Which of the following is a malignant tumor?
C - Papilloma of skin
D - Chondroid hamartoma of the lung
E - Lymphoma
E - Lymphoma
Which of the following neoplasia has been linked to a delition of a tumor suppressor gene?
A - Glioblastoma multiforme
B - Retinoblastoma
C - Hepatocellular carcinoma
D - Chondrosarcoma
E - Medulloblastoma
B - Retinoblastoma
Clinical assessment of tumor size and spread is referred to as ____________.
The remote effects of cancer not attributable to tumor invasion or metastasis can be called ______________.
A tumor of relatively small size which did not involve regional lymph nodes but has metastasized would be indicated in the TNM staging system as...
A)T4 N0 M1.
B)T3 N2 M0.
C)T3 N3 M3.
D)T2 N0 M1.
D)T2 N0 M1.
T/F A solid tumor assessed as stage IV implies an excellent prognosis.
False - stage IV is really bad
A 54-year-old woman who has been diagnosed with early stage breast cancer undergoes surgery for a lumpectomy to remove a small tumor detected by mammography. The pathology report confirms the early stage of the cancer and further comments on the fact that there is significant desmoplasia in the surrounding tissue. The term desmoplasia refers to
(A) an irregular accumulation of blood vessels.
(B) maturation and spatial arrangement of cells.
(C) metastatic involvement of surrounding tissue.
(D) normal tissue misplaced within another organ.
(E) proliferation of non-neoplastic fibrous connective
E - proliferation of non-neoplastic fibrous connective tissue
A 24-year-old woman with a history of heavy and painful menstrual periods has been having difficulty conceiving despite months of trying to become pregnant. Further workup includes a bimanual pelvic examination and an ultrasound, which demonstrates a mass in the uterus that is presumed to be a leiomyoma. This mass is a...
(B) benign tumor of mesenchymal tissue.
A 68-year-old man has a long history of prostate cancer that was metastatic at the time of diagnosis. Over the past 2 months, he has had significant weight loss, loss of appetite, and loss of energy. His current spectrum of conditions can be attributed to which of the following?
(A) Tumor necrosis factor-α
A 58-year-old man with a 700-pack-per-year smoking history presents to the emergency department with shortness of breath and hemoptysis. Portable chest radiography demonstrates a large mass centrally located within the left lung field. The serum calcium is 13.0 mg/dL (normal 8.5 to 10.2). The metabolic abnormality described here is likely due to elaboration of which substance?
(C) Parathyroid-related hormone
An 8-year-old boy is referred to the dermatologist for
numerous "suspicious" pigmented lesions on the face and neck. Further history reveals that the patient has had difficulty seeing out of his right eye; he is referred to the ophthalmologist, who diagnoses an ocular melanoma. Based on the patient's symptoms, the diagnosis of xeroderma pigmentosum is considered. This condition results from
(B) an inborn defect in DNA repair.
A 46-year-old woman with prominent splenomegaly presents with a 3-month history of malaise, easy fatigability, weakness, weight loss, and anorexia. A complete blood count and differential demonstrates a white blood cell count of 250,000/mm3 (normal 3000–10,000/mm3) with a predominance of myelocytes, metamyelocytes, band cells, and segmented neutrophils. Cytogenetic analysis is most likely to reveal which of the following translocations?
(X) A 63-year-old woman discovers a lump in her right breast. Mammography confirms the presence of a suspicious "lump," and a needle core biopsy is performed to determine whether the mass is malignant. The pathology report confirms that the mass is indeed cancerous and that the tissue demonstrates amplification of the Her-2/neu oncogene. The gene product of Her-2/neu is what kind of protein?
(C) Receptor tyrosine kinase
A 27-year-old woman has recently been diagnosed with a glioma (a malignant brain tumor). Further family history reveals that her 4-year-old son has been diagnosed with leukemia and has been undergoing chemotherapy. In addition, the patient's mother died at 36 years of age due to metastatic breast cancer. Li-Fraumeni syndrome is suspected, given the familial clustering of this group of malignancies. The gene mutated in Li-Fraumeni syndrome normally functions in what capacity?
