PATHOLOGY

LE 4 – Projection Feedback
Dr. Atibagos| March 2, 2018

Answer: A – Cholesteatoma
Presence of stratified squamous
epithelium with sac-like
accumulation of keratin flakes in the
middle ear.

1 Presence of:
(1) stratified keratinizing squamous
epithelium
2 (2) granulation tissue
(3) keratin debris
3

1. 6 y/o male elementary student. Give the diagnosis.

a. Cholesteatoma
b. Inverted papilloma
c. Pleomorphic adenoma
d. Squamous cell carcinoma

Answer: B – Mucocoele
Gross: clear and gelatinous cystic
nodule filled with mucin and appears
on the bite line
Microscopic: Pools of mucin are
visible. Cyst wall is lined by
columnar cells, and there may be
denuded lining with granulation
tissue

2. These are gross and microscopic findings in:

a. Irritation fibroma
b. Mucocoele
c. Pyogenic granuloma
d. Sialadenitis
Answer: A - Squamous cell
hyperplasia
Presence of thickened squamous
mucosa
Editor’s note: thickening in
hyperplasia is d/t an increase in cell
NUMBER. NOT size (as is the case
in hypertrophy).

3. This picture depicts which lesion in the spectrum of leukoplakia?

a. Squamous cell hyperplasia
b. Low Grade Squamous Intraepithelial Lesion
c. High Grade Squamous Intraepithelial Lesion
d. Invasive Squamous cell carcinoma

TRANSCRIBERS Telan, Tenazas, Teng, Tia EDITOR Amanda Susulin 1 of 13

 Answer: A - Majority arise from
the minor salivary glands

Warthin’s tumor – benign neoplasm

that usually arises from the parotid
gland

Usual profile:
• Male smoker
• Bilateral neck mass in
parotid area
• When excised: brownish
tan
• Prominent germinal center

There are papillary projections into

cystic spaces (filled with mucinous
or serous projections) surrounded
by lymphoid stroma. Epithelium has
double membrane layer (with
oncocytic cells and cuboidal cells)
and stroma has mature lymphoid
follicles with germinal centers.

4. The following statement/s is NOT true of this tumor:

a. Majority arise from the minor salivary glands
b. It has an association with smoking
c. It is also known as “Adenolymphoma”
d. It is the 2nd most common benign salivary gland tumor

Answer: B - Squamous cell

carcinoma
Location: middle third of the
esophagus

Others:
A - occur almost exclusively in the
distal esophagus
•Plaque-like thickening
•Exophytic, polypoid
•May be multifocal

5. 70-year old male, chronic alcoholic with difficulty swallowing solid food. Dysphagia was •Tumor spread is through the
accompanied by a 20lb weight loss. What is the most likely histology of the tumor? esophagus into peri-esophageal
a. Adenocarcinoma tissues
b. Squamous cell carcinoma
c. Signet ring cell carcinoma C – Linnitis Plastica
d. Carcinoid Tumor Grows diffusely through all layers of
the stomach, greatly thickening its
wall, and giving the stomach a
classic leather bottle appearance. It
has a horrible prognosis.

D - Presence of intramural or
submucosal masses that create
small polypoids

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 Answer: C - Hypertrophic
gastropathy
6. A 19-year-old male with
a 1-week history of Gross:
epigastric abdominal • characterized by giant
pain, nausea, and "cerebriform" enlargement
vomiting. The gross and of the rugal folds due to
microscopic features epithelial hyperplasia
shown are consistent without inflammation
with a diagnosis of: • examples are Menetrier
a. Gastric lymphoma disease and Zollinger-
b. Linnitis plastica Ellison syndrome
c. Hypertrophic
gastropathy Microscopic:
d. Carcinoid tumor • characterized by diffuse
hyperplasia of the foveolar
epithelium of the body &
fundus & hypoproteinemia
due to protein-losing
enteropathy
Answer: B – Barrett’s esophagus

