Question #1: What is the most likely immuno-peroxidase profile
of these cells from the pleural fluid of a 64 year-old man with mediastinal
mass? (Diff-Quik Stain, X200)
a. CEA+, Leu M1+
b. CEA+, EMA+
c. Calretinin+, EMA+
d. Calretinin-, HMB-45+
e. Calretinin-, CLA+
Question #2: Cervico-Vaginal smear from a 69 year-old woman.
These cells have most likely exfoliated from; (Papanicolaou Stain,
X400)
a. Endocervical adenocarcinoma
b. Cervical erosion with marked regenerative atypia
c. Malignant mixed mesodermal tumor
d. HSV infection
e. Benign endocervix with viral cytopathic
effect (possibly adenovirus)
Question #3: FNA of a 68 year-old woman with 45-year history
of heavy smoking revealed these cells from a cystic lesion in left upper
lobe of lung. What is the most probable diagnosis?
(Papanicolaou Stain, X600)
a. Atypical penumocytic hyperplasia
b. Malignant mesothelioma
c. Bronchioloalveolar carcinoma
d. Marked reactive atypia secondary to anthracosis
e. Metastatic malignant melanoma
Question #4: Most likely interpretation of this FNA from
a 2cm nodule in the right thyroid lobe of a 37 year-old woman is
(Papanicolaou Stain, X400)
a. Papillary thyroid carcinoma
b. Adenomatoid (hyperplastic) nodule
c. Graves disease
d. Follicular neoplasm
e. Insular carcinoma
Question #5: A 62 year-old man S/P radical prostatectomy
is being evaluated for gross hematuria. A voided urine sample revealed
these cells. Your best interpretation would be; (Papanicolaou Stain,
X400)
a. Recurrent prostatic adenocarcinoma
b. Urothelial carcinoma, high grade
c. Marked reactive atypia secondary to urolithiasis
d. Benign seminal vesicle cells
e. Renal cell carcinoma
Question #6: Which one of the following is true regarding
the urinary bladder lesion in a 72 year-old man with a recent onset of
hematuria? [Urine] (Papanicolaou Stain, X400)
a. Association with BK-virus infection
b. Worst prognosis
c. Always metastatic in origin
d. CLA+, CK- on immunostaining
e. Cytoplasmic cross-striations on EM
Question #7: FNA of a 3cm solitary round peripheral lung
nodule in a 48 year-old woman revealed these cells. What’s the most
likely diagnosis? (Papanicolaou Stain, X100)
a. Mucinous adenocarcinoma with desmoplasia
b. Metastatic chrondrosarcoma
c. Pulmonary chondroma
d. Metastatic leiomyosarcoma
e. Pulmonary hamartoma
Question #8: All of the following are true about this parotid
gland lesion from a 28 year-old man, EXCEPT; (Papanicolaou Stain,
X200)
a. Abundance of myoepithelial nuclei
b. Often bilateral
c. Exclusively limited to parotid
d. Strong male predominance
e. Higher incidence in smokers
Question #9: This 55 year-old woman with a 3cm pancreatic
tail mass is most likely suffering from; [FNA] (Diff-Quik Stain, X400)
a. Ductal adenocarcinoma
b. Carcinoid/ Islet cell tumor
c. Acinic cell carcinoma
d. Plasmacytoma
e. Metastatic malignant melanoma
Question #10: Cervicovaginal smear from a 38 year-old woman.
What’s the most probable diagnosis? (Papanicolaou Stain, X200)
a. Post-partum atrophy with parakeratosis
b. HSIL, keratinizing type
c. Candida-associated changes
d. Squamous cell carcinoma
e. LSIL
Question #11: Breast FNA of a 2 cm soft round nodule from
a 34 year-old woman reveals these cells. What is the most likely
interpretation? (Papanicolaou Stain, X200)
a. Mucocele
b. Nipple adenoma with duct ectasia
c. Colloid (mucinous) carcinoma
d. Mucinous metaplasia in fibroadenoma
e. Medullary breast carcinoma
Question #12: Cervico-vaginal smear from a 29 year-old woman
with prior history of LSIL. What would be the best recommendation after
interpretation of this smear? (Papanicolaou Stain, X630)
a. Repeat smear at 3 months
b. No special follow-up needed
c. Endocervical curettage
d. Colposcopy, with cervical biopsy
e. Endometrial biopsy
Question #13: Bronchial brush from a 56 year-old man status
post-chemotherapy for small cell lung carcinoma reveals these cells.
What is your best diagnosis? (Papanicolaou Stain, X200)
a. Recurrent/residual small cell carcinoma
b. Bronchial carcinoid
c. Lymphoid hyperplasia
d. Pulmonary hamartoma
e. Reserve cell hyperplasia
Question #14: A 59 year-old man, status-post renal transplant
develops hematuria with flank pain. Smear from a voided urine specimen
is depicted here. What is the most likely diagnosis?
