Neoplasia: asbestos-related tumours: 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 · Neoplasia: asbestos-related tumours

Sample item

A 62-year-old retired shipyard worker has progressive dyspnoea, a right pleural effusion and diffuse pleural thickening. A pleural biopsy shows malignant epithelioid cells. Which immunohistochemical pattern best supports malignant mesothelioma over metastatic lung adenocarcinoma?

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

The answer and the reasoning

B. Calretinin and WT1 positive, with TTF-1 and CEA negative

Mesothelioma is cytokeratin positive and expresses mesothelial markers such as calretinin, WT1 and D2-40. Lung adenocarcinoma is instead positive for TTF-1, napsin A, CEA and Ber-EP4. Asbestos exposure has a latency of 20 to 40 years, and smoking does not add to mesothelioma risk.

Option by option

  • A. TTF-1 and napsin A positive, with calretinin negative

    TTF-1 and napsin A positivity with negative calretinin indicates a lung adenocarcinoma.

  • B. Calretinin and WT1 positive, with TTF-1 and CEA negative (correct)

    Mesothelial markers with negative adenocarcinoma markers favour mesothelioma.

  • C. CEA and Ber-EP4 positive, with WT1 negative

    CEA and Ber-EP4 positivity is typical of adenocarcinoma, while mesothelioma is usually negative for both.

  • D. LCA and CD20 positive, with cytokeratin negative

    LCA and CD20 positivity with negative cytokeratin would indicate B-cell lymphoma, not a carcinoma-like tumour.

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.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is B, Calretinin and WT1 positive, with TTF-1 and CEA negative. Mesothelioma is cytokeratin positive and expresses mesothelial markers such as calretinin, WT1 and D2-40.

Why is "TTF-1 and napsin A positive, with calretinin negative" not the answer?

TTF-1 and napsin A positivity with negative calretinin indicates a lung adenocarcinoma.

Why is "CEA and Ber-EP4 positive, with WT1 negative" not the answer?

CEA and Ber-EP4 positivity is typical of adenocarcinoma, while mesothelioma is usually negative for both.

Why is "LCA and CD20 positive, with cytokeratin negative" not the answer?

LCA and CD20 positivity with negative cytokeratin would indicate B-cell lymphoma, not a carcinoma-like tumour.

What concept does this question test?

It tests Neoplasia: asbestos-related tumours in Pathology. Lung adenocarcinoma is instead positive for TTF-1, napsin A, CEA and Ber-EP4. Asbestos exposure has a latency of 20 to 40 years, and smoking does not add to mesothelioma risk.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Neoplasia: asbestos-related tumours?

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.