Endocrine Pathology Practice Questions

Q: A 24-year-old male presented with a swelling on the anterior aspect of the neck. On examination, the swelling was firm and moved with deglutition. A biopsy from the lesion is shown. What is the typical finding and diagnosis?

Orphan Annie eye nuclei; Papillary carcinoma of the thyroid. ***Orphan Annie eye nuclei; Papillary carcinoma of the thyroid*** - **Orphan Annie eye nuclei** (ground-glass, empty-appearing nuclei with prominent nucleoli) are the **hallmark histological feature** of papillary thyroid carcinoma. - The clinical presentation of a **firm neck swelling that moves with deglutition** in a young male is classic for papillary thyroid carcinoma, the most common thyroid malignancy. *Orphan Annie eye nuclei; Follicular carcinoma of the thyroid* - While **Orphan Annie eye nuclei** are correctly identified, they are **pathognomonic for papillary carcinoma**, not follicular carcinoma. - **Follicular carcinoma** shows **microfollicular architecture** with **capsular and vascular invasion**, lacking the characteristic nuclear features of papillary carcinoma. *Hurthle cell change; Follicular carcinoma of the thyroid* - **Hurthle cell change** (oncocytic cells with abundant eosinophilic cytoplasm) can occur in various thyroid conditions but is **not the primary histological feature** described here. - The **nuclear morphology** (Orphan Annie eye nuclei) is more specific for diagnosis than cytoplasmic changes like Hurthle cell transformation. *Hurthle cell change; Papillary carcinoma of the thyroid* - While papillary carcinoma can occasionally show **Hurthle cell features**, the **primary diagnostic criterion** is the **nuclear morphology** (Orphan Annie eye nuclei). - **Hurthle cell change** is a **secondary feature** and not the **pathognomonic finding** that defines papillary thyroid carcinoma.

Q: A 27-year-old female presented with a long-standing 2 cm x 2 cm nodule in the right lobe of her thyroid, for which she underwent a right hemithyroidectomy. What is the most likely histopathological finding given these clinical details?

Papillary carcinoma. **Explanation:** The correct answer is **Papillary Thyroid Carcinoma (PTC)**. In the context of NEET-PG, any solitary thyroid nodule in a young female (20–40 years) is considered a "red flag." Statistically, PTC is the most common thyroid malignancy (85% of cases) and frequently presents as a painless, slow-growing solitary nodule in an otherwise euthyroid patient [2]. **Why the other options are less likely:** * **Adenomatous Goiter:** This typically presents as a multinodular enlargement of the thyroid (Multinodular Goiter) rather than a discrete, long-standing solitary nodule [1]. * **Follicular Adenoma:** While it presents as a solitary nodule, it is less common than PTC [2]. Furthermore, the "most likely" examiner expectation for a solitary nodule in a young female is malignancy, specifically PTC. * **Graves Disease:** This is a functional disorder presenting with diffuse thyroid enlargement (goiter) and clinical features of hyperthyroidism (tachycardia, tremors, exophthalmos), not a localized 2 cm nodule. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** Fine Needle Aspiration Cytology (FNAC) is the investigation of choice for thyroid nodules [1]. * **Hallmark Histology of PTC:** Look for **Orphan Annie eye nuclei** (optically clear), **Psammoma bodies** (laminated calcifications), and **Nuclear grooves/pseudoinclusions** [1]. * **Prognosis:** PTC has an excellent prognosis despite a tendency for early lymphatic spread to cervical lymph nodes [2]. * **Risk Factor:** Prior exposure to ionizing radiation is a significant risk factor for developing PTC. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1095-1100. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 428-430.

Question 1

A 24-year-old male presented with a swelling on the anterior aspect of the neck. On examination, the swelling was firm and moved with deglutition. A biopsy from the lesion is shown. What is the typical finding and diagnosis?

Accepted Answer

Orphan Annie eye nuclei; Papillary carcinoma of the thyroid

Answer

Orphan Annie eye nuclei; Follicular carcinoma of the thyroid

Answer

Hurthle cell change; Follicular carcinoma of the thyroid

Answer

Hurthle cell change; Papillary carcinoma of the thyroid

Question 2

Which of the following features is NOT seen in papillary carcinoma of the thyroid?

Accepted Answer

Tumor cell immunopositivity for calcitonin

Answer

Papillary structures, often complex, with a fibrovascular core

Answer

Optically clear nuclei with nuclear overlapping

Answer

Nuclear pseudoinclusions and nuclear grooves

Question 3

Psammoma bodies in a thyroid lesion or the adjacent metastatic lymph nodes increase the possibility of which diagnosis?

Accepted Answer

Papillary carcinoma

Answer

Follicular carcinoma

Answer

Anaplastic carcinoma

Answer

Hurthle cell carcinoma

Question 4

What is characteristic of parathyroid carcinoma?

Accepted Answer

Increased parathormone, decreased calcium in bone

Answer

5-10% incidence

Answer

Cytology is diagnostic

Answer

Metastasis is essential

Question 5

Hashimoto's disease is:

Accepted Answer

An autoimmune thyroiditis

Answer

Agranulomatous thyroiditis

Answer

Fibrous thyroiditis

Answer

A viral infection of the thyroid gland

Question 6

What is the prognosis of thyroid cancer?

Accepted Answer

Anaplastic

Answer

Papillary

Answer

Medullary

Answer

Follicular

Question 7

A 27-year-old female presented with a long-standing 2 cm x 2 cm nodule in the right lobe of her thyroid, for which she underwent a right hemithyroidectomy. What is the most likely histopathological finding given these clinical details?

Accepted Answer

Papillary carcinoma

Answer

Adenomatous goiter

Answer

Follicular adenoma

Answer

Graves disease

Question 8

A 40-year-old female patient complains of a painless anterior neck mass. She has a history of hypothyroidism. Her blood work suggests increased TSH levels and decreased T3 and T4 levels. Circulating thyroid autoantibodies are also confirmed. What is the most likely diagnosis?

Accepted Answer

Hashimoto’s thyroiditis

Answer

De Quervain's thyroiditis

Answer

Riedel's thyroiditis

Answer

None of the above

Question 9

What is the pathognomic feature of hyperparathyroidism?

Accepted Answer

Subperiosteal resorption of phalanges

Answer

Osteopenia

Answer

Loss of lamina dura

Answer

Brown's tumor

Question 10

A 25-year-old man presents with 3 months of polyuria and increased thirst. The patient suffered trauma to the base of the skull in a motorcycle accident 4 months ago. A 24-hour urine collection shows polyuria but no evidence of hematuria, glucosuria, or proteinuria. The pathogenesis of polyuria in this patient is most likely caused by a lesion in which of the following areas of the brain?

Accepted Answer

Neurohypophysis

Answer

Adenohypophysis

Answer

Brain stem

Answer

Mammillothalamic tract

Endocrine Pathology — MCQs

Endocrine Pathology — MCQs

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