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NBME 22 Answers

nbme22/Block 3/Question#33

A 22-year-old man comes to the physician because of ...


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submitted by aesalmon(61),

Leydig cell hyperplasia, should also see fibrosis and hylinazation of the tubules but i'm not seeing it... ¯_(ツ)_/¯

meningitis  I think its there.. I thought it was the lighter red/pink material (hyaline material) And I thought the white streaks were the fibrosis like "streaked ovaries"in Turners. +  

 +2  upvote downvote
submitted by step1soon(24),

Testicular biopsies of adult males with Klinefelter syndrome are characterized by extensive fibrosis and hyalinization of the seminiferous tubules and hyperplasia of the interstitium; however, the tubules may show residual foci of spermatogenesis. Histologic findings may include small, firm testes with seminiferous tubular hyalinization; sclerosis; and atrophy with focal hyperplasia of mostly degenerated Leydig cells


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submitted by bubbles(45),

Has anybody found a good explanation for this histology? I genuinely have no idea what I'm looking at.

meningitis  This is common in Klinefelter.. think of the equivalent of Streaked ovaries seen in Turners. White streaks, red/pink material of hyaline, and hyperplasia of Leydig cells. Just remember: It doesn't look like normal structured testicle histology (No organized seminiferous tubules with Sertoli cells around) +8  
niboonsh  https://www.pathologyoutlines.com/topic/testisklinefelter.html these pictures are kinda similar +2  

I kind of reasoned through this by thinking that if they said "22 year old man" that means there has to be a Y in there in order for the person to be presumed male. That left options: 45X/46XY, 46XY, and 47XXY. Beyond that I thought that the picture didn't look normal (couldn't make out tubules or individual cells), so it couldn't be 46XY.

I figured 45X/46XY is a mosaic Turner, and I have no idea what a person with that genotype would look like, nor whether they would have testes, but I know that 47XXY would have testes because SRY is on chromosome Y which makes testes determining factor.