The Gross specimen resembles

7. A 48-year-old woman Reflux esophagitis
presents with 6-months
history of intermittent Microscopically, there is presence
heartburn and of eosinophils in the early stages of
regurgitation. Which of reflux esophagitis
the following is a
complication of this Complication: Barrett Esophagus
clinical condition? Gross: patches of red, velvety
a. Squamous cell mucosa extending upward from the
carcinoma GEJ
b. Barrett esophagus Micro: one important feature for
c. Esophageal rupture Barret esophagus is the presence of
d. Mallory-Weiss tear goblet cells, which are the mucin
vacuole cells

Answer: B – Cholangiocarcinoma
• malignant secreting glands
surrounded by a reactive
sclerotic stroma
• invades perineural space

A - Hepatocellular carcinoma
• presence of tumor cells
and dilated bile ducts
• Variations in nucleus
• Normally there is 1 layer of
hepatocytes in sinusoids,
but here there are 3-4
8. Which of these tumors arises from the intrahepatic bile ducts?

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 Answer: D - Hepatitis C

9. Liver biopsy from a 35-year-old female, what is Chronic viral hepatitis due to HCV
the etiology? showing characteristic portal tract
a. Chronic ethanol ingestion expansion by a lymphoid follicle.
b. Acute acetaminophen toxicity
c. Hepatitis B
d. Hepatitis C

Answer: B - Chronic Hepatitis B

10. Diagnosis: Ground glass hepatocytes – cells

a. Acute Hepatitis B are filled with Hep B
b. Chronic Hepatitis B surface antigen (Hep B).
c. Chronic Hepatitis C
d. Alcoholic steatohepatitis

Answer: D - A & B only

Alcoholic steatofibrosis and NAFLD

11. Diagnosis: (non-alcoholic fatty liver disease)
a. Alcoholic steatofibrosis have a chicken-wire pattern
b. NAFLD
c. Chronic active Hepatitis B
d. A & B only

Answer: C - Crohn Disease

12. A 26-year-old • Haphazard crypt

woman with organization results from
intermittent cramping repeated injury and
abdominal pain and regeneration
low-volume diarrhea • Non-caseating granuloma
for 6 months. A stool • Transmural Crohn Disease
sample is positive for with submucosal and
occult blood. serosal granulomas
Colonoscopy shows (arrows)
several areas of • Microscopically, Crohn's
mucosal edema and ulceration in the colon with intervening normal disease is characterized
segments. What is the most likely diagnosis? by transmural
a. Amebiasis inflammation. Here,
b. Ulcerative colitis inflammatory cells (the
c. Shigellosis bluish infiltrates) extend
d. Crohn Disease from mucosa through
submucosa and
muscularis and appear as
nodular infiltrates on the
serosal surface with pale
granulomatous centers.

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13. A 54-year-old man complains of
increasing abdominal pain with distention
for the past 24 hours. PE: absent bowl
sounds, negative fluid wave. Medical history
is significant only for an appendectomy at
age 26. What is the likely diagnosis?
a. Volvulus
b. Intussusception
c. Adhesions
d. Meckel’s Diverticulum
14. A 68-year-old woman post colectomy due to a mass in the descending colon. The tumor has
infiltrated through the muscularis propria. Three peri-colonic lymph nodes are positive for
tumor metastasis. No distant metastasis noted. What is the stage of the tumor?
a. Stage I
b. Stage II
c. Stage III
d. Stage IV
15. 39-year-old woman with diarrhea and
fatigue and a 3-kg weight loss for the past
6 months. Colonoscopy with duodenal
biopsy was done. She had dramatic
improvement following a special diet with
no wheat or rye grain products. What is
the most common associated malignancy
for this disease?
a. Colorectal Adenocarcinoma
b. T-cell lymphoma
c. Pancreatic carcinoma
d. GIST
Answer: C – Adhesions
Surgical procedures, infection, or
other causes of peritoneal
inflammation may result in
adhesions. These can create closed
loops through which viscera may
slide and become trapped, resulting
in internal herniation
Answer: C - Stage III
Gross: Deeply penetrating and
ulcerated tumor.
Micro: Moderately differentiated
colonic adenocarcinoma.
Stage III: T1, T2 or T3, T4 + N1 or
N2 + MO, where:
T1 - Tumor breaches the muscularis
mucosa and invades into
submucosa
T2 - Extending into the muscularis
propria but not penetrating through it
T3 - Penetrating through the
muscularis propria into subserosa
T4 - Tumor directly invades other
organs or structures
N1 - Metastasis in 1 to 3 lymph
nodes
N2 - Metastasis in 4 or more lymph
nodes
M0 - No distant metastasis
Answer: B - T-cell lymphoma
T-cell lymphoma is commonly
associated with Celiac Disease
• Immune-mediated
enteropathy triggered by
ingestion of gluten-
containing cereals.
• Clinical features: chronic
diarrhea, bloating, or
chronic fatigue, but often
asymptomatic
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 Answer: C – Distal

