Hepatobiliary and Pancreatic Pathology MCQs

Pathology · 115 free questions with answers & explanations.

A 45-year-old alcoholic man develops hepatomegaly. Liver biopsy shows hepatocytes with irregular pink cytoplasmic inclusions that stain with ubiquitin antibody (IHC). Ultrastructurally, these consist of intermediate filament aggregates. These inclusions are:
A 55-year-old woman is found to have a 2 cm cystic pancreatic lesion communicating with the main pancreatic duct on MRCP. Biopsy shows mucin-producing columnar epithelium with papillary projections. Fluid cytology shows high CEA (>192 ng/mL). This lesion, with significant malignant potential, is best classified as:
In alcoholic liver disease, Mallory-Denk bodies (Mallory hyaline) are eosinophilic cytoplasmic inclusions composed primarily of:
Autoimmune pancreatitis (AIP) type 1 (IgG4-related) is characterized by periductal lymphoplasmacytic infiltrate with IgG4+ plasma cells and storiform fibrosis. It typically responds to which treatment, helping distinguish it from pancreatic carcinoma?
A 45-year-old woman with primary biliary cholangitis (PBC) undergoes liver biopsy. Histology shows florid duct lesion with lymphocytic infiltration of bile duct epithelium, granuloma formation around damaged ducts, and ductopenia in portal tracts. Which autoantibody has the highest specificity for PBC and targets which mitochondrial enzyme complex?
A 55-year-old man with chronic HCV develops hepatocellular carcinoma (HCC). AFP is 1200 ng/mL. Imaging shows a 4 cm arterially enhancing nodule with washout on portal phase (LI-RADS 5). Which molecular event in HCV-related hepatocarcinogenesis most directly promotes cell cycle progression?
A 50-year-old woman presents with progressive jaundice, weight loss, and a CA 19-9 of 890 U/mL. MRCP shows a diffusely dilated intrahepatic bile duct with a soft-tissue mass at the hepatic hilum. She is found to have IgG4 serum level of 650 mg/dL. A biopsy shows storiform fibrosis, obliterative phlebitis, and >10 IgG4-positive plasma cells per HPF. Which diagnosis most changes her management?
Wilson disease (hepatolenticular degeneration) results from ATP7B mutation causing copper accumulation. In the liver, the pathological progression includes steatosis, hepatitis, and cirrhosis. Which histochemical stain demonstrates hepatic copper deposition, and what is the primary intracellular compartment where excess copper accumulates?
The 2019 WHO classification of pancreatic ductal adenocarcinoma precursors recognizes three main types. Intraductal papillary mucinous neoplasm (IPMN) of the main duct type carries the highest malignancy risk. Compared to mucinous cystic neoplasm (MCN), IPMN has a defining distinguishing feature:
A 55-year-old alcoholic develops jaundice, coagulopathy, and encephalopathy over 4 weeks. Liver biopsy shows zone 3 (pericentral) necrosis, Mallory-Denk bodies (intracytoplasmic eosinophilic aggregates), neutrophilic infiltration, and ballooning degeneration. The molecular composition of Mallory-Denk bodies includes:
A 40-year-old man with primary sclerosing cholangitis (PSC) and IBD undergoes ERCP showing 'beaded' appearance of intra- and extrahepatic bile ducts. Liver biopsy shows periductal 'onion-skin' fibrosis. The characteristic bile duct lesion and its biliary epithelial cell destruction is mediated primarily by:
A 55-year-old with pancreatic ductal adenocarcinoma undergoes molecular profiling. The tumor shows KRAS G12D mutation, homozygous CDKN2A deletion, TP53 mutation, and SMAD4 deletion. Which of these alterations is most commonly ACQUIRED LATEST in the progression model of PDAC (PanIN → invasive carcinoma)?
In alcoholic liver disease, the key mechanism by which ethanol metabolism leads to hepatic steatosis involves:
Primary biliary cholangitis (PBC) is characterized by a specific autoantibody highly sensitive and specific for the diagnosis. This antibody targets:
In pancreatic ductal adenocarcinoma (PDAC), the molecular progression from normal duct epithelium to carcinoma follows a well-characterized PanIN sequence. Which of the following correctly sequences the key driver mutations in order of acquisition?
