Gastrointestinal: pancreatic ductal adenocarcinoma: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Gastrointestinal: pancreatic ductal adenocarcinoma

Sample item

A 66-year-old man has weight loss and painless jaundice with a palpable, non-tender gallbladder. He has also had recurrent migratory superficial thrombophlebitis. Which oncogene is mutated in the great majority of tumours of this type?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. KRAS

Pancreatic ductal adenocarcinoma is associated with activating KRAS mutations in over 90 percent of cases, an early event in progression from pancreatic intraepithelial neoplasia. Inactivation of CDKN2A, TP53 and SMAD4 follows. Migratory thrombophlebitis is Trousseau sign, and a palpable gallbladder with painless jaundice follows Courvoisier law.

Option by option

  • A. KRAS (correct)

    Correct. KRAS is activated in the vast majority of pancreatic ductal adenocarcinomas.

  • B. BRAF

    BRAF mutation is typical of melanoma, papillary thyroid cancer and hairy cell leukaemia.

  • C. RET

    RET mutation causes MEN2 and medullary thyroid carcinoma.

  • D. ALK

    ALK rearrangement is seen in some lung adenocarcinomas and lymphomas, not in pancreatic cancer.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Pathology questions

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is A, KRAS. Pancreatic ductal adenocarcinoma is associated with activating KRAS mutations in over 90 percent of cases, an early event in progression from pancreatic intraepithelial neoplasia.

Why is "BRAF" not the answer?

BRAF mutation is typical of melanoma, papillary thyroid cancer and hairy cell leukaemia.

Why is "RET" not the answer?

RET mutation causes MEN2 and medullary thyroid carcinoma.

Why is "ALK" not the answer?

ALK rearrangement is seen in some lung adenocarcinomas and lymphomas, not in pancreatic cancer.

What concept does this question test?

It tests Gastrointestinal: pancreatic ductal adenocarcinoma in Pathology. Inactivation of CDKN2A, TP53 and SMAD4 follows. Migratory thrombophlebitis is Trousseau sign, and a palpable gallbladder with painless jaundice follows Courvoisier law.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastrointestinal: pancreatic ductal adenocarcinoma?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.