KOLEGIUM PATOLOGI INDONESIA

UJIAN NASIONAL PPDS PATOLOGI ANATOMIK

SABTU, 22 JANUARI 2011
PILIHLAH SALAH SATU JAWABAN YANG BENAR
1.

2.

3.

4.

Bilateral swelling of the lacrimal, submandibular and parotid glands due to known causes such
as sarcoidosis or tuberculosis is define :
A. Mikulicz syndrome
C. Sjogren syndrome
E. Sialadenitis
B. Sialosis
D. Parotitis
Circumscribed but nonencapsulated tumor containing mucus secreting and epidermoid cell as
well as an intermediate type of basal or non-mucus-secreting cell; low, intermediate, and high
grade cancers are seen. What is the tumor ?
A. Mucoepidermoid carcinoma
D. Acinic cell carcinomas
B. Adenoid cystic carcinoma
E. Metastatic tumors of the intraparotid nodes
C. Malignant mixed tumor
A 53-year-od women noticed a lump on the left side of her face that has become larger over the
part year. The mass is completely excised, and histologic examination shows epithelial island
with enclosed mucin or hyaline cylinders; not encapsulated; the small, darkly stained cell
appear as anastomosing cords lying in mucoid or hyaline stroma. What is the most likely
diagnosis?
A. Adenoid cystic carcinoma
D. Acinic cell carcinoma
B. Mucoepidermoid carcinoma
E. Mikuliez syndrome
C. Malignant mixed tumor
Over the past 3 years, a 65-year-old woman has noticed a slowly enlarging nodule on her face.
On physical examination, a 3-cm, nontender, mobile, discrete, mass is palpable on the left side
of the face, anterior to the ear and just superior to the mandible. The mass is completely
excised, and histologic examination shows ductal epithelial cells in a myxoid stroma containing
islands of chondroid and bone. This patient is most likely to have which of the following
neoplasms?
A. Acinic cell tumor
D. Pleomofphic low grade Adeno carcinoma
B. Pleomorphic adenoma
E. Teratoma matur
C. Warthin tumor

5.

Pada FNAC regio submandibula seorang penderita usia 50 tahun, didapatkan kelompokkelompok sel oncocyte sebagian tersebar satu-satu dengan latar belakang limfoid, material
mukoid dan sel debris. Kadang-kadang dijumpai sel skuamous dan sel goblet. Kemungkinan
apakah diagnosis penderita tersebut?
A. Warthin tumor
C. Sialadenitis
E. Oncocytoma
B. Mukoepidermoid carcinoma
D. Sialosis

6.

A 55 years old man visited his dentist for a routine dental examination. The dentist noticed
whitish, well defined mucosal patches on the lateral side of the tongue, which considered as
leukoplakia. The past medical history showed no major medical problems. Which of the
following etiologic factors most likely contributed to the development of these lesions?
A. Dental cariers
D. Chronic sialadenitis
B. Herpes simplex virus type 1
E. Smoking tobacco
C. Eating smoked and pickled foods

7.

A 35- year-old, HIV positive man complains that he has had a bad taste in his mouth and
discoloration of the tongue for the past 6 weeks. On physical examination, there era areas of
adherent, yellow-tan, circumscribed plaque on the lateral aspects of the tongue. This plaque can
be scraped off as a pseudomembrance to show an underlying granular, erythematous base.
What is the most likely diagnosis ?
A. Aphthous ulcer
C. Cheilosis
E. Glossitis
B. Oral thrush
D. Herpetic stomatitis

8.

A 49-year-old man has used chewing tobacco and snuff for many years. During a visit to his
dentist, a lesion is seen on the hard palate. It cannot removed by scraping. A biopsy is
performed, and microscopic examination of the lesion shows a thickened squamous mucosa.
Several years later, a biopsy spesimen of a similar lesion shows carcinoma in situ. Which of the
following is the most likely diagnosis?
A. Aphthous ulcer
D. Leukoplakia
B. Oral thrush
E. Pyogenic granuloma
C. Lichen planus
F. Xerostomia
A 54-year-old man, a nonsmoker, has a non-healing ulceration at the right base of his tongue
for 2 months. On examination this lesion is 1 cm in diameter with irregular borders. Biopsy of
the lesion is performed and microscopic examination shows infiltrating squamous cell
carcinoma. Which of the following infectious agents is most likely to be associated with the
lesion ?
A. Candida albicans
D. Herpes simplex virus (HSV)
B. Prevotella intermedia
E. Hepatitis B virus
C. Human papilloma virus (HPV)

9.