16. This form of overinflated lung Aka Bullous or Paraseptal

tissue is more associated with what type emphysema
of emphysema? Four major types of emphysema are
a. Centri-acinar identified according to its anatomic
b. Panacinar distribution within the lobule
c. Distal • Centriacinar
d. Irregular • Panacinar
• Paraseptal(distal)
• Irregular

Answer: D – All of the above are

correct

Bronchiectasis

17. This disease condition is associated with the following:

a. Necrotizing pulmonary infection
b. Paralysis of mucociliary clearance
c. Tumor obstructing the airway
d. All of the above are correct
e. Only A & C are correct

Answer: B - Environmental factor

Fibrosing Disease – Silicosis
• caused by inhalation of
18. The causative factor of this crystalline silicon dioxide
disease is strongly associated with: (silica)
a. Genetic factor Gross:
b. Environmental factor • Scarring has contracted
c. Infection the upper lobe into a small
d. Idiopathic dark mass(arrow)
• Dense pleural thickening
Micro:
• there are concentric
nodules deposited in the
lung tissue
• hallmark lesion
characterized by central
whorled collagen fibers
with a more peripheral
zone of dust-laden
macrophages

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 Answer: A - Aspiration of
infective material

19. The most frequent Lung Abscess

cause of this lesion:
a. Aspiration of infective Gross:
material • localized area of
b. Tumor obstruction suppurative necrosis of
c. Penetrating injury to lung tissue
the lung Micro:
d. Post-pneumonic • Alveolar septal walls not
episode seen, instead a collection
of dense inflammatory
cells is present
(neutrophils and
lymphocytes)
• suppurative destruction of
lung parenchyma is the
cardinal histologic change
in all abscesses

Answer: D - Anaerobes from the

20. If aspirated material was obtained oral cavity
and cultured from this lesion, the
following organism/s implicated is/are: Common etiologic agents include:
a. Anaerobes from the oral cavity aerobic: Streptococci, S. aureus,
b. Type 3 pneumococcus and a host of gram-negative
c. Staphylococcus aureus organisms (Klebsiella)
d. All of the above anaerobic bacteria: Bacteroides,
Fusobacterium, & Peptococcus.

B - Chronic exposure to asbestos

• Localized fibrous plaques,

21. The predisposing factor rarely diffuse pleural
strongly associated with this lesion is: fibrosis
a. Repetitive pulmonary infection • Can be diffused or they
b. Chronic exposure to asbestos can form pleura plaques
c. Chronic smoking • Diffuse fibrosis are marked
d. Chronic exposure to carbon with the presence of
multiple asbestos bodies
while thee pleural plaques
are well circumscribed
plaques of dense collagen
that are often calcified

