WBR0505

Author	[[PageAuthor::Gonzalo A. Romero, M.D. [1] (Reviewed by Alison Leibowitz) (Reviewed by Serge Korjian)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Neurology, SubCategory::Oncology, SubCategory::Reproductive
Prompt	[[Prompt::A 57-year-old man presents to the neurology clinic for a 2-month history of a slowly worsening visual disturbance. He explains that his primary care physician first noticed the issue during his annual check-up a week ago, after the patient complained of having difficulty noticing oncoming cars while driving. Physical examination reveals significant bitemporal hemianopsia. Following a thorough work-up, the neurologist diagnoses the patient with a sellar tumor. Transsphenoidal excision is done and a pathologic examination is obtained (shown below). Which of the following tumors is also associated with the same histologic features? ]]
Answer A	AnswerA::Granulosa cell tumor
Answer A Explanation	[[AnswerAExp::A granulosa cell tumor is a non-germ cell ovarian tumor histologically characterized by Call-Exner bodies, which are small follicles filled with eosinophilic secretions. Granulosa cell tumors do not contain psammoma bodies.]]
Answer B	AnswerB::Brenner tumor
Answer B Explanation	[[AnswerBExp::A brenner tumor is a benign and unilateral ovarian tumor characterized by clusters of cells resembling the transitional epithelium of the bladder with coffee bean shaped nuclei. Brenner tumors do not contain psammoma bodies.]]
Answer C	AnswerC::Serous cystadenocarcinoma
Answer C Explanation	[[AnswerCExp::Serous cystadenocarcinoma is the most common malignant ovarian tumor. Similar to meningiomas, serous cystadenocarcinoma shows psammoma bodies on histology.]]
Answer D	AnswerD::Serous cystadenoma
Answer D Explanation	[[AnswerDExp::Serous cystadenomas are benign tumors lined with fallopian tube-like epithelium. They do not contain psammoma bodies.]]
Answer E	AnswerE::Krukenberg tumor
Answer E Explanation	[[AnswerEExp::A Krukenberg tumor is a malignant ovarian tumor resulting from GI malignancy metastasis (gastric signet cell adenocarcinoma). Krukenberg tumors are characterized by signet ring cells; they do not contain psammoma bodies.]]
Right Answer	RightAnswer::C
Explanation	[[Explanation::The clinical presentation of this patient is consistent with a sellar tumor compressing the optic chiasm. Classically, more than 90% of sellar tumors are pituitary adenomas (secretory or non-secretory). Other masses that may have a very similar presentation include meningiomas, germinomas, pituitary abscesses, pituitary metastases, and arachnoid cysts. Tuberculum sellae meningiomas (TSM) usually arise in the midline of the tuberculum sellae and as they enlarge, abut and compress the optic chiasm causing temporal vision field loss. Unilateral vision involvement is more common initially but without adequate treatment almost all patients develop bitemporal hemianopsia. Approximately 95% of patients suffer visual deficits and 75-90% have optic atrophy. Other symptoms of tuberculum sellae meningiomas include headache, endocrinopathies, seizures, and altered mentation. TSMs are more common in women particularly in the fifth to sixth decade. On pathology, findings of laminated, concentric, calcific spherules known as Psammoma bodies, are consistent with the diagnosis of meningioma. These bodies arise from the dystrophic calcification of dead neoplastic cells. Psammoma bodies are also found in other neoplastic growths including papillary adenocarcinoma of the thyroid, serous papillary cystadenocarcinoma of the ovary, and malignant mesothelioma. Educational Objective: Psammoma bodies are products of dystrophic calcification that are found in meningiomas, papillary adenocarcinoma of the thyroid, serous papillary cystadenocarcinoma of the ovary, and malignant meningioma. References: Agrawal A, Mohan KVM, Shanthi V, Reddy U. Intracranial-extracranial meningioma mimicking an aggressive skull bone tumor. Rom Neu. 2013;20(4):389-393. (Image) Chi JH, Mcdermott MW. Tuberculum sellae meningiomas. Neurosurg Focus. 2003;14(6):e6.]]
Approved	Approved::Yes
Keyword	WBRKeyword::Psammoma bodies, WBRKeyword::Psammoma body, WBRKeyword::Meningioma, WBRKeyword::Serous cystadenocarcinoma, WBRKeyword::Ovarian tumors
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