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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor=[[User:Gonzalo Romero|Gonzalo A. Romero, M.D.]] [mailto:gromero@wikidoc.org] {{Alison}}
|QuestionAuthor=[[User:Gonzalo Romero|Gonzalo A. Romero, M.D.]] [mailto:gromero@wikidoc.org] {{Alison}} (Reviewed by Serge Korjian)
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Neurology, Oncology, Reproductive
|SubCategory=Neurology, Oncology, Reproductive
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Neurology, Oncology, Reproductive
|SubCategory=Neurology, Oncology, Reproductive
|Prompt=A 57-year-old male patient comes to the ER after presenting with visual deficits.  The symptoms have been gradually worsening over the last 6 months. His wife denies any history of trauma or drug ingestion. You preform a physical examination and find that his vitals are within normal limits. On neurological exam, you encounter a right hemianopsia with macular sparing, and becomes concerned that the patient may have a stroke or a tumor. A CT scan is ordered and shows a mass in the posterior fossa.  Forty-eight hours following admission, the patient develops a Grand-mal seizure and undergoes respiratory arrest.  Despite aggressive resuscitation measures, the patient dies. Concerned about malpraxis, you order an autopsy.  Upon entering the skull, the pathologist notices a tumor arising from the membranes covering the brain. A specimen under the microscope shows the picture below. Which of the following ovarian tumors is also associated with the latter histologic findings of this tumor?
|Prompt=A 57-year-old man presents to the neurology clinic for a 2-month history of a slowly worsening visual disturbance. He explains that his primary care physician first noticed the issue during his annual check-up a week ago, after the patient complained of having difficulty noticing oncoming cars while driving. Physical examination reveals significant bitemporal hemianopsia. Following a thorough work-up, the neurologist diagnoses the patient with a sellar tumor. Transsphenoidal excision is done and a pathologic examination is obtained (shown below). Which of the following tumors is also associated with the same histologic features?
[[File:WBR0505.jpg|center|pix200]]
[[File:WBR0505a.jpg|400px]]
|Explanation=This patient presents with hallucinations and visual deficits which worsened over time and right hemianopsia with macular sparing. The CT scan displays a tumor rising from the occipital region of the meninges, which correlates with the clinical findings. The histo-pathologic findings of laminated, concentric, calcific spherules are also known as [[Psammoma bodies]], which are associated with meningioma compressing the occipital lobe. [[Psammoma bodies]] are also found in:
|Explanation=The clinical presentation of this patient is consistent with a sellar tumor compressing the optic chiasm. Classically, more than 90% of sellar tumors are [[pituitary adenoma]]s (secretory or non-secretory). Other masses that may have a very similar presentation include meningiomas, germinomas, pituitary abscesses, pituitary metastases, and arachnoid cysts. Tuberculum sellae meningiomas (TSM) usually arise in the midline of the tuberculum sellae and as they enlarge, abut and compress the optic chiasm causing temporal vision field loss. Unilateral vision involvement is more common initially but without adequate treatment almost all patients develop [[bitemporal hemianopsia]]. Approximately 95% of patients suffer visual deficits and 75-90% have optic atrophy. Other symptoms of tuberculum sellae meningiomas include headache, endocrinopathies, seizures, and altered mentation. TSMs are more common in women particularly in the fifth to sixth decade. On pathology, findings of laminated, concentric, calcific spherules known as [[Psammoma bodies]], are consistent with the diagnosis of meningioma. These bodies arise from the dystrophic calcification of dead neoplastic cells. [[Psammoma bodies]] are also found in other neoplastic growths including papillary adenocarcinoma of the thyroid, serous papillary cystadenocarcinoma of the ovary, and malignant [[mesothelioma]].
# Papillary adenocarcinoma of the thyroid
 