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 Answer: D - MgPO4

22. Examination of the pointed • Hydronephrosis with

structure was to be done on the Staghorn Calculus
material pointed by the arrow. The (MgPO4 or struvite
most likely chemical constituent would Stones)
be positive for: • Stone formation starts to
a. Calcium precipitate at a pH that is
b. Cystine alkali
c. Uric acid • Marked dilation of the
d. MgPO4 renal pelvis and calyces
associated with
progressive atrophy of the
kidney due to obstruction
to the outflow of the urine.
• Four Main Types of Renal
Stones:

o CalciumOxalate /
CalciumPhosphate stones
– 70% ↑↑↑Ca
o Magnesium Ammonium
Phosphate (Struvite)
stones – 15%↑ bacteria
o Uric Acid stones
o Cystinestones – 1-2% ↑
UricAcid

Answer: D - “Flea-bitten”
appearance

Malignant Nephrosclerosis.

Gross. Maybe normal or slightly

increased in size. Notice the
pinpoint petechial hemorrhages on
the cortical surface due to arteriolar
or glomerular rupture of the blood
vessel.

Malignant nephrosclerosis is a renal

vascular disorder associated with
malignant or accelerated
hypertension.

23. Given a clinical history of 55 year old known diabetic with episodes of BP reaching up to
240/120 mmgHg. Which one would best describe the gross cortical surface of this kidney?
a. Coarse, granular surface
b. Fine leather grain appearance
c. Irregular, “pitted” scarring
d. “Flea-bitten” appearance

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 Answer: C - Papillary necrosis

Renal Papillary Necrosis is a

complication of acute pyelonephritis

• Characterized by necrosis
of the renal papillae at the
tips of the renal pyramids
• Renal papillae are very
vulnerable to ischemic
necrosis because of its
peculiar arrangement of
blood vessels and
24. The lesion developed from a 45 year old female with on and off episodes of acute hypertonic environment
pyelonephritis. This is most likely to be: • Pallor because of the
a. Abscess necrosis of the tips of the
b. Infarct renal medulla (Yellow
c. Papillary necrosis circle)
d. Fibrosis • This condition may arise in
other disease like
Analgesic Nephropathy
Answer: E - Only A and B are
correct

Bladder Diverticula

• Pouch-like evagination of
the bladder wall, ranging
from 1-10cm in diameter
• May be acquired or
congenital
• Occur as a result of focal
failure of the development
of the normal musculature
25. The following condition/s may arise from this pathologic lesion: of the bladder wall forming
a. Infection the diverticulum
b. Stone formation • Clinical significance:
c. Cancer
d. All of the above o Infection- serve as
e. Only A and B are correct potential sites where urine
can entrap and lead to
inflammation
o Stone formation/formation
of bladder calculi

Answer: B – Transitional

Urothelial Cell Carcinoma

26. The most common histologic
feature of the lesion: Opened bladder showing a high-
a. Squamous grade invasive transitional cell
b. Transitional carcinoma at an advanced stage.
c. Glandular The aggressive multinodular
d. Sarcoma neoplasm has fungated into the
bladder lumen and spread over a
wide area. The yellow areas
represent areas of ulceration and
necrosis

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 Answer: C - Both A & B are
correct

Acute Tubular Injury

• Viable tubules: presence

of nuclei (Red arrow)
• Necrotic tubules: Outline
is present but there is no
nuclei. (Green arrow)
• Detachment of tubules in
the basement membrane
which sloughs off and
causes obstruction. (Blue
arrow)

2 main histologic features:

Coagulative necrosis of tubular
epithelium cells
Tubulorrhexis – detachment of the
cell from its basement membrane

27. Histologic feature/s seen in this photomicrograph:

a. Coagulative necrosis of the tubule
b. Tubulorrhexis
c. Both A & B are correct
d. Neither A nor B is correct

Answer: C - Both A & B are

correct

Chronic Pyelonephritis

Coarse, discrete, corticomedullary

scars overlying dilated, blunted, or
deformed calyces, and flattening of
the papillae

Microscopic Hallmarks:
There is tubular atrophy such that it
is almost flat (renal tubules are
normally lined by cuboidal renal
tubular cells), the pinkish
homogenous material which are
casts accumulating within the
tubular lumen such that it looks like
you are looking at thyroid tissues,
hence the term THYROIDIZATION.

