What type of cell is shown in the image below?
A 40-year-old female presents with frequent headaches. Investigation reveals raised intracranial pressure and the presence of a dural-based tumor. Which of the following histological findings correlate with the diagnosis?
A 5-year-old child presented with a history of edema of the face which later progressed to generalized edema. Urine showed massive proteinuria and light microscopy was normal. Electron microscopy showed effacement of podocyte foot processes. What is the diagnosis?
Which of the following is true about p53?
FMGE 2023 - Pathology FMGE Practice Questions and MCQs
Question 11: What type of cell is shown in the image below?
- A. Mott cells
- B. Faggot cell
- C. Sézary-Lutzner cells
- D. Reed Sternberg cell (Correct Answer)
Explanation: ***Reed Sternberg cell*** - This is a classic **Reed-Sternberg cell**, characterized by its large size, bilobed or multinucleated appearance, and prominent eosinophilic nucleoli, which create a pathognomonic "**owl-eye**" look [1], [2]. - These cells are the neoplastic hallmark of **Hodgkin lymphoma** and are crucial for its diagnosis [2]. *Faggot cell* - Faggot cells are malignant promyelocytes containing numerous **Auer rods** that are bundled together, resembling a bundle of sticks. - They are characteristically seen in **Acute Promyelocytic Leukemia (APL)**, a subtype of AML, and are not depicted in the image. *Mott cells* - Mott cells are plasma cells with cytoplasm packed with **Russell bodies**, which are eosinophilic globules of immunoglobulin, giving the cell a "grape-like" appearance. - They are found in conditions with chronic plasma cell stimulation or plasma cell neoplasms like **multiple myeloma**, but their morphology is distinct from the cell shown. *Sézary-Lutzner cells* - These are malignant T-lymphocytes characterized by a highly convoluted, **cerebriform (brain-like) nucleus**. - They are the hallmark cells of cutaneous T-cell lymphomas, such as **Mycosis Fungoides** and **Sézary syndrome**, and lack the "owl-eye" nucleoli seen in the image. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 614-618. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 556-557.
Question 12: A 40-year-old female presents with frequent headaches. Investigation reveals raised intracranial pressure and the presence of a dural-based tumor. Which of the following histological findings correlate with the diagnosis?
- A. Flexner - Wintersteiner rosettes
- B. Psammoma bodies with whorling of tumor cells (Correct Answer)
- C. Homer - Wright rosettes
- D. Fried egg appearance
Explanation: ***Psammoma bodies with whorling of tumor cells***- The clinical picture of a **dural-based tumor** [2] causing symptoms of **raised intracranial pressure** (headache) is highly suggestive of a **Meningioma**.- **Psammoma bodies** (laminated calcified concretions) formed by the degeneration of the whorled cell clusters [1] are the classic histological hallmark of the transitional and **meningothelial meningioma** subtypes.*Fried egg appearance*- This histological appearance, characterized by clear perinuclear halos, is the classic finding for **Oligodendroglioma**, a type of parenchymal brain tumor.- Oligodendrogliomas typically arise within the cerebral **white matter** and are usually not primarily dural-based.*Flexner - Wintersteiner rosettes*- These are specialized structures representing an attempt at **retinal differentiation** and are the characteristic feature of **Retinoblastoma**.- They are also sometimes seen in highly aggressive midline CNS tumors, such as **Pineoblastoma**.*Homer - Wright rosettes*- These are seen in tumors exhibiting divergent **neuroectodermal differentiation** but lack a true central lumen or fenestration.- They are the characteristic histological finding in **Medulloblastoma** (a cerebellar tumor) and **Neuroblastoma** (a tumor of the adrenal medulla or sympathetic chain). **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 727-728. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1316-1317.
Question 13: A 5-year-old child presented with a history of edema of the face which later progressed to generalized edema. Urine showed massive proteinuria and light microscopy was normal. Electron microscopy showed effacement of podocyte foot processes. What is the diagnosis?
- A. Post streptococcal glomerulonephritis
- B. Minimal change disease (Correct Answer)
- C. Focal segmental glomerulo sclerosis
- D. Membranous glomerulonephritis
Explanation: ***Minimal change disease*** - **Classic presentation** in children aged 2-6 years with nephrotic syndrome (edema, massive proteinuria) [1] - **Normal light microscopy** is the pathognomonic feature that distinguishes MCD from other glomerular diseases [3] - **Electron microscopy shows effacement of podocyte foot processes** (fusion of foot processes) - the only ultrastructural abnormality [1], [3] - **Most common cause** of nephrotic syndrome in children (~90% of cases <6 years) [1], [3] - Excellent response to corticosteroid therapy (steroid-sensitive) [3] *Post streptococcal glomerulonephritis* - Presents with **nephritic syndrome** (hematuria, hypertension, mild proteinuria), not nephrotic syndrome - Light microscopy shows **hypercellular glomeruli** with neutrophil infiltration - EM shows **subepithelial "humps"** (immune complex deposits), not foot process effacement alone *Focal segmental glomerulosclerosis (FSGS)* - Light microscopy shows **focal and segmental sclerosis** of some glomerular [1] - More common in adults and African Americans - Associated with obesity, HIV, heroin use [4] - Poor response to steroids (steroid-resistant nephrotic syndrome) [1] *Membranous glomerulonephritis* - Light microscopy shows **diffuse thickening of glomerular basement membrane** with "spike and dome" appearance [2], [4] - EM shows **subepithelial immune complex deposits** [2], [4] - More common cause of nephrotic syndrome in **adults**, not children [2] - Associated with autoimmune diseases, infections, and malignancies [2] **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 927-928. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 919-921. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 922-923. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 531-532.
Question 14: Which of the following is true about p53?
- A. It retains the telomerase enzyme in the nucleus
- B. It increases telomere length in the liver.
- C. It synthesizes RNA
- D. It stabilizes RNA (Correct Answer)
Explanation: p53, known as the "**guardian of the genome**," has multiple functions beyond its classical role as a tumor suppressor [2]. While primarily known for **cell cycle arrest, DNA repair coordination, and apoptosis induction** [1], p53 also plays a role in **RNA metabolism and stabilization** through its RNA-binding properties and interaction with various RNA-binding proteins. This contributes to its regulation of gene expression at the post-transcriptional level. *Incorrect: It retains the telomerase enzyme in the nucleus* - **p53 actually REPRESSES telomerase activity** by downregulating hTERT (telomerase reverse transcriptase) expression - Loss of p53 function in cancer cells allows telomerase reactivation, contributing to cellular immortalization - This is the opposite of the stated function *Incorrect: It increases telomere length in the liver* - p53 does not increase telomere length; it inhibits telomerase activity - No specific tissue-specific telomere lengthening function in the liver *Incorrect: It synthesizes RNA* - p53 is a **transcription factor** that regulates gene expression but does not synthesize RNA itself [1] - RNA synthesis is performed by RNA polymerase enzymes [3] **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 302-304. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 226-227. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. With Illustrations By, pp. 30-31.