Cytopathology — MCQs
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A 2-year-old child has a history of multiple bone fractures with minor trauma. On examination, he has hepatosplenomegaly and palsies involving cranial nerves II, VII, and VIII. Laboratory studies show pancytopenia. Radiographs reveal diffusely and symmetrically sclerotic bones with poorly formed metaphyses. Molecular analysis of his bone reveals a defect in the production of carbonic anhydrase to solubilize hydroxyapatite crystal. He is treated with hematopoietic stem cell transplantation. Which of the following cells in his bones was most likely functionally deficient and replaced following transplantation?
A 40-year-old man presents with central obesity, "buffalo hump," and violaceous purple striae on his abdomen. His fasting blood glucose levels are in the high normal range. Plasma levels of ACTH and cortisol are both increased compared to normal. An overnight high-dose dexamethasone suppression test produces 75% suppression of cortisol levels. What is the most likely diagnosis for this patient?
Which stain is used to identify Gaucher cells?
A 32-year-old woman has been attempting to become pregnant for the past 2 years without success. She also has had extremely painful menstrual cramping of many years' duration. An exploratory laparoscopy demonstrated multiple red-blue nodules covering the surface of her ovaries and uterine ligaments. These findings are most likely indicative of which of the following conditions?
Fine Needle Aspiration Biopsy is indicated to diagnose which of the following conditions?
Tadpole cells are seen in which of the following conditions?
What stain is used to detect amyloid?
FNAC is not useful in which type of thyroid cancer?
A 47-year-old man presents with a 4-month history of dull, constant pain in the midsection of the right thigh. Physical examination reveals pain on palpation of the anterior right thigh, exacerbated by movement, and a larger circumference of the right thigh compared to the left. Radiography shows no fracture but an ill-defined soft-tissue mass anterior to the femur. MRI reveals a 10x8x7 cm solid mass deep to the quadriceps, without femur involvement. Karyotypic analysis of tumor cells shows t(12;16)(q13;p11) with amplification of the MDM2 gene. What is the most likely diagnosis?
A 10-day-old infant presents with projectile vomiting. His mother states that the infant will actively drink his milk, but he forcefully vomits after each feeding. The infant shows signs of failure to thrive, with weight loss, dehydration, and lethargy. Physical examination reveals a firm, nontender, mobile, "olive-shaped" epigastric mass. Which of the following is the most likely diagnosis?
Cytopathology Indian Medical PG Practice Questions and MCQs
Question 51: A 2-year-old child has a history of multiple bone fractures with minor trauma. On examination, he has hepatosplenomegaly and palsies involving cranial nerves II, VII, and VIII. Laboratory studies show pancytopenia. Radiographs reveal diffusely and symmetrically sclerotic bones with poorly formed metaphyses. Molecular analysis of his bone reveals a defect in the production of carbonic anhydrase to solubilize hydroxyapatite crystal. He is treated with hematopoietic stem cell transplantation. Which of the following cells in his bones was most likely functionally deficient and replaced following transplantation?
- A. Chondroblast
- B. Chondrocyte
- C. Osteoblast
- D. Osteoclast (Correct Answer)
Explanation: ### Explanation **Concept: Osteopetrosis (Marble Bone Disease)** The clinical presentation describes **Osteopetrosis**, a genetic disorder characterized by impaired bone resorption [1]. The hallmark is a defect in **Osteoclasts**, which are specialized cells derived from the **monocyte-macrophage (hematopoietic) lineage** [1]. 1. **Why Osteoclast is correct:** Osteoclasts require an acidic environment to solubilize hydroxyapatite and resorb bone. This is achieved via the enzyme **Carbonic Anhydrase II**, which generates protons ($H^+$). A deficiency in this enzyme leads to non-functional osteoclasts [1]. Bone is continuously formed by osteoblasts but not resorbed, leading to dense, sclerotic, but brittle bones [1]. * **Clinical Correlation:** Sclerotic bone encroaches on the marrow space (causing **pancytopenia** and extramedullary hematopoiesis/hepatosplenomegaly) and narrows cranial foramina (causing **cranial nerve palsies**) [1]. * **Treatment:** Since osteoclasts are derived from hematopoietic stem cells, **Bone Marrow Transplantation** is curative as it provides functional osteoclast precursors. 2. **Why incorrect options are wrong:** * **Osteoblasts (C):** These are derived from mesenchymal stem cells and are responsible for bone *formation* [1]. In osteopetrosis, osteoblast function is typically normal; the pathology lies in the lack of resorption. * **Chondroblasts/Chondrocytes (A & B):** These are cartilage-forming cells. While the metaphyses are poorly formed due to lack of remodeling, the primary functional defect and the cell replaced by hematopoietic transplant is the osteoclast, not cartilaginous cells. ### High-Yield Pearls for NEET-PG * **Radiological Sign:** "Erlenmeyer flask" deformity of the femur and "Stone bone" or "Sandwich vertebrae" (Rugger-jersey spine is more common in renal osteodystrophy, but dense vertebrae are seen here) [1]. * **Genetic Defect:** Most common autosomal recessive mutation involves the **TCIRG1 gene** (proton pump); **CA2 gene** mutations cause the variant with renal tubular acidosis. * **Key Distinction:** Osteopetrosis = Increased bone density (defective resorption); Osteoporosis = Decreased bone mass (normal mineralization). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1182-1189.
