Endocrine pathology: adrenal medulla: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Endocrine pathology: adrenal medulla

Sample item

A 35-year-old woman has episodic headache, palpitations and sweating with a blood pressure of 210/120 mmHg during attacks. A 4 cm adrenal mass is found. Histology is expected to show:

ASmall blue cells with rosettes and neurofibrilsBNests of chromaffin cells (Zellballen) with rich vascular networkCColloid-filled follicles lined by cuboidal cellsDSheets of lipid-rich cells with clear cytoplasm

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Nests of chromaffin cells (Zellballen) with rich vascular network

Phaeochromocytoma arises from chromaffin cells of the adrenal medulla and secretes catecholamines. Histology shows nests (Zellballen) of polygonal cells with granular cytoplasm separated by sustentacular cells and capillaries, which stain with chromogranin. Diagnosis is made by plasma or urinary metanephrines.

Option by option

A. Small blue cells with rosettes and neurofibrils
Small blue cells with rosettes describe neuroblastoma in children.
B. Nests of chromaffin cells (Zellballen) with rich vascular network (correct)
Correct. Nests of chromaffin cells with a capillary network are typical.
C. Colloid-filled follicles lined by cuboidal cells
Follicles with colloid are thyroid tissue.
D. Sheets of lipid-rich cells with clear cytoplasm
Lipid-rich clear cells are seen in adrenal cortical tumours.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is B, Nests of chromaffin cells (Zellballen) with rich vascular network. Phaeochromocytoma arises from chromaffin cells of the adrenal medulla and secretes catecholamines.

Why is "Small blue cells with rosettes and neurofibrils" not the answer?

Small blue cells with rosettes describe neuroblastoma in children.

Why is "Colloid-filled follicles lined by cuboidal cells" not the answer?

Follicles with colloid are thyroid tissue.

Why is "Sheets of lipid-rich cells with clear cytoplasm" not the answer?

Lipid-rich clear cells are seen in adrenal cortical tumours.

What concept does this question test?

It tests Endocrine pathology: adrenal medulla in Pathology. Histology shows nests (Zellballen) of polygonal cells with granular cytoplasm separated by sustentacular cells and capillaries, which stain with chromogranin. Diagnosis is made by plasma or urinary metanephrines.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrine pathology: adrenal medulla?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.