Endocrine Pathology Practice Questions

Q: What is the most common site for a pheochromocytoma?

Adrenal medulla. **Explanation:** **1. Why the Adrenal Medulla is Correct:** Pheochromocytoma is a catecholamine-secreting tumor derived from **chromaffin cells**. These cells are embryologically derived from the neural crest and are primarily concentrated in the **adrenal medulla** [1]. Statistically, approximately **85% to 90%** of these tumors occur within the adrenal medulla, making it the most common site. **2. Why the Other Options are Incorrect:** * **Adrenal Cortex:** This is the outer layer of the adrenal gland derived from mesoderm. it produces steroids (cortisol, aldosterone, androgens). It does not contain chromaffin cells and therefore cannot be the site of a pheochromocytoma. * **Paravertebral Ganglion & Paraaortic-sympathetic Chain:** While these are common sites for **extra-adrenal** pheochromocytomas (also known as **paragangliomas**), they only account for about 10-15% of cases. The most famous extra-adrenal site is the Organ of Zuckerkandl, located at the bifurcation of the aorta. **3. High-Yield Clinical Pearls for NEET-PG:** * **The Rule of 10s:** Traditionally, pheochromocytoma is known as the "10% tumor": 10% are extra-adrenal, 10% are bilateral, 10% are malignant, 10% occur in children, and 10% are not associated with hypertension. (Note: Recent genetics suggest up to 25-30% may be familial). * **Zellballen Pattern:** On histology, the tumor cells are arranged in small clusters or nests surrounded by a rich vascular network. * **Diagnosis:** The best initial screening test is measuring **urinary or plasma metanephrines** (metabolites of catecholamines). * **Associated Syndromes:** MEN 2A, MEN 2B, von Hippel-Lindau (VHL) syndrome, and Neurofibromatosis type 1 (NF1). **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 418-419.

Q: Acinic cell tumor is most commonly seen in which of the following locations?

Parotid gland. ### Explanation **Acinic Cell Carcinoma (ACC)** is a malignant salivary gland tumor that demonstrates cytological differentiation toward serous acinar cells. **Why Parotid Gland is Correct:** The **parotid gland** is the most common site for Acinic Cell Carcinoma, accounting for approximately **80% of cases**. This is because the parotid is primarily composed of serous acini, and this tumor originates from the terminal duct or precursor cells that differentiate into serous cells containing characteristic zymogen-like granules. While it is generally considered a low-grade malignancy with a favorable prognosis, it is the second most common malignant salivary gland tumor in children (after Mucoepidermoid carcinoma) [1]. **Why Other Options are Incorrect:** * **Parathyroid & Thyroid:** These are endocrine glands. While they can develop various adenomas or carcinomas (e.g., Papillary or Follicular thyroid cancer), "Acinic cell tumor" is a specific histopathological entity exclusive to salivary tissues. * **Sublingual Gland:** Although salivary gland tumors can occur here, the sublingual gland is a rare site for any neoplasm. When tumors do occur in minor salivary glands or the sublingual gland, they are more likely to be Adenoid Cystic Carcinoma or Mucoepidermoid Carcinoma [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Histology:** Look for "clear cells" or cells with **basophilic, granular cytoplasm** (resembling normal serous acini). * **Staining:** The granules are **PAS-positive** and diastase-resistant. * **Bilateralism:** Acinic cell carcinoma is the most common salivary gland malignancy to occur **bilaterally** (though still rare overall). * **Demographics:** It shows a slight female predilection and occurs across a wide age range, including pediatric populations. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 753-755.

Q: Which of the following are features of diffuse sclerosing variant of papillary carcinoma?

