A 44-year-old woman notes a lump in her left breast while taking a shower. Her physician notes a 3 cm firm, irregular, non-movable mass located in the upper outer quadrant of her left breast on physical examination. A fine needle aspiration of this mass is performed. Cells obtained from the mass are examined cytologically and are consistent with infiltrating ductal carcinoma. The mass is removed with lumpectomy along with an axillary lymph node dissection. Which of the following findings will best predict a better prognosis for this patient?

A The tumor cells are strongly estrogen receptor positive

B No metastases are found in the sampled lymph nodes

C Flow cytometric analysis demonstrates aneuploidy and a high S-phase

D She has one relative who had a similar type of breast cancer

E The tumor has a high grade

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A change in bowel habits prompts a 53-year-old woman to see her physician. On physical examination there are no lesions noted on digital rectal examination, but her stool is positive for occult blood. A colonoscopy is performed and reveals a 6 cm friable mass located in the cecum. A biopsy of this mass is performed and microscopic examination shows a moderately differentiated adenocarcinoma. Which of the following findings is most likely to be present in this patient?

A A k-ras mutation in the neoplastic cells

B An immunoperoxidase stain positive for vimentin in the neoplastic cells

C A stool culture positive for Shigella flexneri

D A plasma HIV-1 RNA level of 40,000 copies/mL

E A high titer DNA topoisomerase I autoantibody

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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 Sensitivity to radiation or chemotherapy

D Uncontrolled (autonomous) growth

E Necrosis

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A clinical study is performed on biopsy specimens obtained from patients who had a malignant neoplasm. It is observed that a subset of these biopsies shows a neoplasm composed predominantly of cells with a spindle shape and a high N/C ratio with marked pleomorphism. These cells are vimentin positive, cytokeratin negative, and CD45 negative by immunohistochemical staining. This type of neoplasm is most likely to have been diagnosed in which of the following patients?

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

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

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

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

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

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A 48-year-old woman goes to her physician for a routine physical examination. A 4 cm diameter non-tender mass is palpated in her right breast. The mass appears fixed to the chest wall. Another 2 cm non-tender mass is palpable in the left axilla. A chest radiograph reveals multiple 0.5 to 2 cm nodules in both lungs. Which of the following classifications best indicates the stage of her disease?

A T1 N1 M0

B T1 N0 M1

C T2 N1 M0

D T3 N0 M0

E T4 N1 M1

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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

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Review of a series of surgical pathology reports indicates that a certain type of neoplasm is graded as grade I on a scale of I to IV. Clinically, some of the patients with this neoplasm are found to be stage I. Which of the following is the best interpretation of a neoplasm with this stage I designation?

A Is unlikely to be 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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A 51-year-old man has worked for 10 years in a factory producing plastic pipe. He has noted weight loss, nausea, and vomiting worsening over the past 5 months. On examination he is afebrile. There is generalized muscle wasting. Laboratory studies show the serum alkaline phosphatase is 405 U/L with AST 67 U/L, ALT 55 U/L, and total bilirubin 1.2 mg/dL. An abdominal CT scan reveals a 12 cm right liver lobe mass. Liver biopsy reveals a neoplasm composed of spindle cells forming irregular vascular channels. The cells demonstrate vimentin positivity and cytokeratin negativity with immunohistochemical staining. Exposure to which of the following substances most likely led to development of this neoplasm?

A Benzene

B Radon

C Cyclophosphamide

D Asbestos

E Vinyl chloride

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A child is born with a single functional allele of a tumor suppressor gene. At the age of five the remaining normal allele is lost through a point mutation. As a result, the ability to continue the transition from G1 to the S phase of cell cycle is lost. Which of the following neoplasms is most likely to arise via this mechanism?

A Infiltrating ductal carcinoma of breast

B Small cell anaplastic carcinoma of the lung

C Retinoblastoma of eye

D Cerebral astrocytoma

E Chronic myeloid leukemia

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A 22-year-old woman goes to her physician for a routine examination. A palpable nodule is found in the right lobe of her thyroid gland. No lymphadenopathy is noted. A chest x-ray shows no masses. A fine needle aspirate of the nodule is performed and cytologic examination reveals cells present consistent with a papillary carcinoma of the thyroid. There are no other family members affected by this disorder. She works as a secretary for an accounting firm part time and is earning a college degree. Which of the following findings would you consider most relevant in her past history to indicate a risk factor for this neoplasm?

