FRCPath Part1 Course – Cases Page 1of11

FRCPath Part I Revision Course

th th
24 – 28 June 2013

DAY 1
Practice Questions

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FRCPath Part1 Course – Cases Page 2of11

Head and Neck EMQ 2

Many syndromes present with signs in the head
EMQ 1 and neck region. Match the syndrome to the
Identify the special stain / immuno which would aid in clinical description.
diagnosis for each case.
A. Neurofibromatosis type 2
B. Fanconi’s anaemia
A. CD1a C. Gardners syndrome
B. S-100 D. Down’s syndrome
C. CD68 E. Albrights syndrome (McCune-Albright)
D. Synaptophysin F. Osteogenesis imperfecta
E. ZielNeelson G. Gorlin Goltz syndrome
F. CD45 H. MEN2b
G. DPAS I. Cowdens syndrome
H. p16 J. Plummer-Vinson syndrome
I. EBV ISH
J. GFAP
1. A 21 year old male who on a routine dental X-
ray was found to have bilateral multilocular
1. A 37 year old female presents with a polyp on the jaw cysts and also on further examination, a
tongue which is excised. The H and E stained pearly plaque with central telangiectasia on
section shows sheets of plump polygonal cells the forehead
with abundant eosinophilic granular cytoplasm 2. A 60 year old female with long standing
filling the lamina propria. dysphagia and anaemia undergoes pharyngo-
2. A 75 year old female undergoes incisional biopsy laryngectomy for a post-cricoid
of a mixed red and white plaque on the tongue. (hypopharyngeal) squamous cell carcinoma
There is some irregular pseudoepitheliomatous 3. A 25 year old never smoker who has a biopsy
hyperplasia of the epithelium and mild atypia. proven squamous cell carcinoma of the
Aggregates of neutrophils are readily detected in tongue
the surface parakeratin. 4. An 8 year old boy with multiple mucosal
3. A 30 year old male undergoes biopsy of a white polyps especially around the lips and a fixed
patch on the lateral border of the tongue. thyroid mass which is reported as probably
Histological examination shows parakeratosis and malignant on cytology
a band like layer of cells with clear cytoplasm in 5. A 9 year old female with pigmented skin
the upper stratum spinosum. lesions, early onset of puberty and a painless
4. A 45 year old oriental male presents with an unilateral swelling of the maxilla along with
enlarged cervical lymph node and on pan- radiological abnormalities of the ribs and right
endoscopy is found to have a mass in the femur.
nasopharynx.
5. An 8 year old male presents with premature EMQ 3
loosening of deciduous molars on the lower left Tumours most commonly (but not uniquely)
side and an osteolytic lesion is seen on plain X-ray. encountered in the head and neck.
Curettings show sheets of mononuclear cells with
oval nuclei admixed with clusters of eosinophils. A. Granular cell tumour
B. Adenomatoid odontogenic tumour
C. Adenoid cystic carcinoma
D. Acinic cell carcinoma
E. Squamous cell carcinoma
F. Ameloblastoma
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FRCPath Part1 Course – Cases Page 3of11

