Cytopathology Practice Questions

Q: Based on the characteristic cytological findings on PAP smear examination in a 26-year-old female presented for screening, what is your diagnosis?

LSIL (Low-grade squamous intraepithelial lesion). ***LSIL (Low-grade squamous intraepithelial lesion)*** - Characterized by **koilocytosis** (cells with enlarged nuclei and perinuclear halos), **nuclear enlargement** 2-3 times normal size, and **mild nuclear atypia** with preserved nuclear-to-cytoplasmic ratio. - Associated with **HPV infection** and shows **superficial cell involvement** with good cytoplasmic maturation, representing reversible changes in a young patient. *HSIL (High-grade squamous intraepithelial lesion)* - Shows **severe nuclear atypia** with nuclear enlargement >3 times normal size and **increased nuclear-to-cytoplasmic ratio**. - Involves **deeper epithelial layers** with **loss of cellular maturation** and more pronounced **chromatin abnormalities**, which are not typical for screening findings in young women. *Squamous cell carcinoma* - Characterized by **invasive malignant cells** with **severe pleomorphism**, **abnormal mitotic figures**, and **loss of cellular cohesion**. - Shows **necrotic background** and **tumor diathesis** with frankly malignant cytological features, which would be extremely rare in a 26-year-old screening patient. *Adenocarcinoma* - Demonstrates **malignant glandular cells** with **enlarged hyperchromatic nuclei**, **prominent nucleoli**, and **three-dimensional cell clusters**. - Originates from **endocervical glands** and shows **mucin production** with different cytomorphological features compared to squamous lesions.

Q: A 35-year-old patient presents with persistent allergic rhinitis, asthmatic episodes, and peripheral hypereosinophilia. Histological findings are shown below. What is your diagnosis?

Churg-Strauss syndrome. ***Churg-Strauss syndrome*** - The **clinical triad** of **allergic rhinitis**, **asthma**, and **peripheral hypereosinophilia** is pathognomonic for Churg-Strauss syndrome (EGPA). - Histological findings typically show **necrotizing vasculitis** with **eosinophilic infiltration** and **extravascular granulomas** affecting small to medium vessels. *Behcet Disease* - Characterized by **recurrent oral and genital ulcers**, **uveitis**, and **skin lesions** (erythema nodosum, papulopustular lesions). - Lacks the **eosinophilic component** and **respiratory symptoms** seen in this case. *Kawasaki disease* - Primarily affects **children under 5 years** with **fever**, **conjunctivitis**, and **coronary artery involvement**. - Does not present with **allergic rhinitis**, **asthma**, or **hypereosinophilia** as seen here. *Buerger disease* - **Thromboangiitis obliterans** affecting **small and medium arteries** in **young male smokers**. - Presents with **digital ischemia** and **claudication**, not respiratory or allergic symptoms.

Q: Acridine orange is a fluorescent dye used to bind which cellular components?

DNA and RNA. **Explanation:** **Acridine Orange (AO)** is a fluorochrome dye with a unique property called **metachromasia**, meaning it can emit different colors depending on the molecule it binds to and the concentration. It is a nucleic acid-selective stain that interacts with DNA and RNA through electrostatic attraction. * **Why DNA and RNA are correct:** Acridine orange intercalates into double-stranded **DNA**, where it fluoresces **green** (maximum emission at 525 nm). Conversely, it binds to single-stranded **RNA** via electrostatic interactions, where it aggregates and fluoresces **orange-red** (maximum emission at 650 nm). This differential staining allows pathologists to assess the metabolic activity and nucleic acid content of cells. **Analysis of Incorrect Options:** * **B. Proteins:** Proteins are typically stained using dyes like Eosin (in H&E) or specific immunohistochemical markers. AO does not have a high affinity for proteins. * **C. Lipids:** Lipids are hydrophobic and require fat-soluble stains like Sudan Black B or Oil Red O. * **D. Carbohydrates:** Carbohydrates (like glycogen or mucin) are demonstrated using Periodic Acid-Schiff (PAS) or Mucicarmine stains. **NEET-PG High-Yield Pearls:** 1. **Clinical Use:** Used in the **Screening of Cervical Cancer** (cytopathology) because malignant cells have increased RNA synthesis (hyperchromasia). 2. **Microbiology:** It is highly sensitive for detecting bacteria in blood cultures (even before they show up on Gram stain) because it binds to bacterial nucleic acids. 3. **Viability Assay:** It is used to differentiate between live, apoptotic, and necrotic cells in research settings. 4. **Requirement:** Observation requires a **Fluorescence Microscope**.

Q: A 45-year-old female underwent hysterectomy for dysfunctional uterine bleeding. Following are the gross and histological findings. Which of the following is the most likely diagnosis?

