Written Questions Flashcards
2022
Question 1 (Start Q1 answer booklet)
A 55-year-old female presents with a right retroperitoneal mass in the vicinity of the right kidney. A guided core biopsy is performed on the lesion.
A) The biopsy reveals an oncocytic lesion in the right kidney. What is your differential diagnosis? How would you proceed in diagnosing and reporting this biopsy for 3 common oncocytic entities?
B) The biopsy reveals an adrenocortical carcinoma. The right adrenal gland is subsequently resected. How should the specimen be reported?
(Reference to health and safety issues is not required in your response)
2022
Question 2 (Start Q2 answer booklet)
A 45-year-old woman has a left breast mass detected on palpation. A left mastec- tomy and axillary dissection are performed.
A) How do you macroscopically assess the mastectomy and axillary dissection spec- imens? Include details of your block selection.
B) Discuss the technical aspects, and the reporting requirements, of the prognosti- cally important ancillary investigations used in the assessment of breast carcinoma.
2022
Question 3 (Start Q3 answer booklet) Answer the following questions:
A) In the assessment of solid pancreatic lesions, what are the advantages and disadvantages of endoscopic ultrasound guided core biopsy versus fine needle aspiration biopsy?
B) What are the characteristics of pancreatic neuroendocrine neoplasms (tumours and carcinomas) by fine needle aspiration cytology?
C) Describe the impact of human papilloma virus (HPV) detection on cervical screening and its role in cervical cytopathology.
Question 4 (Start Q4 answer booklet) Answer the following questions:
A) Discuss the pre-analytical and analytical issues in the use of formalin fixed paraffin embedded tissue for molecular testing, in the prediction of response to targeted therapy in lung adenocarcinoma (excluding immunotherapy).
B) How is formalin fixed paraffin embedded tissue from malignant tumours used to predict response to immunotherapy?
C) Describe the principles underlying the assessment of HER-2 in oesophageal carcinoma.
Question 5 (Start Q5 answer booklet) Answer the following questions:
A) In the management of a patient with cancer, what are the roles and responsibilities of the anatomical pathologist in the multidisciplinary team?
B) While reviewing a colorectal resection specimen, reported by a colleague, for a multidisciplinary meeting, you notice that some of the lymph nodes show features that you suspect might be small lymphocytic lymphoma/chronic lymphocytic leukaemia. How do you proceed with handling this problem in the department, and at the subsequent meeting?
Made up questions
What are the important biomarkers relevant to treatment of ovarian tumours?
Made up questions
What are the important biomarkers relevant to diagnosis and prognostication of endometrioid endometrial carcinoma?
Made up questions
What are the important ancillary tests for diagnosis, prognostication and treatment of NSCLC?
What are the salivary gland tumours with good prognosis and their morphologic and molecular features?
Made up questions
What are the differential diagnosis for tumours in the retromolar trigone area? What are their morphologic features? How can they be differentiated using ancillary tests?
Made up questions
How are meningiomas graded? Give morphologic and molecular features of two subtypes in each grade.
Made up questions
Writes notes on Lynch syndrome.
2021
Question 1 (Start Q1 answer booklet)
A 45-year-old woman has a right ovarian mass identified on CT scan. She under- goes surgery, and the right ovary is sent to your laboratory as a fresh specimen.
A) How do you assess an ovarian mass specimen macroscopically?
.
B) A frozen section reveals signet ring tumour cells and mucin. What additional clini- cal information do you require from the surgeon, and what is your differential diagno- sis?
C) Discuss the ancillary techniques you would use in assessing this tumour, both for diagnosis and prognosis.
2021
Question 2 (Start Q2 answer booklet)
A 55-year-old male presents with a 44mm diameter ulcerative lesion in the lower oesophagus.
A) What are the pathological diagnostic possibilities for such a lesion?
B) If a diagnosis of cancer is reported, and oesophagectomy is performed after neoadjuvant therapy, how should the specimen be handled and reported? (Reference to health and safety issues is not required in your response)
C) How do you classify and report epithelial dysplasias in the oesophagus?
