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-colored 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 (antiapoptosis gene)
B. C-MYC (transcription factor gene)
C. IL2 (growth factor gene)
D. Lyn (tyrosine kinase gene)
E. PDGF (growth factor overexpression)
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A 32-year-old woman has experienced dull pelvic pain for the past 2 months. Physical examination shows a right adnexal mass. An abdominal ultrasound scan shows a 7.5-cm cystic ovarian mass. The mass is surgically excised. The surface of the mass is smooth, and it is nonadherent to surrounding pelvic structures. On gross examination, the mass is cystic and filled with hair. Microscopically, there is squamous epithelium, tall columnar glandular epithelium, cartilage, and fibrous connective tissue present. Which of the following is the most likely diagnosis. _ _
Adenocarcinoma
B. Fibroadenoma
C. Glioma
D. Hamartoma
E. Teratoma
A 30-year-old man has a 15-year history of increasing numbers of mu1tiple benign skin nodules. On physical examination, the firm nodules average 0.5 to l 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 study of chemical carcinogenesis shows that repeated application of croton oil containing tetra-decanoylphorbolacetate (TPA, a phorbol ester), after one application of a mutagenic agent on the skin, promotes carcinogenesis. Which of the following is the most likely mechanism for this phenomenon. _ _
A. Induction of chromosome breaks
B. Inhibition of DNA repair
C. Activation of protein kinase C
D. Activation of endogenous viruses
E. Blockage of TGF-β pathways
A 50-year-old woman undergoes screening colonoscopy as part of a routine health maintenance workup. An isolated l-cm pedunculated polyp is found in the sigmoid colon. The excised polyp histologically shows well-differentiated glands with no invasion of the stalk. Which of the following investigational research procedures can most clearly distinguish whether the polyp represents hyperplasia of the colonic mucosa or a tubular adenoma. _ _
A. Histochemical staining for mucin
B. Flow cytometry to determine the frequency of cells in the S phase
C. Determination of clonality by pattern of X chromosome inactivation
D. Immunoperoxidase staining for keratin
E. Immunoperoxidase staining for factor VIII