Endocrine Pathology Practice Questions

Q: Which chromosome is involved in the pathogenesis of MEN1?

11. ***11*** - **Multiple Endocrine Neoplasia type 1 (MEN1)** is caused by a germline mutation in the **MEN1 gene**, which is located on **chromosome 11** [1]. - The MEN1 gene acts as a **tumor suppressor gene**, and its inactivation leads to the development of tumors in the parathyroid glands, pituitary gland, and pancreatic islets [1]. *10* - Chromosome 10 is associated with other endocrine disorders, such as **Multiple Endocrine Neoplasia type 2 (MEN2)** due to mutations in the **RET gene** [1]. - However, it is **not involved** in the pathogenesis of MEN1. *12* - Chromosome 12 is generally **not directly implicated** in specific forms of Multiple Endocrine Neoplasia. - While it harbors many genes, none are definitively linked to MEN1. *13* - Chromosome 13 is notably associated with the **Retinoblastoma gene (RB1)**, a tumor suppressor gene involved in retinoblastoma and other cancers. - It plays **no direct role** in the genetic basis of MEN1. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1104-1105.

Q: Hyperglycemia occurs after what % of beta cell mass is destroyed:

80%. ***80%*** - **Hyperglycemia** typically manifests only after a significant portion of **beta cell mass** (around 80-90%) has been destroyed. - This extensive loss of **insulin-producing cells** compromises the body's ability to maintain normal glucose levels [1]. *20%* - A 20% destruction of beta cell mass is generally **insufficient** to cause clinical hyperglycemia. - The remaining beta cells can usually compensate for this relatively small loss through increased insulin secretion. *40%* - While 40% loss represents a considerable reduction, it's often still within the compensatory capacity of the pancreas. - At this stage, individuals might experience **impaired glucose tolerance** but not overt hyperglycemia [1]. *60%* - Even with a 60% loss, the body may still be able to maintain near-normal glucose levels, especially in the early stages of beta cell destruction [1]. - Hyperglycemia is more likely to develop as the destruction progresses beyond this point.

Q: What type of thyroid carcinoma is most commonly associated with long-standing non-toxic goitre?

Follicular thyroid carcinoma. ***Follicular thyroid carcinoma*** - **Follicular carcinoma** is the thyroid malignancy most classically associated with **long-standing non-toxic multinodular goiter** [1] - It accounts for approximately **10-15% of thyroid cancers** and arises from **follicular epithelial cells** - Strong association with **iodine-deficient endemic goiter regions** where long-standing goiters are common [1] - Can develop from **follicular adenomas** or arise de novo in nodular goiters [1] - Diagnosis requires demonstration of **capsular or vascular invasion** on histology [1] *Papillary thyroid carcinoma* - While papillary carcinoma is the **most common thyroid cancer overall** (70-80% of cases), it is **not** the type most associated with long-standing non-toxic goiter [1] - More strongly associated with **radiation exposure** to the head and neck [1] - Can occur in goiters but this is not its classical association - Characterized by **papillary architecture** and distinctive nuclear features (ground glass nuclei, nuclear grooves) *Anaplastic thyroid carcinoma* - Highly aggressive **undifferentiated** thyroid cancer with very poor prognosis - May arise from **pre-existing differentiated thyroid cancers** (follicular or papillary) in some cases - Presents with **rapid growth, invasion**, and bulky neck mass - Not the primary association with slowly progressive non-toxic goiter *Medullary thyroid carcinoma* - Arises from **parafollicular C cells** that produce **calcitonin**, not follicular epithelium - Associated with **MEN 2A and MEN 2B syndromes** and **RET proto-oncogene mutations** - **No association** with non-toxic goiter or follicular pathology - Represents about 5% of thyroid cancers **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1094-1099.

Q: Which type of thyroid carcinoma is least likely to exhibit lymph node metastasis?

