Renal: renal cell carcinoma: 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 · Renal: renal cell carcinoma

Sample item

A 60-year-old smoker has haematuria, a flank mass and a haemoglobin of 18 g/dL. Nephrectomy shows a golden-yellow tumour composed of cells with clear cytoplasm extending into the renal vein. What is the most common genetic alteration?

ADeletion of NF2 on chromosome 22BActivating mutation of MET on chromosome 7CDeletion of WT1 on chromosome 11p13DInactivation of the VHL gene on chromosome 3p

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

The answer and the reasoning

D. Inactivation of the VHL gene on chromosome 3p

Clear cell carcinoma is the commonest renal cancer and nearly always shows loss of function of the VHL tumour suppressor on 3p, in both sporadic and von Hippel-Lindau cases. Loss of VHL stabilises hypoxia-inducible factor, increasing VEGF and erythropoietin, which explains the vascularity and secondary polycythaemia. Spread into the renal vein and inferior vena cava is typical.

Option by option

A. Deletion of NF2 on chromosome 22
NF2 loss causes neurofibromatosis type 2 with schwannomas and meningiomas.
B. Activating mutation of MET on chromosome 7
MET activation is characteristic of hereditary papillary renal carcinoma type 1.
C. Deletion of WT1 on chromosome 11p13
WT1 loss is associated with Wilms tumour in children.
D. Inactivation of the VHL gene on chromosome 3p (correct)
Correct. VHL loss on 3p underlies clear cell renal carcinoma.

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.

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is D, Inactivation of the VHL gene on chromosome 3p. Clear cell carcinoma is the commonest renal cancer and nearly always shows loss of function of the VHL tumour suppressor on 3p, in both sporadic and von Hippel-Lindau cases.

Why is "Deletion of NF2 on chromosome 22" not the answer?

NF2 loss causes neurofibromatosis type 2 with schwannomas and meningiomas.

Why is "Activating mutation of MET on chromosome 7" not the answer?

MET activation is characteristic of hereditary papillary renal carcinoma type 1.

Why is "Deletion of WT1 on chromosome 11p13" not the answer?

WT1 loss is associated with Wilms tumour in children.

What concept does this question test?

It tests Renal: renal cell carcinoma in Pathology. Loss of VHL stabilises hypoxia-inducible factor, increasing VEGF and erythropoietin, which explains the vascularity and secondary polycythaemia. Spread into the renal vein and inferior vena cava is typical.

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 Renal: renal cell carcinoma?

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.