1.
A 38-year-old female undergoes a routine PAP smear examination. The smear is reported as “Atypical cell seen with a high N/C ratio, hyperchromatic and pleomorphic nuclei.” A cervical biopsy is advised. The biopsy shows a tumor composed of sheets and nests of malignant squamous cells invading the underlying stroma. Many of the malignant squamous cell nests show presence of keratin pearls at the center. Which of the following is the best description of her lesion?
A. 
B. 
C. 
Invasive squamous cell carcinoma, well differentiated
D. 
Invasive squamous cell carcinoma, poorly differentiated
E. 
Invasive adenocarcinoma, well differentiated
2.
A 21-year-old woman presents with a painful right knee. An x-ray reveals a mass arising from the distal femur. Biopsy shows a malignant tumor arising from the bone, an osteosarcoma; the malignant tumor cells laying down osteoid. When the patient was 2 years old, a cancerous lesion was surgically removed from the right eye. Which of the following regulatory genes is most likely responsible for these eye and bone lesions?
A. 
B. 
C. 
D. 
E. 
3.
A 4-year-old boy is brought to his pediatrician because his parents have noted some problem in the child’s vision of the left side. Physical examination shows diminished visual acuity in the left eye. Subsequent investigations reveal a malignancy of the eye. The patient is subsequently treated with radiation, but is found to have a similar malignancy in the right eye 2 years later. What is the normal function of the protein that is altered in this condition?
Inhibition of apoptosis
A. 
GTPase activating protein (GAP)
B. 
Inactivation of transcription factor E2F
C. 
D. 
Signal transduction by RAS oncogene
4.
A 5-year-old African boy presents with a mass in his right jaw. A biopsy from the mass shows a high grade tumor composed of lymphoid cells. The pathologist describes the tumor having a “starry-sky appearance” under the microscope. The agent causing the patient’s disorder is most strongly associated with which of the following malignancies?
'
A. 
B. 
C. 
D. 
E. 
5.
A 41-year-old Caucasian woman presents with fatigue, pallor, weight loss, and intermittent diarrhea. On questioning, she reports a family history of colon carcinoma. Colonoscopy reveals three small polyps in the cecum and a 3-cm ulcerated exophytic mass in the ascending colon. Biopsy is performed and histologic examination of the exophytic mass reveals the tissue shown for your evaluation below. Which of the following is the most likely genetic mechanism of the described pathologic condition?
A. 
Microsatellite instability due to defective mismatch repair
B. 
Promoter hypermethylation of tumor suppressor genes
C. 
Defective nucleotide excision repair with formation of pyrimidine dimers
D. 
Defective homologous recombination repair due to ATM gene mutation
6.
15-year-old Caucasian girl presents to the outpatient clinic with two slow-growing nodules on her right arm. Physical examination reveals several large pigmented spots with irregular margins scattered over her body and numerous small brown nodules in her irises. The nodules on the right arm are elongated, 1 X 3 cm each, well demarcated and rubbery in consistency. Which of the following signaling pathways is most likely affected in this case?
A. 
B. 
RAS-RAF-MAP-kinase pathway
C. 
D. 
7.
A 47-year-old Iraqi man presents with dysphagia. The patient reports 20-pack-year history of smoking; he also drinks very hot tea several times a day. Esophagoscopy reveals an ulcerated lesion in the middle portion of the esophagus and biopsy is taken. Histologic examination reveals the tissue shown in the picture below. Which of the following is the most likely diagnosis?
A. 
B. 
C. 
D. 
8.
A 48-year-old man presents to the emergency room complaining of vague abdominal pain, intermittent fevers, and a 9-kg (20-lb) weight loss over the past 4 months. On physical examination, he has diffuse abdominal tenderness, hepatomegaly, and yellow sclera. CT-guided liver biopsy reveals hepatocellular carcinoma. Which of the following tumor markers is useful for monitoring recurrence of disease following surgery in this patient?
A. 
B. 
C. 
D. 
E. 
9.
A 76-year-old Caucasian man presents with dysuria and intermittent hematuria. Rectal exam does not reveal any abnormalities. Cystoscopy with subsequent biopsy is performed and reveals several granular and hyperemic spots on the bladder mucosa; no intraluminal masses are identified. Histologic examination reveals the lesion of the bladder mucosa presented for your evaluation in the picture below. Which of the following is the most likely diagnosis?
