Neoplasia Exam

Question 1

A 42-year-old female discovers a lump in her left breast while taking a shower. She has also had a recent 20
kg weight loss. Physical examination reveals a firm, non-movable, 2 to 3 cm upper outer quadrant mass.
This mass is most likely a:

A Phyllodes tumor

B Breast carcinoma

C Focus of fat necrosis

D Metastasis from a primary brain neoplasm

E Fibroadenoma

Lab

Question 2

A sequence of epithelial metaplasia to dysplasia to carcinoma-in-situ would be most characteristic for:

A Human papilloma virus infection of uterine cervix

B Retroviral infection of T-lymphocytes

C Hepatitis B infection of liver

D Epstein-Barr virus infection of B-lymphocytes

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E Influenza virus infection of lung

Question 3

The feature that best distinguishes a neoplasm from a granuloma is the neoplasm's:

A Recurrence following excision

B Rapid increase in size

C Sensitivity to radiation or chemotherapy

D Uncontrolled (autonomous) growth

E Necrosis

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Question 4

A sarcoma is most likely to be diagnosed in which of the following patients:

A A 35-year-old female with a left breast mass and enlarged axillary lymph nodes

B A 55-year-old female with massive ascites and multiple peritoneal metastases

C A 25-year-old male with an enlarged left testis

D A 15-year-old male with a mass in the left femur and lung metastases

E A 5-year-old male with a right renal mass

Question 5

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Neoplasia Exam

A host response to a neoplasm is LEAST likely to be mediated by:

A Natural killer lymphocytes

B Complement

C Neutrophils

D Macrophages

E Cytotoxic CD8 lymphocytes

Question 6

Of the following histopathologic findings, the one that best indicates that a neoplasm is malignant is:

A Pleomorphism

B Atypia

C Invasion

D Increased nuclear/cytoplasmic ratio

E Necrosis

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Question 7

A surgical pathology report indicates that a certain neoplasm is graded as 1 on a scale of I to IV. Clinically,
this neoplasm is stage I. These findings imply that this neoplasm:

A Is not malignant

B Has probably arisen from epithelium

C May spread via lymphatics

D Has an in situ component

E Is well-differentiated and localized

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Question 8

Which of the following features would best indicate that an adrenal cortical neoplasm was malignant:

A Presence of mitoses

B Cellular atypia

C Dysplasia

D Desmoplasia

E Metastases

Question 9

Of the following chemical agents or materials, which is NOT known to be carcinogenic in humans:

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A Asbestos

B Cyclophosphamide

C Saccharin

D Vinyl chloride

E Nitrosamine

Question 10

A patient with metastatic calcification involving the lungs would most likely have which of the following
primary neoplasms:

A Carcinoid tumor of small intestine

B Squamous cell carcinoma of lung

C Adenocarcinoma of pancreas

D Islet cell carcinoma of pancreas

E Liposarcoma of thigh

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Question 11

A 50-year-old male has felt vague abdominal discomfort for 4 months. A stool guaiac is negative. He has no
lymphadenopathy and no abdominal mass can be palpated. A CT scan shows a retroperitoneal soft tissue
mass obscuring the psoas muscle that is about 20 cm in size This neoplasm is most likely a(n):

A Melanoma

B Hamartoma

C Adenocarcinoma

D Lymphoma

E Liposarcoma

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Question 12

Which of the following persons has the LEAST risk for a subsequent malignant neoplasm because of the
condition given:

A A 40-year-old male with chronic ulcerative colitis

B A 35-year-old female with cervical dysplasia

C A 55-year-old male with prostatic glandular hyperplasia

D A 65-year-old male with oral leukoplakia and atypia

E A 50-year-old male with chronic alcoholism and hepatic cirrhosis

Question 13

The best example of viral oncogenesis in humans is seen with which of the following neoplasms:

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A Retinoblastoma

B Small cell anaplastic carcinoma of lung

C T-cell leukemia

D Prostatic adenocarcinoma

E Hepatic angiosarcoma

Question 14

Which of the following statements regarding teratomas is INCORRECT:

A They can arise in the ovary.

B They arise from totipotential germ cells.

C A sarcomatous element is usually present.

D Tissues resembling those from an embryo can be seen.

