Neoplasia: pattern of metastasis: 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: pattern of metastasis

Sample item

A 70-year-old man has back pain and sclerotic vertebral lesions on radiograph, with PSA of 220 ng/mL. Chest imaging is normal. By which route are vertebral metastases from prostate cancer often explained to occur without lung involvement?

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

The answer and the reasoning

C. Retrograde spread through the valveless vertebral venous plexus of Batson

The prostatic venous plexus communicates with the valveless vertebral veins of Batson. Raised abdominal pressure can reverse flow and carry tumour cells to the lumbar spine and pelvis, bypassing the lungs. Prostate metastases to bone are typically osteoblastic, with a raised alkaline phosphatase.

Option by option

  • A. Spread through the thoracic duct to the left subclavian vein

    The thoracic duct route leads to venous return and lung seeding, not selective vertebral deposits.

  • B. Direct transcoelomic seeding of the peritoneal cavity

    Transcoelomic seeding applies to tumours spreading across serosal cavities, such as ovarian cancer, not the retroperitoneal prostate.

  • C. Retrograde spread through the valveless vertebral venous plexus of Batson (correct)

    Batson plexus allows retrograde venous seeding of vertebrae while sparing the lungs.

  • D. Perineural spread along the pelvic splanchnic nerves

    Perineural invasion is a local route of spread and does not explain distant vertebral lesions.

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 C, Retrograde spread through the valveless vertebral venous plexus of Batson. The prostatic venous plexus communicates with the valveless vertebral veins of Batson.

Why is "Spread through the thoracic duct to the left subclavian vein" not the answer?

The thoracic duct route leads to venous return and lung seeding, not selective vertebral deposits.

Why is "Direct transcoelomic seeding of the peritoneal cavity" not the answer?

Transcoelomic seeding applies to tumours spreading across serosal cavities, such as ovarian cancer, not the retroperitoneal prostate.

Why is "Perineural spread along the pelvic splanchnic nerves" not the answer?

Perineural invasion is a local route of spread and does not explain distant vertebral lesions.

What concept does this question test?

It tests Neoplasia: pattern of metastasis in Pathology. Raised abdominal pressure can reverse flow and carry tumour cells to the lumbar spine and pelvis, bypassing the lungs. Prostate metastases to bone are typically osteoblastic, with a raised alkaline phosphatase.

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: pattern of metastasis?

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.