A. 
Invasive urothelial carcinoma
B. 
C. 
D. 
Urothelial carcinoma in situ
10.
A 76-year-old man presents with a complaint of a change in bowel habits, alternating constipation and diarrhea. A stool sample reveals occult blood. Digital rectal examination reveals a palpable mass. A biopsy was performed. Of the following microscopic findings, which of the following is most Likely to indicate that the neoplasm is malignant?
A. 
B. 
Increased nucleus to cytoplasmic ratio
C. 
Invasion of surrounding tissue
D. 
E. 
11.
In a blind study, a number of biopsies are submitted with the designation of grade 1 and stage 1. Without using any other information except grading and staging, which of the following is the best interpretation for these neoplasms?
A. 
They are Most likely in situ.
B. 
They are Most Likely not malignant
C. 
They are Most Likely of epithelial origin.
D. 
They are Most likely well differentiated and localized
E. 
They Most Likely spread by lymphatics
12.
A genetic study is done on a newborn that indicates the child was born with a single functional allele of a tumor suppressor gene. At the age of five the genetic study was repeated only to find that the remaining normal allele was lost through a point mutation. As a result, the ability to halt the transition from G1 to the S phase of cell cycle is lost.
Which of the following neoplasms is most likely to arise via this mechanism?
A. 
B. 
C. 
D. 
E. 
13.
A 75-year-old man has had a chronic cough for the past 10 years. He has a long cigarette smoking history and has begun to lose weight during the past year. No abnormal findings are noted on physical examination but a chest radiograph reveals a right hilar mass. Sputum cytology shows atypical, hyperchromatic squamous cells. Of the following, which is the most common pathway by which this neoplasm will metastasize?
A. 
B. 
C. 
Contiguous spread to pleural
D. 
E. 
14.
A 40-year-old woman had a firm palpable mass on the dome of her uterus which was discovered six years ago on a routine physical examination. The mass has slowly increased in size and is now about twice the size it was when first discovered. She remains asymptomatic. Which of the following neoplasms is she most likely to have?
A. 
A metastatic tumor from the colon
B. 
C. 
D. 
E. 
15.
A 55-year-old male, a chronic smoker, develops a productive cough with hemoptysis, anorexia and significant weight loss. Subsequent investigations reveal a squamous cell carcinoma of the lung. Laboratory investigations show elevated serum calcium levels. This phenomenon is best explained by which of the following?
A. 
Ectopic production of PTH
B. 
Ectopic production of ACTH
C. 
Ectopic production of ADH
D. 
Ectopic production of PTH-related peptide
E. 
Metastatic deposits in bone
16.
A 23-year-old woman presents to her physician with a lump in her left breast. She has no family history of cancer and is taking low-dose oral contraceptives. On examination, she has a 2-cm rubbery, round, freely mobile mass. An ultrasound is performed showing a solid mass. Core needle biopsy is reported as a fibroadenoma. Which of the following characteristics was most likely seen on the sample?
A. 
High nucleus to cytoplasm ratio
B. 
High fraction of cells with mitotic spindles
C. 
Cellular hyperplasia with glandular architecture
D. 
Loss of glandular architecture
E. 
17.
Postmortem examination of a 73-year-old Caucasian woman reveals multiple well-circumscribed nodules in the liver. The gross and microscopic appearance of the liver is shown for your evaluation below. Which of the following is the most likely location of the primary pathologic process affected the patient?
A. 
B. 
C. 
D. 
18.
An 18-year-old African American presents with a complaint of bloody stools that he attributes to occasional constipation. On questioning, he informs that his father died of colorectal cancer at the age of 51 years. The patient is sent to colonoscopy, the gross appearance of the colonic mucosa is shown for your evaluation below. Which of the following genes is most likely affected in this case?
A. 
Hereditary nonpolyposis colon cancer gene
B. 
Adenomatosis polyposis coli gene
C. 
D. 
19.
A 26-year-old Caucasian man presents with dyspnea, hemoptysis, and enlarged right testicle. Chest x-ray and testicular biopsy is performed and the results are shown for you evaluation. Elevation of which of the following serum markers would be confirmatory in this case?'
A. 
B. 
C. 
Prostate specific antigen
D.