Question 3 (Start Q3 answer booklet) Answer the following questions:
A) Discuss the principal staining techniques used in Aspiration Cytopathology.
B) Give an account of the cytological features of thyroiditis.
C) Describe the Bethesda/Australasian system for reporting thyroid cytopathology.
Question 4 (Start Q4 answer booklet) Answer the following questions:
A) Discuss the approach to the diagnosis of giant cell (cranial) arteritis, and briefly list its complications.
B) Describe the use of FISH in the diagnosis and prognosis of Non-Hodgkin lymphoma.
C) Describe the diagnostic clinicopathological features of malignant adipocytic tumours.
Question 5 (Start Q5 answer booklet) Answer the following questions:
A) Describe the microscopic morphology of three germ cell tumours of the testis.
B) List five (5) hazards which may be encountered in the Anatomical Pathology Laboratory.
C) What features do you include in the report of an orientated excision specimen of squamous cell carcinoma of skin?
Question 1 (Start Q1 answer booklet)
You have been asked to attend a Multidisciplinary (MDT) meeting with your consultant in which two cases of colorectal carcinoma that you have reported are to be discussed. One patient is a 48-year-old woman who has a biopsy confirmed rectal carcinoma. The carcinoma appears to be extensive and not operable by clinical examination. The other patient is a 32-year-old man who has had a right hemi-colectomy for adenocarcinoma of the ascending colon.
A) Provide a definition of the MDT meeting, and describe its functions. Describe the roles of a pathologist in this multidisciplinary meeting.
B) How does the MDT meeting function as a quality measure in pathology? Give examples.
C) Apart from the MDT meeting, describe in detail any three quality processes in which your department participates.
Question 2 (Start Q2 answer booklet)
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A cystic mass is noted in the head of pancreas of a 46-year-old woman on endoscopic ultrasound examination.
A) What are the differential diagnoses?
B) What are the pathological diagnostic modalities for such a lesion?
C) If a Whipple operation was performed with a pre-operative diagnosis of an adenocarcinoma, how is the specimen cut up and reported in your laboratory? (Reference to health and safety issues is not required in your response)
Question 3 (Start Q3 answer booklet) Answer the following questions:
A) Describe the use of molecular markers in the work-up of non-small cell lung carcinoma.
B) Explain the classification of Hodgkin Lymphoma.
C) What are the features which distinguish cellular dermatofibroma from dermatofibrosarcoma protruberans (DFSP)?
Question 4 (Start Q4 answer booklet) Answer the following questions:
A) A fine needle aspiration of the thyroid gland yields oncocytic cells. Explain their significance.
B) Describe the subtypes of oropharyngeal squamous cell carcinoma.
C) Describe the diagnostic and clinical features of eosinophilic oesophagitis.
Question 5 (Start Q5 answer booklet) Answer the following questions:
A) Explain the relationship between endometrial hyperplasia and carcinoma.
B) Explain the classification of urothelial neoplasia.
C) Describe the histological features of subtypes of breast carcinoma having an excellent or good prognosis.
Question 1 (Start Q1 answer booklet)
A lytic lesion was detected radiologically in the right ethmoid sinus of a 23-year-old male. The biopsy revealed infiltrative clusters of tumour cells with hyperchromatic nuclei, high nuclear to cytoplasmic ratios, prominent nuclear pleomorphism and conspicuous mitotic figures.
A. What is your differential diagnosis in this patient?
B. What are the morphological hallmarks of each differential diagnosis and what ancillary tests would you do to resolve the diagnosis?
Question 2 (Start Q2 answer booklet)
A 48-year-old woman presented with rectal bleeding and a polypoid mass in the lower rectum. Biopsy confirmed the tumour to be an adenocarcinoma. The patient received pre-operative chemoradiation and you subsequently received the resected specimen.
A. At the time of macroscopic examination, no tumour was identified in the rectum. Discuss how you would process and report this specimen including the selection of blocks.