G. Myoepithelioma
H. Polymorphous low grade adenocarcinoma 1. A 50 year old female with a polypoid mass in the
I. Mucoepidermoid carcinoma roof of the nasal fossa comprising lobular sheets
J. Pleomorphic adenoma of small blue round cells embedded in a fibrillary
background and with occasional rosettes.
2. A 14 year old male also with a polypoid mass in
1. A 36 year old female with a multilocular the roof of the nasal fossa composed of variable
radiolucency of the left body of mandible. sized vessels embedded in a variably cellular and
Histology shows islands of epithelium composed collagenised fibroblastic stroma with stellate
of loosely cohesive cells centrally with peripheral shaped fibroblasts a notable feature
palisading and reverse polarity 3. A 57 year old carpenter presents with nasal
2. A 45 year old male has a biopsy of the floor of discharge and obstruction. Curettings comprise
mouth swelling which consists of cribriform mucinous material containing glandular structures
islands of angular basaloid cells arranged around and papillary strands of columnar cells showing
gland like spaces filled with homogenous cytological atypia and frequent mitoses
eosinophilic or basophilic material. 4. Crusting and ulceration of the nasal septum,
3. A palatal biopsy from a 15 year old female altered renal function in a 39 year old female. A
showing lobular islands of cytologically bland biopsy from the nasal cavity is largely necrotic but
PR3”C”-
polygonal cells with distinct cell boundaries in viable areas, some non-caseating granulomata ANCA
admixed with scattered mucous / goblet cells. containing multinucleated giant cells are seen.
4. A multinodular submandibular tumour which has 5. A 52 year old male also with crusting and
rather variable appearances including cellular ulceration of the nasal mucosa but with no other
areas containing ductal structures, sheets and systemic symptoms. The biopsy shows geographic
strands of hyaline plasmacytoid cells, all ulceration with sheets of small, medium and large
embedded in a loose myxoid stroma. cells present in viable areas which frequently
5. A well defined parotid gland tumour, reported as invade vessel walls.
probably benign by the radiologist, composed of
sheets of plump cells with voluminous basophilic MCQ 5
granular cytoplasm with a smaller population of Lymph nodes lying deep to sternocleidomastoid at a
clear cells and focal areas of papillary cystic level bounded superiorly by omohyoid muscle and
architectural change inferiorly by the clavicle are located in anatomical
level
EMQ 4 A. IIa
Sinonasal tract – match the diagnosis with the B. IIb
scenarios. C. III
D. IV
A. Tuberculosis E. V
B. Wegeners granulomatosis
C. Capillary haemangioma MCQ 6
D. Nasopharyngeal angiofibroma A tumour resected from the postero-lateral part of
E. Haemangiopericytoma the tongue is seen to be composed of lobules of
F. Malignant melanoma atypical cells with a high n:c ratio showing peripheral
G. Intestinal type adenocarcinoma palisading, a thickened basement membrane and
H. Mucocele focal evidence of keratinisation. Cystic spaces
I. NK/T cell lymphoma containing mucoid material are seen and there is high
J. Sinonasal undifferentiated carcinoma grade dysplasia of the surface epithelium. There is
K. Olfactory neuroblastoma also comedo type necrosis within larger islands. This is
a:

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FRCPath Part1 Course – Cases Page 4of11
Extent of extracapsular spread

A. Adenosquamous squamous cell carcinoma A. Perineural invasion does not influence prognosis
B. Adenoid cystic carcinoma B. ECS is an important prognosticator and presence
C. Adenoid / acantholytic squamous cell carcinoma implies an aggressive tumour and poor prognosis
D. Basaloid squamous cell carcinoma C. pT staging is based purely on size criteria
E. Moderately differentiated squamous cell D. A cohesive pattern of invasion is associated with a
carcinoma poor prognosis

MCQ 7
A resected squamous cell carcinoma of mandibular
Upper Gastrointestinal System
alveolus with a diameter of 22mm and depth of 7mm
MCQ 1
shows superficial erosion of the cortex of the
The commonest disease associated with lymphocytic
mandible but not full thickness loss of cortical plate.
gastritis is:
This is most appropriately graded:
A. Crohn’s disease.
B. Common variable immunodeficiency.
A. pT1
C. Collagenous colitis.
B. pT2
D. Coeliac disease.
C. pT3
E. CMV infection
D. pT4
E. pT4a
MCQ 2
A common complication of chronic gastroesophageal
MCQ 8
reflux is:
Which of the following statements is true:
A. Eosinophilic oesophagitis.
B. Barrett’s oesophagus.
A. High risk HPV can cause squamous cell carcinoma
C. Candida oesophagitis.
at any site in the head and neck
D. MALT lymphoma.
B. HPV associated tumours are well differentiated
E. Squamous cell carcinoma
C. HPV associated tumours have a better prognosis
and are more sensitive to non surgical therapy
MCQ 3
than non-HPV tumours
An oesophagogastrectomy specimen reveals an
D. HPV is a rare cause of head and neck cancer
adenocarcinoma at the gastro-oesophageal junction,
E. HPV associated tumours present with large
about 80% of which lies in the stomach with the
primaries and rarely metastasize to cervical lymph
background oesophageal mucosa showing no
nodes
evidence of Barrett’s change. The tumour invades
just beyond the muscularis propria into the subserosa
MCQ 9
and involves two out of fifteen perigastric lymph
A patient underwent bilateral selective neck
nodes.
dissections at the same time as removal of a floor of
The pathological stage is:
mouth SCC. Pathological assessment found 4 positive
A. pT1, pN1, pMx.
LNs on the right, largest 35mm and one on the left,
B. pT2, pN1, pMx.
diameter 10mm. The pathological stage is:
C. pT3, pN1, pMx.
A. pN1
D. pT1, pN0. pMx.
B. pN2a
E. pT2, pN0. pMx.
C. pN2b
D. pN2c
MCQ 4
E. pN3
A common association of gastric endocrine neoplasms
is:
A. Helicobacter gastritis.
MCQ 10
B. Familial adenomatous polyposis
Which of these statements is true for oral SCC:
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FRCPath Part1 Course – Cases Page 5of11

