LATEST PATHOLOGY - CYTOPATHOLOGY
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PATHOLOGY (ABMS) |
COMPLETE EXAM Q&A WITH RATIONALES
1. A 55-year-old man with a 40-pack-year smoking
history presents with a right upper lobe lung mass.
CT-guided fine-needle aspiration (FNA) shows small
cells with scant cytoplasm, nuclear molding, and
"salt and pepper" chromatin. The cells are positive
for synaptophysin and chromogranin. What is the
most likely diagnosis?
A) Squamous cell carcinoma
B) Adenocarcinoma
C) Small cell carcinoma
D) Carcinoid tumor
Correct answer: C
Rationale: Small cell carcinoma shows small to
medium cells with scant cytoplasm, nuclear molding,
granular chromatin (salt and pepper), and high
mitotic rate. Neuroendocrine markers
(synaptophysin, chromogranin, CD56) are positive.
Carcinoid tumor (D) has more cytoplasm and lower
mitotic rate.
,2. A 45-year-old woman undergoes a routine cervical
Pap test. The cytology shows cells with enlarged,
hyperchromatic nuclei, irregular nuclear
membranes, and a high nuclear-to-cytoplasmic ratio.
The cells are arranged in clusters and as single cells.
The background shows tumor diathesis (necrotic
debris). What is the most likely diagnosis?
A) Low-grade squamous intraepithelial lesion (LSIL)
B) High-grade squamous intraepithelial lesion (HSIL)
C) Squamous cell carcinoma
D) Atrophic vaginitis
Correct answer: C
Rationale: Squamous cell carcinoma shows
malignant cells with marked nuclear atypia, high N/C
ratio, and tumor diathesis (dirty, necrotic
background). HSIL (B) lacks tumor diathesis and has
less severe atypia. LSIL (A) shows koilocytes
(perinuclear halos, binucleation).
3. A 60-year-old woman presents with a thyroid
nodule. Fine-needle aspiration (FNA) shows abundant
colloid, macrophages, and follicular cells with
honeycomb arrangement and no nuclear atypia. What
is the Bethesda category and risk of malignancy?
,A) Bethesda I (nondiagnostic) – 5-10% risk
B) Bethesda II (benign) – 0-3% risk
C) Bethesda III (atypia) – 10-20% risk
D) Bethesda IV (follicular neoplasm) – 20-30% risk
Correct answer: B
Rationale: Bethesda II (benign) includes nodular
goiter and Hashimoto thyroiditis. Features: abundant
colloid, honeycomb sheets of follicular cells,
macrophages. Risk of malignancy is 0-3%. Clinical
follow-up (rather than surgery) is recommended.
4. A 35-year-old woman presents with a breast mass.
Ultrasound-guided FNA shows numerous ductal cells
with mild nuclear enlargement, uniform chromatin,
and myoepithelial cells. The cells are arranged in flat
sheets. What is the most likely diagnosis?
A) Fibroadenoma
B) Invasive ductal carcinoma
C) Ductal carcinoma in situ
D) Papillary carcinoma
Correct answer: A
Rationale: Fibroadenoma shows benign ductal cells
in flat sheets with myoepithelial cells (bipolar bare
nuclei). The absence of significant atypia or single
, malignant cells favors benign. Carcinoma (B,C)
shows discohesion, nuclear pleomorphism, and loss
of myoepithelial cells.
5. A 48-year-old woman has a cervical Pap test
reported as atypical squamous cells of undetermined
significance (ASC-US). High-risk HPV testing is
positive. What is the most appropriate next step?
A) Repeat Pap test in 12 months
B) Colposcopy
C) HPV vaccination
D) Loop electrosurgical excision procedure (LEEP)
Correct answer: B
Rationale: Current guidelines: ASC-US with positive
high-risk HPV → colposcopy. ASC-US with negative
HPV → repeat co-testing in 3 years. LEEP (D) is for
histologically confirmed high-grade dysplasia (CIN 2-
3). HPV vaccination (C) is preventive, not therapeutic.
6. A 62-year-old man presents with a pancreatic
mass. Endoscopic ultrasound-guided FNA shows a
cellular specimen with cells arranged in sheets and
single cells. The cells have eccentrically placed
nuclei, abundant granular cytoplasm, and nuclear
grooves. The background contains mucin. The cells
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PATHOLOGY (ABMS) |
COMPLETE EXAM Q&A WITH RATIONALES
1. A 55-year-old man with a 40-pack-year smoking
history presents with a right upper lobe lung mass.