E They can arise in the testis.

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Question 15

A 44-year-old female has an abnormal Pap smear with cells present showing features of dysplasia. If left
untreated, she is at risk for development of cervical:

A Metaplasia

B Sarcoma

C Hyperplasia

D Carcinoma

E Atypia

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Question 16

A 64 year old male now has abdominal pain and distension. He has had a 20 kg (44 pound) weight loss along
with increasing fatigue over the past year. He develops abdominal distention from bowel obstruction. At
laparotomy, a partial resection of the colon is performed, with removal of an encircling mass in the
descending colon. Which of the following laboratory test findings is most likely to have accompanied this
lesion:

A Microcytic hypochromic anemia

B Positive antinuclear antibody

C Hyperglycemia

D Elevated alpha-fetoprotein

E Decreased lactate dehydrogenase

Question 17

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Neoplasia Exam

During the first two decades of life, the most commonly encountered benign neoplasm is:

A Hemangioma

B Meningioma

C Wilm's tumor

D Lymphoma

E Glioma

Question 18

A 56-year-old male has a chest x-ray that demonstrates a 6 cm perihilar mass. He has had a chronic cough. A
sputum cytology report reads "Atypical cells present suggestive of squamous cell carcinoma." Which of the
following statements is LEAST likely to be associated with these findings:

A He has a history of asbestos exposure.

B He had prolonged formaldehyde exposure.

C His house has a high level of radon.

D He was previously treated for lung cancer.

E His wife smokes.

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Question 19

The most common initial pathway of spread for squamous cell carcinoma of lung is via:

A Bloodstream

B Pleural cavity

C Contiguous spread to chest wall

D Lymphatics

E Bronchi

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Question 20

The liver of a 55-year-old male contains multiple tumor masses with central necrosis. Which of the following
statements would best characterize such an appearance:

A There is multicentric origin of a benign neoplasm.

B The neoplasm has a high grade.

C The primary neoplasm is in the stomach.

D A carcinogen was the underlying cause for the neoplasm.

E The neoplasm has an advanced stage.

Question 21

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Neoplasia Exam

The good response to radiation therapy in a 59-year-old male with a squamous cell carcinoma of the lung is
largely due to:

A Point mutations in DNA of irradiated cells

B Generation of free radicals in irradiated cells

C Loss of the blood supply to the neoplastic cells

D Secondary inflammation in the neoplasm

E Adenosine triphosphate depletion in the irradiated cells

Question 22

A 60 year old woman is diagnosed with infiltrating ductal carcinoma of the left breast by fine needle
aspiration cytology and a mastectomy is performed. Submitting a tissue sample of the neoplasm for analysis
by flow cytometry is most useful for:

A Determination of the karyotype

B Diagnosis of benign neoplasms

C Determination of aneuploidy

D Distinguishing carcinoma from sarcoma

E Quantitation of RNA content

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Question 23

A 35-year-old woman had a firm nodule palpable on the dome of the uterus six years ago on routine
examination. The nodule has slowly increased in size and is now appears to be about twice the size it was
when first discovered. She is asymptomatic. The uterine nodule most likely represents a(an):

A Adenocarcinoma

B Leiomyosarcoma

C Hematoma

D Leiomyoma

E Metastasis

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Question 24

The characterization of a mass lesion composed of a proliferation of lymphocytes as a neoplasm is best

accomplished by:

A Immunohistochemical staining identifying leukocyte common antigen

B Gene rearrangement studies that demonstrate clonality

C Flow cytometry indicating a high S-phase

D A differential white blood count showing a lymphocytosis

E Demonstrating fibrosis within the mass by light microscopy

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Question 25

The edema that may accompany a malignant neoplasm is most often produced as a consequence of:

A Hypoalbuminemia

B Sodium retention

C Thrombosis

D Congestive heart failure

E Lymphatic obstruction

Question 26

A 2 cm firm mass is palpable beneath the skin of the left forearm in a 27-year-old female. She is in excellent
health. This mass is most suggestive of a:

A Metastatic carcinoma

B Mycobacterial granuloma

C Sarcoma

D Lipoma

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E Staphylococcal abscess

Question 27

You receive a cytopathology report on a Pap smear from your 38-year-old patient that states "minimal
dysplasia" is present in ectocervical epithelium. Which of the following statements about this finding is
INCORRECT:

A Hyperplasia preceded this lesion.