Question 52: A 40-year-old man presents with central obesity, "buffalo hump," and violaceous purple striae on his abdomen. His fasting blood glucose levels are in the high normal range. Plasma levels of ACTH and cortisol are both increased compared to normal. An overnight high-dose dexamethasone suppression test produces 75% suppression of cortisol levels. What is the most likely diagnosis for this patient?
- A. Addison's disease
- B. An ectopic ACTH-secreting tumor
- C. Conn's syndrome
- D. Cushing's disease (Correct Answer)
Explanation: ### Explanation **Correct Option: D. Cushing’s disease** The patient presents with classic features of **Cushing’s syndrome** (central obesity, buffalo hump, purple striae) [1]. The biochemical profile shows elevated ACTH and cortisol, narrowing the diagnosis to **ACTH-dependent** causes. The definitive clue is the **High-Dose Dexamethasone Suppression Test (HDDST)**. In **Cushing’s disease** (a pituitary adenoma), the tumor cells retain some sensitivity to negative feedback [2]. A high dose of dexamethasone is sufficient to suppress ACTH secretion, leading to a >50% reduction in cortisol levels [3]. In this case, 75% suppression confirms a pituitary source. **Incorrect Options:** * **A. Addison’s disease:** This is primary adrenal insufficiency characterized by *low* cortisol and *high* ACTH, presenting with hypotension and hyperpigmentation, not obesity. * **B. Ectopic ACTH-secreting tumor:** (e.g., Small cell lung cancer). These tumors are autonomous and **do not** respond to negative feedback [3]. Therefore, cortisol levels remain high (no suppression) even after a high-dose dexamethasone test. * **C. Conn’s syndrome:** This is primary hyperaldosteronism. While it causes hypertension and hypokalemia, it does not cause the glucocorticoid-excess features (striae, buffalo hump) or elevated cortisol/ACTH. **NEET-PG High-Yield Pearls:** 1. **Screening:** The best initial tests for Cushing’s syndrome are 24-hour urinary free cortisol, late-night salivary cortisol, or the Low-Dose Dexamethasone Suppression Test (LDDST). 2. **Localization:** Once Cushing’s syndrome is confirmed, plasma ACTH distinguishes between adrenal (low ACTH) and ACTH-dependent (high ACTH) causes. 3. **HDDST Rule of Thumb:** * Suppression (>50%) = **Cushing’s Disease** (Pituitary) [3]. * No Suppression = **Ectopic ACTH** or **Adrenal Tumor** [3]. 4. **CRH Stimulation Test:** ACTH and cortisol rise in Cushing’s disease but show no response in ectopic ACTH cases. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1127-1129. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1082-1083. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 421-423.
Question 53: Which stain is used to identify Gaucher cells?
