This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Neoplasia, Subject name: Pathology
[{'content': 'A 56-year-old woman has had vaginal bleeding for 1 week. Her last menstrual period was 10 years ago. On physical examination, a lower abdominal mass is palpated. An endometrial biopsy is performed and shows endometrial carcinoma. An abdominal CT scan shows a 6-cm mass in the left ovary. A total abdominal hysterectomy is performed. Microscopically, the ovarian mass is a granulosa-theca cell tumor producing estrogen. Which of the following best describes the relationship between these two neoplasms? \nSelect and explain. \nA. Genetic susceptibility to tumorigenesis, B. Mutational inactivation of a tumor suppressor gene, C. Paraneoplastic syndrome, D. Promotion of carcinogenesis', 'role': 'user'}, {'content': 'Answer: D \nExplanation: Estrogen, similar to many other hormones and drugs, by itself is not carcinogenic, but it is responsible for the stimulation of endometrial growth (hyperplasia), which has a promoting effect when cellular mutations occur to produce carcinoma. Inherited susceptibility can never be completely excluded when an individual has two tumors; this can occur in patients with inherited mutations in the p53 gene. In this case, however, there is a clear hormonal basis for the second tumor. Faulty tumor suppressor genes are not involved in the hormonal promotion of a neoplasm. A paraneoplastic syndrome results from ectopic secretion of a hormone by the tumor (e.g., lung cancer cells producing corticotropin). Tumor heterogeneity does not refer to two separate kinds of neoplasms; it refers to heterogeneity with a given tumor or metastasis.', 'role': 'assistant'}]