Follicular Thyroid Carcinoma. **Follicular Thyroid Carcinoma** - This type predominantly spreads hematogenously, meaning via the **bloodstream**, to distant sites such as bone, lung, and brain, rather than through lymphatics [1]. - While local invasion can occur, **lymph node metastasis** is uncommon and less frequent compared to papillary and medullary thyroid carcinomas [1]. *Medullary Thyroid Carcinoma* - This is an aggressive neuroendocrine tumor that frequently metastasizes to regional **lymph nodes** early in its course [1]. - It often presents with **cervical lymphadenopathy** at the time of diagnosis, indicating widespread lymphatic involvement [1]. *Anaplastic Thyroid Carcinoma* - This is an undifferentiated and highly aggressive carcinoma with a very poor prognosis, characterized by rapid growth and extensive local invasion and early **distant metastasis** [1]. - Although it can involve lymph nodes, its aggressive nature more commonly leads to direct invasion of surrounding structures and widespread systemic dissemination, making **lymph node metastasis** a less defining feature compared to its overall aggressiveness and distant spread [1]. *Papillary Thyroid Carcinoma* - This is the most common type of thyroid cancer and is well-known for its propensity to spread via the **lymphatic system** to regional lymph nodes, sometimes even presenting with palpable nodes in the neck [1]. - **Lymph node involvement** is a common initial presentation and is a significant factor in prognosis and treatment planning [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 428-431.

Q: What is the most common thyroid tumor associated with multiple endocrine neoplasia (MEN)?

Medullary. ***Medullary*** - The **commonest thyroid tumor** in Multiple Endocrine Neoplasia (MEN) type 2 is medullary thyroid carcinoma, associated with **calcitonin production** [1]. - It arises from **C cells (parafollicular cells)** and is linked to **RET oncogene mutations** in MEN syndromes [1]. *Papillary* - Papillary thyroid carcinoma is the **most common thyroid cancer overall**, but not specifically associated with MEN syndromes. - It typically presents with **lymphatic spread**, whereas medullary carcinoma has a different genetic association. *Follicular* - Follicular thyroid carcinoma is less common in MEN and usually occurs sporadically. - It primarily arises from **follicular cells** and involves a different mechanism than medullary carcinoma. *Anaplastic* - Anaplastic thyroid carcinoma is a rare and highly aggressive form, not commonly associated with MEN. - It usually arises from **differentiated thyroid cancers** and presents in older patients, which does not align with MEN's typical presentations. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1102-1103.

Q: What is the most common cause of thyroiditis?

Hashimoto's Thyroiditis. ***Hashimoto's Thyroiditis*** - **Hashimoto's thyroiditis** is the most common cause of thyroiditis, characterized by **autoimmune destruction** of the thyroid gland. - It often leads to **hypothyroidism** and is associated with elevated antithyroid antibodies (anti-TPO, anti-Tg). [1] *Riedl' s Thyroiditis* - This is a rare condition characterized by a **fibrous and painless** infiltration of the thyroid gland. - It does not represent the most common cause of thyroiditis and typically presents differently. *Viral thyroiditis* - This form of thyroiditis may occur following a **viral infection** (e.g., mumps) but is not as prevalent as Hashimoto's. - Symptoms are often acute and resolve quickly, differing from the chronic nature of Hashimoto's. *Subacute Thyroiditis* - Subacute thyroiditis, often post-viral, typically causes a **transient** inflammation of the thyroid. [1] - While it can cause significant pain and thyroid hormone fluctuations, it is less common than Hashimoto's thyroiditis.

Q: All of the following are histological features of Hashimoto thyroiditis, except which of the following?

Orphan Annie eye nuclei. ***Orphan Annie eye nuclei*** - This feature is **not seen** in Hashimoto thyroiditis; it is typically associated with **papillary thyroid carcinoma** [1][2]. - In Hashimoto thyroiditis, the presence of **Orphan Annie eye nuclei** would be considered **abnormal** and indicative of malignancy. *Hurtle cell metaplasia* - **Hurtle cells** can be found in Hashimoto thyroiditis but are not definitive; they are more associated with **thyroid follicular neoplasms**. - Presence of Hurtle cells indicates **metaplasia** but not a hallmark of Hashimoto thyroiditis specifically. *Lymphocytic infiltrate with germinal center formation* - This is a **typical histological feature** of Hashimoto thyroiditis and indicates an **autoimmune response**. - The presence of lymphocytes and germinal centers reflects **chronic inflammation** characteristic of this condition. *Follicular destruction and atrophy* - Follicular destruction is indeed a **key feature** of Hashimoto thyroiditis, leading to hypothyroidism. - Atrophic follicles occur due to **autoimmune-mediated damage**, distinct to Hashimoto thyroiditis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, p. 1099. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 429-430.

