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NBME 24 Answers

nbme24/Block 4/Question#34 (49.3 difficulty score)
A 55-year-old woman comes to the physician ...
Neuroendocrine cell🔍

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submitted by neonem(556),
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iencS hits niatetp si a onenrokms,- ti is essl ot eb amlls lecl mcaiacno,r mqusuaos llec ncaoa,rcmi ro arelg lcel ancmacoir of het .ngul seeiBds lmals lelc oanacimrc ebnig mrfo rndocninreeueo gnroi,i teh eon jamro unlg eccnra deisercdb by entss of i-ieldltneefrfde,wat agre"ru"l lelsc si a incrocaid rotmu. ,diAtdalnilyo seosrett rae iclshgtloiao sferateu of niodicarc rsoutm (fnu cft:a eotstrse aslo ni surnloebnmpaeymosm/atedsoa (in NC),S alm,sanotiborest ruoalnasg lcel utmrso rio(anva rcaen)c)

mousie  When ever I hear Rosettes I always think NE tumors .... and I agree non smoking kind of RO small cell, squamous cell, or lg cell +4  
charcot_bouchard  I thought it was Hamartoma & pick chondrocyte! Can lung even have hamartoma? Pardon me it was the laast ques of whole nbme +7  
drmomo  @charcot_bouchard i thought the same. uworld gave a question on coin lesion in the lungs as classically hamartoma +7  
anbumd  From pathoma benign coin lesions such as bronchial hamartomas composed of lung tissue and cartilage are especially found in younger patients. So i guess because of the age and histology this would be less likely. +  

submitted by susyars(29),

Is it me or this question is worded weird?

“this cells are most likely to closely resemble which of the following types of normal respiratory tract cells“

Like, you dont have normally neuroendocrine cells in the lung

Maybe i miss understood this question, i knew exactly what they were talking about, but the way they set the last sentence really drives me LOCA

abhishek021196  They are talking about Kulchitsky cells = pulmonary neuroendocrine cells (PNEC). These are the cells from which NE tumors of the lung i.e. small cell ca arise from. +9  

submitted by usmleuser007(377),
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moeS oerht dnoerncie lkie scell nda iredssord rfo reeen:crfe

  1. pppne-eradt-Sla hamtocinr (nefi grualanr c)topsmaly in ioecnrEdn ursmto:

  2. auMlyedrl trhiydo miaonaccr

  3. nierrecnneouod ydehnoca ooctramoomusht rmp
  4. icdiCanro oruTm (tnero)sino --- a(lso hsa eshste fo imournf sllec)
  5. alSml elCl iaraoCncm of uslng = ll,amS uble llte hciws ctnas ypsoatlmc dan nrgaalur h anr)timc=o ltfa, e-aopvhldsa cl wshteil nastc splmaotcy nad rctyihcraepmoh niucle

  6. mllaS leBu llesC

  7. wignE oaramcs (nltsacaapi nagmantli )rtumo
  8. CCS fo sguln
  9. tlaf, hapvdla-eos lwl hscite tcasn caytpolsm dan timrpocaeryhhc nlcuie
happysingh  i've never heard of " 6. Small Blue Cells" cancer / tumor / carcinoma .... +1  
niboonsh  might want to look at fa pg 665 +  

submitted by yex(94),
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I hitnk yeth ear frirrgnee to hyutsiclkK lslec = plnmyuoar edreonircnoune llecs N.)PCE( cncdoAgir ot epd:iiaWki lpzeeaciSdi riaywa iaipetlelh cells atth coucr as aitrlyos selcl or as secrustl dcelal eilileuepntahor iboeds B)NE( in eht ung.l yheT ear laedoct in the lansa orrespyirta heiumlptie, langeayrl uasmoc and htotuugorh the neiter sayriterorp ctart fmro eth acetrah to eth eimnalrt ari.sywa hTey anc eb hte crsueo fo rasleve spety of ugln cn-cear tsom tlbno,ay allsm cell ocinrcmaa of eht nl,ug dna nchlroabi aiocridnc m.orut

submitted by sgary(0),

According to Pathoma, this is most likely carcinoid tumor, not small cell tumor w/ Kulchitsky cells as mentioned above. Carcinoid presents as well-differentiated, low mitoses, nest-like trabeculae, and secretory granules. Also explains her absence of smoking but presence of cancer.

I answered Goblet cells b/c I thought it was adenocarcinoma b/c non-smoker, female, and normal respiratory epithelium. Neuroendocrine cells aren't normal but what can you do?