A 40-year-old woman presents with progressive jaundice, pruritus, and elevated ALP (3x normal) with near-normal ALT/AST. ANA and anti-smooth muscle antibodies are negative. Serum AMA (anti-mitochondrial antibodies, specifically anti-M2) are strongly positive (titer 1:320). Liver biopsy shows lymphocytic infiltration and granulomatous destruction of small intrahepatic bile ducts. The diagnosis is:
A 55-year-old chronic alcoholic presents with sudden severe upper abdominal pain radiating to the back, vomiting, and elevated serum lipase (6x upper limit of normal). CT scan shows pancreatic necrosis involving 40% of the gland with peripancreatic fat stranding. The RANSON criteria score is 4. Which sequence of pathological events is MOST correct in severe acute pancreatitis?
Wilson disease (hepatolenticular degeneration) involves copper accumulation due to mutation in ATP7B. In the liver, excess copper primarily accumulates within which organelle BEFORE causing hepatocyte injury?
A liver biopsy from a 45-year-old woman with autoimmune hepatitis shows plasma cell-rich periportal inflammation, rosette formation of hepatocytes, and emperipolesis (penetration of lymphocytes into hepatocyte cytoplasm). The characteristic autoantibody in Type 2 AIH is:
Hepatocellular carcinoma (HCC) associated with hepatitis B infection can arise in non-cirrhotic liver. The primary oncogenic mechanism of HBV in this setting is:
In primary biliary cholangitis (PBC), the liver biopsy shows florid duct lesion — granulomatous destruction of interlobular bile ducts. The stage 4 histological finding is:
A 38-year-old woman with no alcohol use has NASH-related cirrhosis. Liver biopsy shows Zone 3 perisinusoidal fibrosis, hepatocyte ballooning with Mallory-Denk bodies, lobular inflammation, and steatosis >5%. The NASH Activity Score (NAS) and the degree of fibrosis are used independently. A NAS of ≥5 strongly predicts progressive disease. Mallory-Denk bodies in NASH are composed of:
A 55-year-old man with primary sclerosing cholangitis (PSC) has dominant strictures on ERCP and elevated serum CA 19-9. Brush cytology shows aneuploidy. Which molecular mechanism primarily drives malignant transformation to cholangiocarcinoma in PSC?
A 62-year-old presents with painless obstructive jaundice and a 2.5 cm mass in the pancreatic head. CT shows duct dilation ('double duct sign'). Biopsy confirms pancreatic ductal adenocarcinoma (PDAC). Molecular analysis would most likely show which combination of driver mutations?
A 45-year-old woman with primary sclerosing cholangitis (PSC) undergoes liver biopsy. The pathognomonic histological finding in PSC is:
IPMN (intraductal papillary mucinous neoplasm) of the pancreas is classified into subtypes based on mucin expression. Which IPMN subtype has the highest risk of invasive carcinoma and worst prognosis?
A liver biopsy from a 40-year-old woman with autoimmune hepatitis shows interface hepatitis (piecemeal necrosis), plasma cell-rich portal infiltrates, rosette formation of hepatocytes, and hepatocyte 'emperipolesis' (lymphocytes penetrating hepatocyte cytoplasm). Serology shows ANA positive 1:640, anti-smooth muscle antibody (SMA) positive 1:320, elevated IgG (3.8 g/dL). Which HLA allele is most strongly associated with Type 1 AIH in European populations, and what is the mechanistic link?
A 55-year-old man with 20-year history of chronic HCV cirrhosis develops a 3 cm arterially enhancing liver mass with washout appearance on portal-venous phase MRI. AFP is 450 ng/mL. Core biopsy is not performed; LI-RADS 5 diagnosis is made. Which molecular pathway is most frequently dysregulated in hepatocellular carcinoma arising on HCV-associated cirrhosis, and which targeted therapy exploits this?
On liver biopsy from a patient with non-alcoholic steatohepatitis (NASH), the NAFLD Activity Score (NAS) is calculated. Which three histological features are scored to calculate NAS, and what NAS threshold is used to diagnose NASH?
