neoplasia PBL

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72 year old female has been feeling fatigued for weeks. She has had a 10 kg weight loss in the past couple of months. She has some nausea, but no vomiting, hemoptysis, or hematemesis. She does not have a cough. She is afebrile. The most likely explanation for these findings, from the gross appearance of the liver at autopsy seen here, is the presence of: • A Hepatic adenomas • B Metastatic carcinoma • C Multifocal bilary tract dysplasia • D Hepatocellular carcinoma • E Micronodular cirrhosis

• A biopsy of the cervix of a 28 year old woman reveals the microscopic appearance shown here. Which of the following statements is most accurate regarding this finding: • A She requires antibiotic therapy • B She has a very poor prognosis • C She has gestational diabetes • D She is at risk for cervical carcinoma • E She has a disorder of coagulation

• The section of lung seen here grossly is from a 65 year old male who had hemoptysis and a 10 kg weight loss for the past few months. Cases such as this are most often going to result from which of the following risk factors: • A Immunosuppression • B Cystic fibrosis • C Smoking • D Diabetes mellitus • E Asbestosis

• A 48 year old previously healthy woman develops increasing malaise. A CBC indicates that she is markedly anemic, with an elevated WBC count. A bone marrow biopsy is performed and shows a 100% cellular marrow. Chromosome analysis of the cells from the marrow yields the karyotype shown here. Which of the following conditions is most likely to be present: • A Chronic myelogenous leukemia • B Metastatic breast carcinoma • C Myeloid hyperplasia • D Granulomatous infection • E Multiple myeloma

• A study is performed to analyze characteristics of malignant neoplasms in biopsy specimens. The biopsies were performed on patients who had palpable mass lesions on digital rectal examination. Of the following microscopic findings, which is most likely to indicate that the neoplasm is malignant? • A Pleomorphism • B Atypia • C Invasion • D Increased nuclear/cytoplasmic ratio • E Necrosis

• A 56-year-old man has had a chronic cough for the past year. He is a non-smoker. He had an episode of hemoptysis 3 days ago. No abnormal findings are noted on physical examination. A chest x-ray demonstrates a 6 cm perihilar mass. A sputum sample is collected, and the sputum cytology report reads "Atypical cells present suggestive of squamous cell carcinoma." Which of the following environmental exposures is most likely to be associated with these findings? • A Asbestos • B Radon • C Silica • D Benzene • E Formaldehyde

• A 60-year-old man who has a 90 pack year history of cigarette smoking has had a chronic cough for the past 10 years. He has begun to lose weight (3 kg) during the past year. No abnormal findings are noted on physical examination. He has a chest radiograph that reveals a right hilar mass. A biopsy shows features of squamous cell carcinoma. 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 Bronchi

• A 55-year-old man dies after a year-long illness. At autopsy the liver contains multiple tumor masses from 2 to 5 cm in size that are mostly firm and tan and that grossly exhibit umbilication with central necrosis. Which of the following statements would best characterize the significance of 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.

• A 35-year-old woman had a firm nodule palpable on the dome of the uterus six years ago recorded on routine physical examination. The nodule has slowly increased in size and now appears to be about twice the size it was when first discovered. She remains asymptomatic. Which of the following neoplasms is she most likely to have? • A Adenocarcinoma • B Leiomyosarcoma • C Metastases • D Leiomyoma

• A 45-year-old woman has noted a lump on her left shoulder that has enlarged over the past 2 months. On physical examination there is an enlarged, non-tender supraclavicular lymph node. A biopsy of the node is done and on microscopic examination there is a metastatic neoplasm. Which of the following is the most likely primary neoplasm? • A Adenocarcinoma of the colon • B Adenoma of the breast • C Liposarcoma of the retroperitoneum • D Laryngeal papilloma

• A 70-year-old healthy man is found to have a palpable firm nodule in the prostate gland on digital rectal examination. His serum prostate specific antigen (PSA) is 19 ng/mL. The microscopic appearance seen on biopsy of the prostate will probably be most consistent with which of the following conditions? • A Chronic prostatitis • B Adenocarcinoma • C Infarction • D Leiomyoma

• A study of malignant neoplasms reveals that some of them have a greater potential for invasion and metastases. Analysis of the cells of cancers that have metastasized reveals a mutation which results in decreased cell surface expression of E-cadherin. Which of the following genes is most likely mutated to produce these findings? • A beta-catenin • B BRCA-2 • C Cyclin D • D NF-1 • E RAS • F Rb • G RET