(D) Halts the cell cycle if DNA damage is detected
(X) An 8-year-old child is evaluated by the pediatrician, who notes what appears to be ten small café-au-lait spots on the child's torso. In addition, on close inspection of the eyes, the presence of Lisch nodules is noted. The patient is diagnosed with von Recklinghausen neurofibromatosis type 1. The protein that is mutated in this disorder normally
(B) activates the GTPase activity of Ras.
A 78-year-old Navy veteran with a 600-pack-per-year history of cigarette smoking presents with cancer. During his military career, he was involved in fireproofing naval combat ships with asbestos insulation. Given his environmental exposure to both tobacco and asbestos, to which cancer do both of these carcinogens contribute?
(D) Bronchogenic cancer
A 25-year-old woman presents for a gynecologic examination. The cervical Pap smear shows “koilocytic atypia” characterized by perinuclear halos and wrinkled nuclei (shown). A cervical biopsy reveals invasive squamous cell carcinoma. Molecular tests for human papillomavirus (HPV) in the tumor cells are positive. Which of the following mechanisms of disease best explains the role of HPV in the pathogenesis of neoplasia in this patient?
(D) Inactivation of tumor suppressor proteins
The patient described in Question 2 undergoes a
hysterectomy. In addition to a focus of invasive carcinoma, the pathologist identifies dysplastic squamous cells occupying the entire thickness of the cervical epithelium, with no evidence of epithelial maturation. The basal membrane in these areas appears intact. Which of the following terms best describes this cervical lesion?
(A) Carcinoma in situ
A 62-year-old woman presents with a breast lump that she discovered 6 days ago. A breast biopsy shows lobular carcinoma in situ. Compared to normal epithelial cells of the breast lobule, these malignant cells would most likely show decreased expression of which of the following proteins?
An 80-year-old man complains of lower abdominal pain, increasing weakness, and fatigue. He has lost 16 lb (7.3 kg) in the past 6 months. The prostate-specific antigen (PSA) test is elevated (8.5 ng/mL). Rectal examination reveals an enlarged and nodular prostate. A needle biopsy of the prostate discloses invasive prostatic adenocarcinoma. Histologic grading of this patient's carcinoma is based primarily on which of the following criteria?
(D) Resemblance to normal tissue of origin
A 50-year-old woman presents with a lump in her breast. A 4-cm firm and fixed mass is noted on breast examination. Excisional biopsy reveals malignant cells that form gland-like structures and solid nests, surrounded by a dense collagenous stroma. A connective tissue stain (trichrome) of the biopsy is shown. Which of the following descriptive terms best describes the blue areas observed in this specimen?
(E) Desmoplastic change
A 65-year-old man complains of muscle weakness and a dry cough for 4 months. He has smoked two packs of cigarettes daily for 45 years. A chest x-ray shows a 4-cm central, left lung mass. Laboratory studies reveal hyperglycemia and hypertension. A transbronchial biopsy is diagnosed as small-cell carcinoma. Metastases to the liver are detected by CT scan. Which of the following might account for the development of hyperglycemia and hypertension in this patient?
(E) Paraneoplastic syndrome
Which of the following potent carcinogens was most likely involved in the pathogenesis of lung cancer (Squamous cell carcinoma) in the smoker patient described in a different questions?
(C) Polycyclic aromatic hydrocarbons
A 33-year-old woman discovers a lump in her left breast on self-examination. Her mother and sister both had breast cancer. A mammogram demonstrates an ill-defined density in the outer quadrant of the left breast, with microcalcifications. Needle aspiration reveals the presence of malignant, ductal epithelial cells. Genetic screening identifies a mutation in BRCA1. In addition to cell cycle control, BRCA1 protein promotes which of the following cellular functions?
(D) DNA repair
A 60-year-old man who worked for 30 years in a chemical factory complains of blood in his urine. Urine cytology discloses dysplastic cells. A bladder biopsy demonstrates transitional-cell carcinoma. Which of the following carcinogens was most likely involved in the pathogenesis of bladder cancer in this patient?
