BCSE Pathology 4 — Questions and Answers
Question 1: A 50-year-old smoker presents with a central lung mass. Biopsy shows small cells with scant cytoplasm, 'salt and pepper' chromatin, and neurosecretory granules. This tumor most commonly secretes which paraneoplastic product?
- PTH-related peptide
- ACTH or ADH (Correct answer)
- Calcitonin
- Serotonin
Correct answer: ACTH or ADH
Small cell lung carcinoma is a neuroendocrine tumor that most commonly causes paraneoplastic syndromes by ectopically secreting ACTH (causing Cushing syndrome) or ADH (causing SIADH).
Question 2: Microscopically, an atherosclerotic plaque contains foam cells. These foam cells are derived from which cell type?
- Smooth muscle cells
- Neutrophils
- Macrophages (Correct answer)
- Endothelial cells
Correct answer: Macrophages
Foam cells in atherosclerotic plaques are lipid-laden macrophages that have engulfed oxidized LDL via scavenger receptors.
Question 3: A 3-year-old child presents with hematuria, a flank mass, and hypertension. Nephrectomy reveals a tumor with blastemal, stromal, and epithelial components. What is the diagnosis?
- Neuroblastoma
- Renal cell carcinoma
- Wilms tumor (nephroblastoma) (Correct answer)
- Rhabdomyosarcoma
Correct answer: Wilms tumor (nephroblastoma)
Wilms tumor (nephroblastoma) is the most common renal malignancy in children and characteristically shows triphasic histology with blastemal, stromal, and epithelial elements.
Question 4: A patient with chronic myeloid leukemia (CML) has the Philadelphia chromosome. This translocation creates which fusion oncogene?
- BCL2-IGH
- BCR-ABL1 (Correct answer)
- PML-RARA
- EWS-FLI1
Correct answer: BCR-ABL1
The Philadelphia chromosome results from t(9;22) translocation, creating the BCR-ABL1 fusion gene that encodes a constitutively active tyrosine kinase.
Question 5: Which chemical mediator is primarily responsible for the increased vascular permeability seen in the immediate phase of acute inflammation?
- Leukotriene B4
- Histamine (Correct answer)
- Interleukin-1
- C-reactive protein
Correct answer: Histamine
Histamine released from mast cells is the primary mediator of the immediate (seconds to minutes) increase in vascular permeability in acute inflammation.
Question 6: A 60-year-old woman develops bone pain and hypercalcemia. X-ray shows 'punched-out' lytic lesions. Bone marrow biopsy shows >10% plasma cells. Serum protein electrophoresis shows an M-spike. What is the diagnosis?
- Metastatic breast cancer
- Multiple myeloma (Correct answer)
- Waldenstrom macroglobulinemia
- Chronic lymphocytic leukemia
Correct answer: Multiple myeloma
Multiple myeloma presents with CRAB criteria (hypercalcemia, Renal failure, Anemia, Bone lesions) and clonal plasma cells producing a monoclonal immunoglobulin M-spike.
Question 7: A 45-year-old man presents with episodic hypertension, headache, palpitations, and diaphoresis. 24-hour urine shows elevated catecholamines. This tumor arises from which cells?
- Zona glomerulosa cells
- Chromaffin cells of the adrenal medulla (Correct answer)
- Chief cells of the parathyroid
- Parafollicular C cells of the thyroid
Correct answer: Chromaffin cells of the adrenal medulla
Pheochromocytoma arises from chromaffin cells of the adrenal medulla and secretes excess catecholamines causing episodic hypertension.
BCSE Pathology 4
A 50-year-old smoker presents with a central lung mass.
Biopsy shows small cells with scant cytoplasm, 'salt and pepper' chromatin, and neurosecretory granules.
This tumor most commonly secretes which paraneoplastic product?