USMLE Step 1 Question 332

Question:

A 45 year old woman presents with fevers and weight loss. A malignancy workup yields evidence of disseminated cancer. A biopsy of the likely source shows concentric laminar calcified collections resembling “Orphan Annie eyes.” Which of the following tumors was the likely source of the biopsy?

Correct Answer: E.  Papillary adenocarcinoma of thyroid

“Orphan Annie eye” is the classic description of nuclear inclusions found in papillary adenocarcinoma of the thyroid (Answer E). Also present in papillary thyroid carcinoma are lamellar calcifications known as psammoma bodies, which also can be found in serous papillary cystadenocarcinoma of the ovary, meningiomas, and malignant mesothelioma.
Mucus cystadenocarcinoma of the ovary, as the name suggests, produces a lot of mucus, which can lead to pseudomyxoma peritonei. Glioblastoma multiforme, the most common type of adult primary brain tumor, is known to have “pseudopalisading” tumor cells. This means the tumor cells border central areas of necrosis and hemorrhage. Invasive ductal carcinoma of the breast shows ductal tissue that invades surrounding breast tissue. Adenocarcinoma of the lung is the most common cause of lung cancer in non-smokers. It appears as abnormal glandular tissue invading surrounding lung tissue.