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NBME 22 Answers

nbme22/Block 3/Question#45
A 28-year-old man who is seropositive for HIV ...
Slit-like vascular spaces with plump spindle-shaped stromal cells­čöŹ

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 +15  upvote downvote
submitted by usmleuser007(273),

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
drdoom  @usmleuser007 to make lists display correctly, try using the plus sign (+) for each "bullet point"; that should work +1  
mcl  I love this and I love you +2  
usmleuser007  LOL thanks, had to ddo a lot of digging since "spindle cells" are commonly tested +1  



 +5  upvote downvote
submitted by drzed(87),

(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

(C) Intracellular yeasts in macrophages = histoplasmosis

(D) Macrophages containing acid-fast bacilli = mycobacterium

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




 +2  upvote downvote
submitted by mcl(447),

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

mcl  lul i don't know why i spell kaposi like that, my b +3  
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┬áVerocay 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 +4  



 +1  upvote downvote
submitted by enbeemee(11),

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

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  



 +0  upvote downvote
submitted by amy(0),

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?




 -1  upvote downvote
submitted by mdmikek89(-8),

Spindle cells....sarcoma or carcinoma

Kaposi *Sarcoma*...

Why y'all make this shit so complicated?

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



 -2  upvote downvote
submitted by d10s(1),

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.




 -6  upvote downvote
submitted by haliburton(171),

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

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



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