CLASSIC LAB/FINDING IV

Question 1

Pseudopalisading tumor cells on brain biopsy

Answer 1

Glioblastoma multiforme

Question 2

Circular grouping of dark tumor cells surrounding pale

neurofibrils

Answer 2

Homer-Wright rosettes (neuroblastoma, medulloblastoma)

Question 3

“Waxy” casts with very low urine flow

Answer 3

Chronic end-stage renal disease

Question 4

Nodular hyaline deposits in glomeruli

Answer 4

Kimmelstiel-Wilson nodules (diabetic nephropathy)

Question 5

Podocyte fusion or “effacement” on electron microscopy

Answer 5

Minimal change disease (child with nephrotic syndrome)

Question 6

“Spikes” on basement membrane, “dome-like”

subepithelial deposits

Answer 6

Membranous nephropathy (nephrotic syndrome)

Question 7

RBC casts in urine

Answer 7

Glomerulonephritis

Question 8

“Tram-track” appearance of capillary loops of glomerular

basement membranes on light microscopy

Answer 8

Membranoproliferative glomerulonephritis

Question 9

Anti–glomerular basement membrane antibodies

Answer 9

Goodpasture syndrome (glomerulonephritis and
hemoptysis)

Question 10

Cellular crescents in Bowman capsule

Answer 10

Rapidly progressive (crescentic) glomerulonephritis

Question 11

“Wire loop” glomerular capillary appearance on light

microscopy

Answer 11

Diffuse proliferative glomerulonephritis (usually seen with lupus)

Question 12

Linear appearance of IgG deposition on glomerular and

alveolar basement membranes

Answer 12

Goodpasture syndrome

Question 13

“Lumpy bumpy” appearance of glomeruli on immunofluorescence

Answer 13

Poststreptococcal glomerulonephritis (due to deposition of IgG, IgM, and C3)

Question 14

Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis

Answer 14

Granulomatosis with polyangiitis (Wegener; PR3-ANCA/ c-ANCA) and Goodpasture syndrome (anti–basement
membrane antibodies)

Question 15

Thyroid-like appearance of kidney

Answer 15

Chronic pyelonephritis (usually due to recurrent infections)

Question 16

WBC casts in urine

Answer 16

Acute pyelonephritis

Question 17

Renal epithelial casts in urine

Answer 17

Intrinsic renal failure (eg, ischemia or toxic injury)

Question 18

hCG elevated

Answer 18

Choriocarcinoma, hydatidiform mole (occurs with and

without embryo, and multiple pregnancy)

Question 19

Dysplastic squamous cervical cells with “raisinoid” nuclei

and hyperchromasia

Answer 19

Koilocytes (HPV: predisposes to cervical cancer)

Question 20

Disarrayed granulosa cells arranged around collections of

eosinophilic fluid

Answer 20

Call-Exner bodies (granulosa cell tumor of the ovary)

Question 21

“Chocolate cyst” of ovary

Answer 21

Endometriosis (frequently involves both ovaries)

Question 22

Mammary gland (“blue domed”) cyst

Answer 22

Fibrocystic change of the breast

Question 23

Glomerulus-like structure surrounding vessel in germ

cells

Answer 23

Schiller-Duval bodies (yolk sac tumor)

Question 24

Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells

Answer 24

Reinke crystals (Leydig cell tumor)

Question 25

Thrombi made of white/red layers

Answer 25

Lines of Zahn (arterial thrombus, layers of platelets/

RBCs)

Question 26

Hexagonal, double-pointed, needle-like crystals in

bronchial secretions

Answer 26

Bronchial asthma (Charcot-Leyden crystals: eosinophilic
granules)

Question 27

Desquamated epithelium casts in sputum

Answer 27

Curschmann spirals (bronchial asthma; can result in whorled mucous plugs)

Question 28

“Honeycomb lung” on x-ray or CT

Answer 28

Idiopathic pulmonary fibrosis

Question 29

Colonies of mucoid Pseudomonas in lungs

Answer 29

Cystic fibrosis (autosomal recessive mutation in CFTR
gene  fat-soluble vitamin deficiency and mucous plugs)

Question 30

Iron-containing nodules in alveolar septum

Answer 30

Ferruginous bodies (asbestosis: chance of lung cancer)

Question 31

Bronchogenic apical lung tumor on imaging

Answer 31

Pancoast tumor (can compress cervical sympathetic chain and cause Horner syndrome)