- A. Periodic Acid Schiff (PAS) (Correct Answer)
- B. Von Kossa stain
- C. Oil Red O stain
- D. Sudan Black B stain
Explanation: **Explanation:** **Gaucher disease** is an autosomal recessive lysosomal storage disorder caused by a deficiency of the enzyme **glucocerebrosidase** [1]. This leads to the accumulation of **glucocerebroside** (a glycolipid) within the lysosomes of macrophages, transforming them into characteristic **Gaucher cells** [1]. 1. **Why PAS is the Correct Answer:** Gaucher cells contain complex carbohydrates within the accumulated glucocerebroside. The **Periodic Acid Schiff (PAS)** stain reacts with these carbohydrate moieties, staining the cytoplasm a deep magenta. These cells are characteristically described as having a **"wrinkled tissue paper"** or "crumpled silk" appearance due to the fibrillar arrangement of the stored material [1]. 2. **Analysis of Incorrect Options:** * **Von Kossa stain:** Used to detect **calcium** deposits (stains them black). It is used in conditions like Monckeberg’s arteriosclerosis or nephrocalcinosis. * **Oil Red O stain:** A fat stain used to identify **neutral lipids** and trillions. It requires fresh/frozen sections as routine processing dissolves lipids. * **Sudan Black B stain:** Primarily used to differentiate **Acute Myeloid Leukemia (AML)** from ALL by staining phospholipids and sterols in granulocytic granules. **High-Yield Clinical Pearls for NEET-PG:** * **Morphology:** Gaucher cells are large macrophages (20–100 µm) with one or more eccentric nuclei and "wrinkled" cytoplasm [1]. * **Enzyme Marker:** Gaucher cells are also strongly positive for **Tartrate-Resistant Acid Phosphatase (TRAP)**. * **Most Common Type:** Type I (Non-neuronopathic) is the most common form, presenting with massive **splenomegaly** and bone involvement (Erlenmeyer flask deformity) [1]. * **Biomarker:** Plasma **Chitotriosidase** levels are significantly elevated and used for monitoring treatment response. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 162-163.
Question 54: A 32-year-old woman has been attempting to become pregnant for the past 2 years without success. She also has had extremely painful menstrual cramping of many years' duration. An exploratory laparoscopy demonstrated multiple red-blue nodules covering the surface of her ovaries and uterine ligaments. These findings are most likely indicative of which of the following conditions?
- A. Adenomyosis
- B. Endometrial hyperplasia
- C. Endometriosis (Correct Answer)
- D. Leiomyoma
Explanation: **Explanation:** The clinical presentation of **infertility** and **chronic dysmenorrhea** (painful cramping) in a young woman, combined with the laparoscopic finding of **"red-blue nodules"** on the ovaries and uterine ligaments, is a classic description of **Endometriosis** [1]. **1. Why Endometriosis is correct:** Endometriosis is defined as the presence of functional endometrial glands and stroma outside the uterine cavity. The "red-blue" or "powder-burn" nodules represent ectopic endometrial tissue undergoing cyclic bleeding [2]. Over time, this blood organizes, leading to fibrosis and adhesions, which cause pelvic pain and infertility. Common sites include the ovaries (where they may form "chocolate cysts" or endometriomas) and the pouch of Douglas [1]. **2. Why other options are incorrect:** * **Adenomyosis:** This is the presence of endometrial tissue within the **myometrium** (uterine wall). While it causes dysmenorrhea and an enlarged "globular" uterus, it does not present with nodules on the serosal surfaces of ovaries or ligaments. * **Endometrial Hyperplasia:** This is an overgrowth of the uterine lining (endometrium) usually due to excess estrogen. It typically presents with abnormal uterine bleeding (AUB), not serosal nodules or infertility. * **Leiomyoma (Fibroids):** These are benign smooth muscle tumors of the uterus. While they can cause infertility, they appear as firm, white, whorled masses, not small pigmented nodules. **Clinical Pearls for NEET-PG:** * **Triad of Endometriosis:** Dysmenorrhea, Dyspareunia, and Dyschezia (painful defecation). * **Gold Standard Diagnosis:** Laparoscopy with biopsy. * **Pathological Diagnosis:** Requires at least two of the following: Endometrial glands, endometrial stroma, or hemosiderin-laden macrophages. * **Sampson’s Theory:** The most accepted theory for its pathogenesis is retrograde menstruation [2]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 477-478. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1014-1016.
Question 55: Fine Needle Aspiration Biopsy is indicated to diagnose which of the following conditions?