B This lesion is reversible.

C There is an increased risk for a more advanced, aggressive lesion.

D The cells are less differentiated than normal.

.E There is not an increased risk for a benign neoplasm

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Question 28

Which of the following methods for diagnosis gives the best indication that a neoplasm really is malignant:

A Electron microscopy performed on the tumor tissue

B A tumor marker study on the peripheral blood

C Routine light microscopy performed on the tumor tissue

D Flow cytometry performed on the fresh tumor cells

E Immunohistochemical staining for intermediate filaments on tumor tissue

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Question 29

A 45-year-old female has an enlarged 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 the colon

C fibroadenoma of the breast

D liposarcoma of the retroperitoneum

E laryngeal papilloma

Question 30

A 59-year-old male with iron deficiency anemia was found to have a 6 cm mass lesion arising on the
mucosal surface of the colon. Which of the following statements is most appropriate:

A This is an uncommon site for a primary malignant neoplasm

B Microscopically, it is probably an adenocarcinoma

C Persons who are smokers are at much greater risk for colon cancer

D Hypercalcemia is a frequent paraneoplastic complication for colon cancer

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Neoplasia Exam

E The predicted 5 year survival rate for colon cancer is less than 5%

Question 31

A 47-year-old woman had a 2 cm mass in the right breast discovered by a screening mammogram. A fine
needle aspirate yielded cells described as consistent with carcinoma. Which of the following statements is
most appropriate:

A Well-differentiated breast carcinomas are usually estrogen receptor positive.

B The most common site for metastases is lung.

C Flow cytometry is useful to determine the karyotype of the carcinoma.

D Even carcinomas limited to the breast are rarely curable.

. .E The carcinoma is probably keratin negative by immunoperoxidase staining

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Question 32

Which of the following statements is INCORRECT:

A Electron microscopy can help to distinguish melanoma from lymphoma.

B B-lymphocyte proliferations are typically neoplastic when a single immunoglobulin gene

rearrangement is present.

C Aneuploidy can be detected by analysis of a neoplasm by flow cytometry.

D Energy dispersive x-ray analysis is helpful to detect trace elements (such as nickel) in tissues.

E In general, a low histologic grade for a neoplasm suggests a worse prognosis.

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Question 33

The serum prostate specific antigen (PSA) was elevated in this 70 year old male with a palpable firm
prostatic nodule. The microscopic appearance seen on biopsy of the prostate will probably be most
consistent with:

A Chronic prostatitis

B Adenocarcinoma

C Infarction

D Leiomyoma

E Rhabdomyosarcoma

Question 34

One of the most common genetic alterations found in human carcinomas that leads to loss of tumor
suppression is:

A k-ras

B p53

C c-myc

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D 9:22 translocation

E Bcl-2

Question 35

A poorer prognosis for a neoplasm is most closely associated with which of the following findings:

A Aneuploidy by flow cytometry

B Positive immunohistochemical staining for cytokeratins

C A well-differentiated histologic appearance

D Origin in the colon

E Stage of T1 N0 M0

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Question 36

Pre-malignant conditions include all of the following EXCEPT:

A Endometrial hyperplasia following prolonged estrogen therapy

B Chronic alcoholism leading to micronodular cirrhosis of the liver

C Cervical squamous dysplasia

D Chronic ulcerative colitis

E Multiple leiomyomas of the uterine myometrium

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Question 37

The microscopic finding of dysplasia of the uterine cervix in a biopsy from a 34 year old female whose
previous Pap smear was reported as abnormal suggests that she:

A Does not require further treatment

B Has an increased risk for cervical carcinoma

C Has an acute bacterial infection

D May develop a benign neoplasm of the cervix

E Already has widespread metastases

Question 38

A mass lesion in the right upper lobe of lung found by chest radiograph is removed by wedge resection and
sent to Surgical Pathology, where a neoplasm is found. Findings that will be important for determining
further therapy and prognosis include all of the following EXCEPT:

A Is the neoplasm invading the margin of resection?

B What is the size of the neoplasm?

C What is the degree of atypia and pleomorphism of the neoplastic cells?

