last one for today - doctoria

[ArchivalUser]

A 70-year-old male patient dies with severe dementia. Autopsy demonstrates marked atrophy of the frontal and temporal lobes, with relative sparing of the rest of the brain. Which of the following
microscopic features would be most useful in establishing the diagnosis?

A. Enlarged presynaptic axon terminals surrounding a central core of extracellular
amyloid-like substance

B. Intracytoplasmic spherules composed of paired helical filaments

C. Intracytoplasmic spherules that stain brightly eosinophilic

D. Intranuclear and intracytoplasmic inclusion bodies in enlarged cells

E. Small cytoplasmic vacuoles containing a central granule

[ArchivalUser]

bb

[ArchivalUser]

a.........senile plaque

[ArchivalUser]

THIS IS PICK'S DISEASE. FRONTAL AND TEMPORAL LOBES ARE AFFECTED MOST, WITH RELATIVE SPARRING OF THE PARIETAL AND OCCIPTAL LOBES. MAYBE C, SINCE PICK BODIES STAIN EOSINOPHILIC.

[ArchivalUser]

Explanation:

The correct answer is B. Selective frontal and temporal atrophy in a demented patient suggests
Pick's disease. Microscopically, severe neuronal loss and astrocytosis are seen. The
characteristic microscopic finding in this disorder is the presence of Pick's bodies, which are
intracytoplasmic spherules composed of paired helical filaments, seen best with silver stains.

Choice A describes senile plaques. These are seen in Alzheimer disease as well as in some
normal elderly individuals.

Choice C describes Lewy bodies, seen in Parkinson's disease.

Choice D describes the inclusion bodies typically seen in glial cells and endothelial cells in
cytomegalovirus encephalopathy.

Choice E describes granulovacuolar degeneration.