AP Rise Review
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RESIDENT REVIEW COURSE STUDY QUESTIONS ANATOMIC PATHOLOGY APRIL 23-25, 2006
Transcript of AP Rise Review
RESIDENT REVIEW COURSE
STUDY QUESTIONS
ANATOMIC PATHOLOGY
APRIL 23-25, 2006
ASCP RESIDENT REVIEW COURSE PULMONARY PATHOLOGY QUESTIONS
1. The most common histopathologic diagnosis in patients with the acute
respiratory distress syndrome is
A. acute necrotizing bronchopneumonia B. bronchiolitis obliterans with organizing pneumonia ("BOOP") C. diffuse alveolar damage (DAD) D. idiopathic pulmonary fibrosis (IPF) E. respiratory bronchiolitis interstitial lung disease
2. Which of the following conditions can be associated with a pattern of
pulmonary fibrosis referred to as usual interstitial pneumonia (UIP)?
A. asbestosis B. chronic nitrofurantoin toxicity C. idiopathic pulmonary fibrosis (IPF) D. rheumatoid arthritis E. all of the above
3. The histologic feature thought to be key to the development of idiopathic pulmonary fibrosis is
A. Birbeck granules B. Eosinophils C. Fibroblast foci D. Honeycomb change E. Immature smooth muscle
4. Non-specific pneumonia (NSIP)
A. Has been associated with an increased risk for lymphoma B. Has not been associated with connective tissue disease C. Has not been reported in patients over 60 years of age D. Is best regarded as a pattern of interstitial pneumonia E. Usually requires gamma interferon therapy
5. Langerhans' cells
A. are CD-1a positive by immunoperoxidase B. are never present in normal lung tissue C. are pathognomic for cigarette smoking D. are positive for HMB-45 by immunoperoxidase E. contain asteroid bodies by electron microscopy
6. Hypersensitivity pneumonia (extrinsic allergic alveolitis) is usually associated
with each of the following pathologic abnormalities EXCEPT
A. bronchiolitis obliterans organizing pneumonia B. chronic bronchiolitis C. chronic interstitial pneumonia D. eosinophils E. poorly formed non-necrotizing granulomas
7. A necrotizing capillaritis may be present in each of the following conditions
EXCEPT
A. allergic angiitis and granulomatosis (Churg-Strauss disease) B. Goodpasture’s syn\drome C. idiopathic pulmonary hemosiderosis D. pulmonary hemorrhage associated with SLE E. Wegener's granulomatosis
8. The histologic abnormality that is thought to account for the majority of
mucus hypersecretion in chronic bronchitis is
A. chronic inflammation B. enlargement of submucosal mucus glands C. goblet cell metaplasia D. histamine release E. smooth muscle hypertrophy
9. Which of the following is the most common type of emphysema in patients
with moderate to severe chronic airflow obstruction?
A. distal acinar emphysema B. irregular emphysema C. panacinar emphysema D. proximal acinar emphysema
10. Which of the following is the most common type of emphysema in patients
with alpha-1 antitrypsin deficiency?
A. distal acinar emphysema B. irregular emphysema C. panacinar emphysema D. proximal acinar emphysema
11. A 32 year-old cigarette smoker with a long-standing history of reactive
airways disease presents with fever and a right upper lobe infiltrate. While undergoing pulmonary function tests he has a coughing spell and expectorates a mucus plug. The pulmonologist sends to it to pathology and receives a report that it shows Charcot-Leyden crystals, lamellated mucus and degenerating inflammatory cells. The patient’s diagnosis is which of the following
A. Allergic alveolitis B. Allergic bronchopulmonary fungal disease C. Bronchioloalveolar carcinoma D. Churg-Strauss syndrome E. MAC-related airway disease
12. Patients with rheumatoid arthritis who develop rapidly progressive airflow
obstruction usually have which of the following histopathologic abnormalities?
A. bronchiolitis obliterans with organizing pneumonia ("BOOP") B. follicular bronchiolitis C. obliterative bronchiolitis D. rheumatoid nodules E. usual interstitial pneumonia
13. A 40-year-old man with sterile necrotizing granulomas in his lung, sinusiti and a positive c-ANCA might also have as a typical feature:
A. a poor prognosis even with appropriate therapy B. arthralgias C. asteroid bodies D. hydrocarbon exposure E. peripheral blood eosinophilia
14. A 67 year old woman, a former smoker, develops mediastinal
lymphadenopathy and undergoes bronchoscopy at which time a roughened mucosa is identified and biopsied. Sections show a small blue cell tumor. You suspect small cell carcinoma. The two best immunohistochemical stains to confirm this diagnosis are
A. Chromogranin and CD45 B. Chromogranin and synaptophysin C. Chromogranin and keratin D. Keratin and CD45 E. Neuron-specific enolase and Leu 7
Answers: to Pulmonary Pathology – Henry Tazelaar, MD
1. C 2. C 3. C 4. D 5. A 6. D 7. C 8. B 9. D 10. C 11. B 12. C 13. B 14. D
Breast Pathology – Celina Kleer, MD 1. Which is the best prognostic indicator in breast carcinoma patients?
A. Tumor size. B. Axillary lymph node status. C. HER2/new staining of tumor cells. D. Lymphatic vascular invasion by tumor.
2. The most common form of invasive breast carcinoma is:
A. Lobular carcinoma. B. Mucinous carcinoma. C. Medullary carcinoma. D. Ductal or no special type.
3. The best predictor of aggressive tumor behavior in phyllodes tumors is:
A. Mitotic figure content. B. Stromal overgrowth relative to glands. C. Lymphatic-vascular invasion. D. Lymph node status.
4. Which has not been found to be predictive of outcome in breast carcinoma patients?
A. Perineural invasion. B. Lymph node status. C. Tumor size. D. Tumor grade.
5. Which tumor has the best prognosis in breast carcinoma patients?
A. Invasive ductal. B. Invasive lobular. C. Adenoid cystic carcinoma. E. Mixed mucinous and ductal carcinoma.
6. HER2/neu is a test for
A. A membrane receptor. B. A nuclear antigen. C. A cytoplasmic receptor. D. A histone protein.
7. Hormone receptors are
A. Most useful in chosing patients for polyagent chemotherapy. B. Most useful in chosing patients for hormone manipulative therapy. C. Most useful as a prognostic test. D. Provides the therapeutic basis for toxan therapies.
8. Moderate or florid ductal hyperplasia indicates
A. slightly increased risk for subsequent invasive breast carcinoma. B. subsequent development of invasive carcinoma in 50% of all patients. C. has no predictive value. D. indicates slightly increase risk for phyllodes tumors.
9. About how many breast carcinomas occur in men?
A. 1 in 1000 cases. B. 2 in 1000 cases. C. 1 in 100 cases. D. 1 in 10 cases.
10. Which breast tumor has the best prognosis?
A. Mucinous carcinoma. B. Invasive lobular carcinoma. C. Fibroadenoma. D. Adenoid cystic carcinoma.
11. HER2/neu staining is indicated by
A. Cytoplasmic positivity. B. Nuclear positivity. C. Basal lamina positivity. D. Membrane positivity.
12. HER/new staining is used to predict:
A. Tumor grade. B. Response to anti-HER2 therapy. C. Response to hormone manipulation. D. Lymph node status.
Answers to Breast Pathology – Celina Kleer, MD 1. B 2. D 3. B 4. A 5. C 6. A 7. B 8. A 9. C 10. C 11. D 12. B
Multiple Choice Questions – Gynecologic Pathology – Dean Daya, MD
1. A 33-year-old woman and her husband have wanted a child, but she has been unable to conceive. Her husband's sperm count is normal. Of the following, which is LEAST likely to be the cause for her infertility:
A. Endometriosis
B. Prolactinoma
C. Pelvic inflammatory disease
D. Leydig cell tumour
E. Chronic cervicitis
2. A 45-year-old woman with perimenopausal bleeding is found to have a large solitary, solid mass in the uterus by ultrasound. A total abdominal hysterectomy is performed. Examination of the irregular 10.0 cm reddish-tan mass located in the myometrium shows bundles of smooth muscle cells along with heterogenous elements of pleomorphic cartilaginous cells. There are also areas with poorly differentiated gland formation. Mitotic figures are frequent. The most likely diagnosis is:
A. Leiomyosarcoma
B. Adenomyosis
C. Malignant mixed mullerian tumour
D. Endolymphatic stromal myosis
E. Leiomyoma
3. A 23-year-old woman goes to the emergency room because of the sudden onset of lower abdominal pain. Pelvic examination reveals a normal sized uterus and normal appearing cervix and vagina. However, there is marked tenderness upon palpation of the left adnexal region. A transvaginal ultrasound demonstrated no intrauterine gestational sac, but there is a 2.0 cm left adnexal mass. Culdoscopy reveals intra-abdominal hemorrhage. Which of the following is most useful procedure to perform at this point:
A. Serum complement
B. Urinalysis with microscopic examination
C. Pap smear
D. Serum beta-HCG
E. Endometrial biopsy
4. A 32-year-old pregnant woman was found to be large for dates on physical examination and had no fetal heart tones audible at 18 weeks. An ultrasound was performed and revealed that no fetus was present, only many echogenic cystic areas within the uterus. You should most strongly suspect:
A. Invasive mole
B. Partial hydatidiform mole
C. Placental site trophoblastic tumour
D. Choriocarcinoma
E. Complete hydatidiform mole
5. As part of a workup for infertility, a 26-year-old woman has an endometrial biopsy performed for dating. Of the following statements regarding the dating of the endometrium, which is INCORRECT:
A. The secretory phase of the menstrual cycle is fairly constant at 14 days.
B. The proliferative portion of the menstrual cycle is variable among women.
C. Endometrium at menarche is difficult to date because of anovulatory cycles.
D. Glandular and stromal disparity suggests an inadequate luteal phase.
E. The zona basalis is the best region of endometrium for dating.
6. Which statement best characterizes Asherman's syndrome:
A. Long-term exposure to an unopposed progestational agent.
B. Obliterans of the stratum basalis.
C. Leukorrhea caused by inadequate cauterization of a condyloma.
D. Multiple and recurrent papillary hidradenomas.
F. Development of vaginal clear cell carcinoma.
7. A 33-year-old woman has been on oral contraceptives for a year. She had noted vaginal bleeding for the past several weeks. The bleeding is not severe, but it occurs nearly every day. On pelvic examination, there is a 0.7 cm polypoid mass noted to extend outward from the endocervical region. The ectocervix appears normal. The uterus is normal in size. The adnexae have no palpable masses. A biopsy of this lesion is most likely to show:
A. Endocervical adenocarcinoma
B. Clear cell adenocarcinoma
C. Microglandular hyperplasia
D. Sarcoma botryoides
E. Endocervical polyp
8. A 48-year-old woman has noted a small amount of irregular vaginal bleeding for the past two months. She has a pelvic examination that reveals no cervical lesions, and a Pap smear that shows no abnormal cells. Next, an endometrial biopsy is performed, and there is microscopic evidence for endometrial hyperplasia. If an abnormal ultrasound reveals an ovarian mass in this patient, the mass is most likely to be a(an):
A. Mature cystic teratoma
B. Choriocarcinoma
C. Sertoli-Leydig cell tumour
D. Fibrothecoma
E. Krukenberg tumour
9. A 30-year-old infertile woman has had episodic lower abdominal and pelvic pain for several years. A physical examination, including pelvic exam, reveals no masses. A Pap smear shows only a few trichomonads and no dysplastic cells. A laparoscopy is performed, and the gynecologist notes the presence of several blue to red 0.2 to 0.4 cm slightly raised lesions scattered on the pelvic peritoneum in the cul-de-sac and broad ligaments. These findings are most consistent with:
A. Metastatic adenocarcinoma
B. Neisseria gonorrheae infection
C. Endometriosis
D. Candidiasis
E. Leiomyomata
10. A 50-year-old woman has noted increasing abdominal enlargement for the past year. On physician examination, there is a fluid wave, but no tenderness. Bowel sounds are present. She has no vaginal bleeding. An abdominal ultrasound reveals bilateral 10.0 and 7.0 cm adnexal masses. At surgery, you find bilateral mass lesions of the ovaries which are unilocular, filled with watery fluid and covered with papillary excrescences on all surfaces. These masses are probably:
A. Granulosa-theca cell tumours
B. Mature cystic teratomas
C. Fibrosarcoma with metastases
D. Bilateral serous cystadenocarcinomas
E. Clear cell carcinomas
Answers: to Gynecologic Pathology – Dean Daya, MD
1. E
2. C
3. D
4. E
5. E
6. B
7. E
8. D
9. C
10. D
Non-Gyn Cytology Questions Eva M. Wojcik, MD
1. What stain can demonstrate Pneumocystis carinii? A. Papnicolaou B. Giemsa C. Diff Quik D. GMS E. All of the above
2. Satisfactory sputum specimen is the one containing:
A. Bronchial epithelial cells B. Alveolar macrophages C. Ciliated cells D. Respiratory epithelium E. Squamous cells
3. Patient with a history of tuberculosis presented with pleural effusion that
showed: A. Numerous reactive mesothelial cells B. Abundant neutrophiles C. Mostly lymphocytes and few mesothelial cells D. Numerous histiocytes and few giant cells E. Lymphocytes and numerous mesothelial cells
4. Based ONLY on morphologic features which disease can we diagnose by
examining pleural effusions? A. Systemic lupus erythematosus B. Tuberculosis C. Cirrhosis D. Rheumatoid arthritis E. Lymphoma
5. What is NOT characteristic of an angiomyolipoma of the liver?
A. It is seen more often in females B. FNA usually consists of a mixture of thin and thick blood
vessels, fat and spindle and epithelioid smooth muscle cells
C. It is positive for HMB 45 D. The majority of cases are associated with tuberous
sclerosis E. It is negative for cytokeratin
6. FNA of the kidney revealed large cells with abundant cytoplasm, low N/C ratio, binucleation and prominent cellular borders. The most probable diagnosis is:
A. Renal cell carcinoma, clear cell type B. Renal cell carcinoma, chromophil type C. Renal cell carcinoma, chromophobe type D. Renal cell carcinoma, granular cell type E. Renal cell carcinoma, papillary type
7. The most common cause of false positive diagnosis in breast FNA is:
A. Lactating adenoma B. Fibrocystic disease C. Phyllodes tumoe D. Papilloma E. Fibroadenoma
8. FNA of the large soft breast mass revealed bizarre, pleomorphic cells with
prominent nucleoli in syncytial arrangement. The most probable diagnosis is:
A. Metastatic carcinoma B. Metaplastic carcinoma C. Ductal carcinoma D. Medullary carcinoma E. Mucinous carcinoma
9. FNA of the salivary gland revealed hyaline globules, which entity has to be
included in the differential diagnoses? A. Adenoid cystic carcinoma B. Pleomorphic adenoma C. Polymorphous low grade
carcinoma D. Myoepithelioma E. All of the above
10. 35 year old men presented with enlarged supraclavicular lymph node.
FNA of the lymph node revealed dispersed population of large pleomorphic cells with fragile cytoplasm, large nuclei and prominent nucleoli. Lacy, interwoven material was seen in the background. What stain would confirm your diagnosis?
A. LCA B. Cytokeratin C. CD20 D. PLAP E. TTF-1
11. Patient with a history of Hashimoto’s thyroiditis developed a nodule that was aspirated. The most probable finding will be:
A. Papillary carcinoma B. Lymphoma C. Colloid nodule D. Hurthle cell hyperplasia E. Follicular neoplasm
12. In thyroid FNA, intranucler pseudoinclusions are seen in:
A. Papillary carcinoma B. Hyalinizing trabecular adenoma C. Hurthle cell type of follicular
neoplasm D. Medullary carcinoma E. All of the above
13. Bladder washing showed numerous papillary-like clusters. The differential
diagnosis includes all EXCEPT: A. Low grade urothelial carcinoma B. Nephrolithiasis C. Bladder diverticuli D. Instrumentation E. Urothelial carcinoma in situ
14. Initial chromosomal change believed to be associated with urothelial
carcinoma is: A. t (11;14) B. del 9p21 C. t (14;18) D. t (x;18) E. del 3q20
15. Urothelial carcinoma of the bladder:
A. Usually presents as a highly invasive cancer B. Can easily be diagnosed by urine cytology C. Is prone to frequent recurrence D. Predominantly it is seen in women E. Usually affects young people
Answers to: Non-Gyn Cytology - Eva M. Wojcik, MD
1. E 2. B 3. C 4. D 5. D 6. C 7. E 8. D 9. E 10. D 11. D 12. E 13. E 14. B 15. B
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ASCP Resident Review Course GYN Cytopathology Questions
Sunday, April 23, 2006 4:15 – 6:00 pm
Christine Noga Booth, M.D.
1. How many well-preserved and well-visualized squamous epithelial cells are required for
adequacy on liquid-based Papanicolaou tests and conventional Papanicolaou smears by the 2001 Bethesda System criteria?
A. 2000; 1500 B. 10,000; 15,000 C. 5,000; 10,000 D. 12,000; 10,000 E. 5,000; 15,000
2. Per 2001 Bethesda System criteria, 10 endocervical cells are required on a Papanicolaou test
in order to have a satisfactory specimen.
A. True B. False
3. Which of the following is NOT one of the criteria for endocervical adenocarcinoma in-situ?
A. Hyperchromatic crowded cell clusters B. Pseudostratified nuclei C. Feathering D. Tadpole cells E. Pseudorosettes
4. In most instances, carcinomas metastatic to the cervix do not demonstrate a tumor diathesis.
A. True B. False
5. Per CLIA 1988 regulations, what is the maximum number of slides that can be primary
screened by a cytotechnologist/pathologist in no less than an 8-hour time period?
A. 100 / no limit B. 80 / no limit C. No limit / no limit D. 80 / 80 E. 100 / 100
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6. For how long must a Cytopathology laboratory retain Pap test slides in its files?