- A. Traumatic ulcer
- B. Pemphigus (Correct Answer)
- C. Necrotic pulp
- D. Chronic gingivitis
Explanation: **Explanation:** **1. Why Pemphigus is the Correct Answer:** Pemphigus vulgaris is an autoimmune blistering disorder characterized by **acantholysis** (loss of intercellular connections) [1]. In clinical practice, a modified version of Fine Needle Aspiration (FNA) or a **Tzanck Smear** (exfoliative cytology) is used to diagnose this condition. By aspirating or scraping the base of a fresh bulla, cytopathology reveals characteristic **Tzanck cells**—large, rounded, acantholytic keratinocytes with hyperchromatic nuclei and a perinuclear halo. Identifying these cells is a rapid and highly suggestive diagnostic step before proceeding to histopathology and direct immunofluorescence (DIF). **2. Why the Other Options are Incorrect:** * **Traumatic Ulcer:** Diagnosis is primarily clinical based on history and physical examination. Cytology would only show non-specific inflammatory cells and debris. * **Necrotic Pulp:** This is an endodontic condition diagnosed via clinical vitality tests and radiographs. FNAC has no role in assessing the internal status of the tooth pulp. * **Chronic Gingivitis:** This is a clinical diagnosis based on gingival inflammation, bleeding on probing, and plaque accumulation. Biopsy or FNAC is unnecessary as the pathology is superficial and inflammatory. **3. High-Yield Clinical Pearls for NEET-PG:** * **Tzanck Smear:** Used for Pemphigus, Herpes Simplex (HSV), and Varicella-Zoster (VZV). Look for **multinucleated giant cells** in viral infections vs. **acantholytic cells** in Pemphigus. * **Nikolsky Sign:** Positive in Pemphigus (sloughing of skin with lateral pressure). * **Row of Tombstones:** The characteristic histopathological appearance of the basal layer in Pemphigus Vulgaris [1]. * **Immunofluorescence:** Pemphigus shows a "lace-like" or "fishnet" pattern of IgG/C3 deposits [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, pp. 1170-1172.
Question 56: Tadpole cells are seen in which of the following conditions?
- A. Rhabdomyosarcoma (Correct Answer)
- B. Leiomyosarcoma
- C. Chondrosarcoma
- D. Lupus vulgaris
Explanation: **Explanation:** **Tadpole cells** (also known as "strap cells" or "racket cells") are characteristic cytomorphological features of **Rhabdomyosarcoma**, particularly the embryonal and pleomorphic subtypes. These cells are elongated with a bulky, rounded head containing the nucleus and a long, tapering cytoplasmic tail. This appearance mimics a primitive rhabdomyoblast attempting to differentiate into a skeletal muscle fiber. The presence of cross-striations within the cytoplasm, though not always visible, is a pathognomonic finding [1]. **Analysis of Options:** * **A. Rhabdomyosarcoma (Correct):** As a malignant tumor of skeletal muscle origin, it produces rhabdomyoblasts. These cells take various shapes, including tadpole, strap, and spider cells [1]. * **B. Leiomyosarcoma:** This is a malignant tumor of smooth muscle. Cytology typically shows bundles of spindle cells with "cigar-shaped" (blunt-ended) nuclei, rather than tadpole shapes. * **C. Chondrosarcoma:** A malignant cartilage-forming tumor. It is characterized by pleomorphic cells residing within lacunae against a chondroid or myxoid matrix. * **D. Lupus Vulgaris:** A form of cutaneous tuberculosis. Histology shows well-formed granulomas with Langhans giant cells and epithelioid cells, not malignant tadpole cells. **NEET-PG High-Yield Pearls:** * **Spider Cells:** Also seen in Rhabdomyoma/Rhabdomyosarcoma (cells with central nuclei and peripheral vacuoles separated by thin cytoplasmic strands). * **Stain of Choice:** Desmin, Myogenin, and MyoD1 are the most specific immunohistochemical markers for rhabdomyoblastic differentiation [1]. * **Common Site:** Embryonal rhabdomyosarcoma is the most common soft tissue sarcoma in children, often occurring in the head and neck or genitourinary tract (Sarcoma Botryoides) [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1224-1225.
Question 57: What stain is used to detect amyloid?
