BCSE Anatomic and Clinical Pathology 4

Question 1

A surgical pathology specimen from a 50-year-old smoker shows a lung tumor with cells arranged in nests ('Zellballen') and expressing synaptophysin and chromogranin on immunohistochemistry. What is this tumor?

Accepted Answer

Carcinoid tumor (neuroendocrine tumor)

Answer

Carcinoid tumors are well-differentiated neuroendocrine neoplasms that grow in organoid nests and are positive for neuroendocrine markers synaptophysin and chromogranin.

Question 2

A 35-year-old woman has elevated serum ALT, AST, and anti-smooth muscle antibody titer of 1:320. Liver biopsy shows interface hepatitis with plasma cell infiltration. What is the diagnosis?

Accepted Answer

Autoimmune hepatitis

Answer

Autoimmune hepatitis features interface hepatitis, plasma cell-rich inflammation, and positive autoantibodies including anti-smooth muscle antibody.

Question 3

On electron microscopy of a glomerulus, subepithelial electron-dense deposits with a 'spike and dome' appearance are seen. What disease does this represent?

Accepted Answer

Membranous nephropathy

Answer

Membranous nephropathy shows subepithelial immune deposits with reactive GBM spikes forming between deposits, creating the classic 'spike and dome' pattern on EM.

Question 4

A 55-year-old male has a skin lesion on the back showing a melanocytic proliferation with asymmetry, irregular borders, color variation, and a diameter of 8 mm. The Breslow thickness is 1.8 mm. What does Breslow thickness determine?

Accepted Answer

Depth of tumor invasion from the granular layer or ulcer base, used for staging and prognosis

Answer

Breslow thickness measures the vertical depth of melanoma from the granular cell layer (or ulcer base) to the deepest tumor cell, and is the primary prognostic factor.

Question 5

A serum protein electrophoresis shows a sharp, narrow peak in the gamma region. The next best step to characterize this finding is:

Accepted Answer

Serum immunofixation electrophoresis to identify the heavy and light chain class

Answer

Immunofixation electrophoresis identifies and characterizes the specific immunoglobulin class (e.g., IgG kappa) of an M-spike detected on SPEP.

BCSE - Basic and Clinical Sciences Examination Practice Test

BCSE - Basic and Clinical Sciences Examination Practice Test

BCSE Anatomic and Clinical Pathology 4