A Chronic alcoholism

B Radiation therapy in childhood

C Ataxia telangiectasia

D Blunt trauma from a fall

E Exposure to arsenic compounds

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A 50-year-old man has felt vague abdominal discomfort for the past 4 months. On physical examination he has no lymphadenopathy, and no abdominal masses or organomegaly can be palpated. Bowel sounds are present. An abdominal CT scan shows a 20 cm retroperitoneal soft tissue mass obscuring the left psoas muscle. A stool specimen tested for occult blood is negative. Which of the following neoplasms is this man most likely to have?

A Melanoma

B Hamartoma

C Adenocarcinoma

D Lymphoma

E Liposarcoma

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A 52-year-old man has had increasing fatigue for the past 6 months. On physical examination he has a palpable speen tip. Laboratory studies show a WBC count of 189,000/microliter. The peripheral blood smear shows many mature and immature myeloid cells present. Cytogenetic analysis of cells obtained via bone marrow aspiration reveals a t(9:22) translocation to be present. This translocation leads to formation of a hybrid gene that greatly increases tyrosine kinase activity. Which of the following genes is most likely translocated to cause these findings?

A p53

B Rb

C c-abl

D NF-1

E k-ras

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A clinical study is performed of oncogenesis in human neoplasms. It is observed that some neoplasms appear to develop from viral oncogenesis, with serologic confirmation of past viral infection. Which of the following neoplasms is most likely to arise in this manner?

A Retinoblastoma

B Small cell anaplastic carcinoma of lung

C T-cell leukemia

D Prostatic adenocarcinoma

E Hepatic angiosarcoma

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A 40-year-old woman has had a feeling of abdominal discomfort for the past 8 months. On pelvic examination, there is a right adnexal mass. An abdominal CT scan demonstrates a 7 cm cystic mass involving the right ovary with small areas of calcification. The uterus is normal in size. The right fallopian tube and ovary are removed surgically. Grossly, the mass on sectioning is filled with abundant hair and sebum. Microscopically, the mass has glandular spaces lined by columnar epithelium, squamous epithelium with hair follicles, cartilage, and dense connective tissue. Which of the following statements regarding this type of neoplasm is most appropriate?

A A sarcomatous element is usually present.

B A human papillomavirus infection preceded development of this mass.

C Metastases are unlikely to be present.

D Tissues resembling those from an embryo can usually be seen.

E Such a mass is often seen to arise in the testis.

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A 29-year-old woman with a history of multiple sexual partners over the last 15 years has a routine physical examination with no abnormal findings. On pelvic examination, the cervix shows no abnormalities, but a Pap smear is taken and dysplastic cells are reported to be present. A cervical biopsy is performed and shows microscopic features of a minimal dysplasia involving the cervical squamous epithelium. Which of the following is the most appropriate statement to make to the patient regarding these findings?

A No further treatment is indicated

B Antibiotic therapy will be necessary

C You probably have widespread metastases

D Excision of this lesion insures a good prognosis

E You have inherited a BRCA-1 mutation

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A 64-year-old man has has noted a 10 kg weight loss along with increasing fatigue over the past year. He has experienced dull abdominal pain for the past week. He has developed abdominal distention with lack of stools in the past two days. On physical examination, bowel sounds are reduced. An abdominal CT scan reveals a mass involving the descending colon. At laparotomy, a partial resection of the left colon is performed, with removal of an encircling mass in the descending colon. Microscopically, the mass is found to be a moderately differentiated adenocarcinoma. Which of the following laboratory test findings is most likely to be present in this man?

A Microcytic hypochromic anemia

B Positive antinuclear antibody test

C Hyperglycemia

D Elevated alpha-fetoprotein

E Decreased lactate dehydrogenase

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A 14-year-old healthy girl has a 0.3 cm reddish, slightly raised 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. Which of the following neoplasms is this nodule most likely to be?

A Hemangioma

B Melanoma

C Wilms tumor

D Lymphoma

E Glioma

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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

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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 during the past year. No abnormal findings are noted on physical examination. He has a chest radiograph that reveals a right hilar mass. A sputum cytology shows atypical, hyperchromatic 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 Bronchi

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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.

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A 59-year-old man has had a worsening cough with chest pain for the past 6 months. On physical examination he has no remarkable findings. A chest x-ray shows a 3 cm left lung mass. A sputum cytology specimen yields cells diagnosed as a squamous cell carcinoma. A mediastinoscopy is performed and reveals metastases in a lymph node. He is given radiation therapy, and the mass diminishes in size. Which of the following cellular mechanisms is most likely to account for this tumor response?

