ABPath - American Board of Pathology Cytopathology Questions and Answers

Question 1

A 32-year-old woman's liquid-based Pap test shows atypical squamous cells with a high nuclear-to-cytoplasmic ratio, irregular nuclear membranes, and hyperchromatic, coarse chromatin.
The cells are arranged in sheets and as single cells with scant cytoplasm.
According to the Bethesda System for Reporting Cervical Cytology, which of the following is the most likely diagnosis?

Accepted Answer

High-grade Squamous Intraepithelial Lesion (HSIL)

Answer

Atypical Squamous Cells of Undetermined Significance (ASC-US)

Answer

Low-grade Squamous Intraepithelial Lesion (LSIL)

Answer

Reactive cellular changes associated with inflammation

Question 2

A 58-year-old male renal transplant recipient undergoes routine urine cytology. The specimen reveals numerous enlarged urothelial cells containing large, homogenous, ground-glass intranuclear inclusions that obscure the underlying chromatin. These cells are best known as "decoy cells." The presence of these cells is most strongly associated with an infection by which of the following viruses?

Accepted Answer

Polyomavirus (BK virus)

Answer

Cytomegalovirus (CMV)

Answer

Herpes Simplex Virus (HSV)

Answer

Human Papillomavirus (HPV)

Question 3

A fine-needle aspiration of a 3 cm thyroid nodule from a 45-year-old female shows cellular smears with follicular cells arranged in syncytial-type clusters. The nuclei are enlarged and overlapping, with finely dispersed pale chromatin, prominent nuclear grooves, and occasional intranuclear cytoplasmic inclusions. These cytomorphologic features are most characteristic of which of the following?

Accepted Answer

Papillary Thyroid Carcinoma

Answer

Follicular Adenoma

Answer

Medullary Thyroid Carcinoma

Answer

Anaplastic Thyroid Carcinoma

Question 4

A 65-year-old patient with altered mental status undergoes a lumbar puncture. Cytologic examination of the cerebrospinal fluid (CSF) reveals a monomorphic population of large, atypical lymphoid cells with scant basophilic cytoplasm, irregular nuclear contours, prominent nucleoli, and apoptotic debris. Which of the following findings would be most definitive for a diagnosis of B-cell lymphoma?

Accepted Answer

A monotypic B-cell population with surface light chain restriction by flow cytometry

Answer

Positive CD45 and CD20 immunohistochemistry on the cell block

Answer

Numerous reactive lymphocytes and plasma cells in the background

Answer

Positive Glial Fibrillary Acidic Protein (GFAP) staining in scattered cells

Question 5

A 70-year-old female with a history of ER-positive invasive ductal carcinoma of the breast develops a large pleural effusion. Cytologic evaluation shows cohesive clusters of malignant cells. A cell block is prepared for ancillary studies to confirm the origin. Which of the following immunohistochemical markers is most specific for supporting a diagnosis of metastatic breast carcinoma in this context?

Accepted Answer

GATA3

Answer

WT-1

Answer

Calretinin

Answer

TTF-1

Question 6

A fine-needle aspiration is performed on a 3.5 cm solid mass in the head of the pancreas in a 68-year-old male. The cytology shows crowded, three-dimensional clusters of ductal cells with significant nuclear size variation, irregular nuclear membranes, and prominent nucleoli, suspicious for malignancy. Which of the following molecular alterations is most frequently associated with pancreatic ductal adenocarcinoma?

Accepted Answer

KRAS gene mutation

Answer

BRAF V600E mutation

Answer

EGFR mutation

Answer

ALK gene rearrangement