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.

Question 1

A 65-year-old male with hypertension, diabetes, and heavy smoking history is brought to the emergency department with severe crushing chest pain radiating to the left arm. He is found unresponsive 48 hours after onset of chest pain and an autopsy is performed. The gross cardiac specimen at autopsy is shown (Image 2). Which of the following cellular events is the primary pathological process responsible for the gross appearance seen in this specimen at this time point?

Accepted Answer

A. Coagulative necrosis with preserved ghost outlines of cardiomyocytes and prominent neutrophilic infiltration

Answer

B. Early granulation tissue formation with ingrowth of capillaries, fibroblasts, and macrophage-predominant infiltrate replacing necrotic myocardium

Answer

C. Dense fibrous scar tissue replacing the infarcted zone with minimal residual inflammatory infiltrate

Answer

D. Hyperacute ischemic change with wavy fiber deformity, contraction band necrosis, and minimal inflammatory response

Question 2

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 3

Insulin non-dependent diabetes mellitus correlates with which fat reserve?

Accepted Answer

Intra-abdominal fat

Answer

Lower body fat

Answer

Subcutaneous fat

Answer

Upper body fat

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

Osmotic damage is operative in all of the following complications of diabetes mellitus EXCEPT?

Accepted Answer

Insulin receptor deficiency

Answer

The formation of cataracts

Answer

Microaneurysms in retinal vessels

Answer

Peripheral neuropathy

Endocrine Pathology — MCQs

Endocrine Pathology — MCQs

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