# Serous papillary cystadenocarcinoma of the ovary
# [[Meningioma]]
# Malignant [[mesothelioma]]
'''WikiDoc Mnemonic:''' PSaMMoma :
# '''P'''apill ary (thyroid)
# '''S'''erous (ovary)
# '''M'''eningioma
# '''M'''esothelioma
# + '''oma'''
<font color="MediumBlue"><font size="4">'''Educational Objective:'''</font></font>
Psammoma bodies are often present in meningiomas within the central nervous system.  
References: First Aid 2013 reproductive chapter
|AnswerA=Granulosa cell tumor
|AnswerA=Granulosa cell tumor
|AnswerAExp= A [[Granulosa cell tumor]] is a non-germ cell ovarian tumor which secretes estrogen and can cause precocious puberty in children and endometrial hyperplasia and carcinoma in adults. Histologically [[Granulosa cell tumor]]s are characterized by Call-Exner bodies, which are small follicles filled with eosinophilic secretions. It often presents with abnormal uterine bleeding.
|AnswerAExp=A [[granulosa cell tumor]] is a non-germ cell ovarian tumor histologically characterized by Call-Exner bodies, which are small follicles filled with eosinophilic secretions. Granulosa cell tumors do not contain psammoma bodies.
|AnswerB=Brenner tumor
|AnswerB=Brenner tumor
|AnswerBExp= A [[Brenner tumor]] is a benign and unilateral ovarian tumor.  It originates from the surface epithelial-stromal. Macroscopically [[Brenner tumor]]s are solid, pale yellow-tan and  encapsulated. Histologically [[Brenner tumor]]s contains clusters of cells resembling transitional epithelium of the bladder with "coffee bean" shaped nuclei.
|AnswerBExp=A [[brenner tumor]] is a benign and unilateral ovarian tumor characterized by clusters of cells resembling the transitional epithelium of the bladder with coffee bean shaped nuclei. Brenner tumors do not contain psammoma bodies.
|AnswerC=Serous cystadenocarcinoma
|AnswerC=Serous cystadenocarcinoma
|AnswerCExp= Just under half of ovarian tumors are [[serous cystadenocarcinoma]]. They are malignant and frequently bilateral with [[Psammoma bodies]] appearing on histology.
|AnswerCExp=[[Serous cystadenocarcinoma]] is the most common malignant ovarian tumor. Similar to meningiomas, serous cystadenocarcinoma shows [[psammoma bodies]] on histology.
|AnswerD=Serous cystadenoma
|AnswerD=Serous cystadenoma
|AnswerDExp= Approximately 1/5 of ovarian tumors are [[serous cystadenoma]]. They are benign tumors and appear bilaterally. On microscopic examination serous [[cystadenoma]] are lined with fallopian tube-like epithelium.
|AnswerDExp=[[Serous cystadenoma]]s are benign tumors lined with fallopian tube-like epithelium. They do not contain psammoma bodies.
|AnswerE=Krukenberg tumor
|AnswerE=Krukenberg tumor
|AnswerEExp=A [[Krukenberg tumor]] is a malignant ovarian tumor resulting from GI malignancy metastasis, which causes a mucin-secreting signet cell adenocarcinoma.
|AnswerEExp=A [[Krukenberg tumor]] is a malignant ovarian tumor resulting from GI malignancy metastasis (gastric signet cell adenocarcinoma). Krukenberg tumors are characterized by signet ring cells; they do not contain psammoma bodies.
|EducationalObjectives=Psammoma bodies are products of dystrophic calcification that are found in meningiomas, papillary adenocarcinoma of the thyroid, serous papillary cystadenocarcinoma of the ovary, and malignant meningioma.
|References=Agrawal A, Mohan KVM, Shanthi V, Reddy U. Intracranial-extracranial meningioma mimicking an aggressive skull bone tumor. Rom Neu. 2013;20(4):389-393. '''(Image)'''<br>
Chi JH, Mcdermott MW. Tuberculum sellae meningiomas. Neurosurg Focus. 2003;14(6):e6.
|RightAnswer=C
|RightAnswer=C
|WBRKeyword=Psammoma bodies
|WBRKeyword=Psammoma bodies, Psammoma body, Meningioma, Serous cystadenocarcinoma, Ovarian tumors,
|Approved=Yes
|Approved=Yes
}}
}}

Latest revision as of 00:47, 28 October 2020
Author [[PageAuthor::Gonzalo A. Romero, M.D. [1] (Reviewed by Alison Leibowitz) (Reviewed by Serge Korjian)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathology
Sub Category SubCategory::Neurology, SubCategory::Oncology, SubCategory::Reproductive
Prompt [[Prompt::A 57-year-old man presents to the neurology clinic for a 2-month history of a slowly worsening visual disturbance. He explains that his primary care physician first noticed the issue during his annual check-up a week ago, after the patient complained of having difficulty noticing oncoming cars while driving. Physical examination reveals significant bitemporal hemianopsia. Following a thorough work-up, the neurologist diagnoses the patient with a sellar tumor. Transsphenoidal excision is done and a pathologic examination is obtained (shown below). Which of the following tumors is also associated with the same histologic features?

