Endocrine Pathology Practice Questions

Q: Psammoma bodies are characteristic findings in which of the following carcinomas?

Thyroid carcinoma. **Explanation:** Psammoma bodies are microscopic, concentric, laminated calcified structures. They represent a form of **dystrophic calcification** occurring in necrotic tumor cells, where calcium salts deposit in layers around a single necrotic cell, creating a "sand-like" appearance (from the Greek *psammos*, meaning sand). **1. Why Thyroid Carcinoma is Correct:** Psammoma bodies are a hallmark feature of **Papillary Thyroid Carcinoma (PTC)** [1]. They are found in approximately 40-50% of cases, typically within the cores of the papillae or the surrounding stroma. Their presence in a fine-needle aspiration (FNA) or biopsy is highly suggestive of PTC [1]. **2. Analysis of Incorrect Options:** * **Carcinoma of the Breast:** While calcifications (microcalcifications) are common in Ductal Carcinoma in Situ (DCIS), they are usually amorphous or granular rather than the classic laminated Psammoma bodies. * **Carcinoma of the Stomach:** Gastric adenocarcinomas typically present with signet-ring cells or glandular patterns; they do not characteristically form Psammoma bodies. * **Carcinoma of the Testis:** Testicular tumors (like Seminomas or Yolk sac tumors) do not typically show these structures. **3. High-Yield NEET-PG Clinical Pearls:** To remember the common tumors associated with Psammoma bodies, use the mnemonic **"PSaMMoma"**: * **P:** **P**apillary thyroid carcinoma [1] * **S:** **S**erous cystadenocarcinoma of the ovary (most common site) * **M:** **M**eningioma * **M:** **M**esothelioma (Pleural) **Key Fact:** Psammoma bodies are an example of **dystrophic calcification** (occurs in dying/necrotic tissues with normal serum calcium levels), distinguishing them from metastatic calcification. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, p. 1099.

Q: Which of the following findings are seen in Hyperparathyroidism?

All the above. **Explanation:** Primary Hyperparathyroidism (PHPT) is characterized by the overproduction of Parathyroid Hormone (PTH), which leads to increased bone resorption by stimulating osteoclast activity [1]. This process results in a spectrum of skeletal manifestations. * **Osteitis Fibrosa Cystica (Option A):** This is the classic, advanced skeletal manifestation of PHPT. Chronic PTH excess leads to the replacement of bone marrow with fibrous tissue and the formation of cystic lesions (Brown tumors). * **Osteoporosis (Option B):** PTH has a catabolic effect on cortical bone [1]. In modern clinical practice, asymptomatic PHPT often presents as generalized bone loss or decreased bone mineral density (BMD), particularly at the distal radius (cortical bone), mimicking or exacerbating osteoporosis [3]. * **Dissecting Osteitis (Option C):** This is the pathognomonic histological feature of hyperparathyroidism. Osteoclasts tunnel into the center of bony trabeculae, creating a "railroad track" appearance. This "dissecting" nature of bone resorption distinguishes it from other metabolic bone diseases. **Conclusion:** Since all three findings are characteristic pathological or radiological features of hyperparathyroidism, **Option D** is the correct answer. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad:** "Stones (Renal), Bones (Aches/Fractures), Abdominal Groans (Peptic ulcers/Pancreatitis), and Psychic Moans (Depression)." [2] * **Radiology:** Look for **subperiosteal bone resorption**, most specifically on the radial aspect of the middle phalanges of the 2nd and 3rd fingers. * **Skull finding:** "Salt and pepper" appearance (mottled lucencies). * **Biochemical profile:** High Calcium, Low Phosphate, High PTH, and High Alkaline Phosphatase (if bone involvement is significant) [2].

Q: Which of the following is NOT a genetic syndrome associated with an increased incidence of neuroendocrine tumors?

