Endocrine Pathology Practice Questions

Q: MEN syndrome is associated with an increase in which type of thyroid carcinoma?

Medullary carcinoma of thyroid. **Medullary Carcinoma of Thyroid (MTC)** is the correct answer because it is a defining component of **Multiple Endocrine Neoplasia (MEN) type 2 syndromes (2A and 2B)** [1]. MTC originates from the **parafollicular C-cells**, which are neuroendocrine cells derived from the neural crest that secrete calcitonin [2]. In the context of MEN 2, MTC is typically multifocal, bilateral, and preceded by C-cell hyperplasia. It is associated with germline mutations in the **RET proto-oncogene** [1]. **Analysis of Incorrect Options:** * **Papillary Carcinoma (A):** The most common thyroid cancer overall, associated with *BRAF* mutations and radiation exposure, but not typically part of MEN syndromes. * **Follicular Carcinoma (B):** Associated with iodine deficiency and *RAS* mutations/PAX8-PPARγ rearrangements; it does not have a genetic link to MEN. * **Anaplastic Carcinoma (D):** A highly aggressive, undifferentiated tumor seen in older patients; it is not associated with the inherited MEN syndromes. **High-Yield Clinical Pearls for NEET-PG:** * **MEN 2A (Sipple Syndrome):** MTC + Pheochromocytoma + Parathyroid Hyperplasia [1]. * **MEN 2B (Wagenmann-Froboese):** MTC + Pheochromocytoma + Mucosal Neuromas + Marfanoid Habitus [1]. * **Tumor Marker:** Calcitonin is used for diagnosis and monitoring recurrence [2]. Amyloid stroma (formed by calcitonin pro-peptides) is a classic histological finding [3]. * **Prophylactic Thyroidectomy:** Recommended for children carrying the *RET* mutation before MTC develops. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, p. 1137. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 428-429. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 430-431.

Q: The FNAC of the lesion should reveal:

‘Orphan-Annie eye’ nucleus cells. ***'Orphan-Annie eye' nucleus cells*** - **'Orphan-Annie eye' nuclei** are the pathognomonic cytological feature of **papillary thyroid carcinoma (PTC)** on FNAC, appearing as large, pale, ground-glass nuclei with cleared chromatin. - Other key PTC nuclear features include **nuclear grooves**, **intranuclear pseudoinclusions**, and occasional **psammoma bodies**. *Amyloid deposits* - **Amyloid deposits** are characteristic of **medullary thyroid carcinoma**, not papillary thyroid carcinoma. - Medullary carcinoma arises from **C-cells** and secretes **calcitonin**, showing **Congo red positivity** for amyloid. *Epithelioid cells and giant cells* - **Epithelioid cells** and **giant cells** are typical of **granulomatous thyroiditis** (de Quervain's thyroiditis) or **chronic lymphocytic thyroiditis**. - These inflammatory cells are not characteristic features of **papillary thyroid carcinoma**. *Follicular cells* - **Follicular cells** alone are seen in **follicular neoplasms** or **normal thyroid tissue**, lacking the specific nuclear features of PTC. - **Follicular carcinoma** requires **histological examination** to demonstrate **capsular** or **vascular invasion**, not distinguishable on FNAC.

Question 1

Which of the following is not a feature of Papillary carcinoma of thyroid?

Accepted Answer

Mutation of RAS gene

Answer

Rearrangement of RET gene

Answer

Rearrangement of NTRK1 gene

Answer

Mutation of BRAF gene

Question 2

What is the commonest cause of raised serum calcium?

Accepted Answer

Parathyroid adenoma

Answer

Ectopic secretion

Answer

Parathyroid hyperplasia

Answer

Parathyroid carcinoma

Question 3

MEN syndrome is associated with an increase in which type of thyroid carcinoma?

Accepted Answer

Medullary carcinoma of thyroid

Answer

Papillary carcinoma of thyroid

Answer

Follicular carcinoma of thyroid

Answer

Anaplastic carcinoma of thyroid

Question 4

Psammoma bodies are seen in which of the following conditions?

Accepted Answer

Papillary carcinoma of thyroid

Answer

Medullary carcinoma of thyroid

Answer

Follicular carcinoma of thyroid

Answer

Anaplastic carcinoma of thyroid

Question 5

A patient presents with increased metabolic rate, hyperthyroidism, and goiter. Deposits of calcium are noted in the thyroid capsule. What is the likely diagnosis?

Accepted Answer

Medullary carcinoma of the thyroid

Answer

Follicular Carcinoma of the thyroid

Answer

De Quervain's thyroiditis

Answer

Riedel's thyroiditis

Question 6

A 45-year-old man presents with a 3 cm palpable nodule in one lobe of an otherwise normal-sized thyroid gland. Needle aspiration of the nodule demonstrates polygonal tumor cells and amyloid, but only very scanty colloid and normal follicular cells. Which of the following is the most likely diagnosis?

Accepted Answer

Medullary thyroid carcinoma

Answer

Follicular thyroid carcinoma

Answer

Hashimoto's disease

Answer

Papillary thyroid carcinoma

Question 7

Ectopic ACTH syndrome is seen most commonly with which of the following conditions?

Accepted Answer

Bronchogenic carcinoma

Answer

Renal cell carcinoma

Answer

Lymphoma

Answer

Pituitary adenoma

Question 8

Which of the following is the most reliable feature of malignant transformation of pheochromocytoma?

Accepted Answer

Vascular invasion

Answer

Presence of mitotic figures

Answer

Capsular invasion

Answer

Pleomorphism

Question 9

The FNAC of the lesion should reveal:

Accepted Answer

‘Orphan-Annie eye’ nucleus cells

Answer

Amyloid deposits

Answer

Epithelioid cells and giant cells

Answer

Follicular cells

Question 10

A 68-year-old man has experienced increasing malaise for 3 years. Physical examination shows no remarkable findings. Laboratory findings include a serum creatinine level of 4.9 mg/dL and a urea nitrogen level of 45 mg/dL. Abdominal CT scan shows small kidneys. Which of the following endocrine glandular lesions has developed secondary to the underlying disease in this patient?

Accepted Answer

Parathyroid hyperplasia

Answer

Adrenal atrophy

Answer

Islet cell hyperplasia

Answer

Multinodular goiter

Endocrine Pathology — MCQs

Endocrine Pathology — MCQs

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