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NBME 25 Answers

nbme25/Block 2/Question#50 (reveal difficulty score)
A 30-year-old man comes to the office because ...
Apoptosis caused by activation of the death receptor extrinsic pathway ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ
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submitted by โˆ—shak360(14)

An intensely eosinophilic globule in the liver is a Councilman body that is indicative of an underlying hepatic disease, viral Hepatitis (usually Hepatitis A), or Yellow fever. This represents a hepatocyte undergoing APOPTOSIS.

Recall that Yello Fever is caused by flavivirus/arbovirus transmitted by the Aedes mosquito causing black vomitus, jaundiced eyes, and the Councilman bodies (intensely eosinophilic apoptotic globules in the liver).

To also answer this question, one had to know that apoptosis caused by activation of the mitochondrial intrinsic pathway is triggered by cellular damage such as radiation, oxidative damage, ischemia, or toxin exposure and leads to release of cytochrome C from mitochondria. Cytochrome C in turn leads to the activation of caspase enzymes. Viral hepatitis primarily leads to apoptosis through the extrinsic rather than the intrinsic pathway.


Intranuclear eosinophilic droplet-like bodies ~> Cowdry Type A bodies seen in HSV

Eosinophilic inclusion bodies in the cytoplasm of neurons of the hippocampus and cerebellum ~> Negri bodies of Rabies

Eosinophilic cytoplasmic inclusions in liver cell ~> Mallory bodies (alcoholic liver disease)

Eosinophilic cytoplasmic inclusions in neurons ~> Lewy bodies (Parkinson disease and Lewy body dementia)

Disarrayed granulosa cells arranged around collections of fluid ~> Call-Exner bodies (granulosa cell tumor of the ovary)

+/- shak360(14)


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