(Papanicoloau Stain, X600)
a. BK virus infection
b. Urothelial carcinoma, high grade
c. Malakoplakia of the urinary bladder
d. Reactive atypia 20 immunosuppressive therapy
e. Seminal vesicle cells
Question #15: All of the following statements of this FNA
of a pancreatic tail cyst from a 45 year-old woman are true, EXCEPT
(Papanicolaou Stain, X100)
a. It’s displaying mucin-positive epithelial
cells
b. Cyst fluid typically shows a high amylase content
c. Atypical histiocytes may mimic adenocarcinoma
d. It’s the most common pancreatic cyst
e. It may show extensive necrosis, inflammation and calcification
Question #16: FNA from the neck nodule of an 18 year-old
girl revealed these cells. What is the most likely interpretation?
(Diff-Quik Stain, X40 and 400)
a. Medullary thyroid carcinoma
b. Follicular neoplasm
c. Lymphocytic thyroiditis
d. Insular carcinoma of the thyroid
e. Parathyroid adenoma
Question #17: Pleural effusion from a 57 year-old woman with
history of papillary thyroid carcinoma showed numerous fragments like the
one shown here. Most likely analysis would be?
(Papanicolaou stain, X200)
a. Adenocarcinoma- most likely bronchioloalveolar
type
b. Malignant mesothelioma
c. Granulomatous disease
d. Benign mesothelial hyperplasia
e. Metastatic papillary thyroid carcinoma
Question #18: A 67 year-old woman presented with a 5cm hard
cervical node. FNA revealed these cells. What is the most probable
source of these cells? (Diff-Quik Stain, X400)
a. Hodgkin’s disease
b. Anaplastic (Ki-1) lymphoma
c. Metastatic melanoma
d. Metastatic breast carcinoma
e. Anaplastic thyroid carcinoma
Question #19: A transgastric, ultrasound-guided endoscopic
FNA of a pancreatic lesion from a 40 year-old man showed this morphology.
What would be the next step in its evaluation?
(Diff-Quik Stain, X400)
a. Evaluate patients’ serum CA19.9
b. Recommend whole body scan for possible primary tumors
c. Cytohistologic correlation with patients’ previous skin melanoma
d. Immunostaining for chromogranin and NSE
e. Flow cytometry
Question #20: Cervico-vaginal smear from a 29 year-old, HIV
positive woman. What is the most likely source of these cells?
(Papanicolaou Stain, X400)
a. Endocervical AIS
b. HSIL
c. LSIL
d. Squamous cell carcinoma, glassy type
e. ASCUS, probably an intraepithelial lesion
Question #21: Autocyte Prep of voided urine from a 75 year-old
man status-post BCG therapy for a low-grade urothelial carcinoma. Based
on these cells, the patient is most likely suffering from;
(Papanicolaou stain, X600)
a. Recurrent urothelial carcinoma, low grade
b. Urothelial carcinoma, high grade
c. BCG effect on benign urothelium
d. Cystitis cystica
e. Urachal adenocarcinoma
Question #22: Stereotactically-guided brain biopsy of a discrete
4th ventricle mass in a 48 yr-old man revealed numerous fragments of the
type shown here. How would you like to interpret this lesion? (H&E
stain, X100)
a. Metastatic papillary adenocarcinoma
b. Choroid plexus papilloma
c. Central neurocytoma
d. Meningioma, fibroblastic type
e. Ependymoma
Question #23: 68 yr-old woman presented with a rapidly enlarging
right sided neck mass. Past history was significant for thymic radiation
as a child. She is most likely suffering from; [FNA]
(Papanicolaou stain, X400)
a. Foreign body giant cell granulomatous inflammation
b. Cystic metastasis of an occult squamous cell carcinoma
c. Ruptured branchial cleft cyst
d. Anaplastic thyroid carcinoma, giant
cell variant
e. Cystic papillary thyroid carcinoma
Question #24: Pineal gland stereotactic biopsy in a 35 yr-old
man revealed these cells. What is the most probable immune-profile of this
lesion based on the illustrated cytomorphology?
(Diff-Quik stain, X 400)
a. PLAP+, CK-
b. CK+, LCA-
c. LCA+, CK-
d. HMB45+, CK-
e. GFAP+, CK-
Question #25: Transthoracic FNA of a lung lesion in a 53
yr-old woman showed extensive necrosis and clusters of cells, as shown
here. She had a skin lesion resected from her neck a year ago. What is
the most likely diagnosis? (Diff-Quik stain, X400)
a. Metastatic malignant melanoma
b. Metastatic Merkel cell tumor
c. Granulomatous lung disease
d. Malignant lymphoma
e. Atypical Carcinoid
Question #26: Thyroid FNA of a 1.2 cm incidental nodule in
a 37 yr-old woman. How would you like to work her up? (Papanicolaou
stain, X400)
a. Flow cytometry
b. Serum calcitonin levels
c. Immunostaining with thyroglobulin
d. Chest radiographs
e. Parathyroid hormone levels in the aspirate
Question #27: 4 cm firm lobulated breast mass in a 36 yr-old
woman with recent surgery for ovarian carcinoma revealed a cellular aspirate
as shown here. What is your best interpretation?