A. 6 months B. 1 year C. 2 years D. 5 years E. 10 years
7. For how long must the Cytopathology laboratory retain fine needle aspirate slides in their
files?
A. 6 months B. 1 year C. 2 years D. 5 years E. 10 years
8. For what amount of time must the Cytopathology laboratory retain the paperwork for test
requisitions?
A. 6 months B. 1 year C. 2 years D. 5 years E. 10 years
9. Which of the following statements is FALSE in the comparison of Thin Prep liquid-based
Papanicolaou tests to conventional Papanicolaou smears?
A. Improves specimen adequacy B. Decreases false negative diagnoses C. Decreases artifacts on the slides such as air drying, blood, mucus and inflammation D. Less expensive per test E. Can perform HPV testing on the same sample
10. The Papanicolaou test has proven to be an excellent screening test for glandular lesions of the
uterus and cervix.
A. True B. False
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11. Per 2001ASCCP (American Society for Colposcopy and Cervical Pathology) guidelines,
appropriate management for patients with ASC-US includes all of the following EXCEPT?
A. Repeat pap test in 6 months B. Repeat pap test in 3 years C. HPV testing of the sample D. Colposcopy with directed biopsy if necessary
12. Per CLIA 1988 regulations, 10% mandatory review (rescreen) of all negative Pap tests is
required by the Cytopathology laboratory to remain in compliance.
A. True B. False
13. A woman with an atrophic Pap test pattern would be expected to have a maturation index of
which of the following?
A. 0:80:20 B. 10:30:70 C. 20:40:40 D. 60:20:20 E. 80:20:0
14. Which of the following features is seen with Herpes simplex virus on a Papanicolaou test?
A. Nuclear molding B. Fuzzy-appearing cell surface C. Single flagellum D. Cytoplasmic vacuoles E. Cytoplasmic stretching
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ASCP Resident Review Course GYN Cytopathology Answers
Sunday, April 23, 2006
Christine Noga Booth, M.D.
1. C. 2. B. 3. D. 4. A. 5. E. 6. D. 7. E. 8. C. 9. D. 10. B. 11. B. 12. A. 13. E. 14. A.
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ASCP Resident Review CourseKidney Pathology Review Questions
Stephen M. Bonsib, MDDirector, Surgical Pathology
Indiana University Medical Center
1. A 6-year old presents with 12 grams proteinuria/24 hour and normal renal function. He was treated with corticosteriods and had a complete remission in proteinuria. If a renal biopsy had been performed, what would likely be the sole abnormality identified?
a.Subepithelial depositsb.Subendothelial depositsc. Glomerular basement membrane necrosisd.Diffuse hypercellularitye. Diffuse loss of podocyte foot process
2. Seropositivity for what viral infection would likely be demonstrated in a patient with nephrotic syndrome whose biopsy showed a combination of collapsing focal segmental glomerulosclerosis, tubular dilatation, interstitial inflammation, and by electron microscopy, reticulotubular inclusions within glomerular endothelial cells?
a.Hepatitis Bb.Hepatitis Cc. HIVd EBVe CMV
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3. What immunoflourescence pattern best characterizes the pattern of immune deposition (also known as nephrotoxic antibody) of Goodpasture’s syndrome?
a. Linear mesangial patternb. Linear glomerular basement membrane reactionc. Minimal change diseased.Membranous glomerulonephritise. IgA nephropathy
4. A 13-year-old girl presents with hematuria, red blood cell casts, hypertension and low complement. What form of glomerulonephritis would explain these findings and be associated with a favorable prognosis without therapy?
a.Acute poststreptococcal glomerulonephritisb.Membranoproliferative glomerulonephritisc. Minimal change diseased.Membranous glomerulonephritise. IgA nephropathy
5. Cellular crescents form in Bowman’s space in all forms of rapidly progressive glomerulonephritis. What is the abnormality that is responsible for crescent formation?
a.Glomerular basement membrane thickeningb.Glomerular basement membrane spikesc. Glomerular basement membrane duplicationd.Glomerular basement membrane necrosise. Glomerular basement membrane collapse
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6. What is the leading cause of end stage renal disease?
a.Membranous glomerulonephritisb.Diabetic nephropathyc. IgA nephropathyd.Minimal change diseasee. Membranoproliferative glomerulonephritis
7. What is the most common cause of glomerulonephritis in the world?
a. Minimal change diseaseb. Membranous glomerulonephritisc. IgA nephropathyd. Acute poststreptococcal glomerulonephritise. Membranoproliferative glomerulonephritis
8. A 49-year-old IV drug abuser presents with nephrotic syndrome. A renal biopsy showed numerous subendothelial deposits and basement membrane duplication. No reticulotubular inclusions were noted within endothelial cells. What testing should be performed on this patient?
a.Anti-nuclear antibodyb.Anti-neutrophil cytoplasmic antibodyc. HIVd.Hepatitis Ce. Throat culture
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9. Alports syndome and thin glomerular basement membrane disease have what abnormality in
common?
a. Abnormalities in collagen type IIb. Abnormalities in collagen type IIIc. Abnormalities in collagen type IVd. Abnormalities in mesangial matrixe. Abormalities in endothelial cell phenotype
10. Most cases of membranous glomerulonephritis are primary. Which of the following is not a
recognized secondary cause?
a. Gold and penicillamineb. Hepatitis Bc. Sytemic lupus erythematosisd. Malignancy, especially carcinomase. Systemic vasculitis
11. Which of the following is not a potential feature of renal involvement in systemic lupus?
a. Biopsies may show a variety of proliferative patterns.
b. Wire loop subendothelial depositsc. Glomerular and extraglomerular depositsd. Basement memebrane lamellatione. Endothelial cell reticulotubular inclusions
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12. Which of the following lesions is not a significant consideration in a patient with multiple myeloma
and renal disease?
a. AL amyloidb. Light chain cast nephropathyc. Nephrocalcinosisd. Immunoglobulin deposition diseasee. Dense deposit disease
Answers to Kidney Pathology - Stephen M. Bonsib, MD
1. E 2. C 3. B 4. A 5. D 6. B 7. C 8. D 9. C 10. E 11. D 12. E
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Test Question for ASCP Resident Review Course Head and Neck Section Jennifer L. Hunt, M.D. 1) Nasopharyngeal angiofibroma
a) Occurs primarily in adolescent males b) Is androgen receptor positive c) Is a malignancy that frequently metastasizes d) A & B e) All of the above
2) Adenoid cystic carcinoma
a) Has a very high mitotic rate (>50% proliferative index) b) Is usually fatal within 1 year of diagnosis c) Often has perineural invasion d) Is negative for CKIT (CD117) immunohistochemical
stains e) All of the above
3) Warthin’s Tumor
a) Is only found in the parotid gland b) Occurs more commonly in smokers c) Is a malignant tumor d) A & B e) All of the above
4) Pleomorphic adenoma
a) Is a benign tumor b) Is composed of epithelial, myoepithelial and stromal
components c) Can undergo malignant transformation d) A & B e) All of the above
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5) Mucoepidermoid carcinoma
a) Is the most common malignant tumor in children and adults
b) Is composed of epidermoid cells, intermediate cells, and respiratory epithelial cells
c) Is not histologically graded d) A & B e) All of the above
6) Allergic fungal sinusitis
a) Is treated with anti-inflammatory agents and possibly steroids
b) Is associated with polyps c) Is treated with aggressive intravenous antifungal
therapy. d) A & B e) All of the above
7) Sinonasal undifferentiated carcinoma
a) Is an aggressive malignancy b) Usually stains for cytokeratin c) Is usually negative for chromogranin d) A & B e) All of the above
8) Intestinal type adenocarcinoma of the sinuses
a) Usually stains for CDX2, CK7, and CK20 b) Is considered to be a low-grade tumor with a good
prognosis c) Can be easily differentiated from metastatic colon
cancer by its staining profile d) A & B e) All of the above
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9) Odontogenic keratocyst
a) Can be associated with nevoid basal cell carcinoma syndrome
b) Can occur in the mandible or maxilla c) Rarely undergoes malignant degeneration d) A & B e) All of the above
10) Salivary duct carcinoma
a) Is a low-grade salivary gland tumor b) Usually does not metastasize or recur locally c) Often stains for androgen receptor and HER2/neu d) A & B e) All of the above
11) Olfactory neuroblastoma a) Usually stains for chromogranin and synaptophysin b) Occasionally stains for cytokeratin c) May stain for S100 in a sustentacular cell pattern d) A and B e) All of the above
12) Schneiderian papillomas a) Are classified as inverted, exophytic (or fungiform),
and oncocytic types. b) Do not have metastatic potential, but can have
malignant degeneration. c) Are tumors of minor salivary gland origin d) A and B e) All of the above
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13) Epithelial-myoepithelial carcinoma
a) Has a unique deposition of basement membrane type material
b) Is composed of neoplastic epithelial cells and neoplastic myoepithelial cells
c) Does not stain for cytokeratins d) A and B e) All of the above
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Answers to Head and Neck Section - Jennifer L. Hunt, M.D.
