WBR0505

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 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? pix200 ]]
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 it appear bilaterally. On microscopic examination serous cystadenoma are lined with fallopian tube-like epithelium.]]
Answer E	AnswerE::Kruckenberg tumor
Answer E Explanation	[[AnswerEExp::A Kruckenberg 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 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: Papillary adenocarcinoma of the thyroid Serous papillary cystadenocarcinoma of the ovary Meningioma Malignant mesothelioma WikiDoc Mnemonic: PSaMMoma : Papill ary (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 Educational Objective: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Psammoma bodies
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