new_n_lost
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A 45-year-old man presents to the emergency department with severe headache and vomiting. A CT scan shows a well-circumscribed cystic lesion within the 3rd ventricle; there is no calcium deposition.
The cyst is surgically removed. On histologic examination, the wall of the cyst consists of a single layer of mucin-producing columnar epithelium with a ciliated apical surface.
Which of the following is the most likely diagnosis?
A. Colloid cyst
B. Craniopharyngioma
C. Cysticercosis
D. Echinococcus cyst
E. Pilocytic astrocytoma
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| doc179
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A
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| new_n_lost
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Cmon Guys it aint that Hard or is it ??
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| silver
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a
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| afrocaribb
Forum Senior
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ok, i would have picked E pilocystic Astrocytoma, but the patient is too old as this usually occurs in children.....the others do no match the stem so i guess it leaves me with A.....
good question.
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| tanmaynator
Forum Senior
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i think its a..
colloid cyst..
hey nnl.. hats off to you.. you really post some awesome questions.. keep it up buddy..
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| new_n_lost
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| new_n_lost
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The correct answer is A.
This patient has symptoms of increased intracranial pressure, ie, nausea, vomiting, and headache. This pressure is due to the location of the mass in the 3rd ventricle, which is blocking the flow of cerebrospinal fluid from the lateral ventricles into the 3rd ventricle through the foramen of Monro. All cysts and tumors listed here may be found in the 3rd ventricle, but the histologic features are consistent with a colloid cyst. Colloid cysts are thought to derive from embryologically misplaced endodermal epithelium, which explains the presence of mucin-producing ciliated cells similar to respiratory epithelium. The cyst contains mucinous fluid. It usually presents with these type of symptoms in adults, especially middle-aged patients.
Craniopharyngioma (choice B) is a neoplasm arising in the suprasellar region of children and young adults. It derives from misplaced odontogenic epithelium; indeed, the tumor is histologically identical to the most common tumor of teeth, adamantinoma. Craniopharyngiomas contain abundant calcium deposits. Although histologically benign, these tumors frequently recur since complete surgical excision is rarely feasible.
A cysticercus is a cyst that develops following ingestion of Tenia solium eggs in undercooked pork. The brain is one of the preferred sites of cysticercosis (choice C), and cysticerci may develop within the brain (intraparenchymal), within the ventricles, or in the subarachnoid space. The lining of a cysticercus, however, is entirely different from a colloid cyst: it consists of three cell layers, the most superficial of which resembles dome-shaped urothelial cells.
An Echinococcus cyst (choice D) is caused by infestation from another cestode parasite, Echinococcus granulosus, which is acquired from dog feces. The defining feature of an Echinococcus cyst is a tiny, hooklike projection called a scolex. Scolices detach from the wall, accumulating within the cyst and producing a sandlike sediment. Liver and lungs are the usual locations of echinococcosis.
Pilocytic astrocytoma (choice E) is a tumor of astrocytic origin that affects children and young adults. It usually develops either in the cerebellar hemispheres or in the hypothalamic region. In the latter location, it may grow within the 3rd ventricle. Pilocytic astrocytomas often have a cystic structure. Histologically, the tumor consists of elongated astrocytes within an abundant fibrillary background and numerous Rosenthal fibers. The wall of the cystic component is composed of glial (astrocytic) cells, usually of a reactive nature.
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| kingusmle
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without lookingat other choices A
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