Endocrine Pathology Practice Questions

Q: Follicular carcinoma of the thyroid is associated with mutations in which gene?

RAS. **Explanation:** Follicular Carcinoma of the Thyroid (FTC) is primarily driven by mutations in the **RAS oncogene** (specifically N-RAS, H-RAS, and K-RAS) or the **PAX8-PPARG** fusion gene [1]. RAS mutations are found in approximately 40-50% of follicular carcinomas and are also frequently seen in follicular adenomas, suggesting they are an early event in follicular tumorigenesis. **Analysis of Options:** * **A. RAS (Correct):** Mutations in the RAS family of oncogenes lead to constitutive activation of the MAPK and PI3K/AKT signaling pathways, promoting uncontrolled follicular cell proliferation [1]. * **B. HGF:** Hepatocyte Growth Factor (HGF) and its receptor MET are more commonly associated with Papillary Thyroid Carcinoma (PTC) and tumor invasion, but are not the primary drivers for FTC. * **C. RET:** Rearrangements in the *RET* gene (RET/PTC) are characteristic of **Papillary Thyroid Carcinoma** [1], while point mutations in *RET* are the hallmark of **Medullary Thyroid Carcinoma** (both sporadic and MEN 2 syndromes). * **D. ABL:** The *c-ABL* gene is typically associated with the BCR-ABL translocation (Philadelphia chromosome) seen in **Chronic Myeloid Leukemia (CML)**, not thyroid pathology. **High-Yield Clinical Pearls for NEET-PG:** * **Spread:** Unlike Papillary carcinoma (lymphatic spread), Follicular carcinoma spreads **hematogenously** (commonly to bone and lungs). * **Diagnosis:** FTC cannot be diagnosed by FNAC; histological evidence of **capsular or vascular invasion** is mandatory to differentiate it from Follicular Adenoma. * **Iodine:** FTC is more common in areas of **dietary iodine deficiency** [1]. * **Hurthle Cell Carcinoma:** A variant of FTC characterized by cells with abundant granular eosinophilic cytoplasm (due to mitochondria). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1097-1099.

Question 1

Waterhouse-Friderichsen Syndrome is:

Accepted Answer

Massive adrenal hemorrhage following disseminated bacterial infection

Answer

Adrenal failure due to rapid withdrawal of steroids

Answer

Massive adrenal hemorrhage following difficult delivery in neonates.

Answer

Adrenal crisis in individuals with chronic adrenocortical insufficiency precipitated by any form of stress

Question 2

Thyroid carcinoma with pulsatile vascular skeletal metastasis is:

Accepted Answer

Follicular

Answer

Papillary

Answer

Medullary

Answer

Anaplastic

Question 3

Which carcinoma is most commonly associated with adenomatoid goiter?

Accepted Answer

Follicular Carcinoma

Answer

Medullary Carcinoma

Answer

Papillary Carcinoma

Answer

Anaplastic Carcinoma

Question 4

Hurthle cells are characteristically found in which of the following conditions?

Accepted Answer

Follicular adenoma of the thyroid

Answer

Medullary carcinoma of the thyroid

Answer

Papillary carcinoma of the thyroid

Answer

Pituitary adenoma

Question 5

A 58-year-old man with a long-standing history of type 2 diabetes mellitus suffers a massive hemorrhagic stroke and expires. Examination of the pancreas shows hyalinization of many islets of Langerhans. Which of the following characterizes the material within the islets of Langerhans?

Accepted Answer

Amyloid

Answer

Collagen type IV

Answer

Fibrin

Answer

Fibronectin

Question 6

Follicular carcinoma of the thyroid is associated with mutations in which gene?

Accepted Answer

RAS

Answer

HGF

Answer

RET

Answer

ABL

Question 7

Which type of thyroid cancer is known to occur after radiation exposure?

Accepted Answer

Papillary

Answer

Follicular

Answer

Medullary

Answer

Anaplastic

Question 8

De Quervain's thyroiditis is also known as:

Accepted Answer

Granulomatous thyroiditis

Answer

Struma lymphomatosa

Answer

Acute thyroiditis

Answer

Hashimoto's thyroiditis

Question 9

A palpable mass is noted in the right lobe of the thyroid of a 45-year-old man who visits his physician for a periodic checkup. A biopsy is performed and results in a diagnosis of medullary carcinoma of the thyroid. Which of the following histologic features of thyroid disease would most likely be present in this biopsy specimen?

Accepted Answer

Tumor cells embedded in an amyloid-laden stroma

Answer

Tumor cells with "Orphan Annie" nuclei

Answer

Psammoma bodies

Answer

Infiltrates of lymphocytes with germinal center formation

Question 10

A 35-year-old woman complains of nipple discharge and irregular menses of 5 months duration. Physical examination reveals a milky discharge from both nipples. MRI shows an enlargement of the anterior pituitary. Which of the following is the most likely histologic diagnosis of this patient's pituitary tumor?

Accepted Answer

Adenoma

Answer

Choriostoma

Answer

Hamartoma

Answer

Papilloma

Endocrine Pathology — MCQs

Endocrine Pathology — MCQs

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