NBME 22 Slit-like vascular spaces with plump spindle-shaped stromal cells (NBME Answers)

Retired NBME 22 Answers

nbme22/Block 3/Question#45 (reveal difficulty score)
A 28-year-old man who is seropositive for HIV ...
Slit-like vascular spaces with plump spindle-shaped stromal cells 🔍 / 📺 / 🌳 / 📖
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+24 upvote downvote
submitted by ∗usmleuser007(464)

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my list of spindle type cells and conditions:

a. NF-1
b. NF-2 ~ Schwannoma (Antoni A) = Cutaneous neurofibroma ~ high cellularity (w/ palisading patterns with interspersing nuclear-free zones called Verocay bodies
c. Leiomyoma (uterus & esophagus)
d. Mesothelioma (cytokeratin positive)
e. Anaplastic Thyroid cancer (biphasic & along with giant cells)
f. Medullary Thyroid cancer (can also have polygonal cells)
g. Primary cardiac angiosarcoma (malignant vascular spindle cells)
h. Osteosarcoma (bone cancer) (pleomorphic cells)
i. Meningioma
j. Kaposi's Sarcoma (HHV-8) = Slit-like vascular spaces with plump spindle-shaped stromal cells

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drdoom @usmleuser007 to make lists display correctly, try using the plus sign (+) for each "bullet point"; that should work +2

mcl I love this and I love you +10

usmleuser007 LOL thanks, had to ddo a lot of digging since "spindle cells" are commonly tested +3

leaf_house @uslmeuser007 "MAMML PONNK" is the best I can do with that +1

an1 FLOCK MAMa (neuroFibromatosis 1 + 2, Leimyoma, Osteosarcoma, Cardiac angiosarcoma, Kaposi, Medullary Thyroid, Anaplastic Thyroid, Meningioma) +1

l0ud_minority Also Buzz word for Kaposi's sarcoma is SPINDLE +

+16 upvote downvote
submitted by ∗drzed(333)

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(A) aggregates of large atypical lymphocytes = infectious mononucleosis (CD8+ T cells responding to EBV infection in CD21+ B cells)

(B) Granulation tissue containing pseudohyphae and budding yeasts = candidiasis

(D) Macrophages containing acid-fast bacilli = mycobacterium

(E) Multinuclear cells containing intranuclear inclusions = cytomegalovirus (or most members of the herpesvirus family)

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umpalumpa Great explanation! I thought that "aggregates of atypical lymphocytes" means lymphoma, because atypical lymphocytes (mono/mono-like infections) are present in the blood and I can't picture an AGREGATE of atypical lymphocytes in the blood. +

+3 upvote downvote
submitted by ∗jessikasanz(9)

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Don't overthink this one. Kaposi sarcoma activates VEGF, so correct answer will refer to vessels. You sketchy peeps out there, think of the VEGF fertilizer with the red hose (representing vessel formation).

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weirdmed51 You mesmerize me :o +

+3 upvote downvote
submitted by ∗mcl(671)

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To expand on this, pathologyoutlines describes the histology of kapowsi sarcoma as "spindle cells forming slits with extravasated red blood cells"

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mcl lul i don't know why i spell kaposi like that, my b +12

bubbles This site is super helpful. Thanks for sharing :) +

mcl yesssssss ofc <3 I love path outlines +

usmleuser007 Just realize that spindle cells are similar to the endothelial cells of blood vessels. Anything that have vessel association might have spindle-shaped cells. a. NF-1 b. NF-2 ~ Schwannoma (Antoni A) = Cutaneous neurofibroma ~ high cellularity (w/ palisading patterns with interspersing nuclear-free zones called Verocay bodies c. Leiomyoma (uterus & esophagus) d. Mesothelioma (cytokeratin positive) e. Anaplastic Thyroid cancer (biphasic & along with giant cells) f. Medullary Thyroid cancer (can also have polygonal cells) g. Primary cardiac angiosarcoma (malignant vascular spindle cells) h. Osteosarcoma (bone cancer) (pleomorphic cells) i. Meningioma j. Kaposi's Sarcoma (HHV-8) = Slit-like vascular spaces with plump spindle-shaped stromal cells +6

+2 upvote downvote
submitted by ∗amy(4)

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HHV8 belongs to Herpesviridae family. Is it true that all members of this family have multinucleate cell with intranuclear inclusion body? HSV and VZV(cowry type A inclusion), EBV and CMV(owl-eye internuclear inclusion) certainly have them. Did anyone pick E for this reason?

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+1 upvote downvote
submitted by enbeemee(12)

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sketchy says that kaposi's has infiltrating lymphocytes, so why would large aggregates of atypical lymphocytes be incorrect?

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titanesxvi Bcz I think vascular is the key thing here, whereas atypical lynphocytes would be more of EBV +2

d10s the lymphocytes seen in kaposi sarcoma are not atypical. +3

-3 upvote downvote
submitted by ∗mdmikek89(6)

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Spindle cells....sarcoma or carcinoma

Kaposi *Sarcoma*...

Why y'all make this shit so complicated?

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drdoom This explanation only begs the question. (It's a tautology.) +1

-3 upvote downvote
submitted by d10s(0)

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Kaposi sarcoma can sometimes be confused with bacillary angiomatosis, except in bacillary angiomatosis there will be neutrophilic infiltrate while in Kapsoi sarcoma it will be lymphocytic infiltrate.

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-8 upvote downvote
submitted by ∗haliburton(224)

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kaposi sarcoma. HHV8. violaceous (purple) lesions. advanced HIV CD4 < 200 (WHO).

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yotsubato Yeah thats the easy part. But the histology is whats hard +

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