Endocrine Pathology Practice Questions

Q: A thyroid nodule biopsy reveals cells with nuclear overlapping and a papillary architecture. Which molecular alteration is most commonly associated with this condition?

BRAF mutation. ***BRAF mutation*** - The presence of **nuclear overlapping** and **papillary architecture** is characteristic of papillary thyroid carcinoma, which is commonly associated with a **BRAF mutation** [1]. - This mutation is linked to **increased aggressiveness** and poor prognosis in thyroid cancers. *TP53 mutation* - Typically associated with **follicular carcinoma** and **anaplastic thyroid carcinoma**, not papillary carcinoma. - TP53 alterations indicate a **different oncogenic pathway**, primarily related to tumor suppressor gene function. *RET/PTC rearrangement* - More frequently linked with **papillary thyroid carcinoma** but less common than BRAF mutations in current presentations [1]. - Often seen in **radiation-related** thyroid tumors; does not explain the cases associated with BRAF mutation. *PAX8/PPARγ fusion* - Primarily associated with **thyroid follicular adenomas** and **carcinomas**, not with the papillary architecture described. - This fusion indicates a different pathophysiological mechanism and does not correlate with papillary thyroid carcinoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1099-1100.

Q: A 25-Year-old male presented with a 2cm thyroid nodule. A thyroidectomy was done. The histology picture is given below. What could be the diagnosis?

Papillary thyroid carcinoma. ***Papillary carcinoma thyroid*** - Characterized by **papillary structures** and **nuclear features** such as nuclear grooves and overlapping nuclei on histology [1]. - Often presents in young adults and can show **psammoma bodies**, which are indicative of malignancy. *Follicular adenoma* - Generally shows well-circumscribed **follicular structures** without nuclear atypia [2,3]. - Lacks the typical **papillary architecture** and associated aggressive features found in carcinoma. *Graves disease* - Primarily presents with **hyperthyroidism** and diffuse goiter rather than a solitary nodule. - Histologically, it is characterized by **hyperplastic follicles** and does not display features of malignancy. *Adenomatous goitre* - Refers to **nodular enlargement** of the thyroid with benign hyperplastic nodules. - Lacks the **malignant features** present in papillary carcinoma, such as nuclear atypia and invasion. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, p. 1099. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1096-1097. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 428-429.

Q: Which HLA marker is associated with an increased risk of developing type 1 diabetes mellitus?

HLA-DR4. ***DR 4*** - The **HLA-DR4** allele is strongly associated with increased susceptibility to **type 1 diabetes mellitus** [1]. - It plays a crucial role in the **immune response**, promoting autoimmunity against pancreatic beta cells. *B 7* - HLA-B7 is not specifically linked to **type 1 diabetes**, but is more associated with other **autoimmune diseases** like **ankylosing spondylitis**. - It does not show the same level of genetic correlation with **insulin-dependent diabetes** as DR4 does. *DQ 4* - HLA-DQ4 is not the primary marker for **type 1 diabetes**; instead, HLA-DQ2 and DQ8 are more relevant in conditions like **celiac disease**. - Its presence does not have a significant relationship with the autoimmune destruction of **beta cells** in diabetes. *DQ 3* - HLA-DQ3 is less frequently associated with **type 1 diabetes** compared to HLA-DR4 [1]. - It is more involved with other **autoimmune conditions** and does not reflect the same risk for developing diabetes mellitus. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, p. 1113.

Q: Sheehan syndrome is?

