2022 Fall ITE

Question 1

3 Risk factors for thrombosis

Answer 1

1. endothelial injury
2. hypercoagulability
3. stasis

Question 2

4 possible fates of thrombus

Answer 2

1. propagation
2. embolization
3. dissolution
4. organization

Question 3

3 steps in acute inflammation

Answer 3

1. Vasodilation
2. Increase permeability
3. Emigration of leukocytes

Question 4

3 features of chronic inflammation

Answer 4

1. Mononuclear cells
2. Tissue destruction
3. Attempts at healing

Question 5

Non-infectious causes of granulomatous inflammation

Answer 5

Sarcoidosis
Foreign body reaction
Inflammatory bowel disease
Granulomatosis with polyangiitis

Question 6

Molecular subgroups of endometrial carcinoma

Answer 6

POLE ultramutated
microsatellite instability hypermutated
copy number low
copy number high

Question 7

Histologic subtypes of endometrial carcinoma

Answer 7

1. Endometrioid carcinoma
2. Serous carcinoma
3. Clear cell carcinoma
4. Carcinosarcoma
5. Mixed carcinoma
6. Undifferentiated
7. Dedifferentiated

Question 8

Precursor lesions of endometrial carcinoma

Answer 8

1. Endometrial hyperplasia without atypia
2. Endometrioid intraepithelial neoplasia (EIN)
3. Serous endometrial intraepithelial carcinoma (SEIC)

Question 9

Molecular alterations in low grade and high grade endometrial stromal sarcoma

Answer 9

LG-ESS - JAZF1-SUZ12
HG-ESS - YWHAE and BCOR fusions

Question 10

Subtypes of aggressive oral SCC

Answer 10

1. acantholytic
2. adenosquamous
3. spindle cell SCC

Question 11

Risk factors for oral SCC

Answer 11

1. HPV, particularly HPV-16
2. Smoked tobacco
3. Alcohol
4. Betel quid
5. Radiation

Question 12

Risk factors for nasopharyngeal carcinoma

Answer 12

1. EBV
2. Alcohol
3. Smoking
4. Salted fermented foods

Question 13

4 types of blunt force injury

Answer 13

1. Abrasion
2. Laceration
3. Avulsion
4. Bruise

Question 14

Entrance wound gunshot signs

Answer 14

1. Round
2. Regular
3. May have stippling
4. May have soot
5. May have internal beveling

Question 15

Signs of child abuse

Answer 15

1. Different ages of lesions
2. Delay in seeking medical help
3. Vague explanations from parents
4. Lesions in unusual sites for accidents

Question 16

Amsterdam criteria for HNPCC screening

Answer 16

1. ≥ relatives with HNPCC-associated Ca (CRC, SB endometrial, urothelial)
2. CRC ≥2 successive generations
3. 1 FDR to other two
4. 1 Ca diagnosis <50 years

Question 17

Tumors in tuberous sclerosis

Answer 17

PEComas (LAM)
Cortical tubers
Cardiac rhabdomyoma
Angiofibroma
Connective tissue nevi (shagreen patches)
Eosinophilic solid and cystic RCC

Question 18

Features of VHL

Answer 18

Clear cell RCC
Kidney, liver, and pancreas cysts
Hemangioblastoma (retina, cerebellum)
Pheochromocytoma
Pancreatic NET
Papillary cystadenoma of epididymis
Endolymphatic sac tumor of the ear

Question 19

Molecular subtypes of breast carcinoma

Answer 19

Luminal A - + ER, ≥20% PR, <14% Ki-67, Grade 1 or 2
Luminal B - + ER, <20% PR, Ki67 ≥ 14%, Grade 3
HER-2 enriched - HER2+, Grade 3
Basal - Grade 3, triple negative

Question 20

Pre-analytic recommendations for breast biomarker testing from ASCO/CAP

Answer 20

1. 10% formalin 6-72 hours
2. Sliced at 5 mm intervals
3. Record cold ischemia time, fixative type, and time sample placed in formalin
4. Use of unstained slides cut > 6 weeks before analysis is NOT RECOMMENDED.

Question 21

Causes of intrinsic urethral obstruction

Answer 21

1. Calculi
2. Strictures
3. Tumors
4. Blood clots
5. Neurogenic

Question 22

Causes of extrinsic urethral obstruction

Answer 22

1. Pregnancy
2. Periureteral inflammation
3. Tumors
4. Endometriosis

Question 23

Gene mutation in low grade urothelial carcinoma

Answer 23

FGFR3
RAS

Question 24

Gene mutation in high grade urothelial carcinoma

Answer 24

p53, Rb

Question 25

Common chromosomal aberration in urothelial carcinoma

Answer 25

Chromosome 9p deletion

Question 26

Indications for radical cystectomy

Answer 26

1. muscle invasive bladder carcinoma 2. CIS or high-grade papillary cancer refractory to BCG and other intravesical therapies 3. CIS extending into prostatic urethra and ducts, where instilled BCG does not come into contact with neoplastic cells 4. multifocal lesions too large and extensive to completely eradicate by transurethral resection 5. aggressive variant, micropapillary

Question 27

Stages of mycosis fungoides

Answer 27

patch, plaque, tumor

Question 28

Markers in mycosis fungoides

Answer 28

CD2+ CD3+ TCR beta + CD5+ CD4+ CD8- CD7 dim/partially lost Loss of pan T cell antigen Demonstration of clonal TCR gene rearrangements

Question 29

Describe histology of epidermal cyst

Answer 29

Cyst lined by stratified squamous epithelium filled with flaky keratin plaque

Question 30

Differentiate dermoid from epidermal cyst

Answer 30

Dermoid cyst wall has adnexal tissue (hair follicle and sebaceous glands)

Question 31

How does pilar/trichilemmal cyst differ histologically from epidermal cyst?

Answer 31

Pilar cyst has densely packed eosinophilic keration (wet keratin)

Question 32

"Vanishing" cancer reasons

Answer 32

1. False positive biopsy 2. Specimen mix-up 3. Floater on cell block 4. Cancer in remaining blocks: levels, re-embed, flip blocks 5. Cancer lost by trimming blocks 6. Therapeutic biopsy 7. Cancer altered by neoadjuvant treatment effects, inflammation

Question 33

QA monitors in gynecologic cytology

Answer 33

1. Interpretive rates of all TBS diagnostic categories 2. ASC rate 3. ASC:SIL ratio 4. Positivity rate of hrHPV in ASC-US cases 5. Cytotechnologist-pathologist discrepancy logs 6. Cyto-histologic correlation 7. Monitoring of screening performance or sensitivity (prospective rescreening, retrospective rescreening)

Question 34

Critical values in GYN/NON-GYN cytology

Answer 34

1. Any unusual or unexpected cytology result 2. Involving a critical site (e.g. causing SVC syndrome or paralysis) 3. Pathogenic organisms in an immunosuppressed patient or in any orbital or CSF sample 4. Identification of HSV changes in cervical/vaginal sample of near-term pregnant patient 5. Any corrected report, where the diagnosis if significantly changed and will result in different patient management

Question 35

2 causes of genetic hypercoagulability

Answer 35

Antithrombin III deficiency Protein C deficiency Protein S deficiency

Question 36

2 most common causes of fat and marrow emboli

Answer 36

Hip fracture Orthopedic trauma CPR