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ABPath Cytopathology study materials
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ABPath Cytopathology practice questions

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Question 1Gynecologic/Anal Cytopathology

A cervical cytology specimen shows cells with enlarged, hyperchromatic nuclei and a high nuclear-to-cytoplasmic ratio, but the cells are arranged in flat, cohesive sheets with distinct cell borders. This pattern is most consistent with which interpretation?

  1. Squamous cell carcinoma, keratinizing type
  2. High-grade squamous intraepithelial lesion involving glandular epithelium Correct answer.
  3. Adenocarcinoma in situ
  4. Reactive endocervical cells with repair atypia

Explanation

High-grade squamous lesions can colonize and involve glandular spaces, producing cohesive groups that mimic glandular neoplasia. The key discriminator is the presence of squamous features such as dense cytoplasm and distinct borders rather than true glandular differentiation. Keratinizing carcinoma would show keratinized cells and more discohesion.

Question 2Gynecologic/Anal Cytopathology

The Bethesda System recommends that a Pap test report of atypical squamous cells, cannot exclude HSIL (ASC-H) generally be followed by which management step?

  1. Colposcopy with biopsy Correct answer.
  2. Repeat cytology in 12 months
  3. HPV testing alone in 12 months
  4. No further follow-up if HPV negative

Explanation

ASC-H carries a substantial risk of underlying high-grade lesion, so colposcopic evaluation is recommended regardless of HPV status. Repeat cytology or HPV-only follow-up is insufficiently sensitive for this category.

Question 3Gynecologic/Anal Cytopathology

Which finding on anal cytology most strongly supports a diagnosis of high-grade squamous intraepithelial lesion (HSIL) rather than reactive change?

  1. Abundant inflammatory cells in the background
  2. Perinuclear halos with binucleation
  3. Increased nuclear-to-cytoplasmic ratio with irregular nuclear membranes and coarse chromatin Correct answer.
  4. Singly scattered cells with abundant pale cytoplasm

Explanation

HSIL is defined by high N:C ratio, nuclear membrane irregularity, and hyperchromatic coarse chromatin in a population of abnormal cells. These features reflect the underlying clonal proliferation of basal-type cells. Inflammatory background and halos are nonspecific.

Question 4Gynecologic/Anal Cytopathology

In a cervical cytology sample, which feature best distinguishes a true glandular neoplastic process (adenocarcinoma in situ) from a benign tubal metaplasia of the endocervix?

  1. Nuclear pseudostratification with loss of polarity and hyperchromasia Correct answer.
  2. Abundant mucin vacuoles
  3. Smooth nuclear contours with even chromatin
  4. Presence of cilia and terminal bars

Explanation

Adenocarcinoma in situ shows loss of nuclear polarity, pseudostratification, and hyperchromatic nuclei with coarse chromatin. Tubal metaplasia is a benign mimic that retains ciliated cells and terminal bars with orderly nuclei. The presence of cilia favors a benign process.

Question 5Gynecologic/Anal Cytopathology

A Pap test from a postmenopausal woman shows small, round-to-oval cells with high N:C ratio, fine chromatin, and occasional nuclear grooves, arranged in loose clusters. The most appropriate interpretation is which of the following?

  1. High-grade squamous intraepithelial lesion
  2. Atrophy-related basal cell hyperplasia
  3. Adenocarcinoma in situ of the endocervix
  4. Endometrial cells in a woman with abnormal bleeding Correct answer.

Explanation

In a postmenopausal woman, exfoliated endometrial cells outside the expected menstrual window can indicate endometrial pathology, and the cytologic features described (small cells, grooves, fine chromatin) are consistent with endometrial origin. Clinical correlation with bleeding is important. Atrophy typically shows more uniform, bland cells without grooves.

Question 6Gynecologic/Anal Cytopathology

Which statement about HPV testing in cervical cancer screening is most accurate?

  1. HPV testing should not be used in women over 30
  2. A positive HPV test mandates immediate hysterectomy
  3. A negative HPV test essentially excludes high-grade cervical disease in the near term Correct answer.
  4. HPV testing has lower sensitivity than cytology for detecting CIN2+

Explanation

High-risk HPV testing is highly sensitive, and a negative result provides strong reassurance against significant cervical neoplasia in the short term. This high negative predictive value underlies its use in primary screening and co-testing.

Question 7Gynecologic/Anal Cytopathology

On anal cytology, which cell type is sampled when the collection device is inserted into the anal canal to the dentate line?