B. What are the histological features that you may encounter in the tumour bed following neoadjuvant therapy?
C. Please comment on how neoadjuvant therapy impacts the assessment of lymph node status for this patient.
Question 3 (Start Q3 answer booklet)
A 58-year-old man presented with 6 weeks of confusion and a space-occupying lesion in the right temporal lobe, which is radio enhancing. An intraoperative sample is sent to your laboratory. Smear cytology demonstrates a diffuse population of large malignant cells.
A. What is your differential diagnosis?
When you phone your provisional diagnosis, the surgeon tells you that the patient is HIV positive and is sending more fresh tissue from the tumour.
B. Does this additional information change your differential diagnosis?
C. How you would handle and triage the additional specimen to reach a diagnosis?
Question 4 (Start Q4 answer booklet)
Write short notes on:
A. The classification of cystic lesions of the pancreas.
B. The routine assessment of a twin placenta.
C. The morphological features of Lentigo maligna/Hutchinson’s Melanotic Freckle.
Question 5 (Start Q5 answer booklet)
Write short notes on:
A. The classification of benign renal tumours, describing the features of one of them.
B. The significance of HER-2 assessment in lower oesophageal and gastric adenocarcinoma.
C. The current morphological and molecular classification of liposarcoma.
made up question
Write notes on the current and morphological and molecular classification of thyroid tumours.
made up questions
What are the lung tumours with good prognosis? What are their morphologic features and relevant ancillaries tests to distinguish them.
Question 1 (Start Q1 answer booklet)
A 60-year-old man has a space-occupying lesion in the upper lobe of the right lung. A biopsy is obtained by bronchoscopy.
A. Briefly describe how you would triage the biopsy material. Discuss the differential diagnoses and ancillary studies you may want to undertake to arrive at a diagnosis.
B. Discuss the current WHO classification of malignant glandular neoplasms of the lung (excluding salivary gland type tumours).
C. The biopsy shows adenocarcinoma. The patient subsequently has a right upper lobectomy. What features would you include in your structured (synoptic) cancer report (including any additional ancillary tests that are commonly required for pulmonary adenocarcinoma)?
Question 2 (Start Q2 answer booklet)
A-35-year-old woman, on steroid treatment for systemic lupus erythematosus (SLE), develops high fever and flu symptoms after a trip to China. She collapses at a shopping centre and is admitted to the Emergency Department. A chest X-ray reveals bilateral haziness in the chest
Page 1 of 2
and ascites in the abdomen. She dies shortly after admission. A limited autopsy is performed on her chest and abdomen (with retroperitoneum).
A. With this history, what safety precautions would you take when performing the autopsy?
B. What are the likely findings at the limited autopsy and what ancillary investigations would you like to perform?
Question 3 (Start Q3 answer booklet)
A 63-year-old man has a bladder biopsy for investigation of haematuria. At low power examination you see clusters and nests of urothelial cells under the surface raising your suspicion of invasive malignancy
A. Discuss how you would distinguish those benign lesions that may mimic invasive malignancy by histology and other appropriate means.
B. Discuss subtypes of urothelial carcinoma that may be mistaken as benign proliferations and their key histological features. Briefly indicate the biological behaviour of these tumours. (Pleases note that you may combine your answers to A. and B).
C. The biopsy shows a high-grade urothelial carcinoma. A cystoprostatectomy is performed. Discuss how you would dissect the specimen and which macroscopic characteristics you would be particularly interested in and would take sections from?
Question 4 (Start Q4 answer booklet)
You attend an ultrasound guided fine needle aspiration of a submandibular mass in a 69-year- old woman
A. Outline how the specimen could be triaged in the ultrasound suite in order to obtain maximal diagnostic material
B. Discuss the main differential diagnoses and the key cytological features of each.
Question 5 (Start Q5 answer booklet)
Write brief notes on ALL of the following:
A. Clinical implications and principles of testing PD-1 or PD-L1 by pathologists
B. The use of FISH and immunohistochemistry in the diagnosis of common gliomas.
Question 1 (Start Q1 answer booklet)
A 60-year-old man has a follow-up oesophageal biopsy for his long standing Barrett’s oesophagus.