(D) Aniline dyes
A 60-year-old man presents with a small nodule on his forearm that he noticed several months ago. A biopsy of the nodule reveals squamous cell carcinoma. The metastatic potential of this tumor would be enhanced by upregulation of the gene for which of the following proteins?
(C) Plasminogen activator
A 45-year-old man presents with a 9-month history of a reddish nodule on his foot. Biopsy of the nodule discloses a poorly demarcated lesion composed of fibroblasts and endothelial-like cells lining vascular spaces. Further work-up identifies similar lesions in the lymph nodes and liver. The tumor cells contain sequences of human herpesvirus-8 (HHV-8). This patient most likely has which of the following diseases?
(C) Acquired immunodeficiency
During a routine checkup, a 50-year-old man is found to have blood in his urine. He is otherwise in excellent health. An abdominal CT scan reveals a 2-cm right renal mass. You inform the patient that staging of this tumor is key to selecting treatment and evaluating prognosis. Which of the following is the most important staging factor for this patient?
(B) Metastases to regional lymph nodes
A 68-year-old man who has worked in a shipyard and manufacturing plant all his adult life complains of a 4-month history of chest discomfort, malaise, fever, night sweats, and weight loss. A chest x-ray reveals a large pleural effusion. The patient dies 5 months later of cardiorespiratory failure. The lung at autopsy is shown. This malignant neoplasm is associated with environmental exposure to which of the following carcinogens?
A 58-year-old woman with colon cancer presents with 3 months of increasing shortness of breath. A chest x-ray reveals numerous, bilateral, round masses in both lungs. Histologic examination of an open-lung biopsy discloses malignant glandlike structures, which are nearly identical to the colon primary. Which of the following changes in cell behavior was the first step in the process leading to tumor metastasis from the colon to the lung in this patient?
(C) Invasion of the underlying basement membrane
A 68-year-old man complains of recent changes in bowel habits and blood-tinged stools. Colonoscopy reveals a 3-cm mass in the sigmoid colon. Biopsy of the mass shows adenocarcinoma. These neoplastic cells have most likely acquired a set of mutations that cause which of the following changes in cell behavior?
(E) Loss of cell cycle restriction point control
A 35-year-old woman complains of nipple discharge and irregular menses of 5 months duration. Physical examination reveals a milky discharge from both nipples. MRI shows an enlargement of the anterior pituitary. Which of the following is the most likely histologic diagnosis of this patient's pituitary tumor?
A 52-year-old woman presents with a 1-year history of upper truncal obesity and moderate depression. Physical examination shows hirsutism and moon facies. A CT scan of the thorax displays a hilar mass. A transbronchial lung biopsy discloses small-cell carcinoma. Electron microscopy of this patient's lung tumor will most likely reveal which of the following cytologic features?
(A) Neuroendocrine granules
Cytogenetic studies in a 40-year-old woman with follicular lymphoma demonstrate a t(14;18) chromosomal translocation involving the bcl-2 gene. Constitutive expression of the protein encoded by the bcl-2 gene inhibits which of the following processes in this patient's transformed lymphocytes?
A 50-year-old nulliparous woman complains that her menstrual blood flow is more abundant than usual. An ultrasound examination reveals a thickened endometrial stripe with a polypoid mass in the uterine fundus. The patient subsequently undergoes a hysterectomy. The opened uterus reveals a partially necrotic mass, which shows moderately differentiated endometrial adenocarcinoma. The development of this neoplasm was most likely preceded by which of the following histologic changes?
(B) Glandular hyperplasia
A 59-year-old woman presents with increasing pigmentation of the skin. Physical examination shows hyperkeratosis and hyperpigmentation of the axilla, neck, flexures, and anogenital region. Endocrinologic studies reveal normal serum levels of adrenal corticosteroids and glucocorticoids. If this patient's skin pigmentation represents a paraneoplastic syndrome, the primary tumor would most likely be found in which of the following anatomic locations?