  1. Transitional zone cells and squamous cells of the anal canal Correct answer.
  2. Small bowel enterocytes
  3. Columnar rectal mucosa
  4. Keratinized squamous cells of the perianal skin

Explanation

The anal transformation zone near the dentate line contains a mix of squamous and transitional (cloacogenic) epithelium, which is the target of anal cytology sampling. Sampling this zone maximizes detection of anal intraepithelial neoplasia.

Question 8Gynecologic/Anal Cytopathology

A cervical cytology specimen shows a predominant population of superficial and intermediate squamous cells with abundant orangeophilic cytoplasm and pyknotic nuclei. This appearance is best described as which of the following?

  1. Atrophic vaginitis
  2. Hyperkeratosis/parakeratosis Correct answer.
  3. Keratinizing dysplasia
  4. Adenocarcinoma

Explanation

Orangeophilic, anucleate or pyknotic squamous cells reflect keratinization, seen in hyperkeratosis or parakeratosis, which are nonspecific reactive findings. They do not by themselves indicate dysplasia.

Question 9Gynecologic/Anal Cytopathology

Which feature most reliably distinguishes low-grade squamous intraepithelial lesion (LSIL) from HSIL on cervical cytology?

  1. Presence of koilocytes
  2. Presence of inflammatory cells
  3. Nuclear-to-cytoplasmic ratio and degree of nuclear atypia Correct answer.
  4. Cell size

Explanation

The distinction between LSIL and HSIL hinges on the degree of nuclear atypia and the N:C ratio, with HSIL showing higher N:C ratio and more severe nuclear changes. Koilocytes are a hallmark of LSIL but can be seen in HSIL as well.

Question 10Gynecologic/Anal Cytopathology

A cervical cytology sample contains numerous small, uniform cells with scant cytoplasm, arranged in tight clusters with smooth borders and a clean background. Which diagnosis should be considered?

  1. Lymphocytic infiltrate
  2. Follicular cervicitis Correct answer.
  3. Small cell carcinoma
  4. Endometrial cells

Explanation

Follicular cervicitis can produce tight clusters of small lymphoid cells, sometimes with tingible body macrophages, mimicking small cell carcinoma. The clean background and uniform small cells with smooth borders favor a benign lymphoid process.

Question 11Gynecologic/Anal Cytopathology

The presence of which feature in a cervical cytology specimen most strongly suggests a diagnosis of adenocarcinoma in situ over invasive adenocarcinoma?

  1. Abundant mucin vacuoles
  2. Irregular, ragged cell clusters with prominent nucleoli and tumor diathesis
  3. Single cells with high N:C ratio
  4. Cohesive sheets of cells with smooth, well-defined borders Correct answer.

Explanation

Adenocarcinoma in situ tends to show cohesive, well-defined clusters without tumor diathesis, whereas invasive adenocarcinoma often shows ragged clusters, prominent nucleoli, and necrotic background (tumor diathesis). The border quality and background help separate in situ from invasive disease.

Question 12Gynecologic/Anal Cytopathology

Which of the following best describes the cytologic appearance of a typical koilocyte?

  1. Multinucleated giant cell with prominent nucleoli
  2. Small cell with scant cytoplasm and nuclear molding
  3. Cell with a perinuclear halo and nuclear enlargement with irregular contours Correct answer.
  4. Large cell with a dense, hyperchromatic nucleus and no halo

Explanation

Koilocytes show a sharply defined perinuclear halo with an enlarged, often wrinkled or irregular nucleus, reflecting HPV cytopathic effect. This is the hallmark of LSIL.

Question 13Gynecologic/Anal Cytopathology

A 35-year-old woman has a Pap test showing ASC-US. Reflex HPV testing is negative. According to standard management, the most appropriate next step is which of the following?

  1. Endometrial biopsy
  2. Immediate colposcopy
  3. Repeat cytology in 3 years Correct answer.
  4. Hysterectomy

Explanation

ASC-US with a negative high-risk HPV test carries a low risk of significant disease, and current guidelines allow repeat screening in 3 years rather than immediate colposcopy. This reflects the high negative predictive value of HPV testing in this setting.

Question 14Gynecologic/Anal Cytopathology

In anal cytology, the presence of which feature is most consistent with a high-grade lesion rather than a low-grade lesion?

