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Pathology - neoplasia

Terms in this set (25)

A 40-year-old man has a history of intravenous drug use. Physical examination shows needle tracks in his left antecubital fossa. He has mild scleral icterus. Serologic studies for HBsAg and anti-HCV are positive. He develops hepatocellular carcinoma 15 years later. Which of the following viral characteristics best explains why this patient developed hepatocellular carcinoma?
□ (A) Viral integration in the vicinity of protooncogenes
□ (B) Viral capture of protooncogenes from host DNA
□ (C) Viral-induced injury followed by extensive hepatocyte regeneration
□ (D) Viral inactivation of RB and p53 gene expression
□ (E) Viral infection of inflammatory cells with host immunosuppression
C
An experiment involving carcinoma cells grown in culture studies the antitumor surveillance effects of the innate immune system. These carcinoma cells fail to express MHC class I antigens. It is observed, however, that carcinoma cells are lysed in the presence of one type of immune cell that has been activated by IL-2. Which of the following immune cells is most likely to function in this manner?
□ (A) CD4+ lymphocyte
□ (B) CD8+ lymphocyte
□ (C) Macrophage
□ (D) Neutrophil
□ (E) NK cell
□ (F) Plasma cell
E
A 20-year-old man has a raised, irregular, pigmented lesion on his forearm that has increased in size and become more irregular in color over the past 4 months. Physical examination shows a 0.5 × 1.2 cm black-to-brown lesion with irregular borders. An excisional biopsy specimen shows a malignant melanoma that extends into the reticular dermis. Family history indicates that the patient's paternal uncle died of metastatic melanoma that spread to the liver after excision of a primary lesion on the foot. His grandfather required enucleation of the left eye because of a "dark brown" mass in the eyeball.
Which of the following genes is most likely to have undergone mutation to produce these findings?
□ (A) BCL2 (anti-apoptosis gene)
□ (B) C-MYC (transcription factor gene)
□ (C) IL2 (growth factor gene)
□ (D) Lyn (tyrosine kinase gene)
□ (E) p16 (cell cycle inhibition)
□ (F) p53 (DNA damage response gene)
□ (G) PDGF (growth factor overexpression)
E
A 30-year-old man has a 15-year history of increasing numbers of multiple benign skin nodules. On physical
examination, the firm nodules average 0.5 to 1 cm and appear to be subcutaneous. Further examination shows numerous oval 1- to 5-cm pigmented skin lesions. Ophthalmoscopic examination shows hamartomatous nodules on the iris. A biopsy specimen of one skin nodule shows a neoplasm that is attached to a peripheral nerve. Which of the following mechanisms of transformation is most likely related to the mutation that this patient has inherited?
□ (A) Persistent activation of the RAS gene
□ (B) Increased production of epidermal growth factor
□ (C) Decreased susceptibility to apoptosis
□ (D) Impaired functioning of mismatch repair genes
□ (E) Inactivation of the RB gene
A
A 50-year-old woman saw her physician after noticing a mass in the right breast. Physical examination showed a 2-cm mass fixed to the underlying tissues beneath the areola and three firm, nontender, lymph nodes palpable in the right axilla. There was no family history of cancer. An excisional breast biopsy was performed, and microscopic examination showed a well-differentiated ductal carcinoma. Over the next 6 months, additional lymph nodes became enlarged, and CT scans showed nodules in the lung, liver, and brain. The patient died 9 months after diagnosis. Which of the following molecular
abnormalities is most likely to be found in this setting?
□ (A) Inactivation of one BRCA1 gene copy
□ (B) Deletion of one p53 gene copy
□ (C) Amplification of the ERBB2 (HER2) gene
□ (D) Deletion of an RB gene locus
□ (E) Fusion of BCR and C-ABL genes
C
A 59-year-old man has recently noticed blood in his urine. Cystoscopy shows a 4-cm exophytic mass involving the right bladder mucosa near the trigone. Biopsy specimens are obtained, and the patient undergoes a radical cystectomy. Examination of the excised specimen shows that a grade IV urothelial cell carcinoma has infiltrated the bladder wall. Which of the following statements regarding these findings is most appropriate?