Leiomyoma. ***Leiomyoma*** - The **well-circumscribed whorled white-gray mass** with **interlacing bland smooth muscle bundles** and **cigar-shaped nuclei** are classic features of leiomyoma. - **Absence of atypia** and **low mitotic rate** (<10 mitoses/10 HPF) distinguish it from malignant smooth muscle tumors. *Leiomyosarcoma* - Would show **significant nuclear atypia**, **coagulative necrosis**, and **high mitotic rate** (≥10 mitoses/10 HPF). - Often presents as a **poorly circumscribed mass** with irregular borders, unlike the well-demarcated nature described. *Mixed Mullerian tumor* - Contains **biphasic components** with both **epithelial** and **mesenchymal** elements, not pure smooth muscle. - Shows **high-grade malignant features** with significant pleomorphism and mitotic activity. *Vaginal carcinoma* - Represents **squamous** or **glandular malignancy** arising from the **vaginal wall**, not uterine myometrium. - Would not present as a **myometrial mass** removed during hysterectomy for dysfunctional uterine bleeding.

Question 1

A 15-year-old girl undergoes Pap smear analysis. The smear demonstrates koilocytes, which are approximately the same size as intermediate cells, with enlarged hyperchromatic nuclei and perinuclear halos. These abnormal cells are infected by which of the following viruses?

Accepted Answer

Human papillomavirus

Answer

Human Immunodeficiency Virus

Answer

Cytomegalovirus

Answer

Herpes simplex virus 1

Question 2

A 75-year-old woman has experienced increasing dull but constant pain in the back, right chest, left shoulder, and left upper thigh for the past 6 months. She has now developed a sudden, severe, sharp pain in the left thigh. On physical examination, she has intense pain on palpation of the upper thigh, and the left leg is shorter than the right. A radiograph of the left leg shows a fracture through the upper diaphyseal region of the femur in a 5-cm lytic area that extends through the entire thickness of the bone. A bone scan shows multiple areas of increased uptake in the left femur, pelvis, vertebrae, right third and fourth ribs, upper left humerus, and left scapula. Laboratory studies show serum creatinine, 0.9 mg/dL; total protein, 6.7 g/dL; albumin, 4.5 g/dL; total bilirubin, 1 mg/dL; AST, 28 U/L; ALT, 22 U/L; and alkaline phosphatase, 202 U/L. What is the most likely diagnosis?

Accepted Answer

Metastatic carcinoma

Answer

Hyperparathyroidism

Answer

Multiple myeloma

Answer

Osteochondromatosis

Question 3

Based on the characteristic cytological findings on PAP smear examination in a 26-year-old female presented for screening, what is your diagnosis?

Accepted Answer

LSIL (Low-grade squamous intraepithelial lesion)

Answer

HSIL (High-grade squamous intraepithelial lesion)

Answer

Squamous cell carcinoma

Answer

Adenocarcinoma

Question 4

A 60-year-old female with a 8-year history of renal failure on hemodialysis develops Carpal Tunnel syndrome. Which of the following types of amyloid will be associated with this condition?

Accepted Answer

Beta-2 microglobulin

Answer

Amyloid light chain

Answer

ATTR

Answer

Serum amyloid associated protein

Question 5

A 35-year-old patient presents with persistent allergic rhinitis, asthmatic episodes, and peripheral hypereosinophilia. Histological findings are shown below. What is your diagnosis?

Accepted Answer

Churg-Strauss syndrome

Answer

Behcet Disease

Answer

Kawasaki disease

Answer

Buerger disease

Question 6

Acridine orange is a fluorescent dye used to bind which cellular components?

Accepted Answer

DNA and RNA

Answer

Protein

Answer

Lipid

Answer

Carbohydrates

Question 7

FNAC is useful in diagnosing all the following conditions EXCEPT?

Accepted Answer

Follicular carcinoma

Answer

Papillary carcinoma

Answer

Anaplastic carcinoma

Answer

Lymphoma

Question 8

What is the best fixative for a Pap smear?

Accepted Answer

95% ethanol + 5% ether

Answer

10% formaldehyde

Answer

80% isopropyl alcohol

Answer

90% ether + alcohol

Question 9

Regarding the screening of oral cancer, which of the following statements about exfoliative cytology is NOT true?

Accepted Answer

Cells collected include trans-epithelial cells.

Answer

Keratin can interrupt cell collection.

Answer

It is not a very good diagnostic tool.

Answer

Greater numbers of cells collected are not superficial.

Question 10

A 45-year-old female underwent hysterectomy for dysfunctional uterine bleeding. Following are the gross and histological findings. Which of the following is the most likely diagnosis?

Accepted Answer

Leiomyoma

Answer

Leiomyosarcoma

Answer

Mixed Mullerian tumor

Answer

Vaginal carcinoma

Cytopathology — MCQs

Cytopathology — MCQs

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