10. A 17-year-old girl notices a small, sensitive, gray-white area forming along the border of her
tongue 2 days before the end of her final examinations. On examination by the physicians
assistant, the girl is afebrile. There is a shallow, ulcerated, 0.3-cm lesion with an erythematous
rim. No spesific therapy is given, and the lesion disappears within 2 weeks. The past history
shows that the girl does not smoke or chew tobacco and does not go out with boy do. Which
of the following is the most probable cause of this lesion?
A. Aphtous ulcerX
C. Herpes simplex stomatitis
E. Sialadenitis
B. Oral thrus
D. Leukoplakia
11. Seorang laki-laki berusia 30 tahun dibawa ke unit gawat darurat RS karena luka tusuk di
abdomen. Saat laparatomi, dokter menemukan massa submucosal diameter 1 cm di ileum. Lesi
ini direseksi. Makroskopik, massa padat berwarna kekuningan. Mikroskopik, massa ini terdiri
atas sarang-sarang sel monomorf, inti bulat, sitoplasma mengandung granul halus ungu.
Pemeriksaan imunohistokimia positif untuk chromogranin.
Apakah diagnosis yang paling sesuai?
A. Adenocarcinoma ileum
D. Limfoma malignum non hodgkin
B. Pancreatic adenocarcinoma
E. Metastasis hepatocellular carcinoma
C. Carcinoid tumor
12. Seorang laki-laki berusia 45 tahun datang ke praktek dokter dengan keluhan sakit perut dan
mual yang hilang timbul sejak 3 tahun yang lalu. Nyeri ini tidak hilang walau sudah minum
antasida. Pasien tidak ada keluhan menelan dan tidak merasakan nyeri sesudah makan. Pada
pemeriksaan fisik tidak ditemukan abnormalitas. Endoskopi gastrointestinal bagian atas
menunjukkan eritema mukosa antral, tanpa ulserasi atau massa. Dilakukan biopsi dan
mikroskopik menunjukkan gastritis kronik non spesifik.
Apakah diagnosis yang paling tepat?
A. Penyakit Crohn
D. Infeksi Helicobacter Pylori
B. Sindroma Zollinger-Ellison
E. Adenokarsinoma lambung
C. Anemia Pernisiosa
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13. A 40-year-old man has had mid epigastric pain and nausea for the past 2 months. On physical
examination he has no abnormal findings. On upper GI endoscopy a solitary sharply
demarcated 2-cm shallow gastric antral ulcer is seen.
Which of the following is most likely to be present in this man?
A. Gastric achlorhydria
D. Elevated serum gastrin
B. Positive serology for antinuclear antibody
E. Increased plasma cortisol
C. Positive urea breath test
14. A 25-year-old man complains of a low volume but chronic, foul smelling diarrhea for the past
year. He has no nausea or vomiting. On physical examination there is no abdominal pain or
masses and bowel sounds are present. His stool is negative for occult blood. Laboratory studies
include a quantitative stool fat of 10 g/day. Upper GI endoscopy is performed with biopsies of
the duodenum. The biopsies reveal the absence of villi, increased surface intraepithelial
lymphocytes, and hyperplastic appearing crypts.
Which of the following therapies is most likely to be useful for this man?
A. Antibiotics
C. Selective vagotomy
E. Corticosteroids
B. Gluten-free diet
D. Aromatherapy
15. Seorang bayi laki-laki berusia 3 bulan dibawa orangtuanya ke praktek dokter dengan keluhan
perut membesar serta susah buang air besar sejak 1 minggu yang lalu. Dari anamnesis
orangtuanya mengatakan tidak ada kelainan kongenital saat lahir. Pada pemeriksaan fisik
abdomen membesar tetapi tidak ditemukan massa. Foto polos abdomen menunjukkan
pelebaran kolon.
Apakah temuan patologik yang diduga akan ditemukan pada pasien ini?
A. Aganglionic colonic segment
D. Ileal intussusception
B. Congenital bowel malrotation
E. Meconium ileus
C. Cecal volvulus
16. Seorang laki-laki berusia 42 tahun datang ke poliklinik dengan keluhan buang air besar
berdarah sejak 1 minggu yang lalu. Dari anamnesis diketahui pasien adalah pemakai narkoba
intravena heroin selama 20 tahun. Pada pemeriksaan fisik ditemukan bekas suntikan di fossa
antecubiti. Demam tidak ada.
Apakah diagnosis yang paling sesuai?
A. Hemorrhoids
C. Angiodysplasia
E. Adenocarcinoma
B. Megacolon
D. Perirectal fistulae
Dilakukan esophageal washings pada seorang pasien laki-laki berumur 45 tahun dengan disfagia
kronik dan progresif disertai penurunan berat badan. Mikroskopik ditemukan sel tumor ganas yang
pleomorfik dan berstruktur kelenjar.
17. Apakah kemungkinan diagnosis yang paling sesuai?
A. Adenokarsinoma
D. Limfoma malignum
B. Karsinoma epidermoid
E. Melanoma malignum
C. Malignant mesothelioma
Pasien pada no. 17 di atas juga mengeluhkan nyeri epigastrium, terkadang rasa terbakar yang telah
berlangsung sejak 5 tahun yang lalu.
18. Apakah kemungkinan proses yang sudah terjadi pada pasien ini sebelumnya?
A. Laserasi esofagus
C. Striktura esofagus
E. Celiac disease
B. Achalasia
D. Barrett esofagus
Hasil gastric washings seorang pasien laki-laki 50 tahun adalah adanya sel tumor ganas dengan
musin intraseluler dan inti terdorong ke pinggir.
19. Apakah kemungkinan yang akan ditemukan pada biopsi?
A. Linitis plastika
D. Ulkus duodenum
B. Ulkus peptikum
E. GERD (gastroesophageal reflux disease)
C. Gastritis autoimun
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20. Apakah kemungkinan faktor risiko pada pasien No. 19 di atas?

