Anatomic Pathology Prometric exam questions with answers

1. Question 1Autopsy, Laboratory Management, Quality and Ethicsmedium

   A breast excision for invasive carcinoma is sent for biomarker testing. According to ASCO/CAP recommendations, what fixation conditions should be met?

   1. AFormalin within 24 hours, fixed 6 to 72 hours
   2. BFormalin within 6 hours, fixed 1 to 6 hours
   3. CFormalin within 1 hour, fixed 6 to 72 hours
   4. DFormalin within 1 hour, fixed at least 96 hours
   Show answer and explanation▾

   Answer: C. Formalin within 1 hour, fixed 6 to 72 hours

   Cold ischaemia time should be one hour or less and fixation in 10% neutral buffered formalin should last 6 to 72 hours for reliable ER, PR and HER2 results. Under- or over-fixation can produce false negative biomarker staining.

2. Question 2Breast and Gynecologic Pathologyhard

   Products of conception show diffuse villous hydrops, cisterns and circumferential trophoblastic proliferation. Immunohistochemistry shows absent p57 staining in villous cytotrophoblast and stroma with a positive internal control. What is the diagnosis?

   1. APlacental site trophoblastic tumour
   2. BPartial hydatidiform mole
   3. CHydropic abortus
   4. DComplete hydatidiform mole
   Show answer and explanation▾

   Answer: D. Complete hydatidiform mole

   p57 is a paternally imprinted, maternally expressed gene, so it is lost in complete moles, which contain only paternal DNA. Partial moles and hydropic abortuses retain a maternal genome and show p57 positivity.

3. Question 3Breast and Gynecologic Pathologymedium

   A postmenopausal woman with endometrial hyperplasia has a solid ovarian mass. Histology shows cells with grooved nuclei arranged around small eosinophilic spaces, and the tumour is inhibin positive. Which molecular alteration is characteristic?

   1. AKRAS mutation
   2. BDICER1 mutation
   3. CFOXL2 point mutation
   4. DIsochromosome 12p
   Show answer and explanation▾

   Answer: C. FOXL2 point mutation

   Call-Exner bodies, coffee-bean nuclei and oestrogenic effects describe adult granulosa cell tumour, which almost always carries the FOXL2 C134W mutation. DICER1 mutations are seen in Sertoli-Leydig cell tumours, and isochromosome 12p in germ cell tumours.

4. Question 4Cytopathologymedium

   A thyroid FNA shows a cellular sample of follicular cells arranged predominantly in microfollicles with scant colloid and no nuclear features of papillary carcinoma. Which Bethesda category applies?

   1. ACategory II, benign
   2. BCategory IV, follicular neoplasm
   3. CCategory III, atypia of undetermined significance
   4. DCategory V, suspicious for malignancy
   Show answer and explanation▾

   Answer: B. Category IV, follicular neoplasm

   A cellular aspirate dominated by microfollicles with scant colloid and no papillary nuclear features is reported as follicular neoplasm. AUS is used for limited or focal atypia, and category V requires features suspicious for a specific malignancy.

5. Question 5Head and Neck, Endocrine and Thoracic Pathologyeasy

   A thyroid nodule shows papillae lined by cells with enlarged, overlapping, optically clear nuclei. Which additional nuclear feature most supports papillary thyroid carcinoma?

   1. AHyperchromatic round nuclei with nucleoli
   2. BSalt-and-pepper chromatin
   3. CNuclear grooves and pseudoinclusions
   4. DBinucleated cells with halos
   Show answer and explanation▾

   Answer: C. Nuclear grooves and pseudoinclusions

   Nuclear grooves, intranuclear pseudoinclusions and clearing are the diagnostic nuclear features of papillary carcinoma. Salt-and-pepper chromatin is typical of neuroendocrine tumours such as medullary carcinoma.

6. Question 6Gastrointestinal, Liver and Pancreatobiliary Pathologymedium

   A liver biopsy shows macrovesicular steatosis, ballooned hepatocytes containing ropy eosinophilic cytoplasmic inclusions, and lobular neutrophils in zone 3. What are the inclusions?

   1. ACouncilman bodies
   2. BMallory-Denk bodies
   3. CAlpha-1 antitrypsin globules
   4. DGround-glass inclusions
   Show answer and explanation▾

   Answer: B. Mallory-Denk bodies

   Mallory-Denk bodies are aggregates of damaged intermediate filaments within ballooned hepatocytes in alcoholic and non-alcoholic steatohepatitis. Councilman bodies are apoptotic hepatocytes, and ground-glass cells reflect hepatitis B surface antigen.

7. Question 7Hematopathology, Bone and Soft Tissue Pathologyhard

   A deep thigh mass near the knee in a 28-year-old shows a monophasic spindle cell tumour with staghorn vessels. The cells are focally positive for EMA and keratin and diffusely positive for TLE1. Which test confirms the diagnosis?

   1. AUSP6 rearrangement by FISH
   2. BMDM2 amplification by FISH
   3. CKIT exon 11 sequencing
   4. DSS18 rearrangement by FISH
   Show answer and explanation▾

   Answer: D. SS18 rearrangement by FISH

   Synovial sarcoma is defined by t(X;18) producing an SS18-SSX fusion, detectable by SS18 break-apart FISH. MDM2 amplification indicates well or dedifferentiated liposarcoma, and USP6 rearrangement indicates nodular fasciitis.

8. Question 8Hematopathology, Bone and Soft Tissue Pathologyeasy

   A cervical lymph node shows nodules separated by collagen bands containing lacunar cells in a mixed inflammatory background. Which immunophenotype is expected in the large neoplastic cells?

