BCSE Anatomic and Clinical Pathology 2 — Questions and Answers
Question 1: A 55-year-old woman has a breast biopsy showing cells with large nuclei, prominent nucleoli, and loss of normal glandular architecture invading the stroma. What is the most appropriate classification?
- Invasive ductal carcinoma (Correct answer)
- Lobular carcinoma in situ
- Fibroadenoma
- Phyllodes tumor
Correct answer: Invasive ductal carcinoma
Invasive ductal carcinoma is characterized by malignant epithelial cells with stromal invasion, large nuclei, and prominent nucleoli.
Question 2: On a peripheral blood smear, you observe red blood cells shaped like a football or rugby ball with two pointed ends. What is the term for this morphology?
- Elliptocyte (Correct answer)
- Schistocyte
- Acanthocyte
- Stomatocyte
Correct answer: Elliptocyte
Elliptocytes (also called ovalocytes) are elongated red blood cells with two pointed ends seen in hereditary elliptocytosis.
Question 3: A liver biopsy from a patient with chronic alcoholism shows hepatocytes containing eosinophilic, irregular cytoplasmic inclusions. What is this material?
- Mallory-Denk bodies (Correct answer)
- Councilman bodies
- Lewy bodies
- Russell bodies
Correct answer: Mallory-Denk bodies
Mallory-Denk bodies are aggregates of intermediate filaments (cytokeratin) found in hepatocytes in alcoholic liver disease.
Question 4: A 70-year-old male has a serum PSA of 18 ng/mL. Prostate biopsy reveals glands lined by a single layer of cells with no basal cell layer. Gleason grading is used. What does a combined Gleason score of 7 (3+4) indicate?
- Intermediate-grade carcinoma with predominantly well-formed glands (Correct answer)
- Low-grade carcinoma with a favorable prognosis
- High-grade carcinoma with predominantly poorly formed glands
- Benign prostatic hyperplasia
Correct answer: Intermediate-grade carcinoma with predominantly well-formed glands
Gleason 3+4=7 indicates intermediate grade with the dominant pattern being grade 3 (well-formed glands) and secondary pattern grade 4 (poorly formed glands).
Question 5: Which laboratory finding is most characteristic of disseminated intravascular coagulation (DIC)?
- Elevated D-dimer, prolonged PT and PTT, low fibrinogen, low platelets (Correct answer)
- Elevated fibrinogen, shortened PT, elevated platelets
- Normal PT and PTT with low D-dimer
- Isolated thrombocytopenia with normal coagulation studies
Correct answer: Elevated D-dimer, prolonged PT and PTT, low fibrinogen, low platelets
DIC is characterized by widespread clotting consuming clotting factors and platelets, leading to elevated D-dimer, prolonged PT/PTT, low fibrinogen, and thrombocytopenia.
Question 6: A kidney biopsy immunofluorescence shows linear IgG deposits along the glomerular basement membrane. This pattern is most consistent with which disease?
- Goodpasture syndrome (Correct answer)
- Membranous nephropathy
- IgA nephropathy
- Lupus nephritis
Correct answer: Goodpasture syndrome
Linear IgG along the GBM is the hallmark of anti-GBM disease (Goodpasture syndrome), reflecting antibodies directed against the GBM itself.
Question 7: A colon resection specimen shows a tumor that histologically displays mucinous pools with scattered malignant epithelial cells floating within them. What percentage of the tumor must be mucinous for this classification?
- Greater than 50% (Correct answer)
- Greater than 25%
- Greater than 10%
- Greater than 75%
Correct answer: Greater than 50%
Mucinous adenocarcinoma of the colon is defined when more than 50% of the tumor is composed of extracellular mucin pools containing malignant cells.
BCSE Anatomic and Clinical Pathology 2
A 55-year-old woman has a breast biopsy showing cells with large nuclei, prominent nucleoli, and loss of normal glandular architecture invading the stroma.
What is the most appropriate classification?