WBR0505

Author	[[PageAuthor::Gonzalo A. Romero, M.D. [1]]]
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 family history is insignificant. His wife denies any history of trauma or drug ingestion. The physician on call performs a thorough history and physical examination. His vitals are within normal limits. The physician encounters on neurological exam 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. Following 48 hours of admission the patient develops a Grand-mal seizure and undergoes respiratory arrest. Despite aggressive resuscitation measures the patient dies. The team on call is concerned about malpraxis and orders an autopsy with the wife’s consent. 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::Granulosa cell tumor is a non-germ cell ovarian tumor which secretes estrogens and can cause precocious puberty and can cause endometrial hyperplasia or carcinoma in adults. Histologically is characterized by Call-Exner bodies, which are small follicles filled with eosinophilic secretions. It can present with abnormal uterine bleeding.]]
Answer B	AnswerB::Brenner tumor
Answer B Explanation	[[AnswerBExp::Brenner tumor is a benign and unilateral ovarian tumor. It rises from the surface epithelial-stromal. Macroscopically is solid, pale yellow-tan in color and encapsulated. Histologically looks like bladder tissue and has "Coffee bean" nuclei on H&E.]]
Answer C	AnswerC::Serous cystadenocarcinoma
Answer C Explanation	[[AnswerCExp::It consists 45% of the ovarian tumors, malignant and frequently bilateral. Psammoma bodies seen on histology.]]
Answer D	AnswerD::Serous cystadenoma
Answer D Explanation	[[AnswerDExp::Serous cystadenoma represents 20 % of the ovarian tumors. It is a benign tumor and it appears bilaterally. Histologically it is lined with fallopian tube-like epithelium.]]
Answer E	AnswerE::Kruckenberg tumor
Answer E Explanation	[[AnswerEExp::It is a malignant ovarian tumor due to a GI malignancy metastasis which causes a mucin-secreting signet cell adenocarcinoma.]]
Right Answer	RightAnswer::C
Explanation	[[Explanation::This patient is presenting with visual hallucinations and visual deficits which have been worsened over time and right hemianopsia with macular sparing, on CT scan a tumor rising from the occipital region of the meninges correlate with the clinical findings. The histo-pathologic findings of laminated, concentric, calcific spherules are also known as Psammoma bodies which are diagnostic for a meningioma compressing the occipital lobe. Psammoma bodies are also found in: Papillary adenocarcinoma of thyroid Serous papillary cystadenocarcinoma of the ovary Meningioma Malignant mesothelioma Educational Objective: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Psammoma bodies
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::