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

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A 60-year-old woman has a firm mass with irregular borders felt in her left breast on a routine physical examination. A fine needle aspiration is performed and microscopic examination shows an infiltrating ductal carcinoma. A left mastectomy with axillary lymph node dissection is performed. A tissue sample of this neoplasm is submitted for analysis by flow cytometry. Which of the following does flow cytometric analysis most likely provide?

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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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 is 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 Hematoma

D Leiomyoma

E Metastasis

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A 15-year-old boy has had lumps in the right neck for the past 5 months. On physical examination there is painless lymphadenopathy in the right cervical region. One of the lymph nodes is biopsied and on microscopic examination 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 which of the following methods?

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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A previously healthy 42-year-old man has a skin nodule on his right hand that has become larger and darker with more irregular outlines over the past three months. On physical examination there is a 1.2 cm diameter darkly pigmented and slightly raised nodule on the dorsum of his right hand. No other skin lesions are noted. Several nontender enlarged lymph nodes are palpable in the right axilla. The lesion is excised and microscopic examination shows a neoplasm composed of darkly pigmented polygonal and spindle cells. Which of the following risk factors is most important for development of this neoplasm?

A Cigarette smoking

B Allergy to latex gloves

C Inheritance of a faulty Rb gene

D Prior job-related asbestos exposure

E Chronic exposure to ultraviolet radiation

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A a 27-year-old woman in excellent health has a routine health maintenance examination. A 2 cm firm, rounded mass is palpable beneath the skin of the left forearm. She has no difficulty using the arm and there is no associated pain with the mass, either in movement or on palpation. The overlying skin appears normal. The mass does not change in size over the next year. Which of the following neoplasms is she most likely to have?

A Metastatic carcinoma

B Melanoma

C Rhabdomyosarcoma

D Lipoma

E Leiomyoma

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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. She is found to have a positive serologic test for syphilis. Her serum glucose is 157 mg/dL. 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

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A 60-year-old man with a 90 pack year history of smoking experiences an episode of hemoptysis. On physical examination he has puffiness of the face, some pedal edema, bruises of the skin, and a blood pressure of 165/100 mm Hg. A chest radiograph reveals a 5 cm right upper lobe lung mass. A fine needle aspirate of this mass yields cells consistent with small cell anaplastic ("oat cell") carcinoma. A bone scan shows no metastases. Immunohistochemical staining of the tumor cells is likely to be positive for which of the following hormones?

A Parathormone related peptide

B Erythropoietin

C ACTH

D Insulin

E Gastrin

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A 45-year-old woman has noted a lump on her left shoulder that has enlarged over the past 4 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 Cerebral glioma

B Adenocarcinoma of the colon

C Fibroadenoma of the breast

D Liposarcoma of the retroperitoneum

E Laryngeal papilloma

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A 59-year-old man went to his physician for a routine health maintenance examination. The only abnormal physical examination finding is a positive stool guaiac test. Laboratory studies show a CBC with Hgb 10.0 g/dL, Hct 29.8&, MCV 73 fL, platelet count 300,000/microliter, and WBC count 8700/microliter. He is found on colonoscopy to have a 4 cm mass lesion arising on the mucosal surface of the transverse colon. Which of the following statements is most appropriate regarding these findings?

A This is an uncommon site for a primary malignant neoplasm

B Microscopically, the mass is probably an adenocarcinoma

C Persons who are smokers are at much greater risk to develop this lesion

D Hypercalcemia is a frequent paraneoplastic complication

E The predicted 5 year survival rate is less than 5%

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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 regarding these findings 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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A 52-year-old woman feels a lump in her right breast and goes to her physician. On physical examination there is a 3 cm right breast mass fixed to the chest. This mass is biopsied and on microscopic examination shows nests of cells with marked hyperchromatism and pleomorphism. These cells are estrogen receptor positive. Flow cytometry is performed. Compared with surrounding non-neoplastic stromal cells, the neoplastic cells are more likely to be in which of the following phases of the cell cycle?

