Endocrine Pathology Practice Questions

Q: The histopathologic feature of medullary carcinoma of the thyroid is:

Amyloid stroma. **Explanation:** **Medullary Thyroid Carcinoma (MTC)** is a neuroendocrine neoplasm derived from the **parafollicular C-cells** of the thyroid [1]. These cells are responsible for secreting **calcitonin** [1]. 1. **Why Amyloid Stroma is Correct:** The hallmark of MTC is the presence of an acellular, eosinophilic **amyloid stroma**. This amyloid is unique because it is formed by the deposition of **procalcitonin** (altered calcitonin) molecules. On histology, these deposits appear as pink, amorphous material that shows **apple-green birefringence** under polarized light when stained with **Congo Red**. 2. **Why Other Options are Incorrect:** * **Anaplasia:** This is a feature of Anaplastic Thyroid Carcinoma, which shows extreme pleomorphism and giant cells, rather than MTC. * **Mitotic Figures:** While present in aggressive tumors, they are not a diagnostic or pathognomonic feature of MTC. * **Psammoma Bodies:** These are laminated calcifications characteristic of **Papillary Thyroid Carcinoma (PTC)**. They are almost never seen in MTC. **High-Yield Clinical Pearls for NEET-PG:** * **Origin:** Neural crest cells (C-cells). * **Genetics:** Associated with **RET proto-oncogene** mutations. It occurs in **MEN 2A and 2B** syndromes (familial cases are often bilateral/multicentric) [2]. * **Tumor Marker:** Serum **Calcitonin** (used for diagnosis and monitoring recurrence) and CEA [2]. * **Histology:** Polygonal to spindle-shaped cells in nests (Zellballen pattern), follicles, or sheets. * **IHC Markers:** Positive for Calcitonin, Chromogranin A, and Synaptophysin. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 428-429. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1102-1103.

Q: All of the following are features of MEN 1 syndrome except?

Medullary carcinoma of thyroid. **Explanation:** Multiple Endocrine Neoplasia (MEN) syndromes are autosomal dominant disorders characterized by tumors involving two or more endocrine glands. **Why Option D is the correct answer:** **Medullary Carcinoma of Thyroid (MTC)** is the hallmark feature of **MEN 2A and MEN 2B**, not MEN 1 [1]. MTC in these syndromes is typically multicentric and associated with *RET* proto-oncogene mutations. In MEN 1, the genetic defect involves the *MEN1* gene (encoding the protein Menin) on chromosome 11q13, which does not predispose to MTC [2]. **Why the other options are incorrect:** MEN 1 syndrome, also known as **Wermer Syndrome**, is classically defined by the **"3 Ps"**: * **Hyperparathyroidism (Option C):** The most common (95%) and usually the earliest manifestation [2]. It typically presents as multiglandular parathyroid hyperplasia. * **Pancreatic Neuroendocrine Tumors (Option A):** These are the leading cause of morbidity/mortality in MEN 1. Common types include Gastrinomas (Zollinger-Ellison Syndrome) and Insulinomas [2]. * **Pituitary Tumors (Option B):** Most commonly Prolactinomas, followed by Somatotropinomas (causing Acromegaly). **High-Yield Clinical Pearls for NEET-PG:** * **MEN 1 (Wermer):** 3 Ps (Parathyroid, Pancreas, Pituitary). Gene: *MEN1* (Chromosome 11q13) [2]. * **MEN 2A (Sipple):** 2 Ps (Parathyroid, Pheochromocytoma) + MTC. Gene: *RET* [1]. * **MEN 2B:** 1 P (Pheochromocytoma) + MTC + Mucosal Neuromas/Marfanoid habitus. Gene: *RET* [1]. * **Key Distinction:** Parathyroid involvement is common in MEN 1 and 2A, but **absent** in MEN 2B [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, p. 1137. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1104-1105, 1125.

Question 1

Anti-thyroglobulin antibodies are seen in which of the following conditions?

Accepted Answer

Hashimoto thyroiditis

Answer

Graves disease

Answer

De Quervain thyroiditis

Answer

Subacute lymphocytic thyroiditis

Question 2

Which of the following statements is true about pituitary adenoma?

Accepted Answer

Erodes the sellar and extends into surrounding areas

Answer

Accounts for 10% of brain tumors

Answer

Prolactinoma is the least common type

Answer

It is differentiated by reticulin stain

Question 3

The histopathologic feature of medullary carcinoma of the thyroid is:

Accepted Answer

Amyloid stroma

Answer

Anaplasia

Answer

Mitotic figures

Answer

Psammoma bodies

Question 4

All of the following are features of MEN 1 syndrome except?

Accepted Answer

Medullary carcinoma of thyroid

Answer

Pancreatic tumor

Answer

Pituitary tumor

Answer

Hyperparathyroidism

Question 5

Which of the following statements is NOT true regarding medullary carcinoma of the thyroid?

Accepted Answer

Is a component of Multiple Endocrine Neoplasia type 1 (MEN-1)

Answer

Originates from the C cells of the thyroid

Answer

Typically multicentric in origin

Answer

Characterized by amyloid deposition

Question 6

A 3-year-old child presents with an abdominal mass originating from the right adrenal gland. Biopsy reveals sheets of small cells with hyperchromatic nuclei, forming occasional pseudorosettes with central young nerve fibers. Which oncogene is associated with this tumor?

Accepted Answer

N-myc

Answer

erb-B2

Answer

c-myc

Answer

L-myc

Question 7

In Hashimoto's disease, serum antibodies are mainly against which of the following?

Accepted Answer

Thyroglobulins

Answer

Thyroid follicles

Answer

Thyroxine

Answer

Iodine

Question 8

Which cell type is most commonly involved in non-functioning pituitary adenoma?

Accepted Answer

Gonadotropin producing cell

Answer

Prolactin producing cell

Answer

GH producing cell

Answer

TSH producing cell

Question 9

Which of the following is a variant of papillary carcinoma of the thyroid?

Accepted Answer

Columnar cell

Answer

Medullary

Answer

Warthin

Answer

Insular

Question 10

All of the following are histological features of papillary carcinoma of the thyroid, except:

Accepted Answer

Amyloid deposits

Answer

Complex branching papillae with fibrovascular core

Answer

Orphan Annie eye nuclei and intranuclear grooves

Answer

Psammoma bodies

Endocrine Pathology — MCQs

Endocrine Pathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?