NEET-PG 2018 - Pathology Practice Questions

Q: The following is a post-orchidectomy histopathological specimen. Diagnosis is:

Seminoma. ***Seminoma*** - The image shows a **monotonous population of large, clear cells** with prominent nucleoli and distinct cell borders, arranged in lobules separated by fibrous septa with **lymphocytic infiltration** [1]. - This classic histological appearance, along with the presence of **syncytiotrophoblasts** (though not explicitly mentioned as a key feature for diagnosis from this image alone, it can be seen in some seminomas), is characteristic of **seminoma**, the most common germ cell tumor of the testis [1]. *Teratoma* - Teratomas are characterized by the presence of **multiple germ layers** (ectoderm, mesoderm, endoderm) with various differentiated tissues like cartilage, bone, neural tissue, or glandular structures [1]. - The image does not show the **heterogeneous tissue differentiation** typical of a teratoma. *Lymphoma* - Testicular lymphoma typically presents with a **diffuse infiltrate of atypical lymphoid cells**, often with a high mitotic rate, and lacks the clear cell appearance and fibrous septa seen in the image. - It is more common in **older men** and can be bilateral, unlike the typical presentation of seminoma. *Yolk sac tumor* - Yolk sac tumors (endodermal sinus tumors) are characterized by various architectural patterns, including **reticular, microcystic, solid, and papillary**, often with **Schiller-Duval bodies** (glomeruloid structures) [1]. - The image does not display these specific patterns or the characteristic Schiller-Duval bodies. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 979-982.

Q: The image shows a histological section of intestinal tissue with a granuloma. What is the most likely diagnosis?

Crohn's. ***Crohn's*** - Crohn's disease is characterized by **non-caseating granulomas** in the intestinal wall, which are a key diagnostic feature [1][3]. - These granulomas are typically **non-necrotizing** and can be found in any part of the gastrointestinal tract from mouth to anus [1][2]. *TB* - Tuberculosis (TB) typically forms **caseating granulomas** with central necrosis, which is distinct from the non-caseating granulomas of Crohn's. - TB granulomas often contain **Langhans giant cells** [4] and are associated with a specific infectious etiology. *Cat scratch disease* - Cat scratch disease, caused by *Bartonella henselae*, presents with **stellate or suppurative granulomas** in lymph nodes. - These granulomas are characterized by a central area of **necrosis and neutrophils**, surrounded by epithelioid cells, differing from Crohn's. *Syphilis* - Syphilis, particularly in its tertiary stage, can form **gummas**, which are granulomatous lesions. - Gummas are characterized by **coagulative necrosis** and a chronic inflammatory infiltrate, but they are not typically found in the intestinal wall as a primary feature like in Crohn's. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 806-807. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 365-366. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 366-367. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 109.

Q: A 40-year-old man underwent lung transplantation. The resected lung specimen is shown below. Comment on the diagnosis.

Miliary TB. ***Miliary TB*** - The image likely shows numerous small, uniform granulomas scattered throughout the lung parenchyma, characteristic of **miliary tuberculosis** [1]. - This widespread dissemination occurs when **Mycobacterium tuberculosis** spreads hematogenously, leading to a "millet seed" appearance on gross and microscopic examination [1]. *Bronchiectasis* - Bronchiectasis is characterized by **permanent dilation of bronchi** and bronchioles due to destruction of the muscle and elastic tissue [1]. - Grossly, it would show dilated, thickened airways often filled with mucus or pus, not diffuse small nodules. *Lung abscess* - A lung abscess is a **localized collection of pus** within the lung parenchyma, typically appearing as a single or a few large cavitary lesions [2]. - It would present as a well-defined cavity with necrotic debris, not numerous small, widely distributed lesions [2]. *Carcinoma lung* - Carcinoma of the lung typically presents as a **mass lesion**, nodule, or infiltrative growth, often with irregular borders [3]. - While multiple metastases can occur, the uniform, small, and widely distributed pattern seen in miliary TB is not typical for primary lung carcinoma [4]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 320-321. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 715-716. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 336-337. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 723-724.

Q: Which of the following will be the most probable diagnostic finding in the patient with X-Ray skull shown below?

