Neuropathology: vestibular schwannoma: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Neuropathology: vestibular schwannoma

Sample item

A 30-year-old woman has progressive bilateral sensorineural hearing loss and tinnitus. MRI shows bilateral cerebellopontine angle masses. Which gene is involved, and what is the histology?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. NF2 (merlin) inactivation, with Antoni A and B areas and Verocay bodies

Bilateral vestibular schwannomas define neurofibromatosis type 2, due to loss of the NF2 gene on chromosome 22 encoding merlin. Schwannomas show cellular Antoni A areas with palisading nuclei (Verocay bodies), loose Antoni B areas and strong S-100 positivity. Meningiomas and ependymomas are also associated.

Option by option

  • A. NF2 (merlin) inactivation, with Antoni A and B areas and Verocay bodies (correct)

    Correct. NF2 loss gives bilateral vestibular schwannomas with Antoni A and B histology.

  • B. NF1 (neurofibromin) inactivation, with plexiform neurofibromas

    NF1 mutation causes neurofibromas, café-au-lait spots and optic glioma, not bilateral acoustic tumours.

  • C. VHL inactivation, with haemangioblastoma

    VHL disease causes haemangioblastomas, retinal angiomas and renal cell carcinoma.

  • D. TSC1 inactivation, with subependymal giant cell astrocytoma

    TSC1 mutation causes tuberous sclerosis with cortical tubers and subependymal nodules.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is A, NF2 (merlin) inactivation, with Antoni A and B areas and Verocay bodies. Bilateral vestibular schwannomas define neurofibromatosis type 2, due to loss of the NF2 gene on chromosome 22 encoding merlin.

Why is "NF1 (neurofibromin) inactivation, with plexiform neurofibromas" not the answer?

NF1 mutation causes neurofibromas, café-au-lait spots and optic glioma, not bilateral acoustic tumours.

Why is "VHL inactivation, with haemangioblastoma" not the answer?

VHL disease causes haemangioblastomas, retinal angiomas and renal cell carcinoma.

Why is "TSC1 inactivation, with subependymal giant cell astrocytoma" not the answer?

TSC1 mutation causes tuberous sclerosis with cortical tubers and subependymal nodules.

What concept does this question test?

It tests Neuropathology: vestibular schwannoma in Pathology. Schwannomas show cellular Antoni A areas with palisading nuclei (Verocay bodies), loose Antoni B areas and strong S-100 positivity. Meningiomas and ependymomas are also associated.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neuropathology: vestibular schwannoma?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.