Q: What is the most common carcinoma of the thyroid?

Papillary thyroid carcinoma. ***Papillary thyroid carcinoma*** - This is the **most common type** of thyroid cancer, accounting for approximately 80-85% of all thyroid malignancies [1], [2]. - It typically has an **excellent prognosis** due to its relatively slow growth and tendency to metastasize through lymphatics rather than hematogenously [2]. *Follicular thyroid carcinoma* - This is the **second most common** type of thyroid cancer, comprising about 10-15% of cases [2]. - It tends to metastasize **hematogenously** to distant sites like bones and lungs, which is a key differentiator from papillary carcinoma [2]. *Hurthle cell carcinoma* - Also known as **oxyphilic follicular carcinoma**, this is considered a variant of follicular carcinoma, though sometimes classified separately. - It is **less common** than papillary or follicular carcinoma and is characterized by cells with abundant, eosinophilic, granular cytoplasm. *Medullary thyroid carcinoma* - This is a neuroendocrine tumor arising from the **parafollicular C cells** of the thyroid, which produce **calcitonin** [3], [4]. - It accounts for only about 3-5% of thyroid cancers and can be sporadic or hereditary, often associated with **MEN 2 syndromes** [3], [4]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1098-1099. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 428-430. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 428-429. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1102-1103.

Question 1

Which chromosome is involved in the pathogenesis of MEN1?

Accepted Answer

11

Answer

10

Answer

12

Answer

13

Question 2

A 3-year-old boy is found to have spontaneous bursts of non-rhythmic conjugate eye movements in various directions, as well as hypotonia and myoclonus. Physical examination also reveals an abdominal mass. A CT scan shows a mass in the adrenal gland. Which of the following statements is false regarding the patient's condition?

Accepted Answer

Immunohistochemical detection of chromogranin is not useful for diagnosis.

Answer

70-80% of tumors are associated with elevated production of catecholamines.

Answer

Rearrangement or deletion of short arm of chromosome 1 is seen in 25-35% of cases.

Answer

The most common site of tumor is adrenal medulla.

Question 3

Hyperglycemia occurs after what % of beta cell mass is destroyed:

Accepted Answer

80%

Answer

40%

Answer

60%

Answer

20%

Question 4

Which of the following thyroid carcinomas cannot be definitively diagnosed by fine needle aspiration cytology (FNAC)?

Accepted Answer

Follicular carcinoma of thyroid

Answer

Anaplastic carcinoma of thyroid

Answer

Medullary carcinoma of thyroid

Answer

Papillary carcinoma of thyroid

Question 5

What type of thyroid carcinoma is most commonly associated with long-standing non-toxic goitre?

Accepted Answer

Follicular thyroid carcinoma

Answer

Medullary thyroid carcinoma

Answer

Papillary thyroid carcinoma

Answer

Anaplastic thyroid carcinoma

Question 6

Which type of thyroid carcinoma is least likely to exhibit lymph node metastasis?

Accepted Answer

Follicular Thyroid Carcinoma

Answer

Anaplastic Thyroid Carcinoma

Answer

Medullary Thyroid Carcinoma

Answer

Papillary Thyroid Carcinoma

Question 7

What is the most common thyroid tumor associated with multiple endocrine neoplasia (MEN)?

Accepted Answer

Medullary

Answer

Follicular

Answer

Papillary

Answer

Anaplastic

Question 8

What is the most common cause of thyroiditis?

Accepted Answer

Hashimoto's Thyroiditis

Answer

Reidel's Thyroiditis

Answer

Subacute Thyroiditis

Answer

Viral Thyroiditis

Question 9

All of the following are histological features of Hashimoto thyroiditis, except which of the following?

Accepted Answer

Orphan Annie eye nuclei

Answer

Hurthle cell metaplasia

Answer

Follicular destruction and atrophy

Answer

Lymphocytic infiltrate with germinal center formation

Question 10

What is the most common carcinoma of the thyroid?

Accepted Answer

Papillary thyroid carcinoma

Answer

Follicular thyroid carcinoma

Answer

Hurthle cell carcinoma

Answer

Medullary thyroid carcinoma

Endocrine Pathology — MCQs

Endocrine Pathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?