CNS, Endocrine & Bone Pathology

Topics in this chapter

• CNS Vascular Pathology
• CNS Tumors and Neuro-Oncology
• Thyroid and Autoimmune Disorders
• Pituitary and Parathyroid Pathology
• Bone Tumors and Osteosarcoma
• Metabolic and Degenerative Bone Disease

Practice questions

1. Question 1Q-9C7B76

   A 45-year-old man presents with progressive bitemporal hemianopsia and signs of panhypopituitarism. Magnetic resonance imaging reveals a large suprasellar cystic mass containing thick, machine-oil-like fluid and areas of calcification. Histological examination shows nests and cords of stratified squamous epithelium with palisading basal cells and wet keratin. Which of the following is the most likely diagnosis?

   1. A.Pituitary adenoma
   2. B.Craniopharyngioma (adamantinomatous type)
   3. C.Rathke cleft cyst
   4. D.Meningioma
   See the answer and solution
2. Question 2Q-634F1C

   A 55-year-old woman presents with severe fatigue, weight gain, cold intolerance, and constipation. Laboratory tests show low free T4 and significantly elevated TSH. Histological evaluation of her thyroid gland demonstrates a dense mononuclear infiltrate composed of lymphocytes and plasma cells with germinal center formation, along with oxyphilic metaplasia (Hürthle cells) of the follicular epithelium. What is the most likely diagnosis?

   1. A.Subacute granulomatous thyroiditis
   2. B.Hashimoto thyroiditis
   3. C.Riedel thyroiditis
   4. D.Graves disease
   See the answer and solution
3. Question 3Q-915D7B

   A 60-year-old chronic smoker presents with a progressively worsening headache and a single seizure episode. Brain imaging reveals a well-circumscribed, ring-enhancing cortical mass in the frontal lobe with extensive surrounding vasogenic edema. Stereotactic biopsy shows highly cellular glial tumor tissue with pseudopalisading necrosis and microvascular proliferation. Immunohistochemistry is positive for IDH1-R132H mutation. Which of the following is the final World Health Organization (WHO) CNS grade for this tumor?

   1. A.WHO Grade 1
   2. B.WHO Grade 2
   3. C.WHO Grade 3
   4. D.WHO Grade 4
   See the answer and solution
4. Question 4Q-0780A6

   A 30-year-old pregnant woman presents with palpitations, heat intolerance, weight loss, and fine tremors. Laboratory tests confirm hyperthyroidism. Gross examination of the resected thyroid gland shows diffuse, symmetric enlargement. Microscopic examination reveals tall, crowded follicular cells forming papillary infoldings into the colloid, with scalloping of the margins of the colloid. Which of the following autoantibodies is primarily responsible for this disorder?

   1. A.Anti-thyroperoxidase (Anti-TPO)
   2. B.Anti-thyroglobulin
   3. C.Thyroid-stimulating immunoglobulin (TSI)
   4. D.Anti-TSH receptor blocking antibody
   See the answer and solution
5. Question 5Q-C3F8B9

   A 10-year-old boy presents with unsteady gait, frequent stumbling, and behavioral changes. Magnetic resonance imaging shows a large cystic cerebellar mass with a mural nodule. Histological examination reveals bipolar cells with long, thin hair-like processes (Rosenthal fibers) and eosinophilic granular bodies. Which of the following is the most likely diagnosis?

   1. A.Medulloblastoma
   2. B.Pilocytic astrocytoma
   3. C.Ependymoma
   4. D.Subependymoma
   See the answer and solution