A. What are the clinical and histological criteria for making the diagnosis of Barrett oesophagus?
B. Describe the histological features of high grade dysplasia and its mimics.
C. What is your approach for reporting endoscopic mucosal resection (EMR) of oesophagus?
Question 2 (Start Q2 answer booklet)
A 35-year-old man presents to a hospital Emergency Department with shortness of breath and palpitations. He has physical signs of heart failure and dies soon after admission. Autopsy was limited to the chest.
A. What are the possible causes of sudden cardiac death in this patient?
B. What specific macroscopic features would you look for in your examination of the heart?
Question 3 (Start Q3 answer booklet)
A 35-year-old woman has a left complex cystic ovarian mass, 10cm in diameter, detected on pelvic ultrasound. Histology shows serous carcinoma.
A. What is the accepted classification of serous carcinoma of the ovary? Outline the clinical, pathological features and ancillary tests (including molecular tests) that are relevant to the diagnosis and management of a patient with serous carcinoma.
B. What are the morphological and molecular features of ovarian tumours found in hereditary breast and ovarian cancer syndrome and Lynch syndrome?
Question 4 (Start Q4 answer booklet)
You are asked to attend an ultra-sound guided fine needle aspiration of a solitary solid lesion in the right lobe of thyroid of a 42-year-old woman.
A. Describe how an adequate sample can be obtained at the time of aspiration and what the cytological features of an adequate thyroid aspirate specimen are.
B. Name and discuss one standardised classification system for reporting fine needle aspirations of thyroid.
C. What ancillary tests are helpful in the diagnosis of thyroid tumours?
Question 5 (Start Q5 answer booklet)
Write brief notes on ALL of the following:
A. An oncologist requests EGFR testing on a lung biopsy showing carcinoma. How do you assess the suitability of the biopsy prior to molecular testing?
B. Describe, with examples, the application and importance of fluorescence in situ hybridization (FISH) in 3 different types of tumour.
C. Histological features of sessile serrated polyps of colon.
- Discuss 5 quality measurements that are used in your anatomical pathology laboratory and outline how these contribute to risk management
- A 45-year-old woman had bilateral adrenal masses noted on CT scan.
A. Discuss the differential diagnoses of the adrenal tumours in this patient.
B. Outline the morphological features and ancillary tests (including molecular tests) that are relevant to the diagnosis and management of this patient.
- A 42-year-old man presented with abdominal pain and a CT scan reveals a mass involving the pancreas. You are asked to attend the diagnostic FNA procedure for the patient.
A. Describe the different techniques for obtaining cytological samples of the pancreas and the surrounding structures.
B. A lesion in the head of pancreas is identified. What is your differential diagnosis?
C. Discuss the cytological features you would see in pancreatic ductal adenocarcinoma.
D. Discuss the cytological differential diagnoses of well-differentiated pancreatic ductal adenocarcinoma.
E. Discuss how endoscopic fine needle aspiration of the pancreas can be used for staging of pancreatic adenocarcinoma.
- Write brief notes on BOTH of the following:
A. The role of HPV in head & neck cancer and of its significance for the anatomical pathologist.
B. The immunohistochemical assessment of mismatch repair protein expression in colorectal carcinoma including a discussion of the various expression profiles that you may encounter and its impact on patient management.
- A 56-year-old man has transrectal ultrasound guided needle biopsies (TRUS) of his prostate for suspected prostatic adenocarcinoma.
- A 45-year-old woman had a tumour in the lower portion of the oesophagus. She underwent oesophagogastrectomy after neo-adjuvant chemotherapy and radiation.
A. Discuss the different histological types of tumours that can occur in the oesophagus of this patient and how you arrive at the diagnosis at the time of endoscopic biopsy
B. At the time of macroscopic examination, no tumour is identified in the oesophagus. Discuss how you would process and report this oesophagogastrectomy specimen including the selection of blocks.
- A 60-year-old woman presented with ascites. Cell block and smears reveal atypical cells in the ascitic fluid. Describe your differential diagnoses.
How would you distinguish reactive mesothelial cells from malignant cells in ascetic fluid? Include any ancillary tests that help in the making the diagnosis