A 48-year-old woman undergoes cholecystectomy for acute cholecystitis. Histopathology of the gallbladder shows diffuse mucosal thickening with intramural diverticula (Rokitansky-Aschoff sinuses), smooth muscle hypertrophy, and no evidence of malignancy. This diagnosis is best classified as:
A 62-year-old man with a history of chronic pancreatitis is found to have a cystic pancreatic lesion on CT. Endoscopic ultrasound with cyst fluid analysis shows elevated carcinoembryonic antigen (CEA >200 ng/mL) and mucinous fluid. Cyst cytology shows low-grade mucinous epithelium. The two main differential diagnoses for this cyst are mucinous cystic neoplasm (MCN) and intraductal papillary mucinous neoplasm (IPMN). The SINGLE feature that definitively distinguishes MCN from IPMN is:
A 45-year-old woman with autoimmune hepatitis is found to have serum anti-SLA/LP antibody positivity (anti-soluble liver antigen/liver-pancreas). She is also ANA positive and anti-smooth muscle antibody positive. Which gene product is the target of anti-SLA/LP antibody and what is its clinical significance?
A 55-year-old man with a 25-year history of hereditary hemochromatosis (HFE C282Y homozygous) develops hepatocellular carcinoma despite successful iron depletion by phlebotomy. Why does HCC develop even after iron depletion in advanced hemochromatosis?
A 38-year-old woman with primary sclerosing cholangitis (PSC) and inflammatory bowel disease undergoes liver transplantation. Cholangiography of the explant shows multifocal stricturing and dilatation of both intrahepatic and extrahepatic bile ducts. ERCP prior to transplant showed 'beaded' appearance. What is the pathological basis of the ductal changes in PSC?
The 2021 AASLD/EASL non-alcoholic fatty liver disease (NAFLD) nomenclature change reclassifies a subset of patients. Under the new MASLD (Metabolic dysfunction-Associated Steatotic Liver Disease) framework, a patient with hepatic steatosis AND 1 of 5 cardiometabolic risk factors qualifies. Which histological feature distinguishes metabolic-associated steatohepatitis (MASH) from simple hepatic steatosis and determines prognosis?
A 55-year-old man with a 3 cm pancreatic head mass has obstructive jaundice. CT shows a hypodense mass with pancreatic duct dilatation. Endoscopic ultrasound-guided biopsy shows mucin-producing columnar epithelium with moderate dysplasia within a dilated main pancreatic duct. No invasive carcinoma is seen. Which precursor lesion is this, and what is its cancer risk?
A 45-year-old woman with primary sclerosing cholangitis (PSC) undergoes surveillance colonoscopy and is found to have high-grade dysplasia in flat mucosa of the right colon. Her serum CA19-9 is markedly elevated. The most important next diagnostic consideration is:
The WHO 2019 classification of pancreatic neuroendocrine tumors (PanNETs) introduced a grade 3 category. The distinguishing feature between a WHO Grade 3 PanNET (G3 NET) and a large-cell pancreatic neuroendocrine carcinoma (LCNEC) is:
A 50-year-old woman with primary biliary cholangitis (PBC) has AMA (anti-mitochondrial antibody) positivity and liver biopsy showing florid duct lesion with granulomatous inflammation around bile ducts. The target antigen of AMA in PBC is located in which cellular compartment?
A 30-year-old man with severe pancreatitis shows a serum IgG4 level of 480 mg/dL (normal <135 mg/dL). Pancreatic biopsy shows storiform fibrosis, lymphoplasmacytic infiltrate rich in IgG4+ plasma cells, and obliterative phlebitis. This is type 1 autoimmune pancreatitis (AIP). Which molecular mechanism underlies IgG4-related disease?
Hepatocellular carcinoma (HCC) arising in non-cirrhotic liver most characteristically occurs in which specific subtype?
A 40-year-old man with primary sclerosing cholangitis (PSC) and ulcerative colitis undergoes liver biopsy, which shows periductal onion-skin fibrosis. Which pattern of biliary involvement distinguishes large-duct PSC from IgG4-related sclerosing cholangitis, and what is the key pathological difference?