1. D 2. C 3. B 4. E 5. a 6. D 7. E 8. A 9. E 10. C 11. E 12. D 13. C
Liver Pathology
Barbara J. McKenna, MD
1. Which of the following is true about hepatitis B? a. It is the leading cause of liver disease in the US. b. It is more highly associated with hepatocellular carcinoma in Asia than in
the US. c. More than half of those infected will develop chronic liver disease. d. The presence of HbsAg in a patient’s serum indicates immunity. e. It is associated with essential mixed cryoglobulinemia.
2. A patient who has hepatitis C: a. Is more likely to progress to cirrhosis, if untreated, if he/she has genotype
Ia. b. Has no increased risk for hepatocellular carcinoma. c. Has a high likelihood of developing chronic liver disease. d. Will have “sanded nuclei” visible in his/her liver biopsy. e. May be monitored by following viral DNA load in the serum.
3. Which of the following is true about hepatitis C transmission? a. Occupational transmission probably accounts for the higher prevalence of
HCV in health care workers than the general population. b. It cannot occur due to a blood splash to the eye. c. Perinatal transmission has not been documented. d. HCV is not efficiently transmitted by needlestick to a health care worker,
but is highly efficiently transmitted among IV drug users. e. HCV transmission cannot result from a blood transfusion administered
after 1992, when testing was initiated.
4. The surgical pathology report for a liver biopsy obtained to evaluate a patient with
hepatitis C should include which information? a. Stage of fibrosis. b. A suggestion as to the probable genotype. c. A recommendation as to appropriate type and period of therapy. d. A statement of the probability of progression to cirrhosis. e. All of the above.
5. The diagnosis of autoimmune hepatitis requires
a. Documentation of a chronic hepatitis. b. High titer autoantibodies c. No laboratory evidence of cholestasis. d. No histologic evidence of cholestasis. e. All of the above.
6. Patients with type I autoimmune hepatitis: a. A most often African-American. b. Have positive Antinuclear antibodies (ANA) or Smooth Muscle
Antibodies (SMA), but no other autoantibodies. c. Characteristically have anti-LKM1(liver-kidney microsome type 1)
antibodies. d. Often have other autoimmune disease. e. Rarely progress to cirrhosis.
7. Characteristic features of autoimmune hepatitis include: a. Paucity of bile ducts. b. Central vein sclerosis. c. Inflammation confined within portal tracts. d. Mononuclear infiltrates that often include prominent plasma cells. e. All of the above.
8. Histologic features of primary biliary cirrhosis include: a. Ductopenia and bile ductular proliferation. b. Granulomas only when the patient is secondarily infected as a
consequence of immunosuppressive therapy. c. Bile duct inflammation without loss of duct integrity or numbers. d. No copper accumulation until progression to cirrhosis.
9. Primary biliary cirrhosis: a. Is associated with ulcerative colitis, and sometime Crohn’s colitis. b. Is characterized by an immune response to mitochondrial antigens in
>90% of patients. c. Is only diagnosed at an advanced stage, when patients present with pruritis
and complications of cirrhosis. d. Primarily involves a B-cell mediated tissue injury. e. Is generally a self-limited disease characterized by spontaneous resolution
in a majority of patients.
10. Primary sclerosing cholangitis: a. Affects only the large extrahepatic bile ducts. b. Is associated with anti-mitochondrial antigens. c. Is more common in males. d. Can be diagnosed by ERCP only in the subset of patients with ulcerative
colitis. e. Affects segments of the extrahepatic biliary tree in a continuous fashion,
resulting in the characteristic string-like appearance by ERCP.
11. Microvesicular steatosis:
a. Occurs only in pregnant women and pediatric patients. b. Denotes active lipid turnover. c. Is a characteristic histologic feature of hepatitis C. d. Is indicative of insulin resistance. e. Is often accompanied by Mallory bodies.
12. Alcoholic liver disease: a. Is not related to the amount of alcohol intake. b. Although prevalent, is an uncommon cause of death in young adult men in
western societies. c. Would progress more quickly were it not for the metabolites of ethanol,
which tend to protect the liver from injury. d. Results from a combination of factors, including the toxic effect of
acetaldehyde, free radicals generated as byproducts of ethanol metabolism, and immunologic factors.
e. Protects the liver from the toxicity of acetaminophen.
13. Nonalcoholic fatty liver disease is associated with
a. Insulin resistance b. Total parenteral nutrition c. Severe weight loss d. Disorders of lipid metabolism e. All of the above
14. Patients with nonalcoholic fatty liver disease a. Do not develop the fibrosis that is characteristic of alcoholic liver disease. b. Do not develop Mallory bodies. c. Are more likely to have fibrosis if they are obese and/or diabetic. d. Have resolution of disease with prednisone therapy. e. Often have antithyroid antibodies.
15. Histologic features of genetic hemochromatosis include: a. Concentration of iron in zone 3 (centrilobular) in the early stages of the
disease. b. Siderosomes arranged along the biliary poles of the hepatocytes. c. Stainable iron in macrophages during the preclinical phase, followed by
redistribution into hepatocytes, usually around age 20n years. d. Loss of iron in hepatocytes once the liver becomes cirrhotic, making
etiology of cirrhosis difficult to identify. e. Perisinusoidal fibrosis.
16. Focal nodular hyperplasia a. Is a benign lesion of young women. b. Is thought to be a form of hyperplasia related to anatomic abnormalities of
the biliary tree. c. Presents with life-threatening hemorrhage in 15% of cases. d. Is characterized grossly by dense collagenous capsule, with a
homogeneous core of hepatic parenchyma. e. Is associated with elevated serum alpha fetoprotein (AFP).
17. Hepatocellular carcinoma a. Is an uncommon cancer in the US, and even rarer in other parts of the
world, except the Rhine River valley. b. Only develops in patients with cirrhosis. c. Is highly associated with HBV, but not associated with HCV, explaining
its geographic distribution. d. May have HBV surface antigen, core antigen, and DNA within the
neoplastic cells. e. Has not been described in patients with genetic hemochromatosis, but has
been seen in patients with other causes of iron overload.
18. Fibrolamellar hepatocellular carcinoma
a. Is a neoplasm nearly exclusively occurring in young men. b. Is the usual type of hepatocellular carcinoma seen in Asia. c. Is characterized by small cells with scant cytoplasm, divided into small
and large sheets by lamellar fibrosis. d. Is associated with elevated serum alpha fetoprotein. e. Is characterized grossly by a central scar.
Answers to Liver Pathology – Barbara McKenna, MD, FASCP 1. Answer: b 2. Answer: c 3. Answer: d 4. Answer: a 5. Answer: e 6. Answer: d 7. Answer: d 8. Answer: a 9. Answer: b 10. Answer: c 11. Answer: b 12. Answer: d 13. Answer: e 14. Answer: c 15. Answer: b 16. Answer: a 17. Answer: d 18. Answer: e
ASCP Resident Course 2006 Pediatric Pathology Questions Carole Vogler, MD, FASCP
1. Fetal hydrops can be seen in patients with which of the following disorders?
A. Turner Syndrome B. Intestinal atresia C. Tracheoesophageal fistula D. Hirschsprung’s disease E. Diaphragmatic hernia
2. Patients with classic phenylketonuria (PKU) lack which enzyme?
A. Tyrosinase hydroxylase B. Phenylalanine reductase C. Dihydropteridine reductase D. Phenylalanine hydroxylase E. Tetrahydrobiopterinase
3. The test used to screen infants for phenylketonuria (PKU) is:
A. Cooly test B. Guthrie test C. Sweat chloride test D. Adler Reilly test E. Coombs test
4. If one sibling is affected with a congenital heart malformation, the risk of a heart
malformation in another sibling is: A. 0% B. < 1% C. 2 – 7% D. 8 – 10% E. 50%
5. Which of the following findings is most characteristic of a patient with DiGeorge
Syndrome? A. Lysosomal storage of glycosaminoglycans B. Hypocalcemia C. B cell immunodeficiency D. 12q11 deletion E. Polydactyly
6. What is the risk of recurrence of amniotic band syndrome in a sibling of an
affected patient? A. 0% B. 2 – 7% C. 25% D. 50% E. 100%
7. An infant born at term gestation weighs 1700 gm. There are no external
malformations. The infant’s head circumference is normal for a term gestation infant but her length is less than the 5th percentile. Of the following conditions, which is the most likely explanation for these findings?