A. Infeksi HPV
C. Infeksi EBV
E. Infeksi Rotavirus
B. Infeksi HBV
D. Infeksi Helicobacter pylori
Soal untuk nomer 21 - 23
Anak, 8 tahun dengan pembengkakan nodular di daerah mandibula dan maxilla, disertai
limfadenopati leher. Hasil biopsi kelenjar limfe leher didapatkan neoplasma dengan mitosis index
tinggi jaringan limfoid difus terdiri atas limfosit muda dengan gambaran starry sky.
21. Kemungkinan besar kasus diatas adalah suatu:
A. Mantle cell lymphoma
D. Hodgkins lymphoma, nodular sclerosis
B. Anaplastic large cell lymphoma
E. Burkitts lymphoma
C. Diffuse large B cell lymphoma
22. Secara sitogenetik kasus diatas berhubungan dengan:
A. Translokasi gena C-myc
D. Pengaturan kembali gena ALK
B. Disregulasi BCL-6
E. t(11,14) melibatkan cyclic D1 & IgH
C. Translokasi gena BCL-2
23. Secara epidemiologi dan bukti-bukti klinik, kasus di atas berhubungan dengan infeksi:
A. HTLV-1
C. EBV
E. HIV
B. HHV-8
D. HPV
24. Nodular sclerosis type Hodgkins lymphoma characterized by the presence of a particular
variant of the Reed Stenberg cells, the lacunar cell and collagen bands that divide the lymphoid
tissue into circumscribe nodules.
Tumor cells have characteristic immunophenotypes:
A. CD15 negative, CD30 negative, CD45 positive, CD20 negative
B. CD15 negative, CD30 negative, CD45 positive, CD20 positive
C. CD15 negative, CD30 negative, CD45 negative, CD20 negative
D. CD15 negative, CD30 negative, CD45 negative, CD20 positif
E. CD15 positive, CD30 positive, CD45 negative, CD20 negative
25. Pria, 32 tahun dengan pembesaran kelenjar getah bening leher, soliter sekitar 2 cm. Hasil biopsi
menunjukkan gambaran tumor jaringan limfoid dengan infiltrasi nodular limfosit kecil
bercampur dengan histiosit jinak. Sel Reed Sternberg yang khas sulit ditemukan, dan lebih
banyak varian sel limfohistiositik multilobulated menyerupai popcorn Kernel (popcorn cells).
Sel eosinofil, neutrofil dan sel plasma sangat sedikit, disertai sedikit nekrosis dan fibrosis.
Kemungkinan besar diagnosis kasus ini adalah:
A. Hodgkin lymphoma, tipe nodular sclerosis
B. Hodgkin lymphoma, tipe lymphocyte rich
C. Hodgkin lymphoma, tipe cellularity
D. Hodgkin lymphoma, tipe lymphocyte predominance
E. Hodgkin lymphoma, tipe lymphocytic depletion
26. Pria, 60 tahun dengan tanda-tanda klinik cirrhosis hati disertai splenomegali.
Dasar timbulnya splenomegali pada kasus ini adalah:
A. Gangguan imunologik
B. Pengendapan pigmen empedu di limpa
C. Kongesti vena dengan hipertensi portal
D. Terjadinya trombositopenia
E. Pernimbunan amiloid di limfa
27. The vast majority of pancreatic carcinoma is:
A Acinar adenocarcinoma
B. Adenoquamous carcinoma
C. Undifferentiated carcinoma