Wilson disease (hepatolenticular degeneration) results from mutations in ATP7B, a copper-transporting P-type ATPase. In early hepatic involvement, which ultrastructural organelle finding in hepatocytes is most characteristic on electron microscopy?
Pancreatic intraepithelial neoplasia (PanIN) grades 1, 2, and 3 are now unified as 'low-grade PanIN' and 'high-grade PanIN' per the 2019 WHO classification. Which molecular event occurs earliest in the PanIN progression sequence, even in PanIN-1/low-grade lesions?
A liver biopsy in a patient with NASH (non-alcoholic steatohepatitis) shows hepatocyte ballooning and Mallory-Denk bodies. The composition of Mallory-Denk bodies is:
Pancreatic ductal adenocarcinoma characteristically shows near-universal mutation in KRAS. Beyond KRAS, what is the correct sequence of additional driver mutations in the PDAC precursor PanIN progression?
A 50-year-old man with chronic alcoholic cirrhosis develops sudden onset ascites, jaundice, and tender hepatomegaly over 4 weeks. Liver biopsy shows hepatocyte swelling with Mallory-Denk bodies, neutrophilic infiltrates, and pericellular fibrosis in zone 3. Serum AST:ALT ratio is 2:1. What is the diagnosis?
A 40-year-old woman is found to have primary biliary cholangitis (PBC). Liver biopsy shows florid duct lesion — granulomatous destruction of medium-sized bile ducts with lymphocytic and plasma cell infiltration. Which antibody is the MOST specific serological marker?
A 55-year-old man presents with obstructive jaundice and a periampullary mass. CT shows a 'double duct sign' (dilatation of both common bile duct and pancreatic duct). Surgery reveals a firm, gray-white mass in the head of pancreas. Histology shows abundant desmoplastic stroma with malignant glands expressing CK7, CA19-9, and CEA. What mutation is MOST commonly the earliest genetic event in pancreatic ductal adenocarcinoma?
On liver biopsy of a 32-year-old woman with elevated serum ALT, a Kayser-Fleischer ring on slit-lamp examination, and low serum ceruloplasmin, the histological stain MOST useful for confirming copper accumulation is:
Primary biliary cholangitis (PBC) is an autoimmune condition characterised by progressive destruction of intrahepatic bile ducts. The hallmark autoantibody is directed against which antigen?
A 55-year-old man with chronic pancreatitis presents with obstructive jaundice due to a pancreatic head mass. ERCP shows a 'double-duct sign.' Biopsy shows dense stromal fibrosis with bland ductal epithelium and no malignant features. IHC shows IgG4+ plasma cells >10/HPF. The MOST likely diagnosis is:
A 45-year-old alcoholic man has tender hepatomegaly. Liver biopsy shows hepatocyte ballooning, Mallory-Denk bodies, neutrophilic infiltration, and pericellular ('chicken-wire') fibrosis. Mallory-Denk bodies are composed of:
A 50-year-old obese woman with metabolic syndrome has a liver biopsy showing steatosis, lobular inflammation, and perisinusoidal fibrosis. Which histological feature, when present, distinguishes NASH from simple steatosis?
Pancreatic ductal adenocarcinoma most frequently arises in which part of the pancreas, and what percentage of cases carry KRAS mutations?
A 45-year-old woman with primary biliary cholangitis (PBC) has elevated ALP, anti-mitochondrial antibodies (AMA-M2), and liver biopsy showing lymphocytic cholangitis with granulomatous destruction of small bile ducts. The specific mitochondrial antigen targeted by AMA-M2 is:
A 50-year-old alcoholic man develops acute pancreatitis. The proposed mechanism linking alcohol to acinar cell injury involves:
Wilson's disease is characterised by copper accumulation in hepatocytes. The protein defective in Wilson's disease is a:
A 42-year-old patient with Wilson disease has Kayser-Fleischer rings and serum ceruloplasmin of 12 mg/dL. On liver biopsy, which histochemical stain would confirm hepatic copper accumulation?
Primary biliary cholangitis (PBC) is characterised by autoimmune destruction of interlobular bile ducts. The most specific autoantibody, positive in >90% of PBC patients, targets which mitochondrial antigen?
