Endocrine pathology — MCQs

A 28-year-old man presents with painless cervical lymphadenopathy. Excisional lymph node biopsy is performed. The photomicrograph shows effacement of normal nodal architecture by a mixed infiltrate of lymphocytes, plasma cells, eosinophils, and neutrophils. Scattered among the infiltrate are large binucleated cells with prominent eosinophilic 'owl-eye' nucleoli. Immunohistochemistry shows these large cells are CD15+, CD30+, CD20−, and CD45−. Which of the following cell types represents the malignant population in this lesion?

A 67-year-old man with a history of chronic alcohol use and cirrhosis undergoes liver biopsy for evaluation of worsening hepatic function. The photomicrograph shows hepatocytes with eosinophilic, irregularly shaped intracytoplasmic rope-like inclusions. Surrounding these cells is a neutrophilic infiltrate. The inclusions stain positively with ubiquitin immunohistochemistry. Which of the following best describes the composition of the inclusions seen in this biopsy?

A 58-year-old man with a 40-pack-year smoking history presents with progressive dyspnea and a non-productive cough. Chest CT shows bilateral lower-lobe predominant interstitial thickening. An open lung biopsy is performed. The biopsy reveals golden-brown, beaded, dumbbell-shaped structures coated with iron-protein complexes within alveolar macrophages, accompanied by interstitial fibrosis. Which of the following is the most accurate characterization of these structures?

A 38-year-old woman with type 1 diabetes for 20 years presents with diabetic ketoacidosis. She is treated and recovers. Six months later, she develops progressive fatigue, nausea, and hyperpigmentation. Laboratory studies show morning cortisol 3 μg/dL, ACTH 180 pg/mL, TSH 8.2 mIU/L, free T4 0.6 ng/dL, and positive anti-thyroid peroxidase antibodies. She also has positive 21-hydroxylase antibodies. Her 12-year-old daughter was recently diagnosed with type 1 diabetes. Evaluate the pathologic process and most critical monitoring recommendation for the daughter.

A 29-year-old man presents with severe headaches and episodic palpitations, sweating, and anxiety. During an episode, blood pressure is 240/130 mmHg. Between episodes, blood pressure is 135/85 mmHg. 24-hour urine shows metanephrines 4.2 mg (normal: <1.0). MRI reveals a 4 cm right adrenal mass. His brother died suddenly at age 25 from an intracranial hemorrhage, and his father had thyroid cancer. Genetic testing reveals a RET proto-oncogene mutation. Evaluate the pathologic syndrome and preoperative management priority.