A. Congenital Cytomegalovirus infection B. Maternal diabetes C. Edward Syndrome D. Hydrops fetalis E. Maternal hypertension
8. A 19 year-old woman with diagnosis of phenylketonuria hopes to get pregnant and
has been advised to be on a phenylalanine-free diet before she conceives and to continue this diet throughout her pregnancy. If she fails to follow this advice, her infant could have:
A. Pancytopenia B. Trisomy C. High output heart failure D. Muscular dystrophy E. Mental retardation
9. The presence of anaplasia in the tumor cells has the greatest impact on prognosis
which pediatric neoplasm? A. Neuroblastoma B. Nephroblastoma C. Rhabdomyosarcoma D. Hemangioblastoma E. Teratoma
10. Which congenital heart malformation is most likely to cause cyanosis in the
newborn? A. Transposition of the great vessels B. Ventricular septal defect C. Atrial septal defect D. Atrial ventricular canal defect E. Coarctation of the aorta
Answers to Pediatric Pathology – Carol Vogler, MD, FASCP
1. A 2. D 3. B 4. C 5. B 6. A 7. E 8. E 9. B 10. A
ASCP RESIDENT REVIEW COURSE – Ricardo Valdez, MD
Lymphoma Study Questions
1. Which of the following is most likely to involve multiple lymph node groups, visceral organs, bone marrow, and peripheral blood at
diagnosis?
A. Extranodal marginal zone B-cell lymphoma
B. Gamma delta T-cell lymphoma
C. Hairy cell leukemia
D. Mantle cell lymphoma
E Hodgkin lymphoma
2. Which of the following lymphomas has the worst prognosis?
A. Mantle cell lymphoma
B. Nodular lymphocyte predominant Hodgkin lymphoma
C. Extranodal marginal zone B-cell lymphoma
D. Follicular lymphoma, grade 1
E. Lymphoplasmacytic lymphoma
3. Match the following lymphomas with the most appropriate cytogenetic/molecular abnormality.
A. T-cell prolymphocytic leukemia A. t(2;8)
B. Extranodal marginal zone B-cell lymphoma (MALT lymphoma) B. t(11;14)
C. Follicular lymphoma C. t(14;18)
D. Atypical chronic lymphocytic leukemia/lymphoma D. Trisomy 3
E. Mantle cell lymphoma E. Trisomy 12
F. Burkitt lymphoma F. Inversion 14
G. Anaplastic large cell lymphoma G. t(2;5)
4. Which of the following lymphomas typically express CD5?
A. Gamma delta T-cell lymphoma
B. Mantle cell lymphoma
C. Follicular lymphoma
D. Chronic lymphocytic leukemia\/small lymphocytic lymphoma
E. A, B, and C
F. A and C
G. B and D
H. None of the above
5. Which of the following lymphomas can express CD10?
A. Burkitt lymphoma
B. Follicular lymphoma
C. Angioimmunoblastic T-cell lymphoma
D. Precursor B-cell acute lymphoblastic lymphoma
E. All of the above
F. None of the above
6. Match the lymphoma with the correct major pathogenetic mechanism.
A. Mantle cell lymphoma A. EBV infection
B. Follicular lymphoma B. Cyclin D1 overexpression
C. Adult T-cell leukemia/lymphoma C. Helicobacter pylori infection
D. Angioimmunoblastic T-cell lymphoma D. c-myc rearrangement
E. Extranodal marginal zone B-cell lymphoma E. Bcl-2 overexpression
F. Burkitt lymphoma F. HTLV-1 infection
7. Match the clinical scenario with the appropriate lymphoma.
A. 15-year old male with mediastinal mass and high white blood cell count. A. Burkitt lympoma
B. 35-year old woman with mediastinal mass extending into lung. B. Mantle cell lymphoma
C. 50-year old man with splenomegaly and circulating atypical lymphocytes. C. NLPHL*
D. 10-year old male with ileocecal mass. D. Enteropathy-associated T-cell lymphoma
E. 24-year old male with isolated inguinal mass. E. Mediastinal large B-cell lymphoma
F. 56-year old woman with history of celiac sprue. F. Precursor T-cell ALL
* Nodular lymphocyte predominant Hodgkin lymphoma
8. Match the following phenotype with the appropriate lymphoproliferative disorder.
A. CD19, CD20, CD43, kappa positive; CD5, CD10 negative. A. Low grade FL
B. CD5, CD19, CD20 (dim), CD23, kappa (dim) positive; CD10, FMC7 negative. B. CLL/SLL
C. CD5, CD19, CD20 (bright), FMC7, lambda (bright) positive; CD10, CD23 negative. C. Hairy cell leukemia
D. CD10, CD19, CD20, lambda, Bcl-2 positive. D. Mantle cell lymphoma
E. CD10, CD19, CD20, lambda positive; Bcl-2 negative. E. Burkitt lymphoma
F. CD11c (bright), CD19, CD20, CD22 (bright), CD25, CD103 positive. F. Marginal zone lymphoma
9. Match the following lymphomas with the appropriate clinical or pathogenetic association (some may have more than one answer,
choices may be used more than once).
A. Marginal zone lymphoma A. Hemophagocytic syndrome
B. Gamma delta T-cell lymphoma B. EBV infection
C. Endemic Burkitt lymphoma C. Hashimoto’s thyroiditis
D. Angioimmunoblastic T-cell lymphoma D. Contiguous lymph node involvement
E. Classical Hodgkin lymphoma E. Sjogren’s syndrome
F. Nodular lymphocyte predominant Hodgkin lymphoma F. Polyclonal hypergammaglobulinemia
G. Anaplastic large cell lymphoma G. Monoclonal protein
H. Post-transplantation lymphoma H. Isolated inguinal adenopathy
10. Which of the following lymphoprolferative disorders involve the spleen in a sinusoidal pattern?
A. Hairy cell leukemia
B. Follicular lymphoma
C. Gamma delta T-cell lymphoma
D. Diffuse large B-cell lymphoma
E. A, B, and C
F. A and C
G. B and D
H. All of the above
11. Which of the following is the typical phenotype of Hodgkin’s lymphoma?
A. CD10, CD20, CD43 positive
B. CD20, CD30, CD45 positive; CD15 negative.
C. CD15, CD30, fascin positive; CD20, CD45 (common leukocyte antigen) negative
D. CD15 positive; CD20, CD30, CD45 (common leukocyte antigen) negative
E. CD3, CD30, EMA, ALK-1 positive
12. A diffuse lymphoma composed of atypical, polymorphic large cells and expressing CD20, CD30, CD45 (common leukocyte antigen),
CD79a, and focal EMA should be classified as:
A. Anaplastic large cell lymphoma
B. Anaplastic plasmacytoma
C. Mantle cell lymphoma
D. Diffuse large B-cell lymphoma
E. None of the above
13. Which of the following is the typical phenotype of nodular lymphocyte predominant Hodgkin lymphoma?
A. CD3, CD4, CD8, TdT positive.
B. CD15, CD20 (focal, weak), CD30, fascin positive; CD79a negative.
C. CD20, CD45 (common leukocyte antigen), EMA positive; CD15 negative.
D. CD10, CD20, CD45 (common leukocyte antigen), Bcl-2 positive.
E. CD5, CD43, CD79a positive; CD20 negative.
14. Which of the following lymphoma may show a nodular growth pattern in lymph nodes?
A. CLL/SLL.
B. Mantle cell lymphoma
C. Follicular lymphoma
D. Classical Hodgkin lymphoma
E. A, B, and C
F. A and C
G. B and D
H. All of the above
I. None of the above
15. The phenotype of CD1a, CD2, CD4, CD8, and TdT positive is associated with which of the following:
A. Sinus histiocytosis with massive lymphadenopathy
B. Adult T-cell leukemia/lymphoma.
C. Sezary syndrome.
D. Precursor T-cell acute lymphoblastic leukemia/lymphoma
E. Langerhan’s cell histiocytosis
ASCP RESIDENT BOARD REVIEW COURSE
Answers to lymphoma study questions – Ricardo Valdez, MD
1. (D) Mantle cell lymphoma.
Extranodal marginal B-cell lymphoma is not generally widely disseminated (stage IV) at diagnosis and usually only involves lymph nodes in the regions of the affected mucosal site. Gamma delta T-cell lymphoma can involve the spleen, liver, and bone marrow but peripheral blood and lymph node involvement is generally not seen. Hairy cell leukemia does not involve lymph nodes, although retroperitoneal lymph node involvement has been reported in autopsy series. Hodgkin’s lymphoma involves contiguous lymph node groups; it can involve spleen, liver, and bone marrow but not the peripheral blood. Stage IV disease at presentation is unusual in Hodgkin’s lymphoma.
2. (A) Mantle cell lymphoma.
As indicated in question 1, mantle cell lymphoma is often widely disseminated at diagnosis. The median survival is
approximately 3-5 years.
3. A. (F) T-cell prolymphocytic leukemia is associated with inversion 14.
B. (D) Extranodal marginal/MALT lymphoma is associated with trisomy 3 in addition to t(11;18).
C. (C) Follicular lymphoma is associated with t(14;18).
D. (E) Atypical CLL/SLL is associated with trisomy 12. Occasional cases of mantle
cell lymphoma will also show trisomy 12, usually also with a Bcl-1 rearrangement.
E. (B) Mantle cell lymphoma is associated with t(11;14). As noted above, trisomy
12 is sometimes seen in mantle cell lymphoma.
F. (A) Burkitt lymphoma is associated with t(2;8). In addition, patients can have t(8;22) and t(8;14), the latter of which is most common.
G. (G) Anaplastic large cell lymphoma is associated with t(2;5).
4. (G) Gamma delta T-cell lymphoma is CD5-negative.