□ (A) The neoplasm is a metastasis
□ (B) The patient has a poorly differentiated neoplasm
□ (C) A paraneoplastic syndrome is likely
□ (D) The stage of the neoplasm is low
□ (E) The patient is probably cured of the cancer
B
A 51-year-old man who works in a factory that produces plastic pipe has experienced weight loss, nausea, and vomiting over the past 4 months. On physical examination, he has tenderness to palpation in the right upper quadrant of the abdomen, and the liver span is increased. Laboratory findings include serum alkaline phosphatase, 405 U/L; AST, 45 U/L; ALT, 30 U/L; and total bilirubin, 0.9 mg/dL. An abdominal CT scan shows a 12-cm mass in the right lobe of the liver. A liver biopsy is performed, and microscopic examination shows an angiosarcoma. The patient has most likely been
exposed to which of the following agents?
□ (A) Arsenic
□ (B) Asbestos
□ (C) Benzene
□ (D) Beryllium
□ (E) Nickel
□ (F) Vinyl chloride
□ (G) Naphthalene
F
An epidemiologic study of cancer deaths recorded in the last half of the 20th century is conducted. The number of deaths for one particular type of cancer has been decreasing in developed nations, despite the absence of widespread screening programs. Which of the following neoplasms was most likely to be identified by this study?
□ (A) Angiosarcoma of the liver
□ (B) Gastric adenocarcinoma
□ (C) Glioma of the brain
□ (D) Leukemia
□ (E) Lymphoma of the lymph nodes
□ (F) Pancreatic adenocarcinoma
B
A 49-year-old man has a lump near his right shoulder that has been increasing in size for the past 8 months. On physical examination, the physician palpates a 4-cm, firm, nontender mass in the right supraclavicular region. The mass is excised, and microscopically it is diagnosed as follicular lymphoma. Karyotypic analysis of the cells shows a chromosomal translocation, t(14;18), involving the immunoglobulin heavy-chain gene. Which of the following genes is most likely to have undergone mutation to produce these findings?
□ (A) APC (tumor suppressor gene)
□ (B) BCL1 (cyclin gene)
□ (C) BCL2 (anti-apoptosis gene)
□ (D) BRCA1 (DNA repair gene)
□ (E) C-MYC (transcription factor gene)
□ (F) ERBB2 (growth factor receptor gene)
□ (G) IL2 (growth factor gene)
□ (H) K-RAS (GTP-binding protein gene)
□ (I) p53 (DNA damage response gene)
C
A Pap smear obtained from a 29-year-old woman during a routine health maintenance examination is abnormal. She is currently asymptomatic, but has a history of multiple sexual partners. Cervical biopsy specimens are obtained. The representative microscopic appearance of a specimen is shown in the figure. Which of the following is the most likely diagnosis?
□ (A) Adenocarcinoma
□ (B) Carcinoma in situ
□ (C) Dysplasia
□ (D) Hamartoma
□ (E) Melanoma
□ (F) Mesothelioma
□ (G) Small-cell anaplastic carcinoma
□ (H) Squamous cell carcinoma
H
A 22-year-old woman, who works as a secretary for an accounting firm, has noted a palpable nodule on the side of her neck for the past 3 months. On physical examination, there is a 2-cm, firm, nontender nodule involving the right lobe of the thyroid gland. A fine-needle aspiration biopsy specimen of the nodule shows cells consistent with carcinoma of the thyroid. No other family members are affected by this disorder. Which of the following would be considered most relevant in the woman's past medical history?
□ (A) Chronic alcoholism
□ (B) Ataxia telangiectasia
□ (C) Radiation therapy in childhood
□ (D) Blunt trauma from a fall
□ (E) Exposure to arsenic compounds
C
A 30-year-old man has a pheochromocytoma of the left adrenal gland; a sibling had a cerebellar hemangioblastoma. He undergoes adrenalectomy, and on microscopic examination there is extensive vascularity of the neoplasm. Mutational analysis of the neoplastic cells shows that both allelic copies of a gene have been lost, so that a protein that binds to
hypoxia-induced factor 1 alpha is no longer ubiquinated, but instead translocates to the nucleus and activates transcription of VEGF. Which of the following genes is most likely mutated in this man?
□ (A) APC
□ (B) BCL2
□ (C) EGF
□ (D) HER2
□ (E) HST1
□ (F) MYC
G
A 60-year-old woman has noted a feeling of pelvic heaviness for the past 6 months. On physical examination, there is a nontender lower abdominal mass. An abdominal ultrasound scan shows a 12-cm solid mass in the uterine wall. A total abdominal hysterectomy is performed, and on removal, the mass has the microscopic appearance of a well-differentiated
leiomyosarcoma. One year later, a chest radiograph shows a 4-cm nodule on the right lower lung. A biopsy specimen of the nodule shows a poorly differentiated sarcoma. The patient's past medical history indicates that she has smoked cigarettes most of her adult life. Which of the following best explains these findings?