1.A 45-year-old healthy woman has a routine check of her health status. She has no chest pain, cough, or fever. A chest x-ray taken and shows a peripheral 2.5 cm diameter "coin lesion" in the right mid-lung field. Which of the following biologic characteristics best distinguishes this lesion as a neoplasm, rather than a granuloma? a.Recurrence following excision b. Rapid increase in size c.Uncontrolled (autonomous) growth d. Necrosis

2.A study is performed to analyze characteristics of malignant neoplasms in biopsy specimens. The biopsies were performed on patients who had palpable mass lesions on digital rectal examination. Of the following microscopic findings, which is most likely to indicate that the neoplasm is malignant? a.Pleomorphism b.Atypia c. Invasion d. Increased nuclear/cytoplasmic ratio e.Necrosis

3.A 14-year-old healthy girl has a 0.3 cm raised,soft nodule on the skin of the upper part of her chest found on a routine physical examination. She states that this lesion has been present for years and has not appreciably changed in size or color. The excised specimen is encapsulated,circumscribed and has a homogenous yellow appearance.Which of the following neoplasms is this nodule most likely to be? a.Hemangioma b.Squamous cell carcinoma c.Melanoma d.Lipoma

4.A 41-year-old woman has noted a foul-smelling vaginal discharge for 3 weeks. On physical examination there is an exophytic 3 cm mass involving the ectocervix. Pap smear testing is performed; she has never had a previous Pap smear. Cytologic changes are present on this Pap smear that are consistent with squamous cell carcinoma. Her serum glucose is increased above normal . She has been a commercial sex worker in the past. Which of the following is the most likely risk factor for her cervical carcinoma? a.Human papillomavirus infection b.Diabetes mellitus, type II c.Heavy cigarette smoking d. Pelvic inflammatory disease e. Previous cancer chemotherapy

In an experiment, it is observed that chronic, increased exposure to ionizing radiation results in damage to cellular DNA. As a consequence, a protein is now absent that would arrest the cell in the G1 phase of the cell cycle. Subsequent to this, the cell is transformed to acquire the property of unregulated growth. The absent protein is most likely the product of which of the following genes? a. k-ras b. p53 c. c-myc d. c-abl e. Bcl-2

• <Q>In an experiment, biologic characteristics of neoplastic and nonneoplastic cells are analyzed in culture. It is observed that cell division in cells derived from malignant neoplasms, but not in normal cells, is aided by the presence of an enzyme which repairs progressive chromosomal shortening. The lack of chromosomal shortening allows the malignant cells to undergo many more divisions than the normal cells. Which of the following enzymes is most likely to have this effect? a. Reverse transcriptase b. DNA polymerase c. Telomerase d. Protein kinase e. Topoisomerase

A 62-year-old man has complained of pain on urination for the past week. He is afebrile. On cystoscopy, a slightly erythematous 1 cm diameter area is seen on the bladder mucosa. This area is biopsied and on microscopic examination shows cells with marked hyperchromatism and increased nuclear/cytoplasmic ratio involving the full thickness of the epithelium. However, these changes are confined to the epithelium above the basement membrane. Which of the following terms best describes these biopsy findings? a. Metaplasia b. Minimal dysplasia c. Microinvasion d. Hyperplasia e. Carcinoma in situ

A 53-year-old woman feels a lump in her right breast. Her physician palpates an irregular 3 cm mass that is not movable because it appears 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 the surrounding fibrofatty breast stroma. Microscopic examination of the mass reveals malignant cells with pleomorphic nuclei,numerous abnormal mitosis and tumor giant cells.Which of the following terms denotes these features? a. Anaplasia b. Aplasia c. Desmoplasia d. Dysplasia e. Metaplasia

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 colon. Biopsy of the mass yields a diagnosis of adenocarcinoma. A chest x-ray shows multiple 1 to 3 cm nodules in both lungs. Presence of which of the following in the neoplastic cells is most likely to explain the presence of lung nodules? a. Vimentin b. Leukocyte common antigen c. Laminin receptor d. Telomerase e. DNA topoisomerase II

An epidemiologic study is performed involving patients with long-standing Epstein-Barr virus infection. It is observed that these patients have an increased risk for development of malignant neoplasms in adulthood. Which of the following neoplasms is most likely to be found in these patients? a. Squamous cell carcinoma b. Osteosarcoma c. Nasopharyngeal carcinoma d. Endometrial carcinoma

A study of malignant neoplasms reveals that some of them have a greater potential for invasion and metastases. Analysis of the cells of cancers that have metastasized reveals a mutation which results in decreased cell surface expression of E-cadherin. Which of the following genes is most likely mutated to produce these findings? a. beta-catenin b. BRCA-2 c. Cyclin D d. NF-1 e. RAS


				
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