   1. ACD20 and CD45 positive, CD30 negative
   2. BCD30 and CD15 positive, CD45 negative
   3. CCD3 and CD4 positive, CD30 negative
   4. DCD10 and BCL6 positive, CD15 negative
   Show answer and explanation▾

   Answer: B. CD30 and CD15 positive, CD45 negative

   Hodgkin and Reed-Sternberg cells of classic Hodgkin lymphoma (here nodular sclerosis) are CD30 and usually CD15 positive and CD45 negative, with weak PAX5. Strong CD20 and CD45 would favour a B-cell lymphoma or nodular lymphocyte predominant disease.

9. Question 9General Pathology and Cell Injurymedium

   A 60-year-old man with long-standing rheumatoid arthritis develops nephrotic-range proteinuria. Renal biopsy shows glomerular deposits with apple-green birefringence on Congo red under polarised light. Which precursor protein most likely forms these deposits?

   1. ASerum amyloid A protein
   2. BImmunoglobulin light chains
   3. CTransthyretin
   4. DBeta-2 microglobulin
   Show answer and explanation▾

   Answer: A. Serum amyloid A protein

   Chronic inflammatory diseases such as rheumatoid arthritis cause reactive systemic (AA) amyloidosis, derived from the acute phase reactant serum amyloid A. Light chain (AL) amyloid is associated with plasma cell dyscrasias, and beta-2 microglobulin amyloid occurs in long-term dialysis.

10. Question 10Genitourinary and Renal Pathologymedium

    A testicular tumour shows sheets of large cells with clear cytoplasm, central nuclei and fibrous septa containing lymphocytes. Which immunoprofile is expected?

    1. AOCT3/4 positive, CD117 positive, CD30 negative
    2. BOCT3/4 positive, CD30 positive, CD117 negative
    3. CSALL4 negative, glypican-3 positive, AFP positive
    4. DInhibin positive, OCT3/4 negative, CD117 negative
    Show answer and explanation▾

    Answer: A. OCT3/4 positive, CD117 positive, CD30 negative

    Seminoma is OCT3/4, SALL4, CD117 and D2-40 positive and usually CD30 negative. Embryonal carcinoma is OCT3/4 and CD30 positive but CD117 negative, while yolk sac tumour expresses glypican-3 and AFP.

11. Question 11Head and Neck, Endocrine and Thoracic Pathologymedium

    A poorly differentiated non-small cell carcinoma in a small lung biopsy lacks morphologic gland or keratin formation. Which immunohistochemistry pair best separates adenocarcinoma from squamous cell carcinoma while conserving tissue?

    1. ACalretinin and WT1
    2. BCK7 and CK20
    3. CChromogranin and synaptophysin
    4. DTTF-1 and p40
    Show answer and explanation▾

    Answer: D. TTF-1 and p40

    A limited panel of TTF-1 (adenocarcinoma) and p40 (squamous) classifies most poorly differentiated NSCLC and preserves tissue for molecular testing. CK7 and CK20 do not separate these lineages, and neuroendocrine or mesothelial markers answer different questions.

12. Question 12Hematopathology, Bone and Soft Tissue Pathologymedium

    An ileocaecal mass in a 9-year-old boy shows sheets of medium-sized cells with a starry-sky pattern and a Ki-67 index close to 100%. The cells are CD10 positive and BCL2 negative. Which gene rearrangement is expected?

    1. ABCL6
    2. BBCL2
    3. CMYC
    4. DALK
    Show answer and explanation▾

    Answer: C. MYC

    Burkitt lymphoma is driven by MYC translocation, most commonly t(8;14), and shows a germinal centre phenotype with near-100% proliferation and BCL2 negativity. BCL2 rearrangement suggests follicular lymphoma or a high-grade B-cell lymphoma.

13. Question 13Hematopathology, Bone and Soft Tissue Pathologymedium

    A 14-year-old boy has a diaphyseal femoral lesion with an onion-skin periosteal reaction. Biopsy shows sheets of small round blue cells with strong membranous CD99. Which fusion confirms the most likely diagnosis?

    1. APAX3-FOXO1
    2. BEWSR1-FLI1
    3. CSS18-SSX1
    4. DEWSR1-WT1
    Show answer and explanation▾

    Answer: B. EWSR1-FLI1

    Ewing sarcoma most often carries EWSR1-FLI1 from t(11;22), and diffuse membranous CD99 supports it. PAX3-FOXO1 defines alveolar rhabdomyosarcoma and EWSR1-WT1 defines desmoplastic small round cell tumour.

14. Question 14Hematopathology, Bone and Soft Tissue Pathologymedium

    A gastric submucosal spindle cell tumour is negative for desmin and S100. Which marker pair most supports gastrointestinal stromal tumour?

    1. ACD34 and STAT6
    2. BSMA and caldesmon
    3. CSOX10 and S100
    4. DCD117 and DOG1
    Show answer and explanation▾

    Answer: D. CD117 and DOG1

    CD117 (KIT) and DOG1 are the most sensitive and specific markers for GIST. Smooth muscle markers suggest leiomyoma, S100 and SOX10 suggest schwannoma, and STAT6 indicates solitary fibrous tumour.

15. Question 15Immunohistochemistry and Molecular Pathologymedium

    A liver metastasis from an unknown primary is CK7 negative, CK20 positive and CDX2 positive. Which primary site is most likely?

    1. AOvary (serous)
    2. BLung
    3. CBreast
    4. DColorectum
    Show answer and explanation▾

    Answer: D. Colorectum

    The CK7 negative, CK20 positive, CDX2 positive profile is classic for colorectal adenocarcinoma. Lung, breast and serous ovarian carcinomas are typically CK7 positive and CK20 negative.

Last reviewed September 2026. Questions are original and written to the published exam blueprint; they are not taken from any real paper.