□ (A) Development of a second primary neoplasm
□ (B) Inheritance of a defective RB gene
□ (C) Continued cigarette smoking by the patient
□ (D) Loss of an oncogene
□ (E) Metastasis from an aggressive subclone of the primary tumor
E
In an experiment, cells from human malignant neoplasms explanted into tissue culture medium continue to replicate. This allows development of "immortal" tumor cell lines that are extremely useful for study of tumor biology and responses to therapeutic modalities. Which of the following molecular alterations that endows these tumor cells with limitless
replicative ability in vivo and in vitro is most likely to be observed?
□ (A) Activation of telomerase
□ (B) Activation of cyclin genes
□ (C) Inhibition of cyclin activators
□ (D) Activation of vascular endothelial growth factor
□ (E) Activation of BCL2 gene
□ (F) Inability to repair errors in DNA replication
A
A 22-year-old woman, who works as a secretary for an accounting firm, has noted a palpable nodule on the side of her neck for the past 3 months. On physical examination, there is a 2-cm, firm, nontender nodule involving the right lobe of the thyroid gland. A fine-needle aspiration biopsy specimen of the nodule shows cells consistent with carcinoma of the thyroid. No other family members are affected by this disorder. Which of the following would be considered most relevant in the woman's past medical history?
□ (A) Chronic alcoholism
□ (B) Ataxia telangiectasia
□ (C) Radiation therapy in childhood
□ (D) Blunt trauma from a fall
□ (E) Exposure to arsenic compounds
C
A 30-year-old man has a pheochromocytoma of the left adrenal gland; a sibling had a cerebellar hemangioblastoma. He undergoes adrenalectomy, and on microscopic examination there is extensive vascularity of the neoplasm. Mutational analysis of the neoplastic cells shows that both allelic copies of a gene have been lost, so that a protein that binds to
hypoxia-induced factor 1 alpha is no longer ubiquinated, but instead translocates to the nucleus and activates transcription of VEGF. Which of the following genes is most likely mutated in this man?
□ (A) APC
□ (B) BCL2
□ (C) EGF
□ (D) HER2
□ (E) HST1
□ (F) MYC
G
A 60-year-old woman has noted a feeling of pelvic heaviness for the past 6 months. On physical examination, there is a nontender lower abdominal mass. An abdominal ultrasound scan shows a 12-cm solid mass in the uterine wall. A total abdominal hysterectomy is performed, and on removal, the mass has the microscopic appearance of a well-differentiated
leiomyosarcoma. One year later, a chest radiograph shows a 4-cm nodule on the right lower lung. A biopsy specimen of the nodule shows a poorly differentiated sarcoma. The patient's past medical history indicates that she has smoked cigarettes most of her adult life. Which of the following best explains these findings?
□ (A) Development of a second primary neoplasm
□ (B) Inheritance of a defective RB gene
□ (C) Continued cigarette smoking by the patient
□ (D) Loss of an oncogene
□ (E) Metastasis from an aggressive subclone of the primary tumor
E
In an experiment, cells from human malignant neoplasms explanted into tissue culture medium continue to replicate.This allows development of "immortal" tumor cell lines that are extremely useful for study of tumor biology and responses to therapeutic modalities. Which of the following molecular alterations that endows these tumor cells with limitless
replicative ability in vivo and in vitro is most likely to be observed?
□ (A) Activation of telomerase
□ (B) Activation of cyclin genes
□ (C) Inhibition of cyclin activators
□ (D) Activation of vascular endothelial growth factor
□ (E) Activation of BCL2 gene
□ (F) Inability to repair errors in DNA replication
A
An investigational study reviews cells from patients who had hereditary nonpolyposis colon cancer. The patients typically developed multiple lesions of the colon during middle age. Molecular analysis of the cells from the lesions shows changes in hPMS1, hPMS2, and hMLH1 genes. Which of the following principles of carcinogenesis is best illustrated by this study?