Pituitary necrosis. ### Pituitary necrosis - Sheehan syndrome is characterized by **pituitary gland necrosis** due to severe blood loss or low blood pressure during or after childbirth [1]. - This condition leads to **hypopituitarism**, affecting hormone secretion crucial for various bodily functions [1], [2]. *Adrenal necrosis* - Refers to the death of adrenal gland tissue, but is not specifically related to Sheehan syndrome's etiology. - Symptoms may include **adrenal insufficiency**, which is not the primary feature of Sheehan syndrome. *Adrenal adenoma* - This is a benign tumor of the adrenal gland, typically associated with hormonal excess (like Cushing's syndrome) [3]. - Unlike Sheehan syndrome, it does not involve **ischemic damage** to the pituitary gland. *Pituitary adenoma* - A tumor of the pituitary gland that often causes **hypersecretion** of hormones rather than necrosis. - While it may affect pituitary function, it does not occur due to blood loss during childbirth, unlike Sheehan syndrome.

Q: A middle aged male patient presents with painless slow growing neck swelling. On examination, lymph nodes are positive. Surgery is done and biopsy is shown in the image below. Which of the following is false regarding the HPE findings?

FNAC is not diagnostic. ***Fine needle aspiration cytology (FNAC) is not diagnostic*** - FNAC can often provide significant insights, but in cases of **specific malignancies** or certain lesions, it may not yield definitive diagnoses [1]. - Diagnostic challenges arise as **cellular architecture** or certain **nuclear features** may not be appreciated in FNAC samples [1]. *It spreads quickly via lymphatics* - This condition can indeed spread via lymphatics, making it **aggressive** in nature [1]. - **Lymphatic spread** is a common pathway for many head and neck conditions, particularly malignancies [1]. *Excellent prognosis is associated with this condition* - While some conditions may have favorable prognoses, many midline neck lesions can have **serious implications** depending on their nature [1]. - Prognosis often varies widely and may not always be classified as **excellent** based solely on initial presentation [1]. *Nuclear characteristics are used for the identification* - Nuclear morphology is critical for identifying various **neoplastic conditions**, aiding in differentiation from benign lesions [1][2]. - Many pathologies, especially those involving **malignancy**, rely heavily on **nuclear features** for accurate diagnosis [1][2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1101-1102. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1100-1101.

Q: A 30-year-old woman presents with thyroid swelling. On investigations, her TSH levels are found to be elevated. Postoperative reports showed lymphocytic infiltration and Hurthle cells. A most probable diagnosis is?

Hashimoto's thyroiditis. ***Hashimoto's thyroiditis*** - The presence of **lymphocytic infiltration** and **Hurthle cells** on postoperative pathology is characteristic of Hashimoto's thyroiditis [1,2]. - Elevated **TSH levels** indicate hypothyroidism, which aligns with the autoimmune nature of Hashimoto's affecting thyroid hormone production [1]. *Graves disease* - Typically presents with **hyperthyroidism**, leading to suppressed TSH levels rather than elevation. - Characterized by **thyroid enlargement** and the presence of **autoantibodies** like TSI, not lymphocytic infiltration. *Follicular carcinoma* - While it can cause **thyroid swelling**, it is usually associated with **malignant characteristics** rather than Hurthle cells and lymphocytic infiltration. - TSH levels can be normal, as it does not principally engage in autoimmune thyroid destruction like Hashimoto's. *Medullary carcinoma thyroid* - Originates from **C cells** producing calcitonin, and typically presents with elevated calcitonin levels, not TSH. - Characteristic findings include **C-cell hyperplasia** or **neoplastic changes**, which do not match the presented lymphocytic infiltration. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1090-1092. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 427-428.

Q: A 25-year-old male presented with a 2cm thyroid nodule. A thyroidectomy was done. The histology picture is given below. What could be the diagnosis based on the histological findings?

