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NBME 20 Answers

nbme20/Block 4/Question#42

A 65-year-old woman dies 6 months after the onset ...

Meningeal

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 +3  upvote downvote
submitted by johnthurtjr(43),

I'm not a fan of gross path images and questions that say "look, what is this thing?" - that said meningiomas are the most common brain tumor and this picture is is a good example of one. I had no idea what these things looked like and got it wrong, too. Take a look at this one

johnthurtjr  [Here's more info](http://www.pathologyoutlines.com/topic/cnstumormeningiomageneral.html) +  
meningitis  I got it wrong because I didn't see any apparent Dura mater nor other meninges (The veins aren't being covered by any "shiny layer"), so I thought the tumor was coming from inside the brain and not compressing it like meningiomas usually do. +  
meningitis  But it did follow the common aspect where they are found in between divisions of brain and are circular growths like a ball. +1  
nala_ula  Since it was basically implied that the patient died and "here look at what this is" I thought it was a malignant tumor (glioblastoma)... but I guess it's all about placement. +3  




 +0  upvote downvote
submitted by smit 24(0),

Clinical vignette is leading to GBM(astrocyte origin)....not sure about the gross picture.....

Don't know what if such questions appear on real exam😑😑😑

htballer55  I felt the same way. but if you look at autopsy pics on google, you see the meningioma is like a ball coming out of the meninges. compare that to glioblastoma which is within the brain in cerebral hemispheres. so it's mainly one tumor is coming out of the brain and the other is inside the cerebral hemispheres. that's the best i can come up with. but it's confusing +  




 -4  upvote downvote
submitted by thomas(3),

Answer is Astrocyte. Patient has glioblastoma multiforme. Although meningiomas may occur at convexities, meningiomas are benign and often asymptomatic. They may cause h/a seizures, but would be unlikely to cause death w/in 6m of onset of h/a. The size of tumor and course of illness is consistent with the course of GBM

masonkingcobra  Above is obviously incorrect because the answer is Meningeal lol. Here is a link to a good picture: http://neuropathology-web.org/chapter7/chapter7fMiscellaneous.html +1  
kernicterusthefrog  Obviously thomas is disagreeing with the presentation of the question, and I agreed with him! This absolutely sounds like GBM, with rapid onset leading to death, and the symptoms. The question stem leads you to GBM, and the gross image to meningioma (I guess). +1  
kernicterusthefrog  Furthermore, where are the meninges on the gross image form which this (meningioma) grew?! It should at least show the tissue from whence it came! +1  
nala_ula  Had the same problem, got confused since it appeared that the growth was malignant :( +  
sugaplum  FA 2019 pg 514, also agree with everyone. weird presentation. Glios are malignant death within 1 year, meningioma are often asymptomatic or have focal signs. just a gross pathology question at this point +