CD1A positivity. ***CD1A positivity*** - The skull X-ray shows multiple punched-out lytic lesions without sclerotic borders, characteristic of **Langerhans Cell Histiocytosis (LCH)**. - **Langerhans cells** in LCH express surface markers like **CD1a** and S100 protein, which are diagnostic when detected via **immunohistochemistry on tissue biopsy**. - CD1a positivity is the **gold standard** for confirming LCH diagnosis. *Elevated SAP* - **Serum Alkaline Phosphatase (SAP)** is typically elevated in conditions with increased osteoblastic activity or liver/biliary disease. - LCH lesions are generally **lytic** and not associated with increased osteoblastic activity, thus SAP elevation is not a specific or common finding. *Bence Jones proteins* - **Bence Jones proteins** (monoclonal light chains) are found in the urine of patients with **Multiple Myeloma**, which can also cause lytic bone lesions. - However, the image shows more discrete, "punched-out" lesions typical of LCH, whereas myeloma lesions are often more diffuse or "salt-and-pepper" in appearance, and LCH does not secrete Bence Jones proteins. *Elevated HbA2* - **Elevated HbA2** is a characteristic finding in **beta-thalassemia trait**, a genetic blood disorder. - There is no clinical or radiological indication in the provided image or question to suggest a connection to thalassemia.

Q: A 60-year-old man with tobacco chewing history presents with trismus and ankyloglossia. The lesion is shown below. Diagnosis is? (NEET Pattern 2018)

Submucosal fibrosis. ***Submucosal fibrosis*** - **Oral submucous fibrosis (OSMF)** is a chronic, progressive, precancerous condition of the oral cavity characterized by juxta-epithelial fibrosis. It is strongly associated with **areca nut (betel nut) chewing**, often found in tobacco products [1]. - Clinical features include **trismus** (difficulty opening the mouth due to fibrosis of the oral tissues), burning sensation, and **ankyloglossia** (restricted tongue movement) due to fibrosis of the lingual frenum. *Erythroplakia* - **Erythroplakia** is a red patch or lesion in the oral cavity that cannot be characterized clinically or pathologically as any other definable disease. - It is considered a highly dysplastic or **premalignant lesion**, but its primary presentation is a red, velvety patch, not primarily trismus or ankyloglossia. *Chronic hyperplastic candidiasis* - **Chronic hyperplastic candidiasis** (Candidal leukoplakia) is a persistent white lesion that cannot be removed by scraping, caused by chronic *Candida albicans* infection [2]. - While it is a precancerous condition, its main clinical feature is a **white patch** or plaque, and it does not typically cause severe trismus or ankyloglossia as primary symptoms. *Jaffe's tumor* - **Jaffe's tumor** is an outdated term for **fibrous dysplasia**, a bone disorder where normal bone is replaced by fibrous tissue and immature woven bone. - It primarily affects bones, and while it can occur in the jaw, it does not present with the classic oral mucosal symptoms of trismus and ankyloglossia associated with tobacco chewing. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 344-345. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 736-737.

Question 1

The following is a post-orchidectomy histopathological specimen. Diagnosis is:

Accepted Answer

Seminoma

Answer

Teratoma

Answer

Lymphoma

Answer

Yolk sac tumor

Question 2

The image shows a histological section of intestinal tissue with a granuloma. What is the most likely diagnosis?

Accepted Answer

Crohn's

Answer

TB

Answer

Cat scratch disease

Answer

Syphilis

Question 3

A 40-year-old man underwent lung transplantation. The resected lung specimen is shown below. Comment on the diagnosis.

Accepted Answer

Miliary TB

Answer

Bronchiectasis

Answer

Lung abscess

Answer

Carcinoma lung

Question 4

Which of the following will be the most probable diagnostic finding in the patient with X-Ray skull shown below?

Accepted Answer

CD1A positivity

Answer

Elevated SAP

Answer

Bence Jones proteins

Answer

Elevated HbA2

Question 5

A 60-year-old man with tobacco chewing history presents with trismus and ankyloglossia. The lesion is shown below. Diagnosis is? (NEET Pattern 2018)

Accepted Answer

Submucosal fibrosis

Answer

Erythroplakia

Answer

Chronic hyperplastic candidiasis

Answer

Jaffe's tumor

NEET-PG 2018 — Pathology