Endocrine Pathology Practice Questions

Q: A biopsy from the parathyroid gland of a 55-year-old male, a known case of chronic kidney disease with hypertension and type II diabetes who recently developed bone pain, skin lesions, and recurrent kidney stones, is shown below. What is the most likely histopathological finding?

Water clear cells in parathyroid hyperplasia. ***Water clear cells in parathyroid hyperplasia*** - **Chronic kidney disease** leads to **secondary hyperparathyroidism** due to decreased **vitamin D activation** and **phosphate retention**, causing **parathyroid hyperplasia** with characteristic **water clear cells (wasserhelle cells)**. - These cells have **abundant clear cytoplasm** due to **glycogen accumulation** and **mitochondrial swelling**, commonly seen in **long-standing hyperparathyroidism** associated with **CKD**. *Water clear cells in parathyroid carcinoma* - **Parathyroid carcinoma** would show **capsular invasion**, **vascular invasion**, and **mitotic figures**, which are not typical in **secondary hyperparathyroidism** from CKD. - **Carcinoma** is extremely rare and usually presents with **severe hypercalcemia** and **rapid onset** symptoms, not the chronic progression seen with CKD. *Tuberculous parathyroiditis* - **TB parathyroiditis** would show **caseating granulomas**, **epithelioid cells**, and **Langerhans giant cells**, not water clear cells. - This condition is extremely rare and would present with **systemic TB symptoms** like **fever**, **weight loss**, and **night sweats**, which are absent here. *Parathyroid necrosis* - **Parathyroid necrosis** would show **tissue death**, **inflammatory infiltrate**, and **loss of normal architecture**, not hyperplastic changes. - This typically occurs in **acute conditions** like **infarction** or **severe hypocalcemia**, not in chronic progressive CKD with bone pain and stones.

Q: Hyaline in islets of Langerhans resembles which substance?

Amyloid. **Explanation:** The correct answer is **Amyloid**. [1] **Why Amyloid is correct:** In **Type 2 Diabetes Mellitus**, the characteristic pathological finding in the pancreas is the deposition of pink, amorphous, hyaline material within the Islets of Langerhans [1]. This hyaline material is actually **Amyloid**. It is composed of **Amylin** (also known as Islet Amyloid Polypeptide or IAPP), which is co-secreted with insulin by the beta cells. In states of insulin resistance and hyperinsulinemia, excessive IAPP accumulates and misfolds into amyloid fibrils, which are toxic to beta cells and contribute to their gradual loss [2]. **Why other options are incorrect:** * **A. Mucin:** Mucin is a glycoprotein found in epithelial secretions (e.g., adenocarcinoma). It does not form hyaline deposits in the islets. * **C. Glycolipid:** These accumulate in lysosomal storage diseases (e.g., Gaucher’s) but do not present as extracellular hyaline in the pancreas. * **D. Phospholipid:** These are primary components of cell membranes and "myelin figures" in cell injury, not the hyaline seen in diabetic islets. **High-Yield Clinical Pearls for NEET-PG:** * **Staining:** Like all amyloid, islet hyaline shows **Apple-green birefringence** under polarized light when stained with **Congo Red** [1]. * **Type 1 vs. Type 2 DM:** Hyaline/Amyloid deposition is a hallmark of **Type 2 DM**. In contrast, Type 1 DM is characterized by **Insulitis** (lymphocytic infiltration) and a marked reduction in islet size/number. * **Insulinoma:** Amyloid deposition can also be seen in the stroma of an Insulinoma (a pancreatic neuroendocrine tumor). **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. Diseases of the Immune System, pp. 264-266.

Question 1

Which of the following mechanisms is NOT responsible for complications in Diabetes Mellitus?

Accepted Answer

Chronic inflammation

Answer

Non-enzymatic glycosylation

Answer

Protein Kinase C activation

Answer

Disturbance in polyol pathway

Question 2

Pheochromocytoma are tumors of which structure?

Accepted Answer

Adrenal medulla

Answer

Adrenal cortex

Answer

Pancreas

Answer

Bone

Question 3

Expression of which of the following oncogenes is associated with a high incidence of medullary carcinoma of the thyroid?

Accepted Answer

RET Proto oncogene

Answer

FOS

Answer

BRAF

Answer

WNT1

Question 4

A biopsy from the parathyroid gland of a 55-year-old male, a known case of chronic kidney disease with hypertension and type II diabetes who recently developed bone pain, skin lesions, and recurrent kidney stones, is shown below. What is the most likely histopathological finding?

Accepted Answer

Water clear cells in parathyroid hyperplasia

Answer

Water clear cells in parathyroid carcinoma

Answer

Tuberculous parathyroiditis

Answer

Parathyroid necrosis

Question 5

The neuroendocrine carcinoma arising from parafollicular 'C' cells of thyroid is:

Accepted Answer

Medullary carcinoma

Answer

Papillary carcinoma

Answer

Follicular carcinoma

Answer

Anaplastic carcinoma

Question 6

A 30-year-old woman presents with headache, visual disturbances, deepening of the voice, generalized weakness, amenorrhea for one year, and a recent requirement for a larger shoe size. Laboratory studies show impaired glucose tolerance. What additional diagnostic procedure would be most useful?

Accepted Answer

Magnetic resonance imaging of the sella turcica

Answer

Complete blood count with differential count

Answer

Computed tomography scan of the abdomen

Answer

Test for serum 21-hydroxylase activity

Question 7

A 50-year-old man with fasting blood glucose >140 mg/dL on two occasions is put on a restricted caloric diet and started on a glucagon-like peptide-1 (GLP-1) receptor agonist. Which of the following laboratory studies is most likely to afford the best method of monitoring disease control in this man?

Accepted Answer

Glycosylated hemoglobin

Answer

Cholesterol, total

Answer

Fasting plasma glucose

Answer

Microalbuminuria

Question 8

Psammoma bodies are typically found in which of the following conditions?

Accepted Answer

Papillary carcinoma of the thyroid

Answer

Follicular carcinoma of the thyroid

Answer

Medullary carcinoma of the thyroid

Answer

Anaplastic carcinoma of the thyroid

Question 9

Hyaline in islets of Langerhans resembles which substance?

Accepted Answer

Amyloid

Answer

Mucin

Answer

Glycolipid

Answer

Phospholipid

Question 10

Which of the following gene defects is associated with the development of medullary carcinoma of the thyroid?

Accepted Answer

RET Proto Oncogene

Answer

APC gene

Answer

Rb gene

Answer

BRCA 1 gene

Endocrine Pathology — MCQs

Endocrine Pathology — MCQs

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