- A. Gram stain
- B. Congo red (Correct Answer)
- C. Oil red O
- D. Reticulin stain
Explanation: **Explanation:** **Congo Red** is the gold standard stain for identifying **Amyloid**, a pathological proteinaceous substance deposited extracellularly in various tissues [1]. Under ordinary light, Congo red stains amyloid a characteristic **salmon-pink** or orange-red color. However, the diagnostic hallmark occurs under **polarized light**, where the stained amyloid fibrils exhibit a pathognomonic **apple-green birefringence** [1], [2]. This phenomenon is due to the unique cross-beta-pleated sheet configuration of the amyloid proteins [1]. **Analysis of Incorrect Options:** * **Gram stain:** Used in microbiology to differentiate bacteria into Gram-positive (purple) and Gram-negative (pink) based on cell wall composition. * **Oil Red O:** A lipid-soluble dye used to demonstrate **neutral triglycerides and lipids** in frozen sections (e.g., in fat embolism or fatty liver). * **Reticulin stain:** Uses silver impregnation to visualize **Type III collagen (reticulin) fibers**, essential for assessing liver architecture and bone marrow fibrosis. **High-Yield Clinical Pearls for NEET-PG:** * **Thioflavin T/S:** A fluorescent stain that is more sensitive but less specific than Congo red for amyloid. * **H&E Appearance:** On routine H&E staining, amyloid appears as an amorphous, eosinophilic, extracellular hyaline substance [2]. * **Pre-treatment:** Potassium permanganate can be used to differentiate AA amyloid (loses staining) from AL amyloid (retains staining). * **Best Biopsy Site:** For systemic amyloidosis, **Abdominal Fat Pad Aspiration** or Rectal Biopsy are the preferred screening procedures due to high sensitivity and low invasiveness. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 268-269. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 580-581.
Question 58: FNAC is not useful in which type of thyroid cancer?
- A. Follicular Carcinoma (Correct Answer)
- B. Papillary carcinoma
- C. Medullary Carcinoma
- D. Thyroid Lymphoma
Explanation: **Explanation:** The diagnosis of **Follicular Carcinoma (Option A)** is the correct answer because Fine Needle Aspiration Cytology (FNAC) cannot distinguish between a benign Follicular Adenoma and a malignant Follicular Carcinoma [1]. **Why FNAC is not useful for Follicular Carcinoma:** The hallmark of Follicular Carcinoma is the presence of **capsular invasion** or **vascular invasion** [1]. FNAC only samples individual cells or small clusters (cytology); it does not provide a view of the intact capsule or surrounding blood vessels (histology) [3]. Therefore, a cytological report will typically label these cases as "Follicular Neoplasm," and definitive diagnosis requires a formal histopathological examination of the surgically resected lobe. **Why other options are incorrect:** * **Papillary Carcinoma (Option B):** FNAC is the gold standard for diagnosis because it relies on characteristic nuclear features (Orphan Annie eye nuclei, nuclear grooves, and intranuclear inclusions) which are easily visible on cytology [1]. * **Medullary Carcinoma (Option C):** Can be diagnosed via FNAC by identifying salt-and-pepper chromatin, spindle-shaped cells, and positive staining for amyloid (Congo Red) or Calcitonin [3]. * **Thyroid Lymphoma (Option D):** Cytology reveals a monomorphic population of lymphoid cells, which, combined with flow cytometry, is highly effective for diagnosis [3]. **High-Yield Clinical Pearls for NEET-PG:** * **Bethesda System:** Used for reporting thyroid cytopathology (Category IV is Follicular Neoplasm). * **Hürthle Cell Carcinoma:** Like follicular carcinoma, it also requires histological evidence of invasion for a diagnosis of malignancy. * **Psammoma bodies:** Frequently seen in Papillary Carcinoma on FNAC [1]. * **Most common thyroid cancer:** Papillary Carcinoma (best prognosis) [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1099-1101. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 429-430. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 428-429.
Question 59: A 47-year-old man presents with a 4-month history of dull, constant pain in the midsection of the right thigh. Physical examination reveals pain on palpation of the anterior right thigh, exacerbated by movement, and a larger circumference of the right thigh compared to the left. Radiography shows no fracture but an ill-defined soft-tissue mass anterior to the femur. MRI reveals a 10x8x7 cm solid mass deep to the quadriceps, without femur involvement. Karyotypic analysis of tumor cells shows t(12;16)(q13;p11) with amplification of the MDM2 gene. What is the most likely diagnosis?
