MEN- Station 1 Flashcards
STEM; 44 year male patient seen in the clinic, history of mild asthma & parathyroid surgery he had intermitted abdominal discomfort & pancreatic disease is being considered .
STEM; 44 year male patient seen in the clinic, history of mild asthma & parathyroid surgery he had intermitted abdominal discomfort & pancreatic disease is being considered
….
Q1: Define parathyroid hyperplasia ?
Non-malignant pathology in which parathyroid cells proliferates and enlarges
Q2: how many parathyroid glands usually affected ?
Four
Q3: microscopic picture of parathyroid hyperplasia ?
Chief cell (Most commonly in diffuse or multinodular pattern)/ Water clear cells (less common) / Island of oxyphils and delicate fibrous strands
Q4. define the 2 top reasons of parathyroid hyperplasia ?
Renal Failure and Men(type 1 , 2a) Syndr.
Q5. The patient collapsed in the clinic his glucose level can’t be recorded immediately, later confirmed to be 1.2 mmol/ liter by blood sample , History showed repeated attacks of sweating ad fainting, what pancreatic neoplastic process may cause this clinical picture ?
Insulinoma
Q6 : which part of the pancrease is usually affected ?
Beta cells of islets of Langerhans
Q7. How insulinoma is confirmed biochemically ?
By High levels of insulin / high insulin – glucose ratio / presence or proinsulin and high c-peptide
Q8: apart from insulinoma what other pathology can create this condition ?
Isulin Like growth factor from non-pancreatic tumor / Ectopic insulin production by fibrosarcoma / diffuse liver disease.
Q9: define MEN ?
Multiple Endocrine neoplasia Group of related conditions inhertided as AD trait chch by hyperplesia or neoplasia of involved organs
Q10. what other pathology would you suspect in this patient ?
Pit. Adenoma
Q11: what are the gene mutations that happens in insulinoma ?
MEN-1 gene / Loss-of-function mutations in tumor suppressor genes like PTEN TSC2 / Inactivating mutations in 2 genes (ATRX – DAXX)
Q12: what is the two hit hypothesis ?
Tumor supp gene is recessive in nature in order for particular cell to be carcinogenic needs mutation of both genes
Q13: what is telomere ?
Region of repetitive nucleotide sequences at the end of the chromosome
Q14: what are the genes responsible for cancer in general ?
Tumor supp genes (P53 – SPC1/2) – Oncogenes (K-Ras) – Protooncogenes
Q-Genes of MEN syndrome?
MEN type 1 MEN-1 gene
Type 2,3 RET Oncogene – CDKN1pg??