Cri du chat syndrome. **Explanation:** The correct answer is **Cri du chat syndrome**. This condition is a chromosomal deletion syndrome caused by a partial deletion of the short arm of **chromosome 5 (5p-)**. It is characterized by a high-pitched "cat-like" cry, microcephaly, and intellectual disability, but it is **not** associated with a predisposition to neuroendocrine tumors (NETs). **Analysis of other options:** * **Multiple Endocrine Neoplasia 1 (MEN1):** Caused by mutations in the *MEN1* gene (Menin). It classically involves the "3 Ps": Parathyroid hyperplasia, **Pancreatic islet cell tumors** (e.g., gastrinomas, insulinomas), and Pituitary adenomas [1]. * **Von Hippel-Lindau (VHL) disease:** Caused by mutations in the *VHL* gene (Chr 3p). While famous for hemangioblastomas and Renal Cell Carcinoma, it is strongly associated with **Pancreatic Neuroendocrine Tumors (PanNETs)** and Pheochromocytomas [2]. * **Von Recklinghausen’s disease (Neurofibromatosis Type 1):** Caused by *NF1* gene mutations. It is associated with various neuroendocrine manifestations, most notably **Pheochromocytomas** [2] and **Somatostatinomas** (specifically in the duodenum). **Clinical Pearls for NEET-PG:** * **Zollinger-Ellison Syndrome** is the most common functional NET associated with MEN1 [1]. * **Carcinoid tumors** are the most common neuroendocrine tumors of the GI tract (most common site: Appendix/Ileum). * **High-yield marker:** **Chromogranin A** is the most specific serum biomarker for monitoring neuroendocrine tumors, while **Synaptophysin** is a highly reliable immunohistochemical marker. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1139-1140. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, p. 1137.

Q: Which of the following is true regarding diabetes mellitus type II?

Decrease in the number of B cells. Explanation: In Diabetes Mellitus Type II (T2DM), the pathophysiology is characterized by a combination of peripheral insulin resistance and progressive beta-cell (B-cell) dysfunction [1]. While T2DM is initially associated with hyperinsulinemia to compensate for resistance, the chronic metabolic stress (glucotoxicity and lipotoxicity) eventually leads to B-cell exhaustion [2]. Histologically, this manifests as a decrease in the total number (mass) of B-cells, typically reduced by 40–60% in long-standing cases [1]. Analysis of Options: * A. Insulinitis of B cells: This is a hallmark of Type I Diabetes [3]. It refers to lymphocytic infiltration of the islets, representing an autoimmune destruction of B-cells [4]. * B. Hyalinization of B cells: While amyloid (amylin) deposition (which appears as hyalinization) is a classic finding in the islets of T2DM patients, the term "hyalinization of B-cells" is technically inaccurate. Hyalinization occurs in the extracellular space of the islets, not within the cells themselves. * C. Atrophy of B cells: Atrophy implies a reduction in the size of existing cells. In T2DM, the primary pathology is the apoptosis and loss of the cells, leading to a decrease in total number rather than simple cellular atrophy [1]. * D. Decrease in the number of B cells: This is the most accurate description of the quantitative loss of insulin-producing capacity in T2DM [1]. NEET-PG High-Yield Pearls: * Amyloid Deposition: The characteristic histological finding in T2DM islets is the deposition of Islet Amyloid Polypeptide (IAPP) or Amylin. * HLA Association: T2DM has no strong association with HLA-DR3/DR4 (unlike T1DM) [3]. * Genetics: T2DM has a higher genetic concordance in monozygotic twins (>90%) compared to T1DM (~50%) [3]. * Metabolic Syndrome: T2DM is frequently associated with the "Deadly Quartet": obesity, hypertension, dyslipidemia, and hyperglycemia [4].

Q: In papillary carcinoma of the thyroid, all of the following are true except?