5. (E)
6. A. (B) Mantle cell lymphoma is associated with cyclin D1 overexpression.
B. (E) Follicular lymphoma is associated with Bcl-2 overexpression. C. (F) Adult T-cell leukemia/lymphoma is associated with HTLV-1 infection. D. (A) Angioimmunoblastic T-cell lymphoma is associated with EBV infection. E. (C) Extranodal marginal zone B-cell lymphoma is associated with H. pylori
infection. F. (D) Burkitt lymphoma is associated with c-myc rearrangement. In addition, EBV
infection (A) is an acceptable answer.
7. A. (F) Precursor T-cell acute lymphoblastic leukemia/lymphoma B. (E) Mediastinal large B-cell lymphoma C. (B) Mantle cell lymphoma D. (A) Burkitt lymphoma E. (C) Nodular lymphocyte predominant Hodgkin’s lymphoma F. (D) Enteropathy-associated T-cell lymphoma
8. A. (F) Marginal zone B-cell lymphoma.
B. (B) CLL/SLL C. (D) Mantle cell lymphoma D. (A) Low grade follicular lymphoma E (E) Burkitt lymphoma F. (C) Hairy cell leukemia
9. A. (C) Hashimoto’s thyroiditis; (E) Sjögren’s syndrome; (G) Monoclonal protein
B. (A) Hemophagocytic syndrome C. (B) EBV infection D. (A) Hemophagocytic syndrome; (B) EBV infection; (F) Polyclonal
hypergammaglobulinemia E. (D) Contiguous lymph node involvement; (B) EBV infection (low social
economic groups/underdeveloped countries) F. (H) Isolated inguinal adenopathy G. (A) Hemophagocytic syndrome H. (B) EBV infection; (G) Monoclonal protein (in rare cases)
10. (F) Hairy cell leukemia and gamma delta T-cell lymphoma involve the spleen in a
sinusoidal distribution.
11. (C) Hodgkin’s lymphoma is typically CD15, CD30, and fascin positive and CD20 and common leukocyte antigen negative. Tumors with CD15 positivity in the absence of CD20, CD30, and CD45 expression could represent carcinomas.
12. (D) Diffuse large B-cell lymphoma. By definition, anaplastic large cell lymphomas are either T-cell or null-cell neoplasms. Diffuse large B-cell lymphomas may have anaplastic features and may express CD30, but they should not be diagnosed as
anaplastic large cell lymphomas. Plasmacytomas may be CD30 positive, but they are generally CD20 and CD45 negative.
13. (C)
14. (H)
15. (D) Precursor T-cell ALL and T-cell prolymphcytic leukemia (T-cell PLL) can both
show dual expression of CD4 and CD8; T-cell PLL is TdT negative. The only other place to find CD4/CD8 dual positive T-cells is in the thymus.
Central Nervous System Review Questions – Richard Prayson, MD, FASCP
1. Intracranial saccular aneurysms are associated with which of the following? 1. Polycystic kidney disease 2. Ehlers-Danlos syndrome 3. Coarctation of the aorta 4. Pseudoxanthoma elasticum
(a=l,2,3; b=l,3; c=2,4; d=4 only; e=all of the above)
2. Back-to-back sinusoidal vessels without intervening neural parenchyma mark what lesion? a. Arteriovenous malformation b. Venous angioma c. Cavernous angioma d. Capillary telangiectasia e. None of the above
3. All of the following are true regarding CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) except: a. Due to mutation of notch 3 gene b. Defect located to chromosome 19 c. It is a cause of vascular dementia d. Disease is confined to the central and peripheral nervous systems e. It causes vessel wall thickening
4. Diffuse axonal injury is best visualized with which stain? a. Bodain b. PAS c. Luxol fast blue d. B-amyloid e. CD99
5. All of the following may be seen in or are associated with holoprosencephaly except: a. Trisomy 3 b. Absent olfactory bulbs c. Monoventricular cerebrum d. Associated with alcohol use e. Facionasal abnormalities
6. Germinal matrix hemorrhage is most likely to occur at what age? a. a. 28 weeks gestation b. 34 weeks gestation c. 36 weeks gestation d. 38 weeks gestation e. full term infant
7. Which of the following is not a major feature of tuberous sclerosis? a. Adenoma sebaceum b. Shagreen patch c. Lymphangiomyomatosis d. Renal angiomyolipoma e. Subependymoma
8. Friedreich's ataxia is associated with which of the following? a. Autosomal dominant pattern of inheritance b. Chromosome 19 abnormality c. GAA trinucleotide repeat expansion d. X-linked recessive pattern of inheritance e. Increased level of synuclein
9. Which of the following is not generally a feature of Alzheimer's disease? a. Granulovascular degeneration b. Amyloid angiopathy c. Hirano bodies d. Balloon cell neurons e. Neuritic plaques
10. The primary target of pathology in Huntington's disease is: a. Hippocampus/amygdala b. Caudate/putamen c. Substantia nigra d. Nucleus basalis of Meynert e. FrontaVtemporal lobes
11. Match 11-1 Defect in long chain fatty acid metabolism a. Adrenoleukodystrophy
11-2 Rosenthal fibers b. Metachromatic leukodystrophy 11-3 Arylsulfatase A deficiency c. Krabbe's disease
11-4 Globoid cells d. Alexander's disease 11-5 Proteolipid gene defect e. Pelizaeus-Merzbacher disease
12. The most common cause of community-acquired bacterial meningitis is: a. Listeria monocytogenes b. Staphylococcus aureus c. Neisseria meningitidis d. Hemophilus influenzae e. Streptococcus pneumonia
13. Progressive multifocal leukencephalopathy is associated with all the following except: a. Alzheimer II astrocytes b. JC virus c. Demyelination d. HIV infection e. Cowdry A inclusions
14. Better prognosis and chemoresponsiveness in anaplastic oligodendrogliomas is associated with allelic loss on chromosome: a. 17 b. 9 c. 1 d. 21 e. 14
15. The most common location for a central neurocytoma is: a. Third ventricle b. Lateral ventricle c. Temporal lobe d. Fourth ventricle e. Cerebellum
16. Worrisome histologic patterns of meningioma include all of the following except: a. Clear cell b. Angiomatous c. Rhabdoid d. Papillary e. Chordoid
Answers to CNS and references – Richard Prayson, MD, FASCP
1. E Schievink WI. Genetics of intracranial aneurysms. Neurosurgery 9917;40:651-663.
2. C Challa VR, Moody DM, Brown WR. Vascular malformations of the central nervous system. J Neuropathol Exp Neurol 1995;54:609-621.
3. D Ruchoux M-M, Maurage C-A. CADASIL: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. J Neuropathol Exp Neurol 1997:56:947-964.
4. A Gultekin SH, Smith TW. Diffuse axonal injury in craniocerebral trauma. Arch Pathol Lab med 194:118:168-171.
5. A Golden JA. Holoprosencephaly: A defect in brain patterning. J Neuropathol Exp Neurol 1998:57:991-999.
6. A Marin-Padilla M. Developmental neuropathology and impact of perinatal brain damage. I: Hemorrhagic lesions ofneocortex. J Neuropathol Exp Neurol 1996:55:758-773.
7. E Roach ES, Gomez MR, Northrup H. Tuberous sclerosis complex consensus conference: Revised clinical diagnostic criteria. J Child Neurol 1998:13:624-628.
8. C Delatycki MB, Williamson R, Forrest SM. Freidrich ataxia: an overview. J Med Genet 2000:37:1-8.
9. D Probst A, Langui D, Ulrich J. Alzheimer's disease: A description of the structural lesions. Brain Pathol 1991:1:229-239.
10. B Xuereb JH, MacMilliam JC, Snell R, Davies R, Harper PS. Neuropathological diagnosis and CAG repeat expansion in Huntington's disease. J Neurol Neurosurg Psysh 1996:60:78-81.
11. 11-1 A Kaye EM. Update on genetic disorders affecting white matter. 11-2 D Pediatr Neurol 2001 ;24:11-24
11-3 B 11-4 C 11-5 E
12. E Durand ML, Calderwood SB, Weber DJ, et al. Acute bacterial meningitis in adults. A review of 493 episodes. N Engi J Med 1993:328:21-28.
13. A Pray son RA, Estes ML. Stereotactic brain biopsy for diagnosis of progressive multifocal leukoencephalopathy. S Med J 1993:86:1381-1394.
14. C Gairncross JG, Ueki K, Zlatescu MC, et al. Specific genetic predictors of chemotherapeutic response and survival in patients with oligodendrogliomas. J Nati Cancer Inst 1998:90:1473-1479.
15. B Figarella-Branger D, Soylemezoglu F, Kleihues P, Hassoun J. Central neurocytoma. In: Tumours of the Nervous System. Kleihues P and Cavenee WK eds. IARC Press. Lyon, France 2000, pp 107-109.
16. B Louis DN, Scheithauer BW, Budka H, von Deimling A, Kepes JJ. Meningiomas. In: Tumours of the Nervous System. Kleihues P and Cavenee WK eds. IARC Press. Lyon, France 2000, pp 176-184.