C. Pernicious anaemia 4. Pseudoepitheliomatous hyperplasia of the

D. Peptic ulcer disease. squamous epithelium, well circumscribed lesion in the
E. NSAID use. lamina propria composed of sheets of polygonal cells
with bland nuclei and abundant eosinophilic
MCQ 5 cytoplasm showing PAS positivity.
Imatinib (Glivec) is a drug used for the treatment of: 5. Ulceration, dyscohesive and multinucleated
A. Intestinal carcinoids. squamous cells at the margin of the ulcer, ground
B. Gastric MALT lymphoma. glass inclusions filling the nucleus.
C. H. Pylori gastritis
D. Metastatic GIST. EMQ 8
E. Gastric adenocarcinomas. A. Helicobacter pylori gastritis.
B. Whipple’s disease.
MCQ 6 C. Mantle cell lymphoma.
A well-known association/complication of D. Eosinophilic gastritis.
Helicobacter pylori gastritis is: E. Bile reflux/chemical gastritis.
A. Gastric MALT lymphoma. F. Xanthelasma.
B. Inflammatory fibroid polyp. G. Chronic radiation gastritis.
C. Gastric GIST. H. Mycobacterium avium-intracellulare.
D. Fundic gland polyp. I. Gastro-intestinal stromal tumour
E. Mantle cell lymphoma. J. MALT lymphoma.
K. Diffuse signet ring cell carcinoma.
EMQ 7 L. Lymphocytic gastritis.
A. Eosinophilic oesophagitis.
B. Herpes simplex infection Each of the following subjects has a gastric biopsy.
C. Barrett’s oesophagus For each one select the most likely condition from the
D. Reflux oesophagitis option list above.
E. Chronic radiation damage
F. Cytomegalovirus infection 1. A 52 year old male with multiple cream coloured
G. Adenocarcinoma plaques in the antrum, ranging in size from 1mm to
H. Malignant melanoma 4mm: The biopsy shows loosely organised aggregates
I. Chronic graft versus Host disease of foamy histiocytes in the upper lamina propria with
J. Crohn’s disease bland inconspicuous nuclei. The cytoplasm is PAS and
K. Granular cell tumour ZN negative.
2. A 64 year old female with antral ulceration and
Select one of the above oesophageal abnormalities thickening: The biopsy shows individual and small
which fits best for the following histological features clusters of atypical cells in the lamina propria. The
seen in an oesophageal biopsy: cells have abundant vacuolated cytoplasm with
peripheral enlarged nuclei. The cytoplasm is Alcian
1. Ulceration, large intranuclear eosinophilic blue - PAS positive.
inclusions surrounded by a clear halo with cellular 3. A 40 year old male with dyspepsia: The biopsy
enlargement in the stromal and endothelial cells of shows a chronic inflammatory infiltrate and
the ulcer base. occasional lymphoid follicles with germinal centres in
2. Basal zone hyperplasia, papillary elongation, the lamina propria, and several neutrophils infiltrating
vascular dilatation, intraepithelial infiltration by a few the foveolar epithelium.
neutrophils and occasional eosinophils. 4. A 54 year old woman with multiple antral erosions:
3. Apoptosis of individual squamous cells, necrosis The biopsy shows a dense and diffuse lymphoid
and focal lymphocytic infiltration in a patient with infiltrate in the lamina propria with infiltration of the
history of bone marrow transplant. glands by several aggregates of lymphocytes
(lymphoepithelial lesions).
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FRCPath Part1 Course – Cases Page 6of11

5. A 61 year old male with dyspepsia: The antral 3 -Granular cell tumour of the oesophagus.
biopsy shows foveolar hyperplasia and congestion of 4 -Gastrointestinal stromal tumour of the stomach.
the lamina propria associated with smooth muscle 5 –Mantle cell lymphoma of the stomach.
proliferation.