28. Microscopic feature seen on renal biopsy, which of the following gross feature/s is/are likely
seen in this kidney?
a. Scarring of cortical surface
b. Blunting of calyces
c. Both A & B are correct
d. Neither A nor B is correct

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 Answer: C - Both A & B are
correct

Clear Cell Carcinoma - a form of

renal cell carcinoma

Histologically, the tubules are

closely packed. The clear cytoplasm
is attributed to the presence of
glycogen and lipid content. Lumen
has been obliterated.

29. The histologic appearance of the neoplastic cells in particular its cytoplasm is due to:
a. Glycogen
b. Lipids
c. Both A & B are correct
d. Neither A nor B are correct

Answer: C - Both A & B are

correct
30. Which of the following
feature/s is/are characteristics of this Rapidly Progressive (Cresentic)
lesion? Glomerulonephritis
a. Autoimmune disorder
b. Hypercellularity is a prominent Light Microscopy:
feature Crescent (glomeruli) formation by
c. Both A & B are correct proliferation of parietal cells (and
d. Neither A nor B are correct infiltration of monocytes and
macrophages into the urinary space)

Immunofluorescence:
variable (granular/linear)
• Good Pasteur syndrome
(type I) – linear IF
• Post-infectious GN (type II)
– granular IF
• Pauci-immune cases
(type III) – none

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 Answer: D - Minimal change
disease

Histologic specimen of Chronic

Glomerulonephritis

Hyalinization and sclerosis of

glomeruli, inflammatory infiltrates,
tubular atrophy, interstitial fibrosis.
Hallmark of end-stage renal disease
is sclerosis.

31. Least likely condition which will progress to this type of lesion?
a. Lupus nephritis
b. Membranoproliferative GN
c. Membranous GN
d. Minimal change disease

Answer: B - Cholecystitis with

cholelithiasis

Microscopic features:
• Mild chronic inflammation
with Aschoff-Rokitansky
sinuses, granulomas,
smooth muscle
hypertrophy
• Neuromatous hyperplasia,
hyalinized collagen,
dystrophic calcification,
lymphoid aggregates
• Variable mucosal and
metaplastic changes

32. The lesion shown is consistent with diagnosis of:

a. Gall bladder carcinoma with cholelithiasis
b. Cholecystitis with cholelithiasis
c. Cholecystitis with ascending cholangitis
d. Choledocholithiasis

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 Answer: B - Serum amylase

33. Expected laboratory test that Lab values: increase serum lipase
will be elevated in this lesion is: and serum amylase
a. Serum gastrin
b. Serum amylase • Important adjunct to the
c. Serum serotonin diagnosis
d. Serum chloride • Marked elevation of serum
amylase levels during the
first 24 hours, followed by
a rising serum lipase level
by 72 to 96 hours after the
beginning of the attack
• Amylase is rich in the
pancreas. It correlates
primarily with the level of
acinar destruction. If you
have significant acinar
cells that are damaged,
there is an exponential
increase in the levels of
amylase
Answer: C - Pigment stone

Pigment Stones: Bile calcium salts

34. The picture shown is consistent with
the diagnosis of:
Multiple, faceted, greenish black in
a. Cholesterol stone
color
b. Cholesterolosis
c. Pigment stone
d. None of the above

Answer: B - K ras mutation

Pancreatic Carcinoma

• Predisposing factors
• Smoking
• 7,12-dimethylbenz
anthracene
• Diet – high in meat and fat
• DM
• Chronic pancreatitis
• Genetic (mutational
activation of k-ras and over
expression of erb B2)

35. Predisposing factor associated with this lesion is:

a. Obesity
b. K ras mutation
c. Chronic cholecystitis
d. All of the above

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