WBR0505: Difference between revisions

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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 presents to the ER with visual deficits. His 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 are concerned that this may result from a stroke or tumor. A CT scan displays a mass in the posterior fossa.  Forty-eight hours following his admission, the patient has a Grand-mal seizure and develops respiratory distress.  Despite aggressive resuscitation measures, the patient dies. Concerned about malpraxis, you order an autopsywhich discloses a tumor arising from the membranes enveloping the brain. The picture below displays a sample of the tumor under the microscope. Which of the following ovarian tumors is also associated with the histologic features 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 suprasellar 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 worsening hallucinations and right hemianopsia with macular sparing. The CT scan displays a tumor rising from the occipital region of the meninges, which correlates with the described scenario. 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=This patient presents with worsening hallucinations and right hemianopsia with macular sparing. The CT scan displays a tumor rising from the occipital region of the meninges, which correlates with the described scenario. 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:
* Papillary adenocarcinoma of the thyroid
* Papillary adenocarcinoma of the thyroid
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* '''M'''esothelioma
* '''M'''esothelioma
* + '''oma'''
* + '''oma'''
|EducationalObjectives= 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 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.
|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.  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.
|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=Just under half of ovarian tumors are [[serous cystadenocarcinoma]]. They are malignant and frequently bilateral with [[Psammoma bodies]] appearing 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=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.
|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, which causes a mucin-secreting signet cell adenocarcinoma.
|EducationalObjectives=Psammoma bodies are often present in meningiomas within the central nervous system.
|References=First Aid 2013 reproductive chapter
|RightAnswer=C
|RightAnswer=C
|WBRKeyword=Psammoma bodies
|WBRKeyword=Psammoma bodies
|Approved=Yes
|Approved=Yes
}}
}}

Revision as of 20:30, 12 November 2014
Author [[PageAuthor::Gonzalo A. Romero, M.D. [1] (Reviewed by Alison Leibowitz)]]
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 suprasellar 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 which secretes estrogen and can cause precocious puberty in children and endometrial hyperplasia and carcinoma in adults. Histologically Granulosa cell tumors are characterized by Call-Exner bodies, which are small follicles filled with eosinophilic secretions. It often presents with abnormal uterine bleeding.]]
Answer B AnswerB::Brenner tumor
Answer B Explanation [[AnswerBExp::A Brenner tumor is a benign and unilateral ovarian tumor. It originates from the surface epithelial-stromal. Macroscopically Brenner tumors are solid, pale yellow-tan and encapsulated. Histologically Brenner tumors contains clusters of cells resembling transitional epithelium of the bladder with "coffee bean" shaped nuclei.]]
Answer C AnswerC::Serous cystadenocarcinoma
Answer C Explanation [[AnswerCExp::Just under half of ovarian tumors are serous cystadenocarcinoma. They are malignant and frequently bilateral with Psammoma bodies appearing on histology.]]
Answer D AnswerD::Serous cystadenoma
Answer D Explanation [[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.]]
Answer E AnswerE::Krukenberg tumor
Answer E Explanation [[AnswerEExp::A Krukenberg tumor is a malignant ovarian tumor resulting from GI malignancy metastasis, which causes a mucin-secreting signet cell adenocarcinoma.]]
Right Answer RightAnswer::C
Explanation [[Explanation::This patient presents with worsening hallucinations and right hemianopsia with macular sparing. The CT scan displays a tumor rising from the occipital region of the meninges, which correlates with the described scenario. 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:
  • Papillary adenocarcinoma of the thyroid
  • Serous papillary cystadenocarcinoma of the ovary
  • Meningioma
  • Malignant mesothelioma

WikiDoc Mnemonic: PSaMMoma :

  • Papillary (thyroid)
  • Serous (ovary)
  • Meningioma
  • Mesothelioma
  • + oma

Educational Objective: Psammoma bodies are often present in meningiomas within the central nervous system.
References: First Aid 2013 reproductive chapter]]

Approved Approved::Yes
Keyword WBRKeyword::Psammoma bodies
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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