(Papanicolaou stain, X40)
a. Papillary carcinoma of the breast
b. Intraductal papilloma
c. Tubular carcinoma
d. Metastatic ovarian carcinoma
e. Fibroadenoma
Question #28: Thyroid FNA from a 3 cm dominant nodule in
a diffusely enlarged gland of a 26 yr-old woman showed numerous cell fragments.
She is most likely suffering from;
(Diff-Quik stain, X100 and 400)
a. Follicular neoplasm
b. Insular carcinoma
c. Medullary carcinoma
d. Adenomatoid (hyperplastic) nodule
e. Papillary thyroid carcinoma
Question #29: Biliary brushing from a stenotic area of a
57 yr-old man with obstructive jaundice. He has history of multiple stent
placements to relieve his obstruction. Most probable diagnosis is;
(Papanicolaou stain, X400)
a. Cholangiocarcinoma
b. Focal marked glandular dysplasia
c. Reactive atypia secondary to stent
d. Benign, with minimal reactive change
e. Hepatocellular carcinoma
Question #30: Cervico-vaginal smear from a 38 yr-old woman
with past history of endocervical polyps revealed these cells. How would
you manage this patient? (Papanicolaou stain, X400)
a. Endometrial curettage
b. Colposcopy and endocervical curettage
c. Repeat smear in 3 months
d. No follow up needed
e. Pelvic ultrasound for possible ovarian mass
Question #31: FNA of a nontender cystic parotid gland mass
from a 42 yr-old man disclosed a cellular aspirate. What is the most likely
diagnosis? (Papanicolaou stain, X200, 400)
a. Retention cyst
b. Myoepithelioma, hyaline cell type
c. Monomorphic adenoma
d. Oncocytoma
e. Acinic cell carcinoma
Question #32: A 2 cm firm round breast mass from a 65 yr-old
man showed numerous discohesive cells on FNA. How would you interpret these
cytologic findings?
(Papanicolaou stain, X400)
a. Ductal adenocarcinoma
b. Gynecomastia
c. Malignant melanoma
d. Non-Hodgkin’s lymphoma
e. Anaplastic myeloma
Question #33: Cervico-vaginal smear from a 59-yr-old woman
on hormone replacement therapy. What is your best recommendation for her
based on these findings? (Papanicolaou stain, X400)
a. Follow up smear in 3 months
b. No special follow up needed
c. Colposcopy and cervical biopsy
d. Endocervical curettage
e. Endometrial biopsy
Question #34: Stereotactic brain biopsy from a 47 yr-old
man with rapidly growing left frontal lobe mass showing involvement of
the contralateral cerebral lobe. What is the most likely diagnosis?
(Papnicolaou stain, X630)
a. GBM, small cell variant
b. Olidodendroglioma
c. Metastatic small cell carcinoma
d. Primary CNS lymphoma
e. Metastatic melanoma
Question #35: A 55 yr-old HIV positive man with recent onset
of seizures underwent a stereotactic brain biopsy of a right temporal lobe
lesion. He is most likely suffering from;
(Diff-Quik stain, X400)
a. Reactive astrocytosis
b. Progressive multifocal leukoencephalopathy
c. GBM, with gemistocytic feature
d. Metastatic lung adenocarcionma
e. Oligodendroglioma
Question #36: 29 yr old woman with no significant past medical
history presented with post-coital bleeding. Based on the cytomorphology
illustrated here, the most likely explanation of her complaint is;
(Thin Prep, Papanicolaou stain, X400)
a. Trichomonas vaginitis
b. Cervical erosion secondary to infected IUD
c. Atrophic vaginitis
d. Squamous cell carcinoma
e. HSIL, with possible micro invasion
Question #37: 63 yr-old man with history of parotid
surgery 18 yrs ago, underwent a transbronchial “Wang needle” FNA of a hilar
lung mass. How would you interpret this aspirate?
(Diff-Quik stain, X200)
a. Mucin producing adenocarcinoma
b. Metastatic adenoid cystic carcinoma
c. Small cell carcinoma
d. Pulmonary hamartoma
e. Atypical carcinoid tumor
Question #38: Submandibular FNA of a cystic lesion in a 15
yr-old boy is shown in this slide. The patient is most likely suffering
from;
(Papanicolaou stain, X200)
a. Lymphoepithelial cyst
b. Mucoepidermoid carcinoma with cystic
change
c. Branchial cleft cyst
d. Retention cyst
e. Thyroglossal duct cyst
Question #39: 44 yr-old woman underwent an ultrasound-guided
FNA of an incidental 1.2 cm nodule in the central region of her left breast.
She is most likely suffering from;
(Papanicolaou stain, X400)
a. Intraductal papilloma
b. Tubular carcinoma
c. Fibroadenoma
d. Atypical ductal hyperplasia
e. Micropapillary DCIS
Question #40: Cervico-vaginal smear revealed these cells
from a 66 yr-old woman with post-menopausal bleeding and an endometrial
mass. What is the most appropriate interpretation?
(Papanicolaou stain, X400)
a. Squamous cell carcinoma, glassy cell type
b. Endometrial carcinoma, adenosquamous type
c. Malignant mixed mesodermal tumor
d. Reactive/ reparative cellular changes
of the cervix
e. AGUS, endocervical