EMQ 9 Breast pathology

A. Ziehl-Neelsen’s stain.
B. Von Kossa. MCQ 1
C. PAS. A breast carcinoma shows 15 % tubule formation,
D. Gomori’s methenamine sliver. marked variation in nuclear size and shape with
E. Orcein. multiple nucleoli and 30 mitoses/10HPF. The final
F. Hale’s colloidal iron. grade is:
G. Masson’s trichrome. A. Grade 1
H. Gram’s stain. B. Grade 2
I. Congo red. C. Grade 3
J. Perl’s Prussian blue. D. Grade 4
K. Modified Giemsa.
L. Reticulin. MCQ 2
In a sentinel lymph node, a single metastasis
One of the above special stains is most helpful in the measuring 0.3mm is classified as: ITCs are defined as small
diagnosis of each of the following upper A. Isolated tumour cells clusters of cells ≤0.2 mm, or
single tumour cells, or a cluster
gastrointestinal conditions. Select the most B. Micrometastasis of <200 cells in a single
histologic cross-section
appropriate option for each. C. Metastasis
Micrometastases (>0.2 mm and/or
D. None of the above >200 cells but none >2.0 mm)

1- Collagenous gastritis.
MCQ 3
2 - Whipple’s disease.
A 63 year old lady presents with nipple erythema and
3 - Helicobacter associated chronic gastritis.
ulceration. A nipple biopsy reveals large round cells
4 -Mycobacterium avium-intracellulare infection.
with large nuclei, prominent nucleoli and abundant
5 -Tablet induced gastric erosion (? Iron tablet).
vacuolated cytoplasm within the epidermis. The cells
are positive for CK7 and negative for S100. What is
EMQ 10
the most likely diagnosis?
A. CD3.
A. Malignant melanoma
B. Chromogranin.
B. Paget’s disease
C. CD34
C. Bowen’s disease
D. CK20.
D. Phyllodes tumour
E. HMB45.
F. Alk-1 MCQ 4
G. CD117. A HER2 immunohistochemistry score 2+ breast
H. TTF-1. carcinoma means that:
I. S100.
J. Desmin. A. The tumour should be regarded as negative for
K. Cyclin D1. HER2 overexpression
One of the above immunohistochemical stains is the B. The HER2 gene is amplified
most useful in the diagnosis of the following upper C. The HER2 gene is not amplified
gastrointestinal conditions: D. The tumour should be regarded as positive for
HER2 overexpression
1-Gastric Schwannoma. E. FISH testing should be performed
2-Carcinoid (neuroendocrine tumour) of the
duodenum.
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FRCPath Part1 Course – Cases Page 7of11

MCQ 5 Each of the following patients had a breast biopsy. For

A 47 year old lady presents with a left breast lump. each one select the most likely condition from the list
Examination reveals a cyst, which partially resolves on of options. Each option may be used once, more than
aspiration. There is general bilateral breast once or not at all.
nodularity. Core biopsy of the area of concern shows 1. A 45 year old female with a firm lump in the outer
breast tissue with ducts lined by large cells with quadrant of the breast. The biopsy shows a
abundant eosinophilic cytoplasm, stromal fibrosis, stellate lesion with 95% angulated tubules, apical
cyst formation and sclerosing adenosis. Assuming the snouts and stromal desmoplasia.
biopsy is representative, what is the correct biopsy 2. A 65 year old female with bilateral breast lesions.
code? A biopsy of one shows single file cords of tumour
cells with intracytoplasmic spaces.
A. B2 3. A 43 year old female has a mammographically
B. B3 detected stellate lesion with dense central
C. B4 fibrosis. Histology shows central fibrosis and
D. B5a elastosis from which ducts radiate out. The ducts
E. B5b are positive for p63 and SMM.
4. A 25 year old female with a circumscribed,
MCQ 6 encapsulated 2 cm breast lump showing an
A 43 year old woman, previously treated for invasive intracanalicular growth pattern. There is no
ductal carcinoma, presents with a breast lump and stromal atypia.
blue discolouration of the overlying skin. Biopsy 5. A 52 year old female has bloody nipple discharge.
shows a tumour composed of irregular spaces lined by Biopsy reveals a localised papillary proliferation of
pleomorphic cells, abnormal mitoses and infiltration hyperplastic ductal cells on fibrovascular cores
into the surrounding tissue. The tumour cells are within a dilated duct.
negative for AE1/AE3 and positive for CD31 and CD34.
What is the most likely diagnosis?
A. Recurrent ductal carcinoma
Uropathology
B. Malignant phyllodes tumour EMQ 1
C. Spindle cell carcinoma Select the appropriate pathological tumour stage
D. Lobular carcinoma from the options for each of the renal tumours
E. Angiosarcoma described. Each option may be used once, more than
once or not at all.

