Endocrine Pathology Practice Questions

Q: Anti-TPO antibodies are present in which of the following conditions?

Hashimoto's thyroiditis. Explanation: 1. Why Hashimoto’s Thyroiditis is Correct: Hashimoto’s thyroiditis (Chronic Lymphocytic Thyroiditis) is an autoimmune disorder characterized by the destruction of the thyroid gland by cell-mediated and antibody-mediated immune processes. Anti-TPO (Anti-Thyroid Peroxidase) antibodies are the hallmark of this condition, present in over 95% of patients. They are not just markers but are involved in the pathogenesis of thyroid failure. Anti-thyroglobulin (Anti-Tg) antibodies are also frequently present (60-80%). 2. Analysis of Incorrect Options: * A. Riedel’s Thyroiditis: This is a rare condition characterized by dense fibrous replacement of the thyroid tissue (IgG4-related disease). While some patients may have antibodies, it is primarily a fibrotic process, not an autoimmune destruction defined by Anti-TPO. * B. Graves’ Disease: While Anti-TPO can be present in ~70% of Graves' cases, the pathognomonic antibody is TSI (Thyroid Stimulating Immunoglobulin) or TRAb (TSH Receptor Antibody), which causes hyperthyroidism [1]. * C. DeQuervain’s Thyroiditis (Subacute Granulomatous): This is typically a post-viral inflammatory condition. It is characterized by a high ESR and painful goiter; thyroid antibodies are usually absent or only transiently present in low titers [2]. 3. NEET-PG Clinical Pearls: * Most sensitive marker for Hashimoto’s: Anti-TPO antibodies. * Best initial test for thyroid function: TSH. * Histology of Hashimoto’s: Hurthle cells (Askanazy cells) and lymphocytic infiltration with germinal centers. * Risk: Patients with Hashimoto’s have an increased risk of B-cell Non-Hodgkin Lymphoma of the thyroid. * Anti-TPO in Pregnancy: Presence of these antibodies increases the risk of post-partum thyroiditis and miscarriage.

Q: What is true regarding follicular carcinoma of the thyroid?

Hematogenous spread is common.. **Explanation:** **1. Why Option A is correct:** Follicular Thyroid Carcinoma (FTC) is characterized by its propensity for **hematogenous (blood-borne) spread** [1]. Unlike most epithelial malignancies that spread via lymphatics, FTC typically metastasizes through the bloodstream to distant sites, most commonly the **lungs and bones** (often presenting as osteolytic lesions). **2. Why the other options are incorrect:** * **Option B:** FTC is typically a **solitary** nodule [1]. Multifocality is a classic feature of Papillary Thyroid Carcinoma (PTC), not FTC. * **Option C:** FTC **cannot** be diagnosed by FNAC. The distinction between a benign follicular adenoma and a malignant follicular carcinoma depends entirely on identifying **capsular or vascular invasion**. FNAC only samples cells (cytology) and cannot evaluate the intactness of the capsule; therefore, histopathology is mandatory for diagnosis. * **Option D:** **Papillary Thyroid Carcinoma (PTC)** is the most common thyroid malignancy (approx. 85%) [2]. FTC is the second most common (approx. 5-15%). **High-Yield Clinical Pearls for NEET-PG:** * **Risk Factor:** FTC is more common in areas of **iodine deficiency** [2]. * **Genetics:** Associated with **RAS mutations** and the **PAX8-PPARG** fusion gene. * **Hürthle Cell Carcinoma:** A variant of FTC characterized by cells with abundant granular eosinophilic cytoplasm (due to mitochondria). * **Treatment:** Total thyroidectomy followed by Radioiodine ($I^{131}$) ablation, as FTC cells often retain the ability to take up iodine. * **Tumor Marker:** Serum **Thyroglobulin** is used to monitor for recurrence post-surgery. **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. 1098-1099.

Question 1

A 21-year-old woman experiences abruptio placentae with severe bleeding during the delivery of a term fetus. Five months later, she presents with profound lethargy, pallor, muscle weakness, failure of lactation, and amenorrhea. Which of the following pathologic findings is expected in this patient?

Accepted Answer

Infarction of the pituitary

Answer

Atrophy of the endocrine pancreas

Answer

Autoimmune destruction of the adrenal cortex

Answer

Pituitary prolactinoma

Question 2

Anti-TPO antibodies are present in which of the following conditions?

Accepted Answer

Hashimoto's thyroiditis

Answer

Reidel's thyroiditis

Answer

Grave's disease

Answer

DeQuervain's thyroiditis

Question 3

Which of the following statements regarding Hashimoto's thyroiditis is FALSE?

Accepted Answer

It results in a hypoparathyroid state.

Answer

It is an autoimmune thyroiditis.

Answer

It involves plasma cell and lymphocytic infiltration.

Answer

It typically leads to a hypothyroid state.

Question 4

Which type of thyroid carcinoma is known to secrete ACTH?

Accepted Answer

Medullary carcinoma

Answer

Follicular carcinoma

Answer

Papillary carcinoma

Answer

Anaplastic carcinoma

Question 5

Craniopharyngiomas are basically?

Accepted Answer

Tumors derived from Rathke's Pouch

Answer

Tumors resembling osteomas

Answer

Tumors similar to glottis cancer

Answer

Adenocarcinomas

Question 6

Which hormone is produced by pheochromocytoma in MEN 2A (Sipple syndrome)?

Accepted Answer

Epinephrine

Answer

Norepinephrine

Answer

Dopamine

Answer

5-Hydroxyindoleacetic acid

Question 7

Floating teeth is a clinical sign associated with which endocrine disorder?

Accepted Answer

Hyperparathyroidism

Answer

Hypoparathyroidism

Answer

Rickets

Answer

Scurvy

Question 8

Mitosis is a characteristic feature of which of the following conditions?

Accepted Answer

Anaplastic carcinoma

Answer

Follicular carcinoma

Answer

Papillary carcinoma

Answer

All of the above

Question 9

Malignant potential is least with which of the following gastrointestinal neuroendocrine tumors?

Accepted Answer

Insulinoma

Answer

Glucagonoma

Answer

VIPoma

Answer

Somatostatinoma

Question 10

What is true regarding follicular carcinoma of the thyroid?

Accepted Answer

Hematogenous spread is common.

Answer

It is commonly multifocal.

Answer

It is readily diagnosed by fine-needle aspiration cytology (FNAC).

Answer

It is the most common carcinoma of the thyroid.

Endocrine Pathology — MCQs

Endocrine Pathology — MCQs

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