A G0

B G1

C S

D G2

E M

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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

E Rhabdomyosarcoma

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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

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A 50-year-old woman notes a lump inher left breast. She goes to her physician's assistant, who palpates a 2 cm firm mass in her left breast. A fine needle aspiration biopsy is performed, and on microscopic examination a ductal carcinoma is seen. A poorer prognosis for the patient is most closely associated with which of the following findings?

A Aneuploidy by flow cytometry

B Positive immunohistochemical staining for estrogen receptor

C A well-differentiated histologic appearance

D Intraductal growth pattern

E Stage of T1 N0 M0

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An epidemiologic study is performed to determine risk factors for development of malignant neoplasms. A statistical analysis of pre-existing medical conditions is done. Some pre-existing conditions are observed to precede development of malignant neoplasms, while others do not. Which of the following conditions is most likely to be statistically unrelated to subsequent malignancy?

A Endometrial atypical hyperplasia

B Chronic alcoholism with hepatic cirrhosis

C Cervical squamous dysplasia

D Chronic ulcerative colitis

E Uterine leiomyomas

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A 35-year-old man has noted several 1 to 2 cm reddish purple, nodular lesions present on the skin of his right arm which have increased in size and number over the past 3 months. The lesions do not itch and are not painful. He has had a watery diarrhea for the past month. On physical examination he has generalized lymphadenopathy and oral thrush. Which of the following infections is most likely to be related to the appearance of these skin lesions?

A Candida albicans

B Human herpesvirus 8

C Mycobacterium tuberculosis

D Pseudomonas aeruginosa

E Pneumocystis carinii (jirovecii)

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A 66-year-old woman has developed a chronic cough over the past 2 months. No abnormal physical examination findings are noted. A chest x-ray shows a 3 cm mass in the right upper lobe. After fine needle aspiration biopsy, the mass is resected. Gross and microscopic examination of the mass is performed and it is determined that a neoplasm is present. Which of the following findings regarding this mass is most likely to be irrelevant for determining further therapy and prognosis?

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?

D How much inflammation is present in the neoplasm?

E Is the neoplasm primary or metastatic?

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A 49-year-old man complains of pain in his left thigh for 3 months. On physical examination his thigh is increased in size, compared to the right. A plain film radiograph reveals the presence of a 15 cm solid mass that does not appear to arise from bone, but it does have infiltrative margins. A biopsy of this mass is taken, and on microscopic examination the mass is composed of highly pleomorphic spindle cells. Which of the following immunohistochemical markers is most likely to be demonstrated in the cells of this mass?

A Cytokeratin

B Factor VIII

C Alpha fetoprotein

D Lambda light chain

E Vimentin

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A clinical study is performed with patients who had a diagnosis of breast canacer. Characteristics of the grade, stage, molecular biology, and histologic type are analyzed. Of the following characteristics, which is most likely to be associated with the best prognosis for these patients?

A Increased expression of laminin receptors

B Increased cathepsin expression

C Decreased apoptosis

D Decreased doubling time

E Decreased nuclear/cytoplasmic ratio

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A 66-year-old man has noted darker urine for the past 2 weeks. A urinalysis shows hematuria. He is referred to a urologist who performs cystoscopy. A 3 cm mass is found in the dome of the bladder. Biopsies of the mass are taken and on microscopicc examination show a urothelial carcinoma. Cells of this neoplasm demonstrate a single mutation causing cellular inability to hydrolyze GTP, thus resulting in cellular transformation. Which of the following oncogenes is most likely implicated in this case?

A c-abl

B c-neu

C c-sis

D k-ras

E n-myc

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A 44-year-old woman who has had multiple sexual partners for the past 30 years has an abnormal Pap smear with cytologic changes suggesting human papillomavirus infection. Without treatment, she is most likely to develop which of the following lesions?

A Squamous cell carcinoma

B Non-Hodgkin's lymphoma

C Kaposi's sarcoma

D Adenocarcinoma

E Leiomyoma

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In an epidemiologic study, "fallout" from nuclear bomb testing and from nuclear power plant disasters is observed to have released radioactive isotopes into the environment. One of these isotopes is found to be strontium-90. It is observed that the strontium-90 in soils goes into the food chain and eventually contaminates milk products. This contamination is most likely to increase the risk for which of the following neoplasms?

A Kaposi's sarcoma of skin

B Small cell anaplastic carcinoma of lung

C Osteosarcoma

D Nasopharyngeal carcinoma

E Endometrial carcinoma

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A clinical trial of a new chemotherapy protocol is performed involving patients with lung carcinoma. It is observed that a response occurs that leads to DNA strand breakage and carcinoma cell death. The primary carcinomas are initially observed to decrease in size following therapy. However, after 3 months, the carcinoma is no longer regressing with this therapy. Altered expression of which of the following by the neoplastic cells has most likely resulted in this reduced response?