A. pT0
EMQ 1 B. pT1a
C. pT1b
A. Tubular carcinoma D. pT2a
B. DCIS E. pT2b
C. LCIS F. pT3a
D. Atypical hyperplasia G. pT3b
E. Ductal carcinoma H. pT3c
F. Phyllodes tumour I. pTx
G. Benign ductal hyperplasia J. pT4
H. Atypical ductal hyperplasia
I. Lobular carcinoma 1. Tumour 3 cm confined to the kidney.
J. Radial scar/Complex sclerosing lesion 2. Tumour 5cm, invasion into perinephric fat.
K. Fibroadenoma 3. Tumour 4 cm with direct extension into the renal
J. Intraductal papilloma sinus fat. The major tributaries of the renal vein
show macroscopic tumour invasion.
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FRCPath Part1 Course – Cases Page 8of11

4. Tumour 7cm with invasion of the adrenal gland. B. pT1b

C. pT1C
5. Tumour 6 cm with invasion beyond Gerota’s D. pT2a
fascia. E. pT2b
F. pT2C
MCQ 2
G. pT3a
A renal tumour on histology shows solid sheets of
H. pT3b
clear cells with a prominent vascular network. The
I. pT4
majority of the tumour cells have slightly irregular
nuclei with nucleoli visible at X400 magnification. Very
Classify:
focally, a few multilobed nuclei are present with
1. A 73 year old male with PSA levels of 8.4.
prominent nucleoli. What is the Fuhrman’s nuclear
Histology shows adenocarcinoma invading into
grade of the tumour?
the right seminal vesicle.
A. Grade 1 2. A 62 year old male undergoes radical
B. Grade 2 prostatectomy for cancer. On histology, the
C. Grade 3 carcinoma extends beyond the prostate into the
D. Grade 4 periprostatic fat.
E. Grade2 and Grade 3
3. A 68 year old male with elevated PSA levels has a
MCQ 3 normal prostate on clinical and radiological
A 30 year old male presents with bilateral renal clear examination. Needle core biopsies from both
cell carcinoma. Investigations also reveal a posterior lobes however, reveal an adenocarcinoma.
fossa CNS tumour with histological appearances of a
haemangioblastoma. Abnormalities of which of the 4. A 52 year old male with obstructive symptoms
following chromosomes leads to this condition? undergoes radical prostatectomy. On histology, an
adenocarcinoma involving both lobes, but
A. 7q31 confined to the prostate is seen.
B. 3p25
C. 17p11.2 5. A 58 year old male with obstructive symptoms
D. 9q34 and a PSA of 38, undergoes a CT scan of the
E. 1q42 pelvis, which reveals a prostatic tumour extending
into the levator muscles.
MCQ 4
A 56 year old female undergoes cystoscopy for
MCQ 6
investigation of haematuria. Multiple nodular
A 66 year old man undergoes radical prostatectomy
thickenings of the mucosa are seen near the trigone,
for a needle core detected adenocarcinoma. The
which are biopsied. Histology reveals sheets of CD 68
tumour predominantly shows raggedly infiltrating
positive cells with intracytoplasmic concentrically
single and separate glands of varying sizes.
layered inclusions. Which of the following
Approximately 5% of the carcinoma also shows
histochemical stains demonstrates these inclusions?
rounded tumour masses with central necrosis. Which
of the following best represents the grade of the
A. Alcian blue
tumour?
B. Rubeonic acid
C. Orcein
A. Gleason’s 3 + 3 = 6
D. Von Kossa
B. Gleason’s 3 + 4 = 7
E. PTAH
C. Gleason’s 4 + 3 = 7
EMQ 5 D. Gleason’s 3 + 5 = 8
A. pT1a E. Gleason’s 4 + 5 = 9
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WHO —————————————— BTTP
EMBRYONAL CA ————Malignant Teratoma undifferentiated
Teratoma with somatic type malignancy ——malignant Teratoma intermediate