  1. Full-thickness loss of maturation with high N:C ratio cells Correct answer.
  2. Koilocytic change with perinuclear halos
  3. Parakeratosis
  4. Scattered binucleated cells

Explanation

High-grade anal lesions show a greater degree of maturation loss with high N:C ratio cells occupying a larger portion of the epithelium. Low-grade lesions are characterized by koilocytic change and lesser atypia.

Question 15Gynecologic/Anal Cytopathology

Which of the following is the most common cause of a false-negative cervical cytology result?

  1. Overinterpretation of reactive cells
  2. Excessive staining
  3. Sampling error and inadequate cell transfer Correct answer.
  4. Use of liquid-based preparation

Explanation

Most false-negative Pap tests result from sampling or preparation errors, such as failure to collect or transfer abnormal cells, rather than from interpretive errors alone. Recognizing this has driven improvements in collection devices and liquid-based methods.

Question 16Gynecologic/Anal Cytopathology

A cervical cytology specimen from a woman with an intrauterine device shows small clusters of cells with vacuolated cytoplasm and nuclear atypia. Which feature would most favor a reactive IUD effect over a neoplastic process?

  1. Irregular nuclear membranes with hyperchromasia
  2. High N:C ratio with coarse chromatin
  3. Loss of polarity with pseudostratification
  4. Prominent nucleoli with smooth nuclear contours and cytoplasmic vacuoles Correct answer.

Explanation

IUD-related changes often produce cells with vacuolated cytoplasm, prominent nucleoli, and relatively smooth nuclear contours, reflecting a reactive process. Malignant criteria such as coarse chromatin, irregular membranes, and loss of polarity are absent.

Question 17Gynecologic/Anal Cytopathology

Which statement best describes the role of p16 immunocytochemistry in cervical cytology?

  1. It distinguishes squamous from glandular cells
  2. It confirms the presence of inflammation
  3. It identifies endometrial cells
  4. It is a sensitive marker of high-risk HPV-associated dysplasia Correct answer.

Explanation

p16 overexpression reflects cell-cycle dysregulation by high-risk HPV and serves as a sensitive marker supporting a diagnosis of high-grade dysplasia. It is used as an adjunct, not a stand-alone test.

Question 18Gynecologic/Anal Cytopathology

A cervical cytology sample shows a few cells with enlarged nuclei and prominent nucleoli in a background of abundant neutrophils and blood. Which diagnosis should be considered first?

  1. Repair/reactive atypia Correct answer.
  2. High-grade squamous intraepithelial lesion
  3. Small cell carcinoma
  4. Adenocarcinoma in situ

Explanation

Prominent nucleoli with an inflammatory background favor a reactive/repair process, which can mimic neoplasia. Repair cells typically show streaming, smooth nuclear contours, and abundant cytoplasm.

Question 19Gynecologic/Anal Cytopathology

Which of the following findings on anal cytology would most appropriately be reported as atypical squamous cells, cannot exclude HSIL (ASC-H)?

  1. Clearly koilocytic cells
  2. Scattered reactive squamous cells
  3. Rare cells with high N:C ratio in a background of inflammation where HSIL cannot be excluded Correct answer.
  4. Abundant parakeratosis

Explanation

ASC-H is used when cytologic features suggest a high-grade lesion but are insufficient for a definitive HSIL diagnosis, often in the setting of inflammation or limited cellularity. It signals the need for further evaluation.

Question 20Gynecologic/Anal Cytopathology

Which feature most reliably distinguishes a benign endocervical cell cluster from adenocarcinoma in situ on cytology?

  1. Presence of mucin
  2. Nuclear enlargement with hyperchromasia
  3. Prominent nucleoli
  4. Honeycomb arrangement with uniform nuclei and smooth borders Correct answer.

Explanation

Benign endocervical clusters show a honeycomb arrangement with uniform nuclei and smooth borders, reflecting orderly glandular architecture. AIS shows loss of this order with nuclear atypia.

Question 21Gynecologic/Anal Cytopathology

A cervical cytology report describes cells with nuclear enlargement, hyperchromasia, and irregular nuclear contours in a woman with a history of cervical cancer treated with radiation. Which interpretation is most appropriate?

  1. Normal squamous cells
  2. Recurrent carcinoma until proven otherwise Correct answer.
  3. Koilocytosis
  4. Radiation effect with no further workup

Explanation

Post-radiation changes can produce marked nuclear atypia that mimics malignancy, but recurrent carcinoma must be excluded. Cytologic atypia in this setting warrants clinical correlation and further evaluation rather than dismissal.