]]

Answer A AnswerA::Granulosa cell tumor
Answer A Explanation [[AnswerAExp::A granulosa cell tumor is a non-germ cell ovarian tumor histologically characterized by Call-Exner bodies, which are small follicles filled with eosinophilic secretions. Granulosa cell tumors do not contain psammoma bodies.]]
Answer B AnswerB::Brenner tumor
Answer B Explanation [[AnswerBExp::A brenner tumor is a benign and unilateral ovarian tumor characterized by clusters of cells resembling the transitional epithelium of the bladder with coffee bean shaped nuclei. Brenner tumors do not contain psammoma bodies.]]
Answer C AnswerC::Serous cystadenocarcinoma
Answer C Explanation [[AnswerCExp::Serous cystadenocarcinoma is the most common malignant ovarian tumor. Similar to meningiomas, serous cystadenocarcinoma shows psammoma bodies on histology.]]
Answer D AnswerD::Serous cystadenoma
Answer D Explanation [[AnswerDExp::Serous cystadenomas are benign tumors lined with fallopian tube-like epithelium. They do not contain psammoma bodies.]]
Answer E AnswerE::Krukenberg tumor
Answer E Explanation [[AnswerEExp::A Krukenberg tumor is a malignant ovarian tumor resulting from GI malignancy metastasis (gastric signet cell adenocarcinoma). Krukenberg tumors are characterized by signet ring cells; they do not contain psammoma bodies.]]
Right Answer RightAnswer::C
Explanation [[Explanation::The clinical presentation of this patient is consistent with a sellar tumor compressing the optic chiasm. Classically, more than 90% of sellar tumors are pituitary adenomas (secretory or non-secretory). Other masses that may have a very similar presentation include meningiomas, germinomas, pituitary abscesses, pituitary metastases, and arachnoid cysts. Tuberculum sellae meningiomas (TSM) usually arise in the midline of the tuberculum sellae and as they enlarge, abut and compress the optic chiasm causing temporal vision field loss. Unilateral vision involvement is more common initially but without adequate treatment almost all patients develop bitemporal hemianopsia. Approximately 95% of patients suffer visual deficits and 75-90% have optic atrophy. Other symptoms of tuberculum sellae meningiomas include headache, endocrinopathies, seizures, and altered mentation. TSMs are more common in women particularly in the fifth to sixth decade. On pathology, findings of laminated, concentric, calcific spherules known as Psammoma bodies, are consistent with the diagnosis of meningioma. These bodies arise from the dystrophic calcification of dead neoplastic cells. Psammoma bodies are also found in other neoplastic growths including papillary adenocarcinoma of the thyroid, serous papillary cystadenocarcinoma of the ovary, and malignant mesothelioma.

Educational Objective: Psammoma bodies are products of dystrophic calcification that are found in meningiomas, papillary adenocarcinoma of the thyroid, serous papillary cystadenocarcinoma of the ovary, and malignant meningioma.
References: Agrawal A, Mohan KVM, Shanthi V, Reddy U. Intracranial-extracranial meningioma mimicking an aggressive skull bone tumor. Rom Neu. 2013;20(4):389-393. (Image)
Chi JH, Mcdermott MW. Tuberculum sellae meningiomas. Neurosurg Focus. 2003;14(6):e6.]]

Approved Approved::Yes
Keyword WBRKeyword::Psammoma bodies, WBRKeyword::Psammoma body, WBRKeyword::Meningioma, WBRKeyword::Serous cystadenocarcinoma, WBRKeyword::Ovarian tumors
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