Endocrine Pathology Practice Questions

Q: The histopathologic feature of medullary carcinoma of the thyroid is:

Amyloid stroma. **Explanation:** **Medullary Thyroid Carcinoma (MTC)** is a neuroendocrine neoplasm derived from the **parafollicular C-cells** of the thyroid [1]. These cells are responsible for secreting **calcitonin** [1]. 1. **Why Amyloid Stroma is Correct:** The hallmark of MTC is the presence of an acellular, eosinophilic **amyloid stroma**. This amyloid is unique because it is formed by the deposition of **procalcitonin** (altered calcitonin) molecules. On histology, these deposits appear as pink, amorphous material that shows **apple-green birefringence** under polarized light when stained with **Congo Red**. 2. **Why Other Options are Incorrect:** * **Anaplasia:** This is a feature of Anaplastic Thyroid Carcinoma, which shows extreme pleomorphism and giant cells, rather than MTC. * **Mitotic Figures:** While present in aggressive tumors, they are not a diagnostic or pathognomonic feature of MTC. * **Psammoma Bodies:** These are laminated calcifications characteristic of **Papillary Thyroid Carcinoma (PTC)**. They are almost never seen in MTC. **High-Yield Clinical Pearls for NEET-PG:** * **Origin:** Neural crest cells (C-cells). * **Genetics:** Associated with **RET proto-oncogene** mutations. It occurs in **MEN 2A and 2B** syndromes (familial cases are often bilateral/multicentric) [2]. * **Tumor Marker:** Serum **Calcitonin** (used for diagnosis and monitoring recurrence) and CEA [2]. * **Histology:** Polygonal to spindle-shaped cells in nests (Zellballen pattern), follicles, or sheets. * **IHC Markers:** Positive for Calcitonin, Chromogranin A, and Synaptophysin. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 428-429. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1102-1103.

Q: All of the following are features of MEN 1 syndrome except?

Medullary carcinoma of thyroid. **Explanation:** Multiple Endocrine Neoplasia (MEN) syndromes are autosomal dominant disorders characterized by tumors involving two or more endocrine glands. **Why Option D is the correct answer:** **Medullary Carcinoma of Thyroid (MTC)** is the hallmark feature of **MEN 2A and MEN 2B**, not MEN 1 [1]. MTC in these syndromes is typically multicentric and associated with *RET* proto-oncogene mutations. In MEN 1, the genetic defect involves the *MEN1* gene (encoding the protein Menin) on chromosome 11q13, which does not predispose to MTC [2]. **Why the other options are incorrect:** MEN 1 syndrome, also known as **Wermer Syndrome**, is classically defined by the **"3 Ps"**: * **Hyperparathyroidism (Option C):** The most common (95%) and usually the earliest manifestation [2]. It typically presents as multiglandular parathyroid hyperplasia. * **Pancreatic Neuroendocrine Tumors (Option A):** These are the leading cause of morbidity/mortality in MEN 1. Common types include Gastrinomas (Zollinger-Ellison Syndrome) and Insulinomas [2]. * **Pituitary Tumors (Option B):** Most commonly Prolactinomas, followed by Somatotropinomas (causing Acromegaly). **High-Yield Clinical Pearls for NEET-PG:** * **MEN 1 (Wermer):** 3 Ps (Parathyroid, Pancreas, Pituitary). Gene: *MEN1* (Chromosome 11q13) [2]. * **MEN 2A (Sipple):** 2 Ps (Parathyroid, Pheochromocytoma) + MTC. Gene: *RET* [1]. * **MEN 2B:** 1 P (Pheochromocytoma) + MTC + Mucosal Neuromas/Marfanoid habitus. Gene: *RET* [1]. * **Key Distinction:** Parathyroid involvement is common in MEN 1 and 2A, but **absent** in MEN 2B [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, p. 1137. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1104-1105, 1125.

Q: Amyloid deposition is seen in which type of thyroid carcinoma?