Question 22Gynecologic/Anal Cytopathology

Which of the following is an appropriate indication for performing anal cytology screening?

  1. Patients with irritable bowel syndrome
  2. HIV-positive men who have sex with men Correct answer.
  3. All adults over age 50
  4. Women with a history of breast cancer

Explanation

Anal cytology screening is recommended for high-risk groups, particularly HIV-positive men who have sex with men and others with increased risk of anal HPV-related disease. General population screening is not established.

Question 23Gynecologic/Anal Cytopathology

A cervical cytology specimen shows a population of small cells with high N:C ratio, nuclear molding, and crush artifact. Which diagnosis should be prioritized?

  1. Reactive endocervical cells
  2. Koilocytosis
  3. LSIL
  4. Small cell carcinoma Correct answer.

Explanation

Small cell carcinoma is characterized by small cells with scant cytoplasm, nuclear molding, crush artifact, and high N:C ratio. These features distinguish it from low-grade and reactive processes.

Question 24Gynecologic/Anal Cytopathology

Which statement about the adequacy of a cervical cytology specimen is most accurate?

  1. A specimen with fewer than 5,000 squamous cells is generally unsatisfactory for evaluation Correct answer.
  2. Adequacy is irrelevant if HPV testing is performed
  3. Blood always renders a specimen unsatisfactory
  4. Adequacy depends only on the presence of endocervical cells

Explanation

Bethesda criteria specify a minimum estimated number of well-visualized squamous cells (approximately 5,000) for a specimen to be considered satisfactory for evaluation. Adequacy affects the reliability of the cytologic interpretation.

Question 25Gynecologic/Anal Cytopathology

A cervical cytology sample shows cells with enlarged nuclei and prominent nucleoli arranged in three-dimensional clusters with a necrotic background. Which diagnosis is most likely?

  1. LSIL
  2. Koilocytosis
  3. Atrophy
  4. Invasive adenocarcinoma Correct answer.

Explanation

Three-dimensional clusters, prominent nucleoli, and tumor diathesis (necrotic background) are features of invasive adenocarcinoma. These findings help distinguish invasive from in situ disease.

Question 26Gynecologic/Anal Cytopathology

A cervical cytology specimen is reported as unsatisfactory for evaluation. Which of the following is the most common reason for this designation?

  1. Obscuring blood or inflammation Correct answer.
  2. Air-drying artifact
  3. Absence of endocervical cells
  4. Excessive mucus

Explanation

The most common reason for an unsatisfactory cervical cytology specimen is obscuring blood, inflammation, or thick areas that prevent adequate evaluation of epithelial cells. Absence of endocervical cells is not a reason for unsatisfactory in the current Bethesda System. Air-drying artifact and mucus can be present but are less common causes.

Question 27Gynecologic/Anal Cytopathology

Which of the following best describes the cytologic features of a typical endocervical cell?

  1. Columnar shape with basal nucleus and finely vacuolated cytoplasm Correct answer.
  2. Polyhedral shape with central nucleus and abundant glycogen
  3. Round shape with high N:C ratio and prominent nucleoli
  4. Spindle shape with elongated nucleus and keratinized cytoplasm

Explanation

Normal endocervical cells are columnar with basally located nuclei and finely vacuolated cytoplasm. They often appear in honeycomb or picket-fence arrangements. Polyhedral cells with glycogen are superficial squamous cells, spindle cells are not typical, and round cells with high N:C ratio suggest dysplasia.

Question 28Gynecologic/Anal Cytopathology

A cervical cytology specimen shows many superficial squamous cells with large, orangeophilic, keratinized cytoplasm and pyknotic nuclei. What is the most likely diagnosis?

  1. Koilocytosis
  2. Hyperkeratosis Correct answer.
  3. Dyskeratosis
  4. Parakeratosis

Explanation

Hyperkeratosis is characterized by anucleate superficial squamous cells with orangeophilic keratinized cytoplasm. Parakeratosis shows keratinized cells with retained nuclei. Koilocytes have perinuclear halos and nuclear atypia. Dyskeratosis refers to premature keratinization of individual cells, often with atypia.

Question 29Gynecologic/Anal Cytopathology

Which of the following best describes the recommended follow-up for a woman with a cervical cytology result of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H)?