A 65-year-old man dies after a protracted battle with
metastatic colon carcinoma. At autopsy, the liver is filled with multiple nodules of cancer, many of which display central necrosis (umbilication). Which of the following best explains the pathogenesis of tumor umbilication in this patient?
(C) Ischemia and infarction
A 59-year-old man complains of progressive weakness. He reports that his stools are very dark. Physical examination demonstrates fullness in the right lower quadrant. Laboratory studies show iron deficiency anemia, with a serum hemoglobin level of 7.4 g/dL. Stool specimens are positive for occult blood. Colonoscopy discloses an ulcerating lesion of the cecum. Which of the following serum tumor markers is most likely to be useful for following this patient after surgery?
(E) Carcinoembryonic antigen
A 20-year-old woman has an ovarian tumor removed. The surgical specimen is 10 cm in diameter and cystic. The cystic cavity is found to contain black hair and sebaceous material. Histologic examination of the cyst wall reveals a variety of benign differentiated tissues, including skin, cartilage, brain, and mucinous glandular epithelium. What is the diagnosis?
A 42-year-old man presents with upper gastrointestinal bleeding. Upper endoscopy and biopsy reveal gastric adenocarcinoma. Which country of the world has the highest incidence of this malignant neoplasm?
An 8-year-old girl with numerous hypopigmented, ulcerated, and crusted patches on her face and forearms develops an indurated, crater-like, skin nodule on the back of her left hand. Biopsy of this skin nodule discloses a squamous cell carcinoma. Molecular biology studies reveal that this patient has germline mutations in the gene encoding a nucleotide excision repair enzyme. What is the appropriate diagnosis?
(B) Xeroderma pigmentosum
A 59-year-old woman complains of “feeling light-headed” and losing 5 kg (11 lb) in the last month. A CBC reveals a normocytic, normochromic anemia. The patient subsequently dies of metastatic cancer. Based on current epidemiologic data for cancer-associated mortality in women, which of the following is the most likely primary site for this patient's malignant neoplasm?
The parents of a 6-month-old girl palpate a mass on the left side of the child's abdomen. Urinalysis shows high levels of vanillylmandelic acid. A CT scan reveals an abdominal tumor and bony metastases. The primary tumor is surgically resected. Histologic examination of the surgical specimen discloses neuroblastoma. Evaluation of the N-myc proto-oncogene in this child's tumor will most likely demonstrate which of the following genetic changes?
(A) Gene amplification
An 8-year-old African boy presents with swelling in his jaw and massive facial disfiguration. Biopsy reveals a tumor invading the bone marrow of the jaw. The pathogenesis of this malignant neoplasm is associated with a virus that exhibits a tropism for which of the following cells?
A 45-year-old woman presents with abdominal pain and vaginal bleeding. A hysterectomy is performed and shows a benign tumor of the uterus derived from a smooth muscle cell. What is the appropriate diagnosis?
Cytogenetic studies in a 70-year-old woman with chronic myelogenous leukemia (CML) demonstrate a t(9;22) chromosomal translocation. Which of the following best explains the role of this translocation in the pathogenesis of leukemia in this patient?
(A) Altered DNA methylation status
(B) Enhanced expression of telomerase gene
(C) Expansion of a trinucleotide repeat
(D) Inactivation of tumor suppressor protein
(E) Protooncogene activation
(E) Protooncogene activation
A 33-year-old woman presents with a diffuse scaly skin rash of 4 weeks duration. Biopsy of lesional skin reveals a cutaneous T-cell lymphoma (mycosis fungoides). Which of the following immunohistochemical markers would be most useful for identifying malignant cells in the skin of this patient?
A 63-year-old woman with chronic bronchitis presents with shortness of breath. A chest x-ray reveals a 2-cm “coin lesion” in the upper lobe of the left lung. A CT-guided lung biopsy is obtained. Which of the following describes the histologic features of this lesion if the diagnosis is hamartoma?
