NEET-PG 2025 - Pathology PYQs Practice Questions

Q: A lymphoma characterized by the presence of centrocytes and centroblasts, along with BCL2 positivity and CD10 expression, is most commonly associated with which chromosomal translocation?

t(14 ; 18). ***t(14 ; 18)*** [1], [2] - This translocation is the genetic hallmark of **Follicular Lymphoma (FL)**, characterized by the presence of **centrocytes** and **centroblasts**, **BCL2 positivity**, and **CD10 expression** [1], [2]. - It results in the juxtaposition of the **BCL2 gene** (on chromosome 18) with the **IgH locus** (on chromosome 14), leading to constitutive overexpression of the anti-apoptotic BCL2 protein [1], [2]. *t(2 ; 5)* - This translocation is characteristic of **Anaplastic Large Cell Lymphoma (ALCL)**, leading to the activation of the **ALK gene**. - ALCL is typically **CD30 positive** and lacks the centrocytes/centroblasts morphology and germinal center markers (like CD10) seen in the described B-cell lymphoma. *t(11 ; 14)* - This translocation is associated with **Mantle Cell Lymphoma (MCL)**, causing the overexpression of **Cyclin D1**. - While MCL cells are often BCL2 positive, they typically lack **CD10 expression**, which is a key feature of the described germinal center lymphoma. *t(8 ; 14)* - This translocation is the hallmark of **Burkitt Lymphoma**, resulting in **MYC gene** overexpression. - Burkitt Lymphoma is typically **CD10 positive** but shows a high proliferation index (Ki-67 ~100%) and lacks BCL2 expression [3], unlike the described follicular lymphoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 602-604. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 561-562. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 606. [Practice more Pathology PYQs on OnCourse]

Q: A 30-year-old man presents with a painless testicular mass. An ultrasound shows a well-circumscribed, homogeneous, non-hemorrhagic testicular tumor. Which of the following is the most likely diagnosis?

Seminoma. Seminoma - The clinical presentation (painless mass in a 30-year-old) combined with ultrasound findings (well-circumscribed, homogeneous, non-hemorrhagic tumor) strongly favors seminoma, the most common testicular germ cell tumor [1]. - Histologically, seminomas consist of large, clear cells separated by delicate fibrovascular septa infiltrated with lymphocytes, confirming this diagnosis [1]. Yolk sac tumor - This tumor is primarily the most common germ cell malignancy in infants and young children (under 3 years old) [1]. - It is classically associated with significantly elevated serum marker Alpha-fetoprotein (AFP). Choriocarcinoma - This highly aggressive tumor is characterized by significant hemorrhage, necrosis, and cavitation due to vascular invasion, which contradicts the 'non-hemorrhagic' description [2]. - It produces high levels of Human Chorionic Gonadotropin (hCG) due to the presence of syncytiotrophoblasts [1]. Teratoma - Teratomas are typically seen as heterogeneous or complex cystic masses on ultrasound due to the presence of various differentiated tissue elements (e.g., cartilage, bone, fat) [3]. - Pure teratomas are rare in adults; they usually form part of a mixed germ cell tumor [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 979-982. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 512-513. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 982-983. [Practice more Pathology PYQs on OnCourse]

Q: A child presents with visual disturbances and delayed growth. Imaging reveals a suprasellar mass, and histopathology shows the presence of "wet keratin" (compact, eosinophilic anucleate keratin). What is the most likely diagnosis?

Craniopharyngioma. ***Craniopharyngioma*** - This tumor is classically located in the **suprasellar region** and presents in children with visual field deficits and **endocrine dysfunction** (e.g., delayed growth, short stature) due to hypothalamic or pituitary stalk compression. - The histopathology description of **"wet keratin"** (or keratin nests with peripheral palisading of epithelial cells) is pathognomonic for the adamantinomatous subtype of craniopharyngioma. *Medulloblastoma* - This is primarily a **posterior fossa tumor** originating in the cerebellum, typically causing signs of increased intracranial pressure and **ataxia**, not primarily suprasellar syndromes. - Histologically, it is a small, round blue cell tumor of **primitive neuroectoderm (PNET)** origin; it does not exhibit keratin formation. *Glioma* - While gliomas (e.g., optic pathway gliomas) can involve the suprasellar area, the cellular morphology would consist of **astrocytic** or oligodendroglial cells. - Gliomas lack the epithelial components and definitive **keratin formation** that are characteristic of craniopharyngioma. *Pituitary adenoma* - Pituitary adenomas are typically **intrasellar** and are much more common in adults, causing symptoms associated with hormone excess or deficiency (hypopituitarism) [1]. - Histology shows sheets and cords of uniform **polygonal cells** derived from pituitary endocrinocytes [2]; they do not contain squamous elements or keratin. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, p. 1081. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 417-418. [Practice more Pathology PYQs on OnCourse]

Q: A patient presents with a mass in the front of the neck, along with odynophagia and dyspnea. Histopathology reveals tumor cells positive for TTF-1, synaptophysin, and chromogranin, and there is evidence of amyloid deposition. What is the most likely diagnosis?