D. Ductal adenocarcinoma
E. Squamous cell carcinoma

28. Pada infeksi hepatitis virus, sering terjadi status carrier.

Bentuk hepatitis virus yang tidak menimbulkan status carrier adalah hepatitis:
A. A
C. C
E. G
B. B
D. D
29. Alcoholic hepatitis is characterized by hepatocyte swelling and necrosis; neutrophilic reaction,
fibrosis and
A. Negri bodies
C. Schiller Duval bodies
E. Donovan bodies
B. Mallory bodies
D. Gamna Gandy bodies
30. In portal hypertension increased resistence to portal blood flow may develop in variety of
circumstances, which can be divided into prehepatic; intrahepatic and post hepatic causes.
The dominant intrahepatic cause is:
A. Obstructive thrombosis
D. Schistosomasis
B. Narrowing of the portal vein
E. Hepatic vein outflow obstruction
C. Cirrhosis
31. Hurthle cell in the thyroid are metaplastic response to the normally low cuboidal follicular
epithelium to ongoing injury. What kind of thyroiditis that has characteristic of the present of
hurthle cells accompanied by dense lymphocytic infiltrate with germinal centers, and increased
of interstitial conective tissue ?
A. Reidel thyroiditis
D. Transforming to papillary carcinoma
B. Hashimoto thyroiditis
E. Subacute (painless) lymphocytic thyroiditis
C. Subacute granulomatous thyroiditis
32. Seorang laki-laki umur 55 tahun, menderita hipertensi lama, meninggal akibat kecelakaan
mobil. Pada autopsi kelainan apa yang diharapkan pada jantung penderita ini ?
A. Tebal dinding atrium kanan 3 mm
D. Tebal dinding ventrikel kiri 28 mm
B. Tebal dinding ventrikel kanan 8 mm
E. Tebal dinding atrium kiri 4 mm
C. Tebal septum interventrikel 12 mm
Soal untuk No. 33 - 35
Pasien laki-laki 40 tahun datang ke dokter dengan lengan kanan membesar dan tidak nyeri, yang
sudah lama diderita. Kelainannya berawal dari kulit di dekat siku berupa eczema-like lesion,
lama-lama kelainan tadi membesar dengan batas tidak tegas disertai plaque eritematosus,
33. Diagnosa yang ditegakkan adalah :
A. Dermatitis chronic dengan infeksi
D. Lymphoma cutis
B. Fibroma pada sub cutis
E. Psoriasia
C. Kelainan pada sendi karena tumor
34. Perlu dilakukan pemeriksaan lebih lanjut, yaitu :
A. Radiologi
D. Laju endap darah
B. CD4
E. CD 1a
C. Pemeriksaan darah lengkap, khususnya sel limfosit
35. Ciri khusus pada kelainan ini adalah :
A. Lesi hanya menetap pada area tersebut, walau sudah cukup lama
B. Terutama mengenai anak perempuan
C. T helper cell dalam kelompok-kelompok didalam epidermis membentuk microabses kecil
D. Pengobatan dengan chemoterapi tidak ada kemajuan
E. Ditandai dengan urticaria pigmentosa

Soal untuk No. 36 - 37

Seorang anak perempuan datang ke puskesmas dengan keluhan benjolan pada daerah sub
mandibula kiri. Benjolan tadi berkembang cukup cepat dengan ukuran diameter 5 cm, padat, tidak
nyeri dan tidak teraba hangat. Pertumbuhan massa menