Neoplasia: renal cell carcinoma spread: 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: renal cell carcinoma spread

Sample item

A renal cell carcinoma in the right kidney is found at nephrectomy to have grown as a solid plug into the renal vein and beyond. Which further spread is characteristic of this tumour?

ASeeding of the peritoneum with mucinous depositsBExtension along the inferior vena cava toward the right atriumCInvasion of the portal veinDSpread through the ureter into the bladder wall

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

The answer and the reasoning

B. Extension along the inferior vena cava toward the right atrium

Renal cell carcinoma has a tendency to invade the renal vein and grow along the inferior vena cava, sometimes reaching the right atrium, and to give haematogenous metastases to lung and bone. Hepatocellular carcinoma instead invades the portal and hepatic veins.

Option by option

A. Seeding of the peritoneum with mucinous deposits
Mucinous peritoneal seeding is typical of appendiceal and ovarian mucinous tumours.
B. Extension along the inferior vena cava toward the right atrium (correct)
Correct. Intravenous tumour growth along the renal vein into the IVC is characteristic.
C. Invasion of the portal vein
Portal vein invasion is typical of hepatocellular carcinoma.
D. Spread through the ureter into the bladder wall
Ureteric spread is typical of urothelial, not renal cell, 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 B, Extension along the inferior vena cava toward the right atrium. Renal cell carcinoma has a tendency to invade the renal vein and grow along the inferior vena cava, sometimes reaching the right atrium, and to give haematogenous metastases to lung and bone.

Why is "Seeding of the peritoneum with mucinous deposits" not the answer?

Mucinous peritoneal seeding is typical of appendiceal and ovarian mucinous tumours.

Why is "Invasion of the portal vein" not the answer?

Portal vein invasion is typical of hepatocellular carcinoma.

Why is "Spread through the ureter into the bladder wall" not the answer?

Ureteric spread is typical of urothelial, not renal cell, carcinoma.

What concept does this question test?

It tests Neoplasia: renal cell carcinoma spread in Pathology. Hepatocellular carcinoma instead invades the portal and hepatic veins.

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 Neoplasia: renal cell carcinoma spread?

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.