Medullary thyroid carcinoma. ***Medullary thyroid carcinoma*** - The tumor cells are positive for **Synaptophysin** and **Chromogranin**, confirming their **neuroendocrine origin** from the parafollicular C cells [1][2]. - The characteristic finding of **amyloid deposition** is due to the precipitation of stored pro-hormone (primarily **calcitonin**) produced by these C cells, which is highly diagnostic for MTC [2]. *Papillary thyroid carcinoma* - While positive for TTF-1, it is characterized by distinctive nuclear features such as **Orphan Annie eye nuclei** and **nuclear grooves**. - It does **not** exhibit neuroendocrine differentiation (Synaptophysin/Chromogranin negative) or **amyloid deposition**. *Follicular thyroid carcinoma* - This tumor consists of follicular cells and is diagnosed by the demonstration of **capsular** or **vascular invasion**. - It is **negative** for neuroendocrine markers and **lacks** the pathognomonic **calcitonin-derived amyloid**. *Anaplastic thyroid carcinoma* - This is highly malignant and rapidly growing, often presenting with severe compression symptoms, but is histologically characterized by undifferentiated **spindle and giant cells**. - It is typically **negative** for specific neuroendocrine markers and TTF-1 expression is often lost; **amyloid deposits are not a feature**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1102-1103. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 430-431. [Practice more Pathology PYQs on OnCourse]

Question 1

A lymphoma characterized by the presence of centrocytes and centroblasts, along with BCL2 positivity and CD10 expression, is most commonly associated with which chromosomal translocation?

Accepted Answer

t(14 ; 18)

Answer

t(2 ; 5)

Answer

t(11 ; 14)

Answer

t(8 ; 14)

Question 2

A 30-year-old man presents with a painless testicular mass. An ultrasound shows a well-circumscribed, homogeneous, non-hemorrhagic testicular tumor. Which of the following is the most likely diagnosis?

Accepted Answer

Seminoma

Answer

Yolk sac tumor

Answer

Choriocarcinoma

Answer

Teratoma

Question 3

Which of the following laboratory techniques is most commonly used to compare and quantify CD markers on cells?

Accepted Answer

Flow cytometry

Answer

Western blot

Answer

ELISA

Answer

Immunohistochemistry

Question 4

A child presents with visual disturbances and delayed growth. Imaging reveals a suprasellar mass, and histopathology shows the presence of "wet keratin" (compact, eosinophilic anucleate keratin). What is the most likely diagnosis?

Accepted Answer

Craniopharyngioma

Answer

Medulloblastoma

Answer

Glioma

Answer

Pituitary adenoma

Question 5

A patient presents with a mass in the front of the neck, along with odynophagia and dyspnea. Histopathology reveals tumor cells positive for TTF-1, synaptophysin, and chromogranin, and there is evidence of amyloid deposition. What is the most likely diagnosis?

Accepted Answer

Medullary thyroid carcinoma

Answer

Follicular thyroid carcinoma

Answer

Papillary thyroid carcinoma

Answer

Anaplastic thyroid carcinoma

Question 6

A middle-aged woman presents with dry eyes and dry mouth. Laboratory tests reveal positive anti-Ro (SSA) and anti-La (SSB) antibodies. What is the most likely underlying pathological mechanism?

Accepted Answer

Lymphocytic infiltration and destruction of salivary and lacrimal glands

Answer

IgE-mediated hypersensitivity reaction

Answer

Destruction of exocrine glands by neutrophils

Answer

Deposition of amyloid in salivary glands

Question 7

Most common cause of squamous cell carcinoma at the base of the tongue is:

Accepted Answer

HPV

Answer

EBV

Answer

HCV

Answer

CMV

Question 8

A 22-year-old tall male presents with long limbs, increased arm span, hypermobile joints, and high-arched palate. On examination, he has lens subluxation and a diastolic murmur suggestive of aortic root dilation. Which of the following genes is most likely mutated in this condition?

Accepted Answer

Fibrillin-1 (FBN1)

Answer

COL4A5

Answer

Elastin

Answer

COL1A1

Question 9

Which of the following types of cell death involves activation of caspase enzymes?

Accepted Answer

Apoptosis and Pyroptosis

Answer

Necrosis and Apoptosis

Answer

Apoptosis only

Answer

Apoptosis and necroptosis

Question 10

A 68-year-old man presents with bleeding manifestations. Peripheral smear shows the presence of cells shown below. Which of the following is the most common chromosomal abnormality seen in this condition?

Accepted Answer

t(15 ; 17)

Answer

t(14 ; 18)

Answer

inv(16)

Answer

t(8 ; 21)

NEET-PG 2025 — Pathology