Blood-borne metastasis is common.. **Explanation:** The correct answer is **D (Blood-borne metastasis is common)** because Papillary Thyroid Carcinoma (PTC) primarily spreads via the **lymphatics** to regional cervical lymph nodes. Hematogenous (blood-borne) spread is rare in PTC (occurring in <5% of cases) and is much more characteristic of Follicular Thyroid Carcinoma (FTC). **Analysis of Options:** * **Option A:** PTC is indeed the **most common** thyroid malignancy, accounting for approximately 80–85% of all thyroid cancers. It has an excellent prognosis. * **Option B:** **Psammoma bodies** (laminated calcifications) are a classic histological hallmark found in about 50% of PTC cases. They represent infarcted tips of papillae. * **Option C:** Unlike follicular carcinoma, PTC is typically **not encapsulated**. It often presents as an infiltrative lesion, though a rare "encapsulated variant" does exist. **High-Yield NEET-PG Pearls:** * **Nuclear Features (Diagnostic):** Look for "Orphan Annie eye" nuclei (cleared-out chromatin), nuclear grooves, and pseudo-inclusions. * **Risk Factor:** Prior exposure to ionizing radiation is the most significant risk factor. * **Prognosis:** Excellent, with a 10-year survival rate >90%. * **Genetic Markers:** *BRAF* mutations (most common) and *RET/PTC* rearrangements. * **Treatment:** Total thyroidectomy or hemithyroidectomy (depending on size/risk) followed by Radioiodine (RAI) ablation if indicated.

Question 1

The AGE-RAGE signaling axis is related to which of the following processes?

Accepted Answer

Diabetes

Answer

Ageing

Answer

Oncogenesis

Answer

Alzheimer disease

Question 2

All of the following are helpful for the diagnosis of medullary carcinoma of the thyroid except?

Accepted Answer

Histological confirmation of mitochondria is essential for diagnosis

Answer

Spindle cell stroma with few follicles

Answer

Amyloid deposition

Answer

Calcitonin in stroma

Question 3

Psammoma bodies are characteristic findings in which of the following carcinomas?

Accepted Answer

Thyroid carcinoma

Answer

Carcinoma of the breast

Answer

Carcinoma of the stomach

Answer

Carcinoma of the testis

Question 4

Treatment with the antihypertensive drug spironolactone leads to the formation of spironolactone bodies in which part of the adrenal gland?

Accepted Answer

Adrenal cortex

Answer

Adrenal medulla

Answer

Renal cortex

Answer

Renal medulla

Question 5

Which of the following findings are seen in Hyperparathyroidism?

Accepted Answer

All the above

Answer

Osteitis fibrosa cystica

Answer

Osteoporosis

Answer

Dissecting osteitis

Question 6

Which of the following is NOT a genetic syndrome associated with an increased incidence of neuroendocrine tumors?

Accepted Answer

Cri du chat syndrome

Answer

Multiple endocrine neoplasia 1

Answer

Von Hippel-Lindau disease

Answer

Von Recklinghausen's disease

Question 7

Serum calcitonin is a tumor marker for which of the following thyroid pathologies?

Accepted Answer

Medullary carcinoma

Answer

Anaplastic carcinoma

Answer

Papillary carcinoma

Answer

Follicular carcinoma

Question 8

All of the following are features of medullary carcinoma of thyroid, except:

Accepted Answer

RAS gene mutations play an important role in its tumourigenesis

Answer

Arises from parafollicular cells or C-cells

Answer

Known association with MEN-2A or MEN-2B syndromes

Answer

Tumour cells secrete calcitonin

Question 9

Which of the following is true regarding diabetes mellitus type II?

Accepted Answer

Decrease in the number of B cells

Answer

Insulinitis of B cells

Answer

Hyalinization of B cells

Answer

Atrophy of B cells

Question 10

In papillary carcinoma of the thyroid, all of the following are true except?

Accepted Answer

Blood-borne metastasis is common.

Answer

It is the most common type of thyroid cancer.

Answer

Psammoma bodies are often seen.

Answer

It is not encapsulated.

Endocrine Pathology — MCQs

Endocrine Pathology — MCQs

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