FRCPath Part1 Course – Cases Page 9of11

EMQ 7 D. Crohn’s disease

Choose the BTTP classification category from the E. Lymphocytic colitis
options for each of the testicular tumours described F. Collagenous colitis
below. Each option may be used once, more than G. Ishcaemic colitis
once or not at all.
Select the appropriate condition from the list of
A. Embryonal carcinoma options for each of the clinicopathological
B. Seminoma descriptions.
C. Malignant teratoma undifferentiated
D. Malignant teratoma trophoblastic 1. A 64 year old male admitted in ITU for sepsis
E. Malignant teratoma intermediate develops acute onset diarrhoea. Colonic biopsies
F. Dermoid cyst show a luminal spray of mucus and neutrophils. The
G. Teratoma differentiated background mucosa shows minimal inflammatory
H. Yolk sac tumour changes.
I. Choriocarcinoma
2. A 55 year old female with watery diarrhoea and
1. Nests of tumour cells separated by fibrous septae, normal colonoscopy. The colonic biopsies show
infiltrated by lymphocytes. A few increased intraepithelial lymphocytes with a
syncitiotrophoblast like cells are seen. thickened sub epithelial collagen plate.
2. Diffuse sheets of anaplastic cells, positive for
3. A 28 year old male with bloody diarrhaoea and
CD30
abdominal pain. A colonscopy shows patchy
3. Cystic lesion containing keratin and lined by
inflammation affecting the right side colon with
squamous epithelium. The wall contains
apthous ulcers. The colonic biopsies show mild crypt
cutaneous adnexal structures.
distortion with patchy discontinuous inflammation
4. Haemorrhagic tumour showing admixture of
with cryptitis.
atypical syncitio and cytotrophoblastic cells.
5. Diffuse sheets of CD30 + anaplastic cells admixed 4. A 42 year old female with acute onset bloody
with areas showing well differentiated glandular diarrhoea and granular and congested rectum on
structures and islands of mature cartilage endoscopy. The rectal biopsy shows oedematous
MCQ 8 mucosa with dispersed ‘sprinkled salt’ inflammatory
A biopsy of a cryptorchid testis shows atrophy with a cells, cryptitis and dilatation and withering of crypts.
few seminiferous tubules containing atypical germ
cells with clear cytoplasm. These cells are positive for 5. A 72 year old male with abdominal pain and bloody
PLAP. Which other immunostain is routinely used to diarrhoea. Sigmoidoscopy shows inflammation in the
confirm the diagnosis? left side of the colon, most prominent in the sigmoid
colon. Biopsies show extensive ulceration with
A. EMA preservation of basal crypts and active inflammation.
B. CD30 There is no crypt distortion or crypt abscess
C. C-Kit formation.
D. AFP
E. Inhibin EMQ 2

A. Gardner’s syndrome
Lower GI, Liver and Pancreas B. Turcot syndrome
C. Peutz-Jeghers syndrome
EMQ 1
D. Cowden syndrome
A. Infective colitis E. Cronkhite-Canada syndrome
B. Pseudomembranous colitis F. Carney triad
C. Ulcerative colitis G. Muir Torre syndrome

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Select the appropriate syndrome from the list of 5. A 30 mm polyp in the rectum with oedematous
options for each of the conditions described. Each of lamina propria, ulcerated surface and many cystically
the options may be used once, more than once or not dilated glands
at all.
6. A 14 mm polyp is the transverse colon with a
1. Autosomal dominant disorder characterised by serrated architecture and low grade dysplasia
intestinal hamartomatous polyps, facial
trichilemmomas, acral keratosis and oral papillomas MCQ 4
Sections from a pedunculated polyp received through
2. Non hereditary condition characterised by the bowel cancer screening programme show an
gastrointestinal hamartomatous polyps, nail atrophy invasive carcinoma arising within a tubulovillous
and alopecia adenoma. The carcinoma infiltrates into and appears
limited to the stalk of the polyp. No vascular invasion
3. Familial disorder with intestinal adenomatous is seen. The deep margin is 3 mm away. Which of the
polyps, osteomas, epidermal cysts and fibromatosis following best describes the level of submucosal
infiltration?
4. Autosomal dominant condition with microsatellite
instability, gastrointestinal malignancy and sebaceous A. Kikuchi level sm1
neoplasms B. Kikuchi level sm2
C. Kikuchi level sm3
5. Condition characterised by colonic adenomatous
D. Haggit level 1
polyposis and CNS tumours
E. Haggit level 2
EMQ 3 F. Haggit level 3