In pancreatic ductal adenocarcinoma (PDAC), the dominant oncogenic driver is a KRAS mutation. The KRAS protein locked in GTP-bound active state continuously activates which downstream oncogenic pathway?
A 45-year-old woman with primary biliary cholangitis (PBC) has elevated ALP, antimitochondrial antibodies (AMA), and pruritis. The bile duct lesion characteristic of PBC is:
In alcoholic liver disease, which mechanism most directly explains the development of macrovesicular steatosis?
A 45-year-old presents with jaundice, kayser-Fleischer rings, and elevated liver enzymes. Liver biopsy shows periportal copper deposition by rhodanine stain and hepatocyte ballooning with Mallory-Denk bodies. The fundamental molecular defect in Wilson's disease is:
A 60-year-old man with chronic pancreatitis and weight loss undergoes CT showing a mass in the head of the pancreas with upstream ductal dilation. CA 19-9 is elevated. The most common molecular alteration found in early pancreatic intraepithelial neoplasia (PanIN) is:
A 50-year-old woman with primary biliary cholangitis (PBC) has elevated ALP, pruritus, and jaundice. The characteristic histological lesion in early PBC is:
A 40-year-old man with ulcerative colitis presents with progressive fatigue and jaundice. ALP is markedly elevated. MRCP shows multifocal strictures and dilations of intrahepatic and extrahepatic bile ducts ('beaded' appearance). Liver biopsy shows periductal 'onion skin' fibrosis. The diagnosis is:
In alcoholic liver disease, the histological triad of steatohepatitis includes fatty change, hepatocyte ballooning, and which characteristic cytoplasmic inclusion?
Carcinoma of the pancreatic head most commonly leads to obstructive jaundice and dilation of both the common bile duct and pancreatic duct. This combination of dilated ducts is referred to as:
In Wilson disease (hepatolenticular degeneration), the primary molecular defect results in copper accumulation. Which protein is defective?
A 50-year-old man with chronic alcoholism has liver biopsy showing hepatocyte ballooning, Mallory-Denk bodies, neutrophilic infiltration, and centrilobular fibrosis. Which cytoskeletal proteins aggregate to form Mallory-Denk bodies?
A 45-year-old alcoholic man has hepatomegaly. Biopsy shows hepatocytes with large, clear cytoplasmic vacuoles displacing the nucleus peripherally, ballooning degeneration, and Mallory-Denk bodies. Mallory-Denk bodies are composed of:
Primary sclerosing cholangitis (PSC) is most strongly associated with which inflammatory bowel disease and carries risk of which malignancy?
A 45-year-old alcoholic man has Mallory-Denk bodies on liver biopsy. What is the molecular composition of these inclusions?
A 50-year-old woman with primary sclerosing cholangitis (PSC) has a 'beaded' bile duct pattern on ERCP. The pathognomonic histological finding on liver biopsy is:
Which molecular alteration is present in >90% of pancreatic ductal adenocarcinomas and is detectable in the earliest precursor lesion (PanIN-1)?
A 40-year-old woman presents with progressive jaundice, pruritus, and elevated ALP/GGT. Antimitochondrial antibodies (AMA) are strongly positive. Liver biopsy shows lymphocytic infiltration and granulomatous destruction of interlobular bile ducts. The diagnosis is:
Hepatocellular carcinoma (HCC) developing in the context of chronic hepatitis C infection is primarily attributable to which mechanism?
A 50-year-old man with chronic alcohol abuse is found dead at home. Autopsy reveals a yellow, enlarged, greasy liver weighing 2,400 g. Histology shows large vacuoles displacing hepatocyte nuclei to the periphery. This pattern of hepatic steatosis is predominantly:
A 45-year-old woman with primary biliary cholangitis has a liver biopsy showing granulomatous destruction of interlobular bile ducts with a dense lymphocytic infiltrate. The serological marker most specific for this condition is:
In alcoholic liver disease, the sequence of pathological changes from earliest to most advanced is:
Wilson's disease (hepatolenticular degeneration) results from mutation in ATP7B encoding a copper-transporting ATPase. The principal pathological mechanism of copper toxicity in hepatocytes is:
A 40-year-old woman presents with fatigue, pruritus, and elevated alkaline phosphatase. ANA and anti-smooth muscle antibodies are negative. Anti-mitochondrial antibodies (AMA) are strongly positive. Liver biopsy shows florid duct lesion with granuloma formation around the interlobular bile ducts and a lymphoplasmacytic infiltrate. The diagnosis is:
A 50-year-old chronic alcoholic presents with acute pancreatitis. The mechanism of pancreatic acinar cell injury in alcohol-induced acute pancreatitis primarily involves:
Hepatic steatosis in non-alcoholic fatty liver disease (NAFLD) is histologically graded using the NAFLD Activity Score (NAS). Which histological feature, when present, distinguishes NASH from simple steatosis?