All of the above. The **Diffuse Sclerosing Variant (DSV)** is a distinct and aggressive subtype of Papillary Thyroid Carcinoma (PTC). Understanding its unique clinicopathological profile is crucial for NEET-PG. ### **Explanation of Options:** * **Option A (Young individuals):** Unlike the classic variant, DSV typically presents in **younger patients**, frequently involving children and adolescents [1]. It often presents as a diffuse, painless enlargement of the thyroid gland rather than a solitary nodule. * **Option B (Extensive fibrosis):** As the name "sclerosing" suggests, the hallmark of this variant is **marked stromal fibrosis** that extends throughout the thyroid lobe or the entire gland [1]. This often gives the gland a firm, hard consistency on palpation. * **Option C (Lymphocytic infiltrate):** Histologically, DSV is characterized by a prominent **background of chronic lymphocytic thyroiditis** (resembling Hashimoto’s) [1]. This is accompanied by numerous **Psammoma bodies** (often more abundant than in classic PTC) and squamous metaplasia [1]. Since all three features are characteristic of this variant, **Option D** is the correct answer. ### **High-Yield Clinical Pearls for NEET-PG:** * **Imaging:** On ultrasound or X-ray, it may show "snowstorm" calcifications due to the abundance of Psammoma bodies. * **Spread:** It has a higher incidence of **lymph node metastasis** (often bilateral) and **distant metastasis** (especially to the lungs) compared to classic PTC. * **Molecular Profile:** It is frequently associated with **RET/PTC rearrangements** rather than BRAF mutations. * **Prognosis:** Despite its aggressive presentation and higher stage at diagnosis, the overall survival remains relatively good, though the recurrence rate is higher than classic PTC. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, p. 1099.

Q: A 40-year-old female presents with fever, fatigue, and diffuse painful swelling in the midline of the neck. Fine-needle aspiration cytology (FNAC) of the swelling reveals epithelioid cells and giant cells. What is the most likely diagnosis?

Subacute thyroiditis. ### **Explanation** The clinical presentation of a **painful, tender thyroid swelling** following a viral prodrome (fever, fatigue) is the classic hallmark of **Subacute Thyroiditis** (also known as De Quervain’s or Granulomatous Thyroiditis). **1. Why Subacute Thyroiditis is correct:** The diagnosis is confirmed by the FNAC findings of **epithelioid cells and multinucleated giant cells**, which represent the granulomatous inflammatory response to damaged thyroid follicles. This condition is typically triggered by a viral infection (e.g., Coxsackievirus, Mumps) and is the most common cause of a painful thyroid gland. [1] **2. Why the other options are incorrect:** * **Acute Thyroiditis:** Usually caused by a bacterial infection (e.g., *S. aureus*). While it presents with pain and fever, the cytology would show **neutrophils and abscess formation**, not granulomatous inflammation. * **Tubercular Lymphadenitis:** While it shows epithelioid granulomas and giant cells, it typically involves the **lateral cervical lymph nodes**, not a diffuse midline thyroid swelling. Primary tuberculosis of the thyroid is extremely rare. * **Hashimoto’s Thyroiditis:** This is a **painless** goiter. FNAC would reveal a dense lymphocytic infiltrate, germinal centers, and characteristic **Hürthle cells** (oncocytes), but not granulomas. [1] **3. NEET-PG High-Yield Pearls:** * **Etiology:** Post-viral; associated with **HLA-B35**. * **Clinical Phase:** Often follows a triphasic course: Hyperthyroidism (leakage of T3/T4) → Hypothyroidism → Recovery. [1] * **Lab Marker:** Characteristically high **ESR** with **low radioactive iodine uptake (RAIU)** due to follicular damage. [1] * **Treatment:** Self-limiting; managed with NSAIDs or corticosteroids for pain. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1089-1092.

Q: "Orphan Annie nuclei" are seen in which of the following conditions?

