Neoplasia: thyroid carcinomas: 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 · Neoplasia: thyroid carcinomas

Sample item

A 28-year-old woman has a thyroid nodule with an enlarged cervical lymph node. FNAC shows overlapping, optically clear nuclei with grooves and intranuclear pseudoinclusions. Which genetic alteration is the most common in this tumour?

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

The answer and the reasoning

A. BRAF V600E point mutation

These nuclear features, often called Orphan Annie eye nuclei, define papillary thyroid carcinoma, which also shows psammoma bodies and spreads by lymphatics. BRAF V600E is its commonest mutation. Prognosis is excellent, and radioiodine ablation and TSH suppression are used after thyroidectomy.

Option by option

  • A. BRAF V600E point mutation (correct)

    BRAF V600E is the most frequent driver mutation in papillary thyroid carcinoma.

  • B. TP53 inactivation

    TP53 inactivation is characteristic of anaplastic thyroid carcinoma.

  • C. RET germline point mutation

    Germline RET point mutations cause MEN 2 and medullary thyroid carcinoma.

  • D. PAX8-PPARG fusion

    PAX8-PPARG fusion is associated with follicular thyroid carcinoma.

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.

More Pathology questions

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is A, BRAF V600E point mutation. These nuclear features, often called Orphan Annie eye nuclei, define papillary thyroid carcinoma, which also shows psammoma bodies and spreads by lymphatics.

Why is "TP53 inactivation" not the answer?

TP53 inactivation is characteristic of anaplastic thyroid carcinoma.

Why is "RET germline point mutation" not the answer?

Germline RET point mutations cause MEN 2 and medullary thyroid carcinoma.

Why is "PAX8-PPARG fusion" not the answer?

PAX8-PPARG fusion is associated with follicular thyroid carcinoma.

What concept does this question test?

It tests Neoplasia: thyroid carcinomas in Pathology. BRAF V600E is its commonest mutation. Prognosis is excellent, and radioiodine ablation and TSH suppression are used after thyroidectomy.

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 Neoplasia: thyroid carcinomas?

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.