□ (A) Tumor initiators are mutagenic
□ (B) Tumor promoters induce proliferation
□ (C) Many oncogenes are activated by translocations
□ (D) Inability to repair DNA is carcinogenic
□ (E) Carcinogenesis is a multistep process
D
A 55-year-old woman has felt an enlarging lump in her left breast for the past year. A hard, irregular 5-cm mass fixed to the underlying chest wall is palpable in her left breast. Left axillary nontender lymphadenopathy is noted. There is no hepatosplenomegaly. A chest CT scan reveals multiple bilateral pulmonary "cannonball" nodules. A left breast biopsy is performed, and on microscopic examination shows high-grade infiltrating ductal carcinoma. The appearance of the nodules in her lungs is most likely related to which of the following?
□ (A) Proximity of the breast carcinoma to the lungs
□ (B) Lymphatic connections between the breast and the pleura
□ (C) Internal mammary artery invasion by carcinoma cells
□ (D) Pulmonary chemokines that bind carcinoma cell chemokine receptors
□ (E) Overexpression of laminin receptors on carcinoma cell surfaces
□ (F) Overexpression of estrogen receptors within the carcinoma cell nuclei
D
A 50-year-old woman has had easy fatigability and noted a dragging sensation in her abdomen for the past 5 months.
Physical examination reveals that she is afebrile. She has marked splenomegaly, but no lymphadenopathy. Laboratory studies show her total WBC count is 250,000/mm3 with WBC differential count showing 68% segmented neutrophils, 11% band neutrophils, 6% metamyelocytes, 5% myelocytes, 5% myeloblasts, 3% lymphocytes, and 2% monocytes. A bone marrow biopsy is performed, and karyotypic analysis of the cells reveals a t(9;22) translocation. Medical treatment with a
drug having which of the following modes of action is most likely to produce a complete remission in this patient?
□ (A) Antibody binding to ERB-2 receptor
□ (B) Inhibiting tyrosine kinase activity
□ (C) Selective killing of cells in S phase
□ (D) Activating caspases
□ (E) Preventing translocation of β-catenin to the nucleus
□ (F) Delivering normal p53 into cells with viral vectors
B
A 35-year-old man with a family history of colon carcinoma undergoes a surveillance colonoscopy. It reveals hundreds
of polyps in the colon, and two focal 0.5-cm ulcerated areas. A biopsy specimen from an ulcer reveals irregularly shaped glands that have penetrated into the muscular layer. Which of the following molecular events is believed to occur very early in the evolution of his colonic disease process?
□ (A) Mutations in mismatch repair genes.
□ (B) Inability to hydrolyze GTP-bound RAS
□ (C) Activation of the WNT signaling pathway
□ (D) Loss of heterozygosity affecting the p53 gene
□ (E) Translocation of BCL2 from mitochondria to cytoplasm
C
An epidemiologic study of cancer deaths recorded in the last half of the 20th century is conducted. The number of deaths for one particular cancer increased markedly in developed nations. In 1998, more than 30% of cancer deaths in men and more than 24% of cancer deaths in women were caused by this neoplasm. Which of the following neoplasms was most likely identified by this study?
□ (A) Breast carcinoma
□ (B) Bronchogenic carcinoma
□ (C) Cervical squamous cell carcinoma
□ (D) Adenocarcinoma of the colon
□ (E) Melanoma of the skin
□ (F) Prostatic adenocarcinoma
B
The mother of a 5-year-old boy notices that his abdomen is enlarged. On physical examination, the physician palpates an ill-defined abdominal mass. An abdominal CT scan shows a 9-cm mass in the region of the right adrenal gland. The mass is removed and microscopically appears to be a neuroblastoma. Cytogenetic analysis of tumor cells shows many double minutes and homogeneously staining regions. Which of the following genes is most likely to have undergone
alterations to produce these findings?
□ (A) BCL1 (cyclin gene)
□ (B) BCL2 (anti-apoptosis gene)
□ (C) IL2 (growth factor gene)
□ (D) Lyn (tyrosine kinase gene)
□ (E) K-RAS (GTP-binding protein gene)
□ (F) N-MYC (transcription factor gene)
□ (G) p53 (DNA damage response gene)
F
A 53-year-old man diagnosed with oral cancer and treated with radiation and chemotherapy 1 year ago now has a positron emission tomography (PET) scan of his neck that shows a single focus of increased uptake. This focus is resected and microscopic examination shows that it is a metastasis. Molecular analysis of this cancer shows p53, PTEN, and c-MYC gene mutations. Which of the following metabolic pathways is most likely upregulated to promote his cancer
cell survival and proliferation?
□ (A) Aerobic glycolysis
□ (B) Gluconeogenesis
□ (C) Hexose monophosphate shunt
□ (D) Oxidative phosphorylation
□ (E) Purine degradation
A
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