cancer.Rate this question:
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- 11.
Besides their local spread and a tendency to invade lymph nodes, carcinomas of the breast, thyroid and prostate share a tendency to metastasize to the same distant site. These metastasis cause an elevation of blood calcium. Name the organ involved by these distant metastases
- A.
Liver
- B.
Colon
- C.
Bone
- D.
Skin
- E.
Lungs
Correct Answer
C. BoneExplanation
C. Correct. Breast, thyroid and breast cancers spread to boneRate this question:
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- 12.
Histologic grading of cancer is based on…
- A.
Depth of invasion of normal tissue
- B.
Presence of multiple activated oncogenes
- C.
Degree of resemblance to normal tissue of origin
- D.
No. of lymph nodes involved by metastasis
- E.
No. of satellite nodules
Correct Answer
C. Degree of resemblance to normal tissue of originExplanation
C. Correct.
A. Incorrect. Depth of invasion determines the stage of a tumor.
B. Incorrect. Presence of multiple activated oncogenes is not related to grading.
D. Incorrect. No. of lymph nodes involved by metastasis determine the prognosis of a tumor.
E. Incorrect. No. of satellite nodules reflect an advanced stage and do not affect the tumor grade.Rate this question:
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- 13.
An 80-year old man presents with a tumor on his left arm. A biopsy shows a tumor composed of spindle shaped cells suggestive of sarcoma that infiltrate the dermis. The pathologist is uncertain of the diagnosis, so he orders immunoperoxidase stains which show that the tumor is cytokeratin negative, S100 and GFAP negative, but is positive for vimentin. It can be stated that this tumor is a:
- A.
Melanoma
- B.
Squamous cell carcinoma
- C.
Basal cell carcinoma
- D.
Tumor of mesenchymal cells
- E.
Tumor metastatic from glioblastoma
Correct Answer
D. Tumor of mesenchymal cellsExplanation
D. Correct. A tumor composed of spindle cells usually refers to a mesenchymal origin. This suspicion is confirmed by vimentin positivity which indicates a mesenchymal origin of the tumor.
A. Incorrect. Melanomas are positive for S-100 and HMB-45.
B. Incorrect. Squamous cell carcinomas is an epithelial malignancy positive for cytokeratin and epithelial membrane antigen (EMA).
C. Inocrrect. Basal cell carcinoma is an epithelial malignancy positive for cytokeratin and epithelial membrane antigen (EMA). Vimentin is negative.
E. Incorrect. Glioblastomas are positive for GFAP (Glial fibrillary acidic protein).Rate this question:
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- 14.
In order to establish the definitive diagnosis of a poorly differentiated bone tumor, the pathologist stained the section with antibodies to vimentin. Since the tumor cells were all positive, this proved that the tumor was
- A.
Osteosarcoma
- B.
Lymphoma
- C.
Glioma
- D.
Carcinoma
- E.
Melanoma
Correct Answer
A. OsteosarcomaExplanation
A. Correct. Vimentin positivity indicates a tumor of mesenchymal origin.i.e. osteosarcoma.
B. Incorrect. Lymphomas stain positive with leukocyte common antigen (LCA).
C. Incorrect. Gliomas stain positive with glial fibrillary acidic protein (GFAP).
D. Incorrect. Carcinoma stains positive with cytokeratin, keratin and epithelial membrane antigen (EMA).
E. Incorrect. Melanoma stains positive with S-100, HMB-45 and melanin.Rate this question:
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- 15.
A 49 year old man complains of pain in his left thigh for several months. The thigh is increased in size, compared to the right. A plain film x-ray reveals a 15 cm solid mass that does not appear to arise from bone, but has infiltrative margins. A biopsy reveals a mass composed of highly pleomorphic spindle cells suggestive of a sarcoma. Which of the following immuno-histochemical markers is most likely to be demonstrated in the cells of this mass:
- A.
Cytokeratin
- B.
NSE
- C.
S-100
- D.
Leukocyte common antigen
- E.
Vimentin
Correct Answer
E. VimentinExplanation
Answer. E. Vimentin is positive in tumors of mesenchymal origin.
A. Cytokeratin is positive in carcinomas.
B. NSE is positive in tumors of neuroendocrine origin.
C. S-100 is positive in tumors of neuroendocrine origin.
D. LCA or CD45 is positive in leukemia and lymphoma.Rate this question:
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- 16.
A 50-yr old man presents with hematuria. An abdominal CT reveals a 2-cm right renal mass. Which of the following is the most important factor in staging of his disease?
- A.
Histologic grade of tumor
- B.
Metastasis to regional lymph nodes
- C.
Growth rate of tumor cells
- D.
Somatic mutations in p53
- E.
Aneuploidy
Correct Answer
B. Metastasis to regional lymph nodesExplanation
B. Correct. Presence of lymph node metastasis is a significant factor in staging this tumor.
Other choices reflect the grade of the tumor and not stage. Factor used for staging are size of tumor, extent of local growth, presence of lymph node metastasis and presence of distant metastasis.Rate this question:
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Current Version
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Mar 20, 2023Quiz Edited by
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Jun 15, 2012Quiz Created by
Chachelly
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