A 30-year-old man with ulcerative colitis develops progressive jaundice and pruritis. ERCP shows multifocal biliary strictures and dilations with a 'beads on a string' appearance affecting both intrahepatic and extrahepatic bile ducts. Liver biopsy shows periductal 'onion skin' fibrosis of large bile ducts. AMA is negative; pANCA is positive. The diagnosis is:
A 30-year-old woman is found to have elevated ALT and AST. Liver biopsy shows periportal hepatocyte rosetting, lymphoplasmacytic infiltrate in portal tracts extending into lobule, and interface hepatitis with emperipolesis. Anti-smooth muscle antibodies are positive at 1:640. What histological finding is most specific for autoimmune hepatitis (AIH) type 1?
In primary sclerosing cholangitis (PSC), the characteristic histological pattern is 'onion-skin fibrosis' around bile ducts. PSC is strongly associated with which inflammatory bowel disease, and what percentage of PSC patients have this association?
Acinar cell carcinoma of the pancreas differs from ductal adenocarcinoma in several ways. Which serum tumour marker is characteristically elevated in acinar cell carcinoma but NOT in pancreatic ductal adenocarcinoma, and is associated with a specific paraneoplastic syndrome?
In alcoholic liver disease, the sequence of morphological changes in the correct order from earliest to most advanced is:
Wilson disease leads to copper accumulation in the liver, brain, and Kayser-Fleischer rings in the cornea. The defective protein is:
Primary sclerosing cholangitis (PSC) is characterized by fibrous obliteration of bile ducts producing an 'onion-skin' periductal fibrosis pattern. PSC is most strongly associated with:
A 48-year-old man with alcohol use disorder has liver biopsy showing Mallory-Denk bodies, neutrophilic infiltrate, and ballooning hepatocyte degeneration. Mallory-Denk bodies are composed of:
Wilson disease (hepatolenticular degeneration) results from mutations in ATP7B. Which statement best describes the consequence of ATP7B dysfunction?
A 55-year-old woman presents with pruritus, jaundice, and fatigue. Biopsy shows granulomatous destruction of interlobular bile ducts with a lymphocytic infiltrate and 'florid duct lesion.' Serology reveals anti-mitochondrial antibodies (AMA) directed against PDC-E2. What is the diagnosis?
Which type of pancreatic cystic neoplasm carries the highest risk of malignant transformation and is characterized by mucinous epithelium with ovarian-type stroma in a predominantly female patient?
In Wilson disease (hepatolenticular degeneration), copper accumulates due to defective ATP7B protein. Kayser-Fleischer rings in the cornea represent copper deposition in:
Primary sclerosing cholangitis (PSC) is most closely associated with which inflammatory bowel disease, and the characteristic histological finding on liver biopsy is:
Autoimmune pancreatitis type 1 (AIP-1) is an IgG4-related disease. Which diagnostic histological feature is most specific for AIP-1?
A 28-year-old woman presents with bloody diarrhea, crampy abdominal pain, and tenesmus for 4 months. Colonoscopy shows continuous mucosal inflammation beginning at the rectum extending to the splenic flexure with loss of haustral folds and pseudopolyps. Biopsy shows crypt architectural distortion and crypt abscesses. This is most consistent with:
A 55-year-old man undergoes colonoscopy for rectal bleeding and is found to have a 4 cm polypoid lesion in the sigmoid colon. Histology shows malignant glands invading through the muscularis mucosae into the submucosa. Molecular analysis reveals microsatellite instability. This feature is associated with which hereditary syndrome?
