WBR0863: Difference between revisions

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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor= {{SSK}} (Reviewed by Will Gibson & Serge Korjian)
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Pulmonology
|SubCategory=Pulmonology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Pulmonology
|SubCategory=Pulmonology
|Prompt=A 82 year old retired marine corps veteran presents to the pulmonary clinic for 2 weeks of unremitting cough and pleuritic chest pain. The patient reports a 20 pound unintentional weight loss in the past 2 months and slowly increasing dyspnea. Due to the high suspicion for malignancy the physician orders a CT scan that shows obliteration of parts of the diaphragm with diffuse nodular thickening of the pleura. He admits the patient for a diagnostic biopsy. The pathologist notices several whorl-like structures on biopsy shown below. What pathologic mechanism is responsible for the formation of these structures?
|Prompt=A 82-year-old retired marine corps veteran presents to the pulmonary clinic for 2 weeks of unremitting cough and pleuritic chest pain. The patient reports a 20 pound unintentional weight loss in the past 2 months and slowly increasing dyspnea. Due to the high suspicion for malignancy the physician orders a CT scan that shows obliteration of parts of the diaphragm with diffuse nodular thickening of the pleura. He admits the patient for a diagnostic biopsy. The pathologist notices several whorl-like structures on biopsy shown below. What pathologic mechanism is responsible for the formation of these structures?




[[Image:WBR0863.jpg|450px]]
[[Image:WBR0863.jpg|450px]]
|Explanation=Mesothelioma is a malignant tumor of the lung pleura associated with exposure to asbestos. Typically patients present with dyspnea, pleuritic chest pain, and weight loss. Patients can also have significant pleural effusions that are often hemorrhagic. Pathologically the tumor begins as discrete thickened plaques along the pleura that eventually coalesce into a single neoplasm. A characteristic finding in mesothelioma is psammoma bodies. Psammoma bodies are whorl shaped structures composed of calcium that are the result of tumor cell necrosis with associated dystrophic calcification. Psammoma bodies can be seen in other tumors as well including papillary thyroid carcinoma, ovarian serous cystadenocarcinoma, and meningioma.
|Explanation=Mesothelioma is a malignant tumor of the lung pleura associated with exposure to asbestos. Typically patients present with dyspnea, pleuritic chest pain, and weight loss. Patients can also have significant pleural effusions that are often hemorrhagic. Pathologically the tumor begins as discrete thickened plaques along the pleura that eventually coalesce into a single neoplasm. A characteristic finding in mesothelioma is psammoma bodies. Psammoma bodies are whorl shaped structures composed of calcium that are the result of tumor cell necrosis with associated dystrophic calcification. Psammoma bodies can be seen in other tumors as well including papillary thyroid carcinoma, ovarian serous cystadenocarcinoma, and meningioma. Tumors that cause psammoma bodies are memorized by the mnemonic '''PSaMMoma''': Papillary thyroid cancer - Serous cystadenocarcinoma of the ovaries - Meningioma - Mesothelioma
 
 
Learning objective: Psammoma bodies are formed due to tumor cell necrosis and dystrophic calcification.
 
 
Reference:
 
Kubota T, Sato K, Yamamoto S, Hirano A. Ultrastructural study of the formation of psammoma bodies in fibroblastic meningioma. J Neurosurg. 1984;60(3):512-7.
|AnswerA=Tumor cell proliferation
|AnswerA=Tumor cell proliferation
|AnswerAExp=This is not the mechanism involved in the formation of psammoma bodies.
|AnswerAExp=This is not the mechanism involved in the formation of psammoma bodies.
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|AnswerE=Tumor cell necrosis with dystrophic calcification
|AnswerE=Tumor cell necrosis with dystrophic calcification
|AnswerEExp=Psammoma bodies are calcium structures formed due to tumor cell necrosis and dystrophic calcification.
|AnswerEExp=Psammoma bodies are calcium structures formed due to tumor cell necrosis and dystrophic calcification.
|EducationalObjectives=Psammoma bodies are formed due to tumor cell necrosis and dystrophic calcification.
|References=Kubota T, Sato K, Yamamoto S, Hirano A. Ultrastructural study of the formation of psammoma bodies in fibroblastic meningioma. J Neurosurg. 1984;60(3):512-7.
|RightAnswer=E
|RightAnswer=E
|WBRKeyword=Psammoma bodies, Mesothelioma, Dystrophic calcification
|WBRKeyword=Psammoma bodies, Mesothelioma, Dystrophic calcification
|Approved=No
|Approved=Yes
}}
}}

Latest revision as of 01:55, 28 October 2020

 
Author [[PageAuthor::Serge Korjian M.D. (Reviewed by Will Gibson & Serge Korjian)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathology
Sub Category SubCategory::Pulmonology
Prompt [[Prompt::A 82-year-old retired marine corps veteran presents to the pulmonary clinic for 2 weeks of unremitting cough and pleuritic chest pain. The patient reports a 20 pound unintentional weight loss in the past 2 months and slowly increasing dyspnea. Due to the high suspicion for malignancy the physician orders a CT scan that shows obliteration of parts of the diaphragm with diffuse nodular thickening of the pleura. He admits the patient for a diagnostic biopsy. The pathologist notices several whorl-like structures on biopsy shown below. What pathologic mechanism is responsible for the formation of these structures?


]]

Answer A AnswerA::Tumor cell proliferation
Answer A Explanation AnswerAExp::This is not the mechanism involved in the formation of psammoma bodies.
Answer B AnswerB::Tumor cell apoptosis and structured accumulation
Answer B Explanation AnswerBExp::This is not the mechanism involved in the formation of psammoma bodies. Apoptosis is usually inhibited in tumor cells.
Answer C AnswerC::Tumor cell destruction by the activated T-cells
Answer C Explanation AnswerCExp::This is not the mechanism involved in the formation of psammoma bodies.
Answer D AnswerD::Tumor cell de-differentiation and invasion
Answer D Explanation AnswerDExp::This is not the mechanism involved in the formation of psammoma bodies.
Answer E AnswerE::Tumor cell necrosis with dystrophic calcification
Answer E Explanation AnswerEExp::Psammoma bodies are calcium structures formed due to tumor cell necrosis and dystrophic calcification.
Right Answer RightAnswer::E
Explanation [[Explanation::Mesothelioma is a malignant tumor of the lung pleura associated with exposure to asbestos. Typically patients present with dyspnea, pleuritic chest pain, and weight loss. Patients can also have significant pleural effusions that are often hemorrhagic. Pathologically the tumor begins as discrete thickened plaques along the pleura that eventually coalesce into a single neoplasm. A characteristic finding in mesothelioma is psammoma bodies. Psammoma bodies are whorl shaped structures composed of calcium that are the result of tumor cell necrosis with associated dystrophic calcification. Psammoma bodies can be seen in other tumors as well including papillary thyroid carcinoma, ovarian serous cystadenocarcinoma, and meningioma. Tumors that cause psammoma bodies are memorized by the mnemonic PSaMMoma: Papillary thyroid cancer - Serous cystadenocarcinoma of the ovaries - Meningioma - Mesothelioma

Educational Objective: Psammoma bodies are formed due to tumor cell necrosis and dystrophic calcification.
References: Kubota T, Sato K, Yamamoto S, Hirano A. Ultrastructural study of the formation of psammoma bodies in fibroblastic meningioma. J Neurosurg. 1984;60(3):512-7.]]

Approved Approved::Yes
Keyword WBRKeyword::Psammoma bodies, WBRKeyword::Mesothelioma, WBRKeyword::Dystrophic calcification
Linked Question Linked::
Order in Linked Questions LinkedOrder::