BCSE Anatomic and Clinical Pathology 5 — Questions and Answers
Question 1: A 4-year-old child has a large abdominal mass with histology showing triphasic components: blastemal cells, stromal cells, and epithelial cells forming primitive tubules. What is the diagnosis?
- Wilms tumor (nephroblastoma) (Correct answer)
- Neuroblastoma
- Rhabdomyosarcoma
- Hepatoblastoma
Correct answer: Wilms tumor (nephroblastoma)
Wilms tumor is the most common pediatric renal malignancy and is defined by its triphasic histology of blastema, stroma, and epithelium.
Question 2: A patient's cervical Pap smear shows cells with high nuclear-to-cytoplasmic ratio, nuclear hyperchromasia, and irregular chromatin in squamous cells. These findings are classified as HSIL. HSIL corresponds to which histologic diagnosis?
- CIN 2 or CIN 3 (Correct answer)
- CIN 1 only
- Invasive squamous cell carcinoma
- Normal squamous mucosa
Correct answer: CIN 2 or CIN 3
HSIL (High-grade Squamous Intraepithelial Lesion) on Pap smear corresponds histologically to CIN 2 or CIN 3, indicating significant dysplasia.
Question 3: A 60-year-old female has a lung biopsy showing pink, amorphous alveolar filling material that stains with PAS and is congophilic with apple-green birefringence under polarized light. What is the diagnosis?
- Pulmonary alveolar proteinosis
- Alveolar amyloidosis (Correct answer)
- Organizing pneumonia
- Pulmonary edema
Correct answer: Alveolar amyloidosis
Congo red staining with apple-green birefringence under polarized light is diagnostic of amyloid deposition; pulmonary amyloidosis can present as alveolar filling.
Question 4: A 72-year-old man has a splenectomy specimen showing a diffuse infiltration of small lymphoid cells that also fill the splenic red pulp sinusoids and are positive for CD20, CD11c, DBA.44 with TRAP (tartrate-resistant acid phosphatase) staining. What is the diagnosis?
- Hairy cell leukemia (Correct answer)
- CLL/SLL
- Marginal zone lymphoma
- Mantle cell lymphoma
Correct answer: Hairy cell leukemia
Hairy cell leukemia is characterized by B-cells with hairy cytoplasmic projections, CD11c and DBA.44 positivity, TRAP positivity, and infiltration of splenic red pulp.
Question 5: An autopsy on a 55-year-old male with a history of chronic hypertension shows concentric left ventricular wall thickening with a normal or reduced chamber size. What is this change called?
- Concentric hypertrophy (Correct answer)
- Eccentric hypertrophy
- Dilated cardiomyopathy
- Hypertrophic obstructive cardiomyopathy
Correct answer: Concentric hypertrophy
Concentric hypertrophy results from pressure overload (as in hypertension), causing sarcomeres to add in parallel, increasing wall thickness while preserving or reducing chamber size.
Question 6: A 48-year-old woman with rheumatoid arthritis develops new proteinuria. Kidney biopsy shows amorphous pink material in the mesangium and glomerular capillaries on H&E, Congo red positive with apple-green birefringence, and positive for SAA (serum amyloid A) by immunohistochemistry. What type of amyloid is this?
- AA amyloid (secondary amyloidosis) (Correct answer)
- AL amyloid (primary amyloidosis)
- ATTR amyloid (transthyretin)
- Aβ2M amyloid (dialysis-related)
Correct answer: AA amyloid (secondary amyloidosis)
AA amyloidosis results from chronic inflammatory conditions (like RA) where sustained elevation of serum amyloid A protein leads to AA fibril deposition.
Question 7: A 65-year-old male smoker has a centrally located lung tumor. Histology shows large polygonal cells with abundant pink cytoplasm, intercellular bridges, and keratin pearls. What is the diagnosis?
- Squamous cell carcinoma (Correct answer)
- Large cell carcinoma
- Adenocarcinoma
- Small cell carcinoma
Correct answer: Squamous cell carcinoma
Squamous cell carcinoma of the lung is characterized by keratin pearl formation, intercellular bridges, and p40/p63 positivity, and typically arises centrally in smokers.
BCSE Anatomic and Clinical Pathology 5
A 4-year-old child has a large abdominal mass with histology showing triphasic components: blastemal cells, stromal cells, and epithelial cells forming primitive tubules.
What is the diagnosis?