A Vimentin

B Leukocyte common antigen

C Laminin receptor

D Actin

E DNA topoisomerase II

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In an experiment, biologic characteristics of neoplastic and non-neoplastic 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

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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

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A 32-year-old woman has noted dull pelvic pain for the last two months. On physical examination there is a mass palpated in the right lower quadrant. An abdominal ultrasound reveals an 8 cm mass involving the right ovary. The mass is surgically excised. On gross inspection, the surface of the mass is smooth, is not adherent to surrounding pelvic structure, and is cystic and filled with hair on sectioning. On microscopic examination there is squamous epithelium, tall columnar glandular epithelium, cartilage, and fibrous connective tissue. Which of the following neoplasms is she most likely to have?

A Choristoma

B Hamartoma

C Myxoma

D Teratoma

E Mesothelioma

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A 54-year-old woman had an episode of coughing with blood-streaked sputum. On physical examination she appeared cachectic. A chest x-ray showed an irregular mass lesion in the right lung. A transbronchial biopsy was done and on microscopic examination showed small cell anaplastic carcinoma. She was treated with a multidrug chemotherapy regimen and had a partial response. However, metastatic disease is now present eight months later. A second chemotherapy protocol is tried, but no response is noted. Which of the following is the most likely reason for failure of the second protocol to elicit a response?

A The neoplastic cells have an abnormal p53 protein

B This carcinoma was caused by a viral infection

C A ras oncogene has been activated

D The neoplastic cells have increased P-glycoprotein

E There is a second primary lung cancer present

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A previously healthy 66-year-old man has been feeling tired for 5 months. He goes to his physician, who performs a complete physical examination, including stool guaiac, which is positive. A colonoscopy is performed, and a large, sessile 4.5 cm mass with surface ulceration is found in the cecum. A biopsy of this mass microscopically shows irregular glands with crowded, tall columnar cells having marked nuclear hyperchromatism. Which of the following statements about his condition is most accurate?

A His relatives have hereditary adenomatous polyposis

B There is lack of apoptosis from a faulty Bcl-2 gene

C A p53 mutation is present in the neoplastic cells

D He has hereditary non-polyposis colon cancer

E He has inherited a faulty Rb gene from one parent

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An 8-year-old boy has complained of difficulty swallowing for the past month. On physical examination he has a palpable, firm mass in the right neck. A head CT scan reveals a 7 cm solid soft tissue mass lateral to the esophagus on the right. A biopsy of this mass demonstrates pleomorphic spindle cells that are cytokeratin negative, CD45 negative, and vimentin positive. Further history indicates that this boy was affected by fetal alcohol syndrome and he does poorly in school. Which of the following neoplasms is he most likely to have?

A Wilms tumor

B Rhabdomyosarcoma

C Neuroblastoma

D Ewing's sarcoma

E Malignant lymphoma

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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. The mass is firm, white, and has a fibrous consistency. Which of the following features is most likely demonstrated by the gross appearance of this mass?

A Anaplasia

B Aplasia

C Desmoplasia

D Dysplasia

E Metaplasia

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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

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A healthy 22-year-old woman undergoes a routine physical examination. A discrete, firm, rubbery, movable mass is found in the left breast. She has no axillary lymphadenopathy. The skin overlying the breast and the nipple appear normal. Which of the following neoplasms is most likely to be present?

A Lipoma

B Intraductal carcinoma

C Malignant lymphoma

D Fibroadenoma

E Leiomyoma

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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 Kaposi sarcoma

B Small cell anaplastic carcinoma of lung

C Osteosarcoma

D Nasopharyngeal carcinoma

E Endometrial carcinoma

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A 45-year-old man has felt increasingly fatigued for the past 8 months. There are no remarkable physical examination findings. Laboratory studies show a WBC count of 250,000/microliter. A bone marrow biopsy is performed that shows the marrow is 100% cellular with an increase in both mature myeloid cells and their precursors. Cytogenetic analysis of the marrow reveals cells with a 9:22 translocation. Which of the following oncogenes is most likely to be involved in this process?

A c-abl

B c-neu

C c-sis

D k-ras

E n-myc

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