A. Tubulovillous adenoma
B. Tubular adenoma EMQ 5
C. Villous adenoma
D. Serrated adenoma A. pT3N2, Dukes C2
E. Sessile serrated polyp B. pT1N0, Dukes A
F. Mixed hyperplastic polyp – serrated adenoma C. ypT2yN1, Dukes C1
G. Juvenile polyp D. pT4N0, Dukes B
H. Hamartomatous polyp E. pT3N1, Dukes C1
I. Hyperplastic polyp F. pT4N1, Dukes C1
G. ypT2yN2, Dukes C1
Select the appropriate term from the list of options H. pT4N0, Dukes B
for each of the polyps described.
Select the appropriate pathological tumour and nodal
1. Polyp with low grade dysplasia and approximately stage from the options for each of the colorectal
10% villous architecture tumours described. Each option may be used once,
more than once or not at all.
2. Polyp with high grade dysplasia and approximately
1. Caecal adenocarcinoma with intramural extension
60% villous architecture
into terminal ileum and infiltration into subserosal fat;
3. A 3 mm polyp in the rectum with a serrated 3/22 lymph nodes involved, apical node clear.
architecture and no dysplasia
2. Low rectal adenocarcinoma infiltrating into the
4. A 25 mm polyp in the ascending colon with a levator muscles; lymph nodes free of tumour.
serrated architecture and no dysplasia. The bases of
3. Large rectal adenocarcinoma with macroscopic
the crypts show dilatation and branching.
tumour perforation through the mesorectal fat into
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the retroperitoneum, 2/13 nodes involved, apical MCQ 8

node clear A 52 year old male presents with multiple nodules in
the right lobe of the liver showing enhancement in
4. Rectal adenocarcinoma with preoperative long the arterial phase on CT scan. A needle biopsy of the
course chemoradiation. Residual tumour infiltrating mass shows a moderately differentiated
into but not beyond muscularis propria. A total of 7 adenocarcinoma with a tubular pattern of growth and
lymph nodes retrieved of which 3 show carcinoma focal clear cell change. It has the following
and one contains mucin lakes with no demonstrable immunoprofile: CK7 –ve, CK20 –ve, AFP –ve, mCEA –
tumour cells. Apical node clear ve, canalicular positive staining for CD10 and pCEA,
cytoplasmic positive staining for TTF1 and Hep Par 1
5. Polypoid adenocarcinoma infiltrating into the
positive. What is the most likely diagnosis?
submucosa. No lymph nodes involved.
A. Fibrolamellar carcinoma
MCQ 6
B. Metastatic clear cell renal carcinoma
A 52 year old female is found to have a pelvic mass
C. Primary hepatocellular carcinoma
arising from the rectum, which is resected. The mass
D. Metastatic pulmonary carcinoma
measures 12 cm in maximum dimension and has a
E. Cholangiocarcinoma
uniform solid cut surface. On histological examination,
this is a predominantly spindle cell lesion, with the
MCQ 9
cells showing minimal nuclear pleomorphism, no
A 52 year old female presents with abdominal pain
necrosis and up to 3 mitoses per 50 hpf. The cells
and vomiting. A CT scan demonstrates a cystic lesion
have the following immunoprofile: AE1/AE3 negative,
in the tail of the pancreas, which is excised. On gross
SMA focally positive, desmin negative, S100 negative,
examination the cyst is multilocular and contains
CD117 negative, CD34 positive and DOG-1 positive.
seromucinous fluid. On histology, the wall of the cyst
What is the risk of progressive disease for this
shows focal calcification and contains a cellular ovary
tumour?
like stroma. The surface epithelium is extensively
A. None denuded. Which of the following is the cyst most
B. Low likely to represent?
C. Intermediate
D. High
E. Very high A. Serous cystadenoma
B. Mucinous cystadenoma
MCQ 7 C. Intraductal mucinous neoplasm
A 46 year old male presents with jaundice and D. Lymphoepithelial cyst
worsening liver function tests. A cholangiography E. Pancreatic pseudocyst
reveals beaded appearance of the bile ducts. A liver
biopsy is performed, which shows portal
inflammation. Periduct oedema and concentric ‘onion
skin’ fibrosis is also noted. Which of the following
underlying conditions is the patient most likely to
have?

A. Angiodysplasia of the colon

B. Ulcerative colitis
C. Primary biliary cirrhosis
D. Wilson’s disease
E. Haemochromatosis

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