Department of Pathology, University of Oklahoma Health Sciences Center

NeuroTest Sample Question #50 Next question Previous question

Answer: A (Metastatic adenocarcinoma) Level of difficulty: 2 NeuroTest NeuroLearn NeuroHelp

Discussion: 

• Metastatic adenocarcinoma: The background is necrotic and "dirty" looking. There is significant pleomorphism of nuclei and well defined nucleoli are common (Þ). Binucleated cells are also present. The cells are round and form small adhesive clusters. In contrast to glial cells, the cytoplasmic membrane is well defined. Some cells have large cytoplasmic vacuoles (Þ). Small vacuoles leading to a bubbly cytoplasm are present in other cells (Þ). These features are diagnostic of a metastatic adenocarcinoma.
• Secretory meningioma: The pleomorphism and necrotic background are unusual for a meningioma. Besides, the secretory globules can be several times the size of the nuclei. [Click here to see a cytologic preparation of a secretory meningioma]
• Metastatic melanoma: The cytoplasmic vacules essentially rule out this diagnosis. In addition, the nucleoli tend to be more prominent in many, but not all, metastatic melanoma.
• Glioblastoma and oligodendroglioma: The large bubbly globules go against a diagnosis of glial neoplasm including glioblastoma and oligodendroglioma.

Comment: KarMing-Fung@ouhsc.edu