  1. Repeat cytology in 3 years
  2. Colposcopy with biopsy Correct answer.
  3. Repeat cytology in 1 year
  4. HPV testing in 1 year

Explanation

ASC-H is associated with a significant risk of high-grade dysplasia, so colposcopy with biopsy is recommended for initial management. Repeat cytology or HPV testing alone is not sufficient. The ASCCP guidelines recommend colposcopy for ASC-H regardless of HPV status.

Question 30Gynecologic/Anal Cytopathology

In anal cytology, which of the following is the recommended method for specimen collection?

  1. Superficial swab of the perianal skin
  2. Anal lavage with saline
  3. Biopsy of the anal transformation zone
  4. Insertion of a moistened swab into the anal canal to the dentate line Correct answer.

Explanation

Anal cytology specimens should be collected by inserting a moistened swab or brush into the anal canal to the dentate line to sample the transformation zone. Superficial swabbing of the perianal skin is inadequate. Lavage and biopsy are not standard collection methods for cytology.

Question 31Gynecologic/Anal Cytopathology

Which of the following statements about the Bethesda System for reporting cervical cytology is most accurate?

  1. It specifies that all atypical findings must be reported as LSIL.
  2. It provides standardized terminology for reporting cervical cytology results. Correct answer.
  3. It requires the use of liquid-based cytology.
  4. It mandates the use of HPV testing for all specimens.

Explanation

The Bethesda System is a standardized reporting terminology for cervical cytology, facilitating communication and management. It does not mandate HPV testing or liquid-based cytology, and it distinguishes various categories of atypia, not just LSIL.

Question 32Gynecologic/Anal Cytopathology

A 28-year-old woman has a cervical cytology result of LSIL. According to standard management guidelines, what is the next step?

  1. HPV testing
  2. Repeat cytology in 6 months
  3. Colposcopy Correct answer.
  4. Treatment with cryotherapy

Explanation

LSIL is managed with colposcopy to evaluate for underlying high-grade disease. Repeat cytology or HPV testing alone is not recommended for LSIL in most cases. Treatment without histologic confirmation is not standard.

Question 33Gynecologic/Anal Cytopathology

Which of the following is the most common cause of atypical squamous cells of undetermined significance (ASC-US) on cervical cytology?

  1. Atrophic vaginitis
  2. Human papillomavirus infection Correct answer.
  3. Recent intercourse
  4. Candida infection

Explanation

ASC-US is most commonly associated with HPV infection, which can cause mild cytologic changes that do not meet criteria for LSIL. Infections, atrophy, and recent intercourse can cause reactive changes but are less common causes of ASC-US.

Question 34Gynecologic/Anal Cytopathology

A cervical cytology specimen shows a cluster of columnar cells with nuclear enlargement, hyperchromasia, and nuclear overlap, but no definite invasion. What is the most appropriate interpretation?

  1. Reactive endocervical cells
  2. Adenocarcinoma in situ Correct answer.
  3. Endocervical adenocarcinoma, usual type
  4. Atypical glandular cells, favor neoplastic

Explanation

The features described-nuclear enlargement, hyperchromasia, and overlap in a glandular cluster-are characteristic of adenocarcinoma in situ (AIS). AIS shows severe nuclear atypia but maintains glandular architecture without invasion. Reactive cells would not show such atypia.

Question 35Gynecologic/Anal Cytopathology

Which of the following best describes the cytologic appearance of a koilocyte?

  1. Squamous cell with abundant orangeophilic cytoplasm and a pyknotic nucleus
  2. Small cell with high N:C ratio and nuclear molding
  3. Columnar cell with basal nucleus and finely vacuolated cytoplasm
  4. Squamous cell with a perinuclear halo and nuclear enlargement with irregular contours Correct answer.

Explanation

Koilocytes are squamous cells with a sharply defined perinuclear halo and nuclear atypia, including enlargement, hyperchromasia, and irregular contours. They are a hallmark of HPV infection. The other options describe other cell types.

Question 36Gynecologic/Anal Cytopathology

A cervical cytology specimen from a postmenopausal woman shows small, round to oval cells with high N:C ratio and hyperchromatic nuclei in a clean background. What is the most likely diagnosis?

  1. Adenocarcinoma in situ
  2. LSIL
  3. Atrophy Correct answer.
  4. HSIL

Explanation

Atrophic changes in postmenopausal women can mimic dysplasia, presenting as small cells with high N:C ratio and hyperchromatic nuclei. However, the background is clean, and the cells are uniform without significant atypia. LSIL and HSIL would show more definitive features such as koilocytes or marked nuclear atypia.