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D How much inflammation is present in the neoplasm?

E Is the neoplasm primary or metastatic?

Question 39

A 49 year old male is found to have a 15 cm mass in his left thigh. This mass does not arise from bone, but it
does have infiltrative margins. Microscopically, the mass is composed of highly pleomorphic spindle cells.
Which of the following markers is most likely to be demonstrated by immunohistochemical staining of the
cells of this neoplasm:

A Cytokeratin

B Factor VIII

C Alpha fetoprotein

D Lambda light chain

E Vimentin

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Question 40

Of the following characteristics of neoplasms, which implies the best prognosis:

A Increased laminin receptors

B Increased cathepsin

C Aneuploidy

D Increased doubling time

E Decreased nuclear/cytoplasmic ratio

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Neoplasia Exam

Questions 41 and 42: Click on the checkbox first, then the lettered item:

(41) Activation by point mutation to result in a pancreatic adenocarcinoma.

(42) Loss of both alleles to result in a retinoblastoma.

A Oncogenes on chromosome 13

B c-neu

C c-sis

D ras

E n-myc

Questions 43 and 44: Click on the checkbox first, then the lettered item:

(43) Associated with human papillomavirus infection of the cervix in a 44 year old female.

(44) A discreet, firm, rubbery, movable mass in the breast of a 22 year old female.

A Squamous cell carcinoma

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B Follicular lymphoma

C Melanoma

D Fibroadenoma

E Leiomyoma

Questions 45 and 46: Click on the checkbox first, then the lettered item:

(45) Children in the Ukraine following the Chernobyl nuclear disaster.

(46) A 50-year-old male with long-standing Epstein-Barr virus infection.

A Kaposi's sarcoma

B Small cell anaplastic carcinoma of lung

C Thyroid carcinoma

D Nasopharyngeal carcinoma

E Endometrial carcinoma

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Neoplasia Exam

Questions 47 and 48: Click on the checkbox first, then the lettered item:

(47) Identification of this intermediate filament in a neoplasm seen on liver biopsy from a 57 year old
female suggests an epithelial origin for the tumor.

(48) Presence of this feature promotes invasion by a neoplasm of the colon in a 66 year old female.

A Vimentin

B Leukocyte common antigen

C Laminin receptor

D Actin

E Cytokeratin

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Question 49

Cell division in malignant neoplasms, but not in normal cells, is aided by the presence of an enzyme which
repairs progressive chromosomal shortening. This enzyme is known as:

A Reverse transcriptase

B DNA polymerase

C Telomerase

D Protein kinase

E Topoisomerase

Question 50

Biopsy of the bladder is performed in a 62 year old male who has complained of pain on urination.

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Neoplasia Exam

Microscopically, the epithelium shows cells with marked hyperchromatism and increased
nuclear/cytoplasmic ratio involving the full thickness. However, these changes are confined to the
epithelium above the basement membrane. This process is best described as:

A Metaplasia

B Minimal dysplasia

C Microinvasion

D Hyperplasia

E Carcinoma in situ

Question 51

A 10 x 8 cm ovoid mass arising in the left ovary of a 38 year old female is grossly cystic and filled with hair.
Microscopically, this mass has benign appearing tissues that include squamous epithelium, colonic glandular
epithelium, and cartilage. The best diagnosis is:

A Choristoma

B Hamartoma

C Myxoma

D Teratoma

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E Mesothelioma

Question 52

A 54 year old female with small cell anaplastic carcinoma of the right lung is treated with a multidrug
chemotherapy regimen and has a partial response. However, metastatic disease is present eight months later.
A second chemotherapy protocol is tried, but no response is noted. Failure of the second protocol to elicit a
response probably occurs because:

A The neoplastic cells have an abnormal p53 protein

B This carcinoma was caused by a viral infection

C A ras oncogene is present and active

D The neoplastic cells have increased P-glycoprotein

E There is a second primary lung cancer present

Answer Key:
(1-5) BADDC

(6-10) CEECB

(11-15) ECCCD

(16-20) AABDE

(21-25) BCDBE

(26-30) DACBB

(31-35) AEBBA

(36-40) EBDEE

(41-48) DAADCDEC

(49-52) CEDD