Endocrine Pathology Practice Questions

Q: FNAC is least diagnostic in which type of thyroid carcinoma?

Follicular carcinoma. **Explanation:** The correct answer is **Follicular Carcinoma (Option C)**. The primary limitation of Fine Needle Aspiration Cytology (FNAC) in thyroid pathology is its inability to distinguish between a **Follicular Adenoma** and a **Follicular Carcinoma**. This is because the diagnosis of malignancy in follicular lesions depends on identifying **capsular invasion** or **vascular invasion**, which are architectural features that can only be seen on formal histopathology (biopsy) and not on a cytological smear. FNAC only provides cellular detail, not tissue architecture. **Analysis of other options:** * **Anaplastic Carcinoma (A):** FNAC is highly diagnostic as it shows overt features of malignancy, such as extreme pleomorphism, giant cells, and spindle cells. * **Papillary Carcinoma (B):** This is the most common thyroid cancer and is easily diagnosed via FNAC based on characteristic nuclear features: Orphan Annie eye nuclei, intranuclear inclusions, and nuclear grooves. * **Thyroiditis (D):** Conditions like Hashimoto’s thyroiditis show distinct cytological patterns (Hürthle cells and lymphocytic infiltration), making FNAC a reliable tool for diagnosis. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard:** Histopathology (Lobectomy/Thyroidectomy) is the only way to confirm Follicular Carcinoma. * **Bethesda System:** Follicular lesions are usually reported as "Follicular Neoplasm" (Bethesda Category IV), carrying a 15–30% risk of malignancy. * **Hürthle Cell Carcinoma:** Like follicular carcinoma, it also cannot be diagnosed by FNAC alone. * **Psammoma Bodies:** Highly suggestive of Papillary Thyroid Carcinoma on FNAC.

Q: Crookes hyaline body is present in which of the following?

Basophil cells of the pituitary gland in Cushing's syndrome. **Explanation:** **Crooke’s hyaline change** refers to a specific histopathological finding in the **basophil cells (corticotrophs)** of the anterior pituitary gland. This change occurs in patients with **Cushing’s syndrome**, regardless of the cause (exogenous steroids, adrenal tumors, or pituitary adenomas) [1]. 1. **Why Option C is Correct:** In Cushing’s syndrome, there are chronically high levels of circulating glucocorticoids [1]. This leads to a feedback effect where the normal ACTH-producing basophils undergo a cytoplasmic transformation. The normal granular cytoplasm is replaced by homogenous, pale, glassy **cytokeratin intermediate filaments** [1]. This accumulation is known as Crooke’s hyaline body. 2. **Why Other Options are Incorrect:** * **Yellow Fever (A):** Characterized by **Councilman bodies**, which are eosinophilic apoptotic hepatocytes. * **Parkinsonism (B):** Characterized by **Lewy bodies**, which are intracellular inclusions of alpha-synuclein found in the substantia nigra. * **Huntington Disease (D):** Associated with intranuclear inclusions of **huntingtin protein** and atrophy of the caudate nucleus, but not hyaline changes in the pituitary. **High-Yield Clinical Pearls for NEET-PG:** * **Nature of the change:** It is a result of the accumulation of **cytokeratin filaments** (specifically CK 8 and 18) [1]. * **Reversibility:** Crooke’s hyaline change is a reactive, reversible process once the source of hypercortisolism is removed. * **Crooke Cell Adenoma:** A rare, aggressive variant of pituitary adenoma where the tumor cells themselves show these hyaline changes. * **Mnemonic:** Remember **"C"** for **C**rooke, **C**ushing, **C**orticotrophs, and **C**ytokeratin.

Q: MEN syndrome is associated with an increase in which type of thyroid carcinoma?