Question 37Gynecologic/Anal Cytopathology

Which of the following statements about HPV testing in cervical cancer screening is most accurate?

  1. HPV testing should be performed only in women with abnormal cytology.
  2. HPV testing is recommended as the primary screening test for women under 25 years.
  3. A negative HPV test result has a high negative predictive value for cervical precancer. Correct answer.
  4. HPV testing is not useful in women over 65 years.

Explanation

A negative HPV test is associated with a very low risk of cervical precancer, providing strong reassurance. HPV testing is not recommended for women under 25 due to high prevalence of transient infections. It can be used for primary screening in women 25 and older, and it remains useful in older women.

Question 38Gynecologic/Anal Cytopathology

A cervical cytology sample shows numerous small, uniform cells with scant cytoplasm arranged in tight clusters with molding and crush artifact. What is the most likely diagnosis?

  1. Small cell carcinoma Correct answer.
  2. HSIL
  3. Endometrial adenocarcinoma
  4. Lymphoma

Explanation

Small cell carcinoma is characterized by small cells with scant cytoplasm, nuclear molding, crush artifact, and high N:C ratio. HSIL cells are larger with more cytoplasm and distinct nuclear features. Endometrial adenocarcinoma cells are glandular, and lymphoma cells are discohesive.

Question 39Gynecologic/Anal Cytopathology

Which of the following features best distinguishes a high-grade squamous intraepithelial lesion (HSIL) from a low-grade squamous intraepithelial lesion (LSIL) on cervical cytology?

  1. High N:C ratio and irregular nuclear contours Correct answer.
  2. Presence of koilocytes
  3. Perinuclear halos
  4. Abundant cytoplasm

Explanation

HSIL is characterized by cells with high N:C ratio, irregular nuclear contours, and hyperchromasia, reflecting more severe dysplasia. Koilocytes and perinuclear halos are features of LSIL. Abundant cytoplasm is more typical of LSIL or normal cells.

Question 40Gynecologic/Anal Cytopathology

A 45-year-old woman with HIV infection undergoes anal cytology screening. Which of the following is the most appropriate indication for anal cytology in this patient?

  1. History of cervical HPV infection
  2. Presence of hemorrhoids
  3. Age over 40 years
  4. HIV infection with a history of receptive anal intercourse Correct answer.

Explanation

Anal cytology screening is recommended for high-risk groups, including HIV-infected individuals, especially those with a history of receptive anal intercourse. Age alone, cervical HPV history, or hemorrhoids are not sufficient indications.

Question 41Gynecologic/Anal Cytopathology

Which of the following best describes the cytologic features of anal high-grade squamous intraepithelial lesion (HSIL)?

  1. Perinuclear halos and nuclear enlargement
  2. Multinucleation and prominent nucleoli
  3. High N:C ratio, irregular nuclear contours, and hyperchromasia Correct answer.
  4. Abundant keratinized cytoplasm

Explanation

Anal HSIL shows features similar to cervical HSIL: high N:C ratio, irregular nuclear contours, and hyperchromasia. Koilocytes with halos are seen in LSIL. Keratinization and multinucleation are not specific for HSIL.

Question 42Gynecologic/Anal Cytopathology

A cervical cytology specimen shows cells with enlarged nuclei, prominent nucleoli, and abundant cytoplasm with a finely vacuolated appearance in a background of inflammation. What is the most likely interpretation?

  1. HSIL
  2. LSIL
  3. Reactive squamous cells Correct answer.
  4. Squamous cell carcinoma

Explanation

Reactive squamous cells can show nuclear enlargement and prominent nucleoli, but they retain abundant cytoplasm and do not have the high N:C ratio or irregular contours of dysplasia. The inflammatory background supports a reactive process.

Question 43Gynecologic/Anal Cytopathology

Which of the following statements about the adequacy of a cervical cytology specimen is most accurate?

  1. A specimen is satisfactory if it contains any squamous cells.
  2. The presence of endocervical cells is not required for adequacy in the current Bethesda System. Correct answer.
  3. A specimen is unsatisfactory if it lacks endocervical cells.
  4. A specimen is unsatisfactory if it contains blood.

