FRCPath Part1 Course
Special stains and Immunohistochemistry MCQ 1 A 69 year old male with history of asbestos exposure presents with pleural effusion: The CT scan shows diffuse left sided pleural thickening. The pleural cytology shows clusters of atypical cells with an epithelioid morphology which are immunohistochemically AE1/3 and CK7 positive, but negative for BerEP4, CEA, TTF1, CK20, CD34 and desmin. The likely diagnosis is: A. B. C. D. E.
Pulmonary adenocarcinoma. Malignant mesothelioma. Small cell carcinoma. Malignant solitary fibrous tumour. Epithelioid leiomyosarcoma.
MCQ 2 CD34 is positive in which of the following tumours: A. Dermatofibrosarcoma protuberans. B. Solitary fibrous tumour. C. Gastrointestinal stromal tumour. D. Spindle cell lipoma. E. All of the above. MCQ 3 The commonest phenotype of primary ovarian mucinous cystadenocarcinoma is: A. B. C. D. E.
CK7 positive/CK20 negative. CK7 negative/CK20 positive. CK7 negative/CK20 negative. CK7 diffuse positive/CK20 patchy positive CK7 patchy positive/CK20 diffuse positive.
MCQ 4 An 80 year old man undergoes a skin excision biopsy for an ill-defined nodule on the face measuring 2cm in diameter: Histologically the epidermis is atrophic but otherwise normal. The sun-damaged dermis shows a pleomorphic spindle cell lesion with many mitotic figures, which does not extend into the subcutaneous tissue. Immunohistochemically, the tumour cells are negative for AE1/3, MNF116, S100, smooth muscle actin and desmin. The most likely diagnosis is: A. Spindle cell carcinoma. B. Synovial sarcoma C. Cutaneous leiomyosarcoma. D. Atypical fibroxanthoma E. Malignant melanoma.
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FRCPath Part1 Course MCQ 5 A 60 year-old male with pancytopenia undergoes a bone marrow trephine biopsy: This shows infiltration by sheets of immature blast-like cells. Immunohistochemically, these cells are negative for CD3, CD20 and CD138 but positive for CD117, CD34 and myeloperoxidase. The most likely diagnosis is: A. Hodgkin lymphoma. B. Acute myeloid leukaemia C. Diffuse large B-cell lymphoma. D. Plasma cell myeloma. E. Metastatic gastrointestinal stromal tumour. MCQ 6 A 32 year old male undergoes an orchidectomy: This shows a tumour composed of pleomorphic epithelioid cells forming solid papillary and glandular patterns with areas of necrosis and many mitoses. The tumour cells are diffusely positive for AE1/3 and CD30 and show patchy positivity with placental alkaline phosphatase. They are negative for EMA and Human chorionic gonadotropin. The most likely diagnosis is: A. Embryonal carcinoma. B. Seminoma. C. Choriocarcinoma. D. Yolk sac tumour. E. Hodgkin’s lymphoma. EMQ 7 A: PAS with diastase. B: Alcian blue C: Perl’s Prussian blue. D: Warthin Starry. E: Toluidine blue. F: Masson Trichrome G: ZN stain H: Reticulin. I: Congo red. J: Von Kossa. K: Elastic Van Gieson. In each of the following situations, select the special stain most likely to help make a definitive diagnosis: 1. A 70 year old female suffering from rheumatoid arthritis for the past 20 years undergoes a renal biopsy for deranged renal function test: Extensive eosinophilic, homogenous appearing deposits are noted in the mesangium and capillary loops of the glomeruli.
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FRCPath Part1 Course 2. A 25 year old female with multiple small yellow brown papules over the trunk and arms with a clinical suspicion of urticaria pigmentosa undergoes a skin biopsy: Histologically, nodular aggregates and sheets of mast cells and eosinophils are seen in the dermis. 3. A 47 year old man undergoes a liver biopsy for mildly deranged liver function tests: The hepatocytes show prominent, brown coarse and granular cytoplasmic pigment, but no other significant abnormality. 4. A 67 year old immuno-compromised male presents with multiple oesophageal ulcers: A biopsy shows extensive necrosis and inflammation, but no evidence of malignancy. A few possible hyphae are noted within the necrotic debris. 5. A 56 year old female with headaches undergoes a temporal artery biopsy: It shows patchy transmural inflammation. EMQ 8 A: Oestrogen receptor. B: Thyroglobulin. C: Calcitonin. D: Prostase specific antigen. E: Inhibin. F: CK7. G: CD56 (NCAM). H: Melan-A. I: CA125. J: p63. K: WT-1 In each of the following situations, select the special stain most likely to make a definitive diagnosis: 1. A 60 year old male undergoes a bronchial biopsy: It shows infiltration by cells with scanty cytoplasm, nuclear molding, granular chromatin, inconspicuous nucleoli and many mitoses. 2. A 74 year old male has a six quadrant prostate core biopsy for a high PSA: One of these cores shows a cluster of small, round glands with a back to back architecture and prominent nucleoli. 3. A 52 year old woman who has MEN 2a syndrome undergoes thyroidectomy: Shows an infiltrative 3cm large tumour on slicing. Histologically, it is composed of nests of epithelioid and spindle shaped cells with fairly uniform nuclei, separated by fibrous stroma containing foci of amyloid deposition. 4. A 72 year old female undergoes hysterectomy for an enlarged right ovarian mass: It shows a poorly differentiated adenocarcinoma with a focal papillary architecture, marked nuclear pleomorphism, prominent nucleoli and psammoma bodies. 5. A 68 year old male undergoes an axillary lymph node biopsy for lymphadenopathy: Histology shows replacement by malignant epithelioid and spindle shaped cells with large eosinophilic nucleoli. He has history of excision of a dark skin nodule on the arm six months before.
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FRCPath Part1 Course EMQ 9 A. Follicular lymphoma. B. Anaplastic large cell lymphoma. C. Classical Hodgkin’s lymphoma. D. Marginal zone lymphoma. E. CLL/SLL. F. Peripheral T-cell lymphoma G. T-lymphoblastic lymphoma. H. Burkitt’s lymphoma I. Angioimmunoblastic T-cell lymphoma. J. Mantle cell lymphoma. K. Nodular lymphocyte predominant Hodgkin’s lymphoma. Choose the above category of lymphoma which best fits the immunoprofile given below: 1. CD5 positive/CD10 negative/CD23 positive/Cyclin D1 negative/CD20 positive. 2. CD5 positive/CD10 negative/CD23 negative/Cyclin D1 positive/CD20 positive. 3. CD5 negative/CD10 positive/Bcl-6 positive/Bcl-2 positive/CD20 positive. 4. CD10 positive/Bcl-6 positive/Bcl-2 negative/Ki67 100%/CD20 positive/cmyc positive. 5. CD3 positive/CD20 negative/EMA negative/CD30 positive/Alk-1 positive. EMQ 10 A. HMB45 B. p53. C. CK20. D. TTF-1. E. Desmin F. F. CD10. G. CD117. H. Vimentin. I. Alpha Inhibin. J. CD34. K. K. CD1a. L. Myeloperoxidase. In each of the following lesions, select the antibody from the above list, which is most likely to make the diagnosis: 1. 2. 3. 4. 5.
Renal angiomyolipoma. Endometrial stromal sarcoma. Langerhan’s cell histiocytosis. Merkel cell carcinoma. Pulmonary adenocarcinoma.
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