Medullary carcinoma of thyroid. **Medullary Carcinoma of Thyroid (MTC)** is the correct answer because it is a defining component of **Multiple Endocrine Neoplasia (MEN) type 2 syndromes (2A and 2B)** [1]. MTC originates from the **parafollicular C-cells**, which are neuroendocrine cells derived from the neural crest that secrete calcitonin [2]. In the context of MEN 2, MTC is typically multifocal, bilateral, and preceded by C-cell hyperplasia. It is associated with germline mutations in the **RET proto-oncogene** [1]. **Analysis of Incorrect Options:** * **Papillary Carcinoma (A):** The most common thyroid cancer overall, associated with *BRAF* mutations and radiation exposure, but not typically part of MEN syndromes. * **Follicular Carcinoma (B):** Associated with iodine deficiency and *RAS* mutations/PAX8-PPARγ rearrangements; it does not have a genetic link to MEN. * **Anaplastic Carcinoma (D):** A highly aggressive, undifferentiated tumor seen in older patients; it is not associated with the inherited MEN syndromes. **High-Yield Clinical Pearls for NEET-PG:** * **MEN 2A (Sipple Syndrome):** MTC + Pheochromocytoma + Parathyroid Hyperplasia [1]. * **MEN 2B (Wagenmann-Froboese):** MTC + Pheochromocytoma + Mucosal Neuromas + Marfanoid Habitus [1]. * **Tumor Marker:** Calcitonin is used for diagnosis and monitoring recurrence [2]. Amyloid stroma (formed by calcitonin pro-peptides) is a classic histological finding [3]. * **Prophylactic Thyroidectomy:** Recommended for children carrying the *RET* mutation before MTC develops. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, p. 1137. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 428-429. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 430-431.

Question 1

A 58-year-old patient presents with increased "fullness" in her neck. Examination reveals non-tender, diffuse enlargement of her thyroid gland. Clinically, she is euthyroid. Microscopic examination of her thyroid gland reveals numerous, mainly enlarged follicles filled with abundant colloid material. There are areas of fibrosis, hemorrhage, and cystic degeneration. No papillary structures are identified, and neither colloid scalloping nor Hurthle cells are present. What is the most likely diagnosis?

Accepted Answer

Multinodular goiter

Answer

Colloid carcinoma

Answer

Diffuse toxic goiter

Answer

Graves disease

Question 2

Gs-alpha mutation may lead to which of the following conditions?

Accepted Answer

All of the above

Answer

McCune-Albright syndrome

Answer

Pseudohypoparathyroidism

Answer

Pseudopseudohypoparathyroidism

Question 3

FNAC is least diagnostic in which type of thyroid carcinoma?

Accepted Answer

Follicular carcinoma

Answer

Anaplastic carcinoma

Answer

Papillary carcinoma

Answer

Thyroiditis

Question 4

Autoimmune thyroiditis is commonly associated with which of the following conditions?

Accepted Answer

Down syndrome

Answer

Marfan syndrome

Answer

Lowe syndrome

Answer

Edwards syndrome

Question 5

Crookes hyaline body is present in which of the following?

Accepted Answer

Basophil cells of the pituitary gland in Cushing's syndrome

Answer

Yellow fever

Answer

Parkinsonism

Answer

Huntington disease

Question 6

A patient presents with a pituitary tumor, pheochromocytoma, and a thyroid nodule. Which type of thyroid cancer is most likely to occur?

Accepted Answer

Medullary carcinoma

Answer

Follicular carcinoma

Answer

Papillary carcinoma

Answer

Anaplastic carcinoma

Question 7

A 45-year-old male was evaluated for secondary hypertension and diagnosed with pheochromocytoma. MRI abdomen revealed a 3 cm mass in the left adrenal gland. He underwent a left adrenalectomy, after which his hypertension is well controlled. How will you decide whether his pheochromocytoma was malignant?

Accepted Answer

The presence or absence of distant metastases is the primary determinant of malignancy.

Answer

Approximately 50% of pheochromocytomas are malignant.

Answer

Cellular atypia and invasion of blood vessels on pathology define malignancy for pheochromocytoma.

Answer

123I-metaiodobenzylguanidine scans are not useful in locating distant metastases.

Question 8

Which of the following is not a feature of Papillary carcinoma of thyroid?

Accepted Answer

Mutation of RAS gene

Answer

Rearrangement of RET gene

Answer

Rearrangement of NTRK1 gene

Answer

Mutation of BRAF gene

Question 9

What is the commonest cause of raised serum calcium?

Accepted Answer

Parathyroid adenoma

Answer

Ectopic secretion

Answer

Parathyroid hyperplasia

Answer

Parathyroid carcinoma

Question 10

MEN syndrome is associated with an increase in which type of thyroid carcinoma?

Accepted Answer

Medullary carcinoma of thyroid

Answer

Papillary carcinoma of thyroid

Answer

Follicular carcinoma of thyroid

Answer

Anaplastic carcinoma of thyroid

Endocrine Pathology — MCQs

Endocrine Pathology — MCQs

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