NEET-PG 2024 - Pathology Practice Questions

Q: A patient presents with headaches, palpitations, hypertension, and urine VMA positivity. The biopsy findings are shown in the image. Which of the following statements is correct?

Associated with MEN 2A. ***Associated with MEN 2A*** - The clinical presentation (headaches, palpitations, hypertension) and positive **urine VMA (vanillylmandelic acid)** strongly suggest a **pheochromocytoma**. - Pheochromocytomas are tumors of the adrenal medulla that secrete catecholamines and are frequently associated with **Multiple Endocrine Neoplasia Type 2A (MEN 2A)**, along with medullary thyroid carcinoma and primary hyperparathyroidism. *Mostly malignant* - Pheochromocytomas are generally benign, with approximately **10% being malignant** ("rule of 10s"). - Malignancy is difficult to predict based on histology alone and is usually defined by the presence of **metastases**. *Mostly in children* - While pheochromocytomas can occur at any age, they are **more common in adults**, typically between 30 and 50 years old. - When they do occur in children, they are more often bilateral, extra-adrenal, or associated with genetic syndromes. *Mostly bilateral* - The majority of pheochromocytomas (approximately **90%**) are **unilateral**. - Bilateral pheochromocytomas are often seen in genetic syndromes such as **MEN 2**, von Hippel-Lindau disease, and neurofibromatosis type 1.

Q: A patient presents with a renal mass leading to hematuria and flank pain. The histological image below is shown. What is the likely diagnosis? ![img-31.jpeg](img-31.jpeg)

Clear Cell Carcinoma. ***Clear Cell Carcinoma*** - The image displays cells with **clear cytoplasm** due to the accumulation of lipids and glycogen, a classic histological feature of **Clear Cell Renal Cell Carcinoma** [1]. - These cells often have **small, round nuclei** and are arranged in nests or cords, supported by a rich vascular network, which aligns with the image provided [1]. *Papillary Cell Carcinoma* - This subtype is characterized by cells arranged in **papillary structures** with fibrovascular cores, which is not clearly evident in the image [1]. - The cells typically have **basophilic cytoplasm** and generally do not exhibit the extensive clear cytoplasm seen here. *Chromophobe Renal Cell Carcinoma (RCC)* - Chromophobe RCC is characterized by cells with **pale, flocculent cytoplasm** and prominent cell membranes, often appearing like a "plant cell" pattern [1]. - The nuclei are typically irregular and often contain perinuclear halos, which are not the predominant features in the provided image [1]. *Bellini Duct Carcinoma* - Also known as collecting duct carcinoma, this is a rare and aggressive subtype originating from the medullary collecting ducts. - Histologically, it features a **tubulointerstitial growth pattern**, often with an infiltrative appearance and significant desmoplasia, distinctly different from the clear cell morphology shown. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 958-961.

Q: A 34-year-old female presented with low hemoglobin, platelet count of 25,000 / mm³, raised PT and APTT. The image shows a peripheral smear. Which of the following fusion genes is affected?

PML-RARA. ***PML-RARA*** - The image shows **promyelocytes** with prominent granules and **Auer rods** (indicated by the arrow), which are characteristic of Acute Promyelocytic Leukemia (APL). [1] - APL is strongly associated with the **t(15;17)** translocation, leading to the **PML-RARA** fusion gene. The patient’s clinical presentation of pancytopenia (low hemoglobin, low platelet count) and prolonged PT/APTT leading to **DIC**, is highly consistent with APL. [1] *RUNX1-RUNX1T1* - This fusion gene is associated with **Acute Myeloid Leukemia (AML) M2** (AML with maturation), often due to t(8;21) translocation. [1] - While it is a type of AML, the peripheral smear and clinical features are more specific to APL, not AML M2. *INV 16* - Inversion 16, denoted as **inv(16)(p13q22)**, is associated with an AML subtype that typically presents with **myelomonocytic differentiation** and **abnormal eosinophils** in the bone marrow. [1] - The image and clinical findings do not suggest myelomonocytic morphology or the presence of abnormal eosinophils, making APL a more likely diagnosis. *IGH-NSD2* - This fusion gene is characteristic of **Multiple Myeloma**, a plasma cell malignancy. - Multiple myeloma would present with plasma cell proliferation, bone lesions, and hypercalcemia, which differ significantly from the acute leukemia presentation seen here. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 620-622.

Question 1

A patient presents with headaches, palpitations, hypertension, and urine VMA positivity. The biopsy findings are shown in the image. Which of the following statements is correct?

Accepted Answer

Associated with MEN 2A

Answer

Mostly malignant

Answer

Mostly in children

Answer

Mostly bilateral

Question 2

A child presenting with leukocoria has an intraocular mass. Microscopic examination shows rosettes with scanty cytoplasm and positive synaptophysin. What is the most likely diagnosis?

Accepted Answer

Retinoblastoma

Answer

Medulloblastoma

Answer

Neuroblastoma

Answer

Ependymoma

Question 3

A patient presents with a renal mass leading to hematuria and flank pain. The histological image below is shown. What is the likely diagnosis?
![img-31.jpeg](img-31.jpeg)

Accepted Answer

Clear Cell Carcinoma

Answer

Papillary Cell Carcinoma

Answer

Chromophobe Renal Cell Carcinoma (RCC)

Answer

Bellini Duct Carcinoma

Question 4

A 40-year-old female presents with an irregular 5 × 6 cm mass in the right breast. Histopathological examination reveals the image shown. What is the most likely diagnosis?

Accepted Answer

Phyllodes tumor

Answer

Fibroadenoma

Answer

Invasive ductal carcinoma

Answer

Intraductal papilloma

Question 5

A 34-year-old female presented with low hemoglobin, platelet count of 25,000 / mm³, raised PT and APTT. The image shows a peripheral smear. Which of the following fusion genes is affected?

Accepted Answer

PML-RARA

Answer

RUNX1-RUNX1T1

Answer

INV 16

Answer

IGH-NSD2

NEET-PG 2024 — Pathology