ASCP RISE EXAM QUESTIONS SOFT TISSUE PATHOLOGY 1. Pleomorphic lipoma
A) may have lipoblasts B) usually arises in the superficial soft tissue of middle-aged males C) most commonly arises in the posterior neck or upper back region D) often has ropey collagen bundles E) all of the above
2. Which of the following statements regarding liposarcoma are not true?
A) Subtypes of well-differentiated liposarcoma include sclerosing and inflammatory subtypes
B) Well-differentiated liposarcoma is frequently admixed with areas of myxoid liposarcoma.
C) Round cell liposarcoma is the poorly differentiated form of myxoid liposarcoma. D) Retroperitoneal well-differentiated liposarcomas are more likely to dedifferentiate than
those located in the extremities. E) Pleomorphic liposarcoma may be difficult to distinguish from other types of high-grade
pleomorphic sarcomas.
3. All of the following statements regarding angiomyolipoma are true except A) AML are typically HMB45-positive. B) May be associated with tuberous sclerosis C) Are frequently malignant D) May show cytologic atypia but still act in a clinically benign fashion E) Are most commonly found in the kidney
4. All of the following statements regarding intramuscular myxoma are true except
A) typically a lesion of low cellularity B) often arise in the deep soft tissue of adults C) are composed predominantly of cells with fibroblastic differentiation D) are typically S-100 protein-positive E) may have cells that resemble lipoblasts (“pseudolipoblasts”)
5. Myxoid liposarcoma
A) is associated with marked cytologic atypia B) is characterized by thick-walled curvilinear blood vessels C) is characterized by a t(12;16) D) frequently progresses to dedifferentiated liposarcoma E) is most common in the retroperitoneum
6. Malignant fibrous histiocytoma-like lesions include
A) pleomorphic liposarcoma B) pleomorphic malignant peripheral nerve sheath tumor C) some examples of melanoma D) some examples of sarcomatoid carcinoma E) all of the above
7. All of the following statements regarding cellular schwannoma are true except
A) may be mistaken for spindle cell sarcoma B) shows patchy S-100 protein positivity C) may have cytologic atypia D) may have mitotic activity E) erodes bone in up to 10% of cases
8. Synovial sarcoma is
A) characterized by a t(x;18) B) may be monophasic or biphasic C) may be associated with calcifications D) may have a hemangiopericytoma-like vascular pattern E) all of the above
9. All of the following statements regarding rhabdomyosarcoma are true except
A) Pleomorphic rhabdomyosarcoma most commonly arises in children less than 5 year of age.
B) Alveolar rhabdomyosarcoma most commonly arises in the extremities. C) Alveolar rhabdomyosarcoma is associated with a t(2;13). D) Subtypes of embryonal rhabdomyosarcoma include botryoid and spindle cell subtypes. E) Botryoid and spindle cell rhabdomyosarcomas are associated with an excellent prognosis.
10. The cells of epithelioid sarcoma
A) may be spindled or epithelioid B) have densely eosinophilic cytoplasm C) are frequently intermingled with dense collagen fibers D) typically coexpress vimentin and cytokeratin E) all of the above
11. Alveolar soft part sarcoma
A) characteristically expresses desmin B) may metastasize prior to the discovery of the primary tumor C) is characterized by marked cytologic atypia D) coexpresses vimentin and cytokeratin E) is characterized by a t(5;7)
12. All of the following statements regarding dermatofibrosarcoma protuberans are true except
A) is characterized by an infiltrative growth pattern B) is typically CD34-positive C) is related to giant cell fibroblastoma D) is characterized by a t(17;22) E) is uniformly S-100 protein-positive
Answers: to Soft Tissue Pathology – John Goldblum, MD, FASCP
1. E 2. B 3. C 4. D 5. C 6. E 7. B 8. E 9. A 10. E 11. B 12. E
ASCP RISE EXAM QUESTIONS GASTROINTESTINAL PATHOLOGY 1. Reflux esophagitis
A) has a specific histologic appearance B) always has intraepithelial eosinophils C) is characterized by goblet cell metaplasia D) often shows evidence of squamous hyperplasia E) none of the above
2. Which of the following statements regarding Barrett’s esophagus is true?
A) It is a complication of chronic gastroesophageal reflux disease. B) It is a premalignant condition. C) It is associated with an endoscopic abnormality. D) It is characterized by intestinal metaplasia on biopsy. E) All of the above.
3. Esophageal adenocarcinoma
A) is decreasing in incidence B) is associated with achalasia C) usually has dysplasia in the surrounding mucosa D) is less common than squamous cell carcinoma in the United States E) usually occurs in women
4. All of the following are typically seen in Helicobacter pylori-related chronic active gastritis
except: A) numerous eosinophils B) lamina propria plasmacytosis C) foveolar hyperplasia D) neutrophilic injury to glands (activity) E) lymphoid aggregates
5. Reactive gastropathy
A) is a common pattern of injury caused by multiple different etiologies B) may be seen as a component of bile reflux C) may occur secondary to ingestion of non-steroidal anti-inflammatory drugs D) is associated with foveolar hyperplasia and regenerative epithelial changes E) all of the above
6. All of the following regarding celiac sprue are true except
A) It is always associated with a flat mucosal contour. B) may be seen in patients with collagenous colitis C) may be associated with a normal villous architecture D) has characteristic serologic laboratory findings E) is associated with an epithelial lymphocytosis
7. All of the following are associated with Crohn’s disease except
A) granulomas B) pyloric gland metaplasia C) neural hyperplasia D) myenteric neuritis E) skip lesions
8. Ulcerative colitis
A) typically involves the rectum B) may involve the cecum as a “skip lesion” in patients with left-sided colitis C) may involve the appendix as a “skip lesion” in patients with left-sided colitis D) is associated with primary sclerosing cholangitis E) all of the above
9. All of the following statements regarding ulcerative colitis-related dysplasia are true except
A) can be classified as low, moderate or high-grade B) is a marker of dysplasia or carcinoma elsewhere in the colon C) is more common in patients with primary sclerosing cholangitis and ulcerative colitis
than with ulcerative colitis alone D) is difficult to distinguish from a sporadic adenoma E) is frequently seen adjacent to ulcerative colitis-related adenocarcinoma
10. Gastrointestinal stromal tumors
A) are characterized by activating mutations in c-kit B) are more common than leiomyosarcomas of the gastrointestinal tract C) typically express CD117 D) may be composed of epithelioid or spindled cells E) all of the above
11. All of the following statements regarding lymphocytic colitis are true except
A) it is typically associated with a normal endoscopic appearance B) it is characterized by an epithelial lymphocytosis C) may have cryptitis D) is characterized by architectural distortion E) may be associated with the use of medications
12. Mucosal prolapse
A) may be mistaken for a neoplastic process B) may have architectural distortion and mimic quiescent inflammatory bowel disease C) is associated with fibromuscular proliferation of the lamina propria D) often has a villiform appearance which may be ulcerated E) all of the above
Answers to: GI Pathology – John Goldblum, MD, FASCP
1. D 2. E 3. C 4. A 5. E 6. A 7. D 8. E 9. A 10. E 11. D 12. E
Answers to: GU Pathology – Jennifer Brainard, MD Prostate
1. B 2. C 3. D 4. A
Bladder
1. C 2. E 3. A 4. D
Testis
1. A 2. C 3. F 4. C
RESIDENT REVIEW COURSE BONE PATHOLOGY
David G. Hicks, M.D.
Roswell Park Cancer Institute Buffalo, New York
Tuesday, April 25, 2006 4:15 pm – 6:00 pm
1. Which of the following is not true concerning the pattern of growth of a lesion
within skeletal tissue?
a) The pattern of growth of a lesion is usually indicative of its biologic potential and behavior
b) How abnormal tissue interacts with the surrounding host bone should be a
key consideration in the evaluation of a skeletal lesion.
c) How abnormal tissue interacts with the host bone can never be evaluated from a histologic section.
d) If the biopsy has not sampled the interface between the lesion and
surrounding host bone, the pathologist can still obtain information on the pattern of growth from appropriate radiographic studies.
2. The radiographic hallmark of a benign skeletal lesion is containment of the lesion
by a rim of reactive host bone. Which of the following is not true about the pattern of growth of benign lesions?
a) In a slowly growing lesion a rim of reactive bone is often deposited
around the lesion and appears as a radiodense border on plain films. b) Benign lesions tend to be well circumscribed with a pushing border.
c) A benign lesion usually demonstrates a periosteal reaction, which at times
can be complex.
d) Benign lesions may or may not show evidence of matrix calcification. 3. Which of the following is not true concerning the radiographic appearance of a
malignant lesion of bone?
a) Malignant lesions tend to demonstrate an infiltrative or permeative pattern of growth with destruction of surrounding host bone.
b) Malignant lesions tend to have a well-defined border.
c) Malignant lesions typically demonstrate a periosteal reaction, which is
often times complex.
d) Malignant lesions may or may not show evidence of matrix calcification on radiographic studies.
