1.

A 30-year-old woman who has had multiple sexual partners sees her physician because she
has had vaginal bleeding and discharge for the past 5 days. Pelvic examination shows an
ulcerated lesion arising from the squamocolumnar junction of the uterine cervix. A cervical
biopsy is performed. Microscopic examination reveals an invasive tumor containing areas of
squamous epithelium with marked atypical changes.
a) What is the likely diagnosis. (1)
b) Name the causative agent for the mentioned pathology. (1)
c) Briefly describe the underlying pathogenesis for the development of the above lesion. (3)

2. A 55-year-old man visits the physician because of hemoptysis and worsening cough. On
physical examination, wheezes are auscultated over the right lung posteriorly. A chest
radiograph shows a 6-cm perihilar mass on the right. A fine-needle aspiration biopsy yields
cells consistent with bronchogenic carcinoma. Molecular analysis of the neoplastic cells shows
a p53 gene mutation.
a) What is the likely pathogenic mechanism underlying tumorigenesis in this case. (3.5)
b) List the hormones which might be elaborated by the tumor. (1.5)

3. A 58 year old woman presents to the OPD after noticing a lump in her left breast. On physical
examination the physician palpates a firm, immobile, 3 cm mass in the upper outer quadrant
of left breast along with enlarged, firm, non-tender lymph nodes in the left axilla. A
subsequent biopsy of the mass reveals an invasive tumor composed of few tubules and solid
sheets of cells with marked pleomorphism and frequent mitosis. Mastectomy is performed
and during surgery the sentinel lymph node is sent for histopathology which shows tumor
infiltration.
a) What is the significance of sentinel lymph node examination. (2)
b) What is the biological behavior of the mentioned lesion. Give reasons for your answer. (3)

4. A 42-year-old man presents with puffiness of face, pedal edema, a prominent fat pad in the
posterior neck and abdominal cutaneous striae as well as systolic hypertension. His serum
ACTH level is high. A chest radiograph shows a 5cm mass in the right upper lobe of the lung.
Genetic analysis of tumor cells reveals mutation of the p53 gene.
a) What is the likely cause of the patients presenting symptoms. (2)
b) Briefly describe the significance of p53 mutation in the development of the above tumor.
(3)

5. A 30-year-old woman who has had multiple sexual partners sees her physician because she
has had vaginal bleeding and discharge for the past 5 days. Pelvic examination shows an
ulcerated lesion arising from the squamocolumnar junction of the uterine cervix. Biopsy of
the lesion reveals an invasive tumor containing areas of squamous epithelium, with pearls of
keratin. In situ hybridization shows the presence of human papillomavirus type 16 (HPV-16)
DNA within the tumor cells.
a) Briefly describe the molecular pathogenesis of this tumor in relation to infection with HPV-
16. (3)
b) List other neoplasms related to HPV infection. (2)

6. A 26-year-old woman has a lump in the left breast. On physical examination, the physician
finds an irregular, firm, 2-cm mass in the upper inner quadrant of the breast. A fine-needle
aspirate of the mass shows carcinoma. The patient's 30-year-old sister was recently
diagnosed with ovarian cancer, and 3 years ago her maternal aunt was diagnosed with
ductal carcinoma of the breast and had a mastectomy.
a) Which genes are most likely to have undergone mutation to produce these findings. (1)
b) Briefly mention the criteria for staging and grading this tumor. (2.5)
c) List three significant tumor markers for the above lesion. (1.5)