- A. Chondrosarcoma
- B. Liposarcoma (Correct Answer)
- C. Metastatic adenocarcinoma
- D. Nodular fasciitis
Explanation: **Explanation:** The clinical presentation and cytogenetic findings point definitively toward **Liposarcoma**, specifically the **Myxoid/Round Cell** and **Well-Differentiated** subtypes [1]. **1. Why Liposarcoma is correct:** The key to this question lies in the cytogenetic and molecular markers. * **t(12;16)(q13;p11):** This translocation is the hallmark of **Myxoid Liposarcoma**, resulting in the *FUS-CHOP* fusion gene [1]. * **MDM2 Amplification:** This is the characteristic molecular driver of **Well-Differentiated Liposarcoma (WDLPS)** and **Dedifferentiated Liposarcoma** [1]. MDM2 is an E3 ubiquitin ligase that degrades the p53 tumor suppressor protein, leading to uncontrolled cell proliferation [1]. * **Clinical Context:** Liposarcomas are the most common soft tissue sarcomas in adults, typically presenting as large, deep-seated masses in the thigh or retroperitoneum [2]. **2. Why incorrect options are wrong:** * **Chondrosarcoma:** Usually involves the bone (medullary cavity) and shows a "popcorn" calcification pattern on X-ray [3]. It is associated with *EXT1/EXT2* mutations, not MDM2 amplification. * **Metastatic Adenocarcinoma:** While it can present as a mass, it would not show these specific mesenchymal translocations. Cytology would show glandular patterns and epithelial markers (Cytokeratin+). * **Nodular Fasciitis:** A benign, reactive fibroblastic proliferation. It is typically small (<3 cm), grows rapidly over weeks (not months), and is characterized by a **t(17;22)** translocation involving the *USP6* gene [2]. **NEET-PG High-Yield Pearls:** * **Lipoblast:** The characteristic cell in liposarcoma (vacuolated cytoplasm indenting the nucleus) [1]. * **MDM2/CDK4 amplification:** Gold standard for diagnosing Well-Differentiated Liposarcoma via FISH [1]. * **Most common site:** Lower extremity (Thigh) > Retroperitoneum [2]. * **Myxoid Liposarcoma:** Shows a "chicken-wire" (plexiform) capillary pattern on histology [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1222-1223. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1222. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1204-1205.
Question 60: A 10-day-old infant presents with projectile vomiting. His mother states that the infant will actively drink his milk, but he forcefully vomits after each feeding. The infant shows signs of failure to thrive, with weight loss, dehydration, and lethargy. Physical examination reveals a firm, nontender, mobile, "olive-shaped" epigastric mass. Which of the following is the most likely diagnosis?
- A. Candida esophagitis
- B. Congenital pyloric stenosis (Correct Answer)
- C. Esophageal cancer
- D. GERD
Explanation: ### **Explanation** **Correct Answer: B. Congenital Pyloric Stenosis** **1. Why it is correct:** The clinical presentation is classic for **Congenital Hypertrophic Pyloric Stenosis (CHPS)**. This condition involves hypertrophy and hyperplasia of the muscularis propria of the pylorus, leading to gastric outlet obstruction. [1] * **Projectile, non-bilious vomiting:** Occurs because the obstruction is proximal to the Ampulla of Vater. [2] * **Age of onset:** Typically presents between **2 to 6 weeks** of life (though can appear as early as 1 week). [1] * **Physical Exam:** The pathognomonic finding is a firm, mobile, **"olive-shaped" mass** in the epigastrium, representing the hypertrophied pylorus. * **Metabolic Profile:** Persistent vomiting of gastric acid leads to **hypochloremic, hypokalemic metabolic alkalosis**. **2. Why incorrect options are wrong:** * **A. Candida esophagitis:** Usually seen in immunocompromised patients; presents with odynophagia and white plaques, not projectile vomiting or an abdominal mass. * **C. Esophageal cancer:** Extremely reason in infants; typically presents in older adults with progressive dysphagia and weight loss. [2] * **D. GERD:** Common in infants ("spit-ups"), but the vomiting is not usually projectile, and it lacks the characteristic "olive" mass and severe dehydration/failure to thrive seen in CHPS. [2] **3. High-Yield Clinical Pearls for NEET-PG:** * **Epidemiology:** More common in **first-born males**; associated with **erythromycin** or azithromycin exposure (maternal or neonatal). [1] * **Diagnosis:** **Ultrasonography** is the gold standard (shows increased pyloric muscle thickness >3mm and length >14mm). Barium swallow shows the **"String sign"** or **"Beak sign."** * **Management:** Initial priority is fluid and electrolyte resuscitation, followed by surgical correction via **Ramstedt’s pyloromyotomy**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 759-760. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, p. 342.
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Basic Principles of Cytopathology
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Effusion Cytology
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Fine Needle Aspiration Cytology
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Gastrointestinal Tract Cytology
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Ancillary Studies in Cytopathology
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