(A) Disorganized normal tissue
A 66-year-old woman presents with a massively swollen abdomen. The patient was diagnosed with papillary, serous cystadenocarcinoma of the ovary 3 years ago. She dies in a hospice 1 month later. At autopsy, the peritoneum is studded with tumors, and there are 10 L of ascites. Which of the following routes of tumor metastasis accounts for these autopsy findings?
(E) Seeding of body cavity
A 2-year-old boy is found to have bilateral retinal tumors. Molecular studies demonstrate a germline mutation in one allele of the Rb gene. Which of the following genetic events best explains the mechanism of carcinogenesis in this patient?
(B) Loss of heterozygosity
A 60-year-old man presents with a 6-month history of
increasing weight loss and fatigue. Physical examination reveals hepatomegaly. A CT scan of the
abdomen shows multiple nodules in the liver, and a CT-guided biopsy reveals a mucous-secreting adenocarcinoma. This patient's metastatic cancer most likely originated in which of the following anatomic locations?
A benign TUMOR (neoplasm) arising from glandular
Natural product of the fungus Aspergillus flavus; an extremely potent hepato-carcinogen in many species, including humans.
Lack of differentiated features in a cancer cell, characterized by cellular pleomorphism (variation in size and shape of cells and their nuclei), enlarged and hyperchromatic nuclei, prominant nucleoli, atypical mitoses, and bizarre cells, including giant cells.
Formation of new blood vessels often induced by tumors. Many tumors secrete growth factors that stimulate growth of new vessels.
Growth of cells without external influences. Typically, the cell secretes its own growth factors which binds to its own receptor expressed on the plasma membrane of the same cell.
Mutations in the _______ gene predispose individuals to increased risk of breast and/or ovarian cancer.
Malignant neoplasm of epithelial origin.
Pre-invasive form of carcinoma, does not penetrate the basement membrane.
Carcinoma in situ
A theory based upon the hypothesis that cancer consists of cells which all originate from a single progenitor cell.
Clonal origin of caner
Connective tissue proliferation in response to
A benign tumor arising from squamous epithelium.
DNA virus of herpesvirus family that causes infectious mononucleosis and has been implicated in Burkitt
lymphoma and nasopharyngeal carcinoma.
Tumor of the brain composed of glia cells.
Histologic assessment of malignancy of a neoplasm usually scored from 1 to 3, corresponding to well, moderately, or poorly differentiated tumors.
___________________________ are oncogenic viruses causing leukemia/lymphoma It is endemic in parts of Japan, Africa, and the Caribbean.
Human T-cell Leukemic Viruses (HTLV I and II).
Class of DNA viruses that cause ("nipple-like") lesions, i.e., warts, benign skin cell papillomas and squamous cell carcinomas.
Human Papilloma Virus (HPV)
Malignant tumor of hematopoietic white blood cell precursors that results in the entry of malignant cells from the bone marrow into the circulating blood.
Malignant tumor of lymphoid cells. Typically involves lymphoid organs (e.g., lymph nodes, spleen thymus) but may occur in extranodal lymphoid tissues (e.g., MALT of intestines).
Clinical symptoms caused by distant effects of tumors which may include various endocrine, hematologic, neurologic and other symptoms.
Malignant tumor of the eye related to the loss of the RB tumor suppressor gene. May be congenital and familial or
sporadic, bilateral or unilateral.
Malignant neoplasm of connective tissue origin.
Clinical assessment of tumor size, spread to regional lymph nodes, and metastatic potential; used for prognosis and therapeutic decisions
A malignant neoplasm arising from the ovary or testis that contains a component of embryonal carcinoma, in addition to teratoma-like elements.
Tumor composed of tissues that are derived from all three germ layers, i.e., ectoderm; mesoderm; and endoderm. Usually benign when it arises in an ovary (so-called "dermoid", because it often contains skin and sebaceous material).
Substances that are expressed on tumor cells or secreted by tumor cells. They can be detected by means of immunochemical techniques and are useful in tumor diagnosis.