Medullary. **Explanation:** **Medullary Thyroid Carcinoma (MTC)** is the correct answer because it originates from the **Parafollicular C-cells** [3], which are neuroendocrine cells responsible for secreting the hormone **Calcitonin** [1]. In MTC, excessive calcitonin molecules undergo misfolding and aggregate to form pro-amyloid fibrils. These are deposited within the tumor stroma as **localized amyloid**, which stains positive with **Congo Red** (showing apple-green birefringence under polarized light) [2]. This is a classic diagnostic hallmark of MTC. **Why other options are incorrect:** * **Papillary Carcinoma (B):** The most common thyroid cancer, characterized by "Orphan Annie eye" nuclei and **Psammoma bodies** (laminated calcifications), not amyloid. * **Follicular Carcinoma (A):** Characterized by follicular architecture with capsular or vascular invasion [2]. It does not involve neuroendocrine secretions that lead to amyloidosis. * **Anaplastic Carcinoma (C):** A highly aggressive, undifferentiated tumor composed of pleomorphic giant cells or spindle cells [2]. It lacks the secretory machinery to produce amyloid. **High-Yield Clinical Pearls for NEET-PG:** * **Origin:** Derived from C-cells (Ultimobranchial body) [3]. * **Genetics:** Associated with **RET proto-oncogene** mutations. It occurs in **MEN 2A and 2B** syndromes [1]. * **Tumor Marker:** Serum Calcitonin is used for diagnosis and monitoring recurrence [1]. * **Histology:** Nests of polygonal cells in a prominent fibrovascular stroma containing amyloid [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1102-1103. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 430-431. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 428-429.

Question 1

What is the goitrous form of autoimmune thyroiditis called?

Accepted Answer

Hashimoto's disease.

Answer

Myxoedema.

Answer

Riedel's thyroiditis.

Answer

All of the above.

Question 2

Which of the following statements is true about pituitary adenoma?

Accepted Answer

Erodes the sellar and extends into surrounding areas

Answer

Accounts for 10% of brain tumors

Answer

Prolactinoma is the least common type

Answer

It is differentiated by reticulin stain

Question 3

Amyloid deposition is characteristic of which of the following conditions?

Accepted Answer

Medullary carcinoma of the thyroid

Answer

Acute liver failure

Answer

Cirrhosis

Answer

Budd-Chiari syndrome

Question 4

Which of the following is not a histological variant of thyroid neoplasm?

Accepted Answer

Merkel cell

Answer

Follicular

Answer

Insular

Answer

Anaplastic

Question 5

Vanillylmandelic acid (VMA) is increased in which of the following conditions?

Accepted Answer

Pheochromocytoma

Answer

Parathyroidism

Answer

Multiple Endocrine Neoplasia type 1 (MEN-1)

Answer

Addison's disease

Question 6

The histopathologic feature of medullary carcinoma of the thyroid is:

Accepted Answer

Amyloid stroma

Answer

Anaplasia

Answer

Mitotic figures

Answer

Psammoma bodies

Question 7

All of the following are features of MEN 1 syndrome except?

Accepted Answer

Medullary carcinoma of thyroid

Answer

Pancreatic tumor

Answer

Pituitary tumor

Answer

Hyperparathyroidism

Question 8

Which of the following is not directly related to Hashimoto's thyroiditis?

Accepted Answer

Neuropathy

Answer

Hypothyroidism

Answer

Slow onset

Answer

Autoimmune disease

Question 9

Amyloid deposition is seen in which type of thyroid carcinoma?

Accepted Answer

Medullary

Answer

Follicular

Answer

Papillary

Answer

Anaplastic

Question 10

Which of the following statements is NOT true regarding medullary carcinoma of the thyroid?

Accepted Answer

Is a component of Multiple Endocrine Neoplasia type 1 (MEN-1)

Answer

Originates from the C cells of the thyroid

Answer

Typically multicentric in origin

Answer

Characterized by amyloid deposition

Endocrine Pathology — MCQs

Endocrine Pathology — MCQs

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