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NBME 24 Answers

nbme24/Block 4/Question#34

A 55-year-old woman comes to the physician for a ...

Neuroendocrine cell

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submitted by neonem(334),

Since this patient is a non-smoker, it is less to be small cell carcinoma, squamous cell carcinoma, or large cell carcinoma of the lung. Besides small cell carcinoma being from neuroendocrine origin, the one major lung cancer described by nests of well-differentiated, "regular" cells is a carcinoid tumor. Additionally, rosettes are histological features of carcinoid tumors (fun fact: rosettes also in neuroblastomas/ependymomas (in CNS), retinoblastomas, granulosa cell tumors (ovarian cancer))

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 +2  
charcot_bouchard  I thought it was Hamartoma & pick chondrocyte! Can lung even have hamartoma? Pardon me it was the laast ques of whole nbme +1  
drmomo  @charcot_bouchard i thought the same. uworld gave a question on coin lesion in the lungs as classically hamartoma +  

Some other endocrine like cells and disorders for reference:

  1. Salt-and-pepper chromatin (fine granular cytoplasm) in Endocrine tumors:

  2. Medullary thyroid carcinoma

  3. neuroendocrine tumors and pheochromocytoma
  4. Carcinoid Tumor (serotonin) --- (also has sheets of uniform cells)
  5. Small Cell Carcinoma of lungs = Small, blue cells with scant cytoplasm and granular chromatin) = flat, oval-shaped cells with scant cytoplasm and hyperchromatic nuclei

  6. Small Blue Cells

  7. Ewing sarcoma (anaplastic malignant tumor)
  8. SCC of lungs
  9. flat, oval-shaped cells with scant cytoplasm and hyperchromatic nuclei
happysingh  i've never heard of " 6. Small Blue Cells" cancer / tumor / carcinoma .... +1  
niboonsh  might want to look at fa pg 665 +  

 +0  upvote downvote
submitted by susyars(1),

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

 +0  upvote downvote
submitted by yex(25),

I think they are referring to Kulchitsky cells = pulmonary neuroendocrine cells (PNEC). According to Wikipedia: Specialized airway epithelial cells that occur as solitary cells or as clusters called neuroepithelial bodies (NEB) in the lung. They are located in the nasal respiratory epithelium, laryngeal mucosa and throughout the entire respiratory tract from the trachea to the terminal airways. They can be the source of several types of lung cancer- most notably, small cell carcinoma of the lung, and bronchial carcinoid tumor.