A 50-year-old alcoholic man develops ascites, jaundice, and spider angiomata. Liver biopsy shows bridging fibrosis, regenerative nodules surrounded by fibrous septa, and loss of normal hepatic architecture. Which cell type is primarily responsible for fibrogenesis in the liver?
A 30-year-old healthcare worker presents with acute hepatitis. Serology shows HBsAg positive, anti-HBc IgM positive, HBeAg positive, anti-HBs negative. What is the correct interpretation?
A 58-year-old man with Child-Pugh class B cirrhosis due to chronic hepatitis C has a rising serum AFP and a 3 cm arterially enhancing hepatic mass with portal-phase washout on CT. Core needle biopsy shows trabeculae of malignant hepatocytes without bile duct structures. Which molecular pathway is most commonly altered in hepatocellular carcinoma?
A 60-year-old Japanese man presents with early satiety and weight loss. Upper GI endoscopy reveals a large ulcerated lesion in the antrum. Biopsy shows mucin-secreting signet ring cells individually infiltrating the gastric wall without gland formation. This histological type is associated with:
A 35-year-old woman presents with right upper quadrant pain radiating to the right shoulder, worse after fatty meals. Ultrasound shows gallstones and a thickened gallbladder wall. Cholecystectomy specimen shows mucosal inflammation with Rokitansky-Aschoff sinuses. These sinuses represent:
A 2-year-old child with failure to thrive has frothy, pale, bulky, foul-smelling stools. Duodenal biopsy shows flattened villi with villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes. Serology is positive for anti-tissue transglutaminase IgA. The pathogenesis involves:
A 45-year-old man with primary sclerosing cholangitis undergoes liver biopsy for elevated alkaline phosphatase. Biopsy shows periductal 'onion-skin' fibrosis around bile ducts with eventual duct obliteration. This disease is most strongly associated with:
A 55-year-old obese woman with type 2 diabetes and hyperlipidemia is found to have elevated transaminases. Liver biopsy shows macrovesicular steatosis, hepatocyte ballooning degeneration, Mallory-Denk bodies, lobular inflammation, and perisinusoidal fibrosis in zone 3. These findings are diagnostic of:
A 48-year-old man who drinks 6–8 units of alcohol daily for 20 years presents with right upper quadrant discomfort, jaundice, and hepatomegaly. Liver biopsy shows ballooning degeneration of hepatocytes, Mallory-Denk bodies (intracytoplasmic eosinophilic inclusions), neutrophilic lobular infiltrates, and pericellular (chicken-wire) fibrosis around zone 3 hepatocytes. What is the diagnosis?
A 32-year-old woman presents with fatigue, jaundice, and elevated serum aminotransferases (AST 620, ALT 890 U/L). Anti-smooth muscle antibody (ASMA) titer is 1:160 and ANA 1:320. Serum IgG is 2.8 times the upper limit of normal. Liver biopsy shows interface hepatitis with a dense lymphoplasmacytic infiltrate and prominent plasma cells forming 'rosettes' around hepatocytes. What is the most likely diagnosis?
A 65-year-old man with a 25-year history of gastroesophageal reflux disease undergoes surveillance endoscopy. Biopsies from 3 cm above the gastroesophageal junction show replacement of the normal stratified squamous epithelium by columnar epithelium with goblet cells. Which of the following best explains why this lesion is clinically significant?
A 55-year-old man with a 10-year history of ulcerative colitis (pancolitis) undergoes surveillance colonoscopy. A flat, velvety red patch is biopsied from the sigmoid colon and histology shows markedly dysplastic glands throughout the full thickness of the mucosa with cytological atypia and loss of nuclear polarity, but no invasion through the muscularis mucosae. What is the significance of this finding?
NASH (non-alcoholic steatohepatitis) histology is scored using the NAS (NAFLD Activity Score). Which three histological features are assessed by the NAS?
A 50-year-old man with cirrhosis and rising serum AFP (1200 ng/mL) has a 3 cm hepatocellular carcinoma on imaging showing arterial enhancement and portal-venous washout on dynamic CT. The WHO/AASLD Liver Imaging Reporting and Data System (LI-RADS) category for this lesion would be:

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