CT-guided fine-needle aspiration (FNA) shows small
cells with scant cytoplasm, nuclear molding, and
"salt and pepper" chromatin. The cells are positive
for synaptophysin and chromogranin. What is the
most likely diagnosis?
A) Squamous cell carcinoma
B) Adenocarcinoma
C) Small cell carcinoma
D) Carcinoid tumor
Correct answer: C
Rationale: Small cell carcinoma shows small to
medium cells with scant cytoplasm, nuclear molding,
granular chromatin (salt and pepper), and high
mitotic rate. Neuroendocrine markers
(synaptophysin, chromogranin, CD56) are positive.
Carcinoid tumor (D) has more cytoplasm and lower
mitotic rate.
,2. A 45-year-old woman undergoes a routine cervical
Pap test. The cytology shows cells with enlarged,
hyperchromatic nuclei, irregular nuclear
membranes, and a high nuclear-to-cytoplasmic ratio.
The cells are arranged in clusters and as single cells.
The background shows tumor diathesis (necrotic
debris). What is the most likely diagnosis?
A) Low-grade squamous intraepithelial lesion (LSIL)
B) High-grade squamous intraepithelial lesion (HSIL)
C) Squamous cell carcinoma
D) Atrophic vaginitis
Correct answer: C
Rationale: Squamous cell carcinoma shows
malignant cells with marked nuclear atypia, high N/C
ratio, and tumor diathesis (dirty, necrotic
background). HSIL (B) lacks tumor diathesis and has
less severe atypia. LSIL (A) shows koilocytes
(perinuclear halos, binucleation).
3. A 60-year-old woman presents with a thyroid
nodule. Fine-needle aspiration (FNA) shows abundant
colloid, macrophages, and follicular cells with
honeycomb arrangement and no nuclear atypia. What
is the Bethesda category and risk of malignancy?
,A) Bethesda I (nondiagnostic) – 5-10% risk
B) Bethesda II (benign) – 0-3% risk
C) Bethesda III (atypia) – 10-20% risk
D) Bethesda IV (follicular neoplasm) – 20-30% risk
Correct answer: B
Rationale: Bethesda II (benign) includes nodular
goiter and Hashimoto thyroiditis. Features: abundant
colloid, honeycomb sheets of follicular cells,
macrophages. Risk of malignancy is 0-3%. Clinical
follow-up (rather than surgery) is recommended.
4. A 35-year-old woman presents with a breast mass.
Ultrasound-guided FNA shows numerous ductal cells
with mild nuclear enlargement, uniform chromatin,
and myoepithelial cells. The cells are arranged in flat
sheets. What is the most likely diagnosis?
A) Fibroadenoma
B) Invasive ductal carcinoma
C) Ductal carcinoma in situ
D) Papillary carcinoma
Correct answer: A
Rationale: Fibroadenoma shows benign ductal cells
in flat sheets with myoepithelial cells (bipolar bare
nuclei). The absence of significant atypia or single
, malignant cells favors benign. Carcinoma (B,C)
shows discohesion, nuclear pleomorphism, and loss
of myoepithelial cells.
5. A 48-year-old woman has a cervical Pap test
reported as atypical squamous cells of undetermined
significance (ASC-US). High-risk HPV testing is
positive. What is the most appropriate next step?
A) Repeat Pap test in 12 months
B) Colposcopy
C) HPV vaccination
D) Loop electrosurgical excision procedure (LEEP)
Correct answer: B
Rationale: Current guidelines: ASC-US with positive
high-risk HPV → colposcopy. ASC-US with negative
HPV → repeat co-testing in 3 years. LEEP (D) is for
histologically confirmed high-grade dysplasia (CIN 2-
3). HPV vaccination (C) is preventive, not therapeutic.
6. A 62-year-old man presents with a pancreatic
mass. Endoscopic ultrasound-guided FNA shows a
cellular specimen with cells arranged in sheets and
single cells. The cells have eccentrically placed
nuclei, abundant granular cytoplasm, and nuclear
grooves. The background contains mucin. The cells