Papillary thyroid carcinoma. ***Papillary carcinoma thyroid*** [1] - Typically presents as a **thyroid nodule** with distinctive histological features such as **papillary structures** and nuclear **grooves or inclusions** [1]. - Often associated with a history of radiation exposure and is the most common type of **thyroid cancer** in young adults. *Graves disease* - Characterized by **hyperthyroidism** and usually presents with diffuse **goiter** rather than a solitary nodule. - Histological findings typically show **diffuse hyperplasia** rather than a well-circumscribed nodule. *Adenomatous goitre* - Usually presents as a **multinodular goiter** with no malignant potential. - Histologically characterized by **colloid accumulation** and enlarged follicles, not indicative of malignancy. *Follicular adenoma* [2] - Characterized by a well-encapsulated nodule with **uniform follicular cells** and abundant **colloid** [1,2]. - Does not exhibit the **invasive features** seen in malignancies like papillary carcinoma [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1099-1101. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 428-429.

Question 1

A 5-year-old child presents with a large abdominal mass and hypertension. Histology reveals small round blue cells and Homer-Wright rosettes. What is the most likely diagnosis?

Accepted Answer

Neuroblastoma

Answer

Wilms tumor

Answer

Rhabdomyosarcoma

Answer

Hepatoblastoma

Question 2

A 67-year-old woman with hypertension and diabetes presents with a painless neck mass. Fine-needle aspiration biopsy reveals spindle-shaped cells. What is the most likely diagnosis?

Accepted Answer

Anaplastic thyroid cancer

Answer

Thyroid lymphoma

Answer

Papillary thyroid cancer

Answer

Medullary thyroid cancer

Question 3

A thyroid nodule biopsy reveals cells with nuclear overlapping and a papillary architecture. Which molecular alteration is most commonly associated with this condition?

Accepted Answer

BRAF mutation

Answer

RET/PTC rearrangement

Answer

PAX8/PPARγ fusion

Answer

TP53 mutation

Question 4

A 25-Year-old male presented with a 2cm thyroid nodule. A thyroidectomy was done. The histology picture is given below. What could be the diagnosis?

Accepted Answer

Papillary thyroid carcinoma

Answer

Follicular thyroid adenoma

Answer

Graves' disease

Answer

Adenomatous goiter

Question 5

Which of the following is true about the development of thyroid tumors in nodular goiter?

Accepted Answer

Prevalence of thyroid carcinoma ranges between 5-15% in the patients with multinodular goiter

Answer

Papillary carcinoma is a common carcinoma in patients with nodular goiter, but not specific to multinodular goiter

Answer

The risk of development of carcinoma is not correlated with the level of TSH

Answer

Both benign and malignant neoplasms occur in nodular goiter, with benign lesions being more common

Question 6

Which HLA marker is associated with an increased risk of developing type 1 diabetes mellitus?

Accepted Answer

HLA-DR4

Answer

HLA-B7

Answer

HLA-DQ3

Answer

HLA-DQ4

Question 7

Sheehan syndrome is?

Accepted Answer

Pituitary necrosis

Answer

Pituitary adenoma

Answer

Adrenal necrosis

Answer

Adrenal adenoma

Question 8

A middle aged male patient presents with painless slow growing neck swelling. On examination, lymph nodes are positive. Surgery is done and biopsy is shown in the image below. Which of the following is false regarding the HPE findings?

Accepted Answer

FNAC is not diagnostic

Answer

Spread is through lymphatics

Answer

Nuclear features are the characteristic of this tumor

Answer

It has excellent prognosis

Question 9

A 30-year-old woman presents with thyroid swelling. On investigations, her TSH levels are found to be elevated. Postoperative reports showed lymphocytic infiltration and Hurthle cells. A most probable diagnosis is?

Accepted Answer

Hashimoto's thyroiditis

Answer

Graves' disease

Answer

Follicular thyroid carcinoma

Answer

Medullary thyroid carcinoma

Question 10

A 25-year-old male presented with a 2cm thyroid nodule. A thyroidectomy was done. The histology picture is given below. What could be the diagnosis based on the histological findings?

Accepted Answer

Papillary thyroid carcinoma

Answer

Follicular thyroid adenoma

Answer

Graves' disease

Answer

Adenomatous goiter

Endocrine Pathology — MCQs

Endocrine Pathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?