Explanation

In the Bethesda System, the presence of endocervical cells is not a requirement for adequacy; it is a quality indicator but not mandatory. A specimen is unsatisfactory if it is obscured by blood, inflammation, or other factors that prevent evaluation. The presence of any squamous cells alone does not guarantee adequacy.

Question 44Gynecologic/Anal Cytopathology

A cervical cytology sample shows cells with enlarged nuclei and prominent nucleoli arranged in three-dimensional clusters with feathering at the edges. What is the most likely diagnosis?

  1. Squamous cell carcinoma
  2. Reactive endocervical cells
  3. HSIL
  4. Adenocarcinoma in situ Correct answer.

Explanation

Adenocarcinoma in situ (AIS) often presents with three-dimensional glandular clusters, nuclear enlargement, prominent nucleoli, and feathering at the edges. Squamous cell carcinoma would show malignant squamous cells, HSIL would show high N:C ratio and irregular contours, and reactive cells would lack these atypical features.

Question 45Gynecologic/Anal Cytopathology

Which of the following is the most appropriate management for a woman with a cervical cytology result of atypical glandular cells (AGC) on a Pap test?

  1. Colposcopy with endocervical sampling and endometrial biopsy Correct answer.
  2. Empiric treatment with antibiotics
  3. Repeat cytology in 6 months
  4. HPV testing

Explanation

AGC is associated with a significant risk of endometrial and cervical glandular neoplasia, so colposcopy with endocervical sampling and endometrial biopsy is recommended. Repeat cytology or HPV testing alone is insufficient. Antibiotics are not indicated.

Question 46Gynecologic/Anal Cytopathology

A cervical cytology specimen shows a predominant population of superficial and intermediate squamous cells with abundant cytoplasm and small, uniform nuclei. What is the most likely diagnosis?

  1. HSIL
  2. Normal superficial and intermediate squamous cells Correct answer.
  3. Atrophy
  4. LSIL

Explanation

The description matches normal superficial and intermediate squamous cells, which have abundant cytoplasm and small, uniform nuclei. LSIL and HSIL would show nuclear atypia. Atrophy would show smaller cells with higher N:C ratio.

Question 47Gynecologic/Anal Cytopathology

Which of the following best describes the cytologic features of a high-grade squamous intraepithelial lesion (HSIL) in anal cytology?

  1. Abundant keratinized cytoplasm
  2. High N:C ratio, irregular nuclear contours, and hyperchromasia Correct answer.
  3. Multinucleation and prominent nucleoli
  4. Perinuclear halos and nuclear enlargement

Explanation

Anal HSIL shows features similar to cervical HSIL: high N:C ratio, irregular nuclear contours, and hyperchromasia. Koilocytes with halos are seen in LSIL. Keratinization and multinucleation are not specific for HSIL.

Question 48Gynecologic/Anal Cytopathology

A cervical cytology specimen shows a few cells with enlarged nuclei and prominent nucleoli in a background of abundant neutrophils. What is the most appropriate interpretation?

  1. Reactive changes due to inflammation Correct answer.
  2. Squamous cell carcinoma
  3. LSIL
  4. HSIL

Explanation

Enlarged nuclei with prominent nucleoli in an inflammatory background are typical of reactive changes. LSIL and HSIL would show specific features of HPV infection or dysplasia. Squamous cell carcinoma would show malignant features.

Question 49Gynecologic/Anal Cytopathology

Which of the following statements about p16 immunocytochemistry in cervical cytology is most accurate?

  1. p16 staining is negative in HSIL.
  2. p16 is a marker for glandular differentiation.
  3. p16 is used to confirm the diagnosis of LSIL.
  4. p16 overexpression is a surrogate marker for high-risk HPV infection. Correct answer.

Explanation

p16 overexpression is a surrogate marker for high-risk HPV infection and is helpful in distinguishing HSIL from mimics. It is not used to confirm LSIL, and it is typically positive in HSIL. It is not a marker for glandular differentiation.

Question 50Gynecologic/Anal Cytopathology

A cervical cytology specimen shows cells with nuclear enlargement, hyperchromasia, and irregular nuclear contours in a background of necrotic debris. What is the most likely diagnosis?

  1. HSIL
  2. Reactive changes
  3. LSIL
  4. Squamous cell carcinoma Correct answer.

Explanation

The presence of necrotic debris (tumor diathesis) with markedly atypical cells is highly suggestive of invasive squamous cell carcinoma. HSIL would not typically show necrosis. LSIL and reactive changes lack these malignant features.