Papillary carcinoma of thyroid. **Explanation:** **Papillary Carcinoma of Thyroid (PTC)** is the most common thyroid malignancy [1]. The diagnosis is primarily based on characteristic nuclear features rather than architectural patterns. **"Orphan Annie eye" nuclei** refer to large, overlapping nuclei with finely dispersed chromatin that appears optically clear or empty on H&E staining [1], [2]. This appearance is an artifact of fixation [1]. **Why the other options are incorrect:** * **Medullary Carcinoma:** Derived from parafollicular C-cells. It is characterized by nests of cells in an amyloid-rich stroma [2]. It is associated with *RET* mutations and MEN 2A/2B syndromes. * **Anaplastic Carcinoma:** A highly aggressive, undifferentiated tumor seen in older patients [2]. It shows pleomorphic giant cells or spindle cells but lacks the specific nuclear features of PTC. * **Follicular Carcinoma:** Defined by capsular or vascular invasion [2]. The nuclei typically resemble normal follicular cells and do not show clearing or grooves [1]. **High-Yield Clinical Pearls for NEET-PG:** 1. **Other Nuclear Features of PTC:** Besides Orphan Annie nuclei, look for **Nuclear Grooves** (coffee bean appearance) and **Intranuclear Cytoplasmic Inclusions** (Pseudo-inclusions) [1]. 2. **Psammoma Bodies:** These are laminated calcifications frequently seen in the stroma of Papillary Carcinoma (rare in other thyroid cancers). 3. **Genetics:** PTC is associated with **BRAF mutations** (most common) and **RET/PTC rearrangements**. 4. **Prognosis:** It has an excellent prognosis and typically spreads via the **lymphatics** to cervical lymph nodes [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1098-1099. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 429-430.

Question 1

Which of the following thyroid abnormalities is associated with IgG4-related disease?

Accepted Answer

Riedel thyroiditis

Answer

De Quervain thyroiditis

Answer

Postpartum thyroiditis

Answer

Hashimoto thyroiditis

Question 2

What is the most common site for a pheochromocytoma?

Accepted Answer

Adrenal medulla

Answer

Adrenal cortex

Answer

Paravertebral ganglion

Answer

Paraaortic-sympathetic chain

Question 3

A 5-year-old boy has developed features suggestive of precocious puberty over the past 6 months. On physical examination, the boy exhibits secondary sex characteristics, including pubic hair and penile enlargement. Which of the following morphologic features is most likely to be observed in his adrenal glands?

Accepted Answer

Cortical hyperplasia

Answer

Cortical atrophy

Answer

Cortical nodule

Answer

Medullary atrophy

Question 4

What is true about adrenal pheochromocytoma?

Accepted Answer

Bilateral in 10 percent of cases

Answer

Chromaffin negative

Answer

Mostly malignant

Answer

Unilateral in 10 percent of cases

Question 5

A 34-year-old patient presents with a thyroid nodule. Ultrasonography shows foci of calcification. Based on typical histological features, what is the likely diagnosis?

Accepted Answer

Papillary carcinoma

Answer

Follicular carcinoma

Answer

Medullary carcinoma

Answer

Anaplastic carcinoma

Question 6

Acinic cell tumor is most commonly seen in which of the following locations?

Accepted Answer

Parotid gland

Answer

Parathyroid

Answer

Sublingual gland

Answer

Thyroid

Question 7

Which of the following are features of diffuse sclerosing variant of papillary carcinoma?

Accepted Answer

All of the above

Answer

Occurs in young individuals including children

Answer

Extensive fibrosis throughout the gland

Answer

Associated with lymphocytic infiltrate

Question 8

A 40-year-old female presents with fever, fatigue, and diffuse painful swelling in the midline of the neck. Fine-needle aspiration cytology (FNAC) of the swelling reveals epithelioid cells and giant cells. What is the most likely diagnosis?

Accepted Answer

Subacute thyroiditis

Answer

Acute thyroiditis

Answer

Tubercular lymphadenitis

Answer

Hashimoto's thyroiditis

Question 9

A boy presented with hypertension is found to have pheochromocytoma. All of the following are true about pheochromocytoma, EXCEPT:

Accepted Answer

Malignant tumor

Answer

Benign in nature

Answer

Secretes hormones

Answer

Hypertension is seen

Question 10

"Orphan Annie nuclei" are seen in which of the following conditions?

Accepted Answer

Papillary carcinoma of thyroid

Answer

Medullary carcinoma of thyroid

Answer

Anaplastic carcinoma of thyroid

Answer

Follicular carcinoma of thyroid

Endocrine Pathology — MCQs

Endocrine Pathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?