4. The cytologic appearance of a skeletal lesion along with the pattern of growth of
the lesion are two main factors taken into consideration when trying to decide if a lesion is benign or malignant. Which of the following features is not true of benign skeletal lesions.
a) Benign skeletal lesions tend to be made up of cells, which closely
resemble the cell of origin. b) Benign skeletal lesions may demonstrate variable cellularity.
c) Benign lesions typically demonstrate infiltrative borders.
d) Benign lesions typically demonstrate low to absent mitotic activity, and
abnormal mitoses should be absent. 5. Which of the following features is not true when considering cytologic features of
a malignant neoplasm of bone?
a) Malignant neoplasms typically are poorly differentiated and may bear little resemblance to the cell of origin.
b) Malignant neoplasms typically show pleomorphic cells and bizarre tumor giant cells may be present.
c) Necrosis is usually absent in malignant neoplasms of bone.
d) Malignant neoplasms of bone typically are poorly circumscribed with infiltrating borders demonstrating entrapment of spicules of lamellar host bone.
6. Osteoid producing lesions of bone all demonstrate extracellular osteoid matrix production. Which of the following is not true concerning osteoid producing lesions of bone?
a) Osteoid production can be seen in both benign and malignant lesions.
b) Osteoid is the unmineralized protein matrix of bone and consists of Type I collagen predominantly.
c) A number of non-collagenous proteins including osteocalcin, osteopontin and osteonectin are present within osteoid.
d) Osteoid usually demonstrates a distinct fibular longitudinal arrangement and the flattened spindle shaped osteoblasts are usually present between fibilar osteoid.
7. Which of the following is not true of osteoblastoma of bone?
a) Osteoblastoma may arise in any portion of the skeleton but has a distinct predilection for the small bones of the hands and feet.
b) Radiographically osteoblastoma produces a uniform sharply circumscribed expansile lesion, which is usually radiolucent.
c) Histologically osteoblastomas demonstrate a mixture of fibrovascular stroma with interlacing spicules and trabeculae of osteoid.
d) The osteoblasts of osteoblastoma typically are plump but uniform in appearance and nuclear pleomorphism is minimal.
8. Which of the following is not true of osteoid osteoma?
a) Osteoid osteoma is usually associated with marked pain, which is described as being worst at night and relieved by aspirin.
b) Osteoid osteoma typically involves cortical bone and shows reactive sclerosis at its periphery.
c) The central nidus of an osteoid osteoma is always greater than 2 cm in diameter.
d) The osteoblasts of an osteoid osteoma typically have abundant cytoplasm and show osteoblastic rimming.
9. Which of the following is not true of osteogenic sarcoma?
a) Approximately 60% of patients with osteogenic sarcoma are in their second decade of life, however older patients can develop osteogenic sarcoma usually secondary to radiation or Paget’s disease.
b) Osteogenic sarcomas characteristically appear as a large poorly defined infiltrative lesion radiographically with evidence of a periosteal reaction.
c) Osteogenic sarcoma histologically usually consists of pleomorphic cells embedded in lacy extracellular osteoid with little intervening stroma.
d) Osteogenic sarcoma never shows evidence of cartilaginous or fibrous extracellular matrix production.
10. Which of the following is not a variant of osteogenic sarcoma?
a) Small cell osteogenic sarcoma.
b) Telangiectatic osteogenic sarcoma.
c) Well-differentiated intraosseous osteogenic sarcoma
d) Parosteal osteogenic sarcoma
e) Myxoid osteogenic sarcoma.
11. Which of the following is not true of fracture callus?
a) Occasionally early or incipient fracture callus can mimic a sarcoma both clinically and pathologically.
b) Both benign as well as malignant lesions of bone can lead to pathologic fracture, and the presence of fracture callus can make interpretation of a small biopsy sample difficult.
c) Fracture callus, depending upon the age, can show evidence of both osteoid and chondroid matrix production.
d) The orderly arrangement and uniformity of cells along with gradual transition from one matrix type to another is not helpful in distinguishing fracture callus from malignancy.
12. Which of the following is not true of enchondromas of bone?
a) The most common location for an enchondroma is the tubular bones of the hands and feet.
b) Most enchondromas are asymptomatic and are incidental findings, or present after a pathologic fracture.
c) Enchondromas typically show cortical destruction and frequently present with a soft tissue mass.
d) Histologically enchondromas are well circumscribed, lobulated and tend to be hypocellular.
e) Small foci of myxoid change in enchondromas may be seen in lesions of the hands and feet but large myxoid foci or necrosis should arouse suspicion of malignant transformation.
13. Which of the following is not true of chondromyxoid fibroma of bone?
a) Radiographically, chondromyxoid fibromas tend to be eccentric, metaphysical, and lytic lesions with sharply circumscribed borders.
b) Chondromyxoid fibromas typically occur in younger patients and vast majority are between the ages of 5 and 30 years.
c) Chondromyxoid fibromas typically show evidence of a periosteal reaction, which is often complex in nature.
d) Histologically, chondromyxoid fibromas have a lobular appearance at low power in which the lobules are more densely cellular peripherally and hypocellular centrally.
e) The cells within a chondromyxoid fibroma typically have a characteristic stellate or spindle shape and appear to be floating within a watery myxoid ground substance.
14. Which of the following is not true of chondroblastoma of bone?
a) Chondroblastoma is always located within the epiphysis or the apophysis of bone.
b) Multinucleated osteoclasts sized giant cells are never seen in chondroblastoma of bone.
c) Discrete islands of chondroid type matrix are typically seen in chondroblastoma of bone.
d) Often a characteristic pericellular “chicken wire” pattern of calcification is seen within the chondroid matrix.
15. Which of the following is not true of chondrosarcomas?
a) Chondrosarcomas usually occur in an older age group, and are rarely seen in persons under 20 years of age.
b) Chondrosarcomas may be either primary, or arise from a previously benign lesions such as an osteochondroma or and enchondroma.
c) More than three-quarters of primary chondrosarcomas are located within the distal aspects of the extremities.
d) Chondrosarcomas typically are poorly demarcated lytic lesions that demonstrate erosions and destruction of cortical bone.
e) Speckle calcifications may be present radiographically in a chondrosarcoma but is usually less than the calcification seen in a typical enchondroma, and decrease in amount with increasing grade of tumor.
16. Which of the following is not true of giant cell tumors of bone.
a) The giant cell tumor of bone almost always occurs in skeletally immature persons with an open epiphyses.
b) More than 75% of giant cell tumors are located near the articular ends of the long bone.
c) Radiographically giant cell tumor of bone typically involves both the epiphyses and the metastasis and may occasionally erode and expand the cortex.
d) Giant cell tumors are vascular neoplasms and may be associated with secondary aneurysmal bone cyst formation.
e) The mononuclear stromal cells within a giant cell tumor are uniform and round, containing small nucleoli and do not show evidence of nuclear pleomorphism.
17. Which of the following is not true of Ewing sarcoma of bone.
a) Ewing’s sarcoma typically presents as a large poorly defined lytic lesion without obvious cortical destruction and a complex periosteal reaction.
b) Ewing’s sarcoma classically appears as a monotonous sheet of poorly cohesive uniform small round cells with scant cytoplasm and indistinct borders.
c) Molecular studies typically are not helpful in confirming the diagnosis of Ewing’s sarcoma because these neoplasms typically do not show evidence of chromosomal translocations.
d) Special stains such a PAS stain with and without diastase along the reticulin stains can sometimes be helpful in distinguishing Ewing’s sarcoma from other small round blue cell tumors.
18. Which of the following is not true of acute osteomyelitis of bone.
a) On occasion the acute phase of an aggressive infection involving bone may mimic a malignancy both clinically and radiographically.
b) Cultures taken at the time of surgery are usually not helpful for confirming a diagnosis of osteomyelitis.
c) Histologically osteomyelitis demonstrates marrow necrosis, acute inflammatory infiltrates and extensive osteoclastic bone resorption in its earlier acute phases.
d) As osteomyelitis progresses and begins to resolve, reactive bone is formed demonstrating sclerosis radiographically.
19. Which of the following is not true about the media assessment and evaluation of a small round blue cell tumor of bone.
a) Immediate assessment of a potential small round blue cell tumor either by fine needle aspiration or frozen section is important, as it allows collection of additional material for appropriate ancillary studies and potentially could alleviate the need for a more invasive biopsy.
b) The differential diagnosis of a small round blue cell tumor of bone is broad and includes a number of primary as well as metastatic neoplasms.
c) Cultures at the time of biopsy represent an important component of the immediate assessment of a potential small round blue cell tumor, given that an infection may mimic these neoplasms both clinically and radiographically.
d) A careful search of histologic sections looking for evidence of neoplastic extracellular matrix production is not an important component of evaluating of a small round blue cell tumor of bone, and this category of neoplasms will never show evidence of extracellular matrix production.
Answers: to Bone Pathology – David G. Hicks, MD
1. C.
2. C
3. B
4. C
5. C
6. D
7. A
8. C
9. D
10. E
11. D
12. C
13. C
14. B
15. C
16. A
17. C
18. B
19. D
