[Taiyakikung]

A 48-year-old man has experienced abdominal pain for the past 3 months. On physical examination there are no abnormal findings. Upper GI endoscopy is performed and there is a 2 cm diameter sharply demarcated ulceration in the antrum. Laboratory studies show his serum calcium is 11.5 mg/dL, phosphorus 2.3 mg/dL, and albumin 5.9 g/dL. The microscopic appearance of the lesion removed at surgery is depicted below.

click image to enlarge

Which of the following additional complications of his disease is he most likely to have?

A. Nephrolithiasis
B. Hemoptysis
C. Hepatitis
D. Diarrhea
E. Macrocytic anemia
F. Non-Hodgkin lymphoma

 

[patelMD]

sounds like malignancy :notsure:

 

[pakbrain]

gastric lymphoma comes to mind when gastric ulcers are mentioned

 

[doctorsmonsters]

I think its
A .Nephrolithiasis

The calcium is kinda high and phosphorus low, which is what happens in primary hyperparathyroidism. Not sure though, just a guess.)

 

[Mondoshawan]

I was thinking nephrolithiasis too. I kept rearranging the lab abnormalities, and the one that makes the most sense is that the hypercalcemia came first, and that the ulcer is a benign peptic ulcer secondary to the elevated calcium. :notsure:

 

[Taiyakikung]

This picture is a parathyroid adenoma with a rim of normal parathyroid on top of the adenoma. Adenoma secretes parathyroid hormone which rises serum calcium. High serum calcium contributes to ulcer.
So the correct answer is A.nephrolithiasis

 

[patelMD]

This picture is a parathyroid adenoma with a rim of normal parathyroid on top of the adenoma. Adenoma secretes parathyroid hormone which rises serum calcium.High serum calcium contributes to ulcer.
So the correct answer is A.nephrolithiasis

So it's a PNS?

 

[Taiyakikung]

So it's a PNS?

Do you mean Paraneoplastic syndrome? I think it's not.
Symptom complexes that occur in patients with cancer and that cannot be readily explained by local or distant spread of the tumor or by the elaboration of hormones indigenous to the tissue of origin of the tumor are referred to as paraneoplastic syndromes.
Because hypercalcemia and ulcer can be explained by elevated parathyroid hormone that results from parathyroid adenoma so it's not Paraneoplastic syndrome.

 

[Mondoshawan]

So it's a PNS?

Is it still paraneoplastic if the tumor is in the parathyroid rather than another cancer making pt-like hormone?

 

[patelMD]

Is it still paraneoplastic if the tumor is in the parathyroid rather than another cancer making pt-like hormone?

Well, according to the definition above, it wouldn't be.

IF you had a PT-like hormone secreting tumor in your liver (hypothetical) that would be a PNS.

Hormone that is secreted, which is not normally secreted by that tissue is PNS.

 

[rah_mem]

i guess ans z 'A'. MEN Syndrome?????????

 

[geof1]

i think it s hyperthyrodism
so A

 

[apx85]

A

Luckily I was able to get this question right without really knowing what the histology was because of the lab findings of hypercalcemia + hypophosphatemia.

I got confused by the question though because it sounded like the biopsy was taken from the ulcer so I was completely lost when looking at the histology

 

[silenttmutation]

A

I think the answer is A. The stem fits the description of a MEN I, gastric ulcer possibly due to zollinger ellison syndrome and high calcium along with low phosphate levels, can be because of a parathyroid adenoma.
Not a 100% sure about the pic but it seems to a parathyroid adenoma. you can see the pink thyroid acini at the top left.

 

[Mondoshawan]

Luckily I was able to get this question right without really knowing what the histology was because of the lab findings of hypercalcemia + hypophosphatemia.

I got confused by the question though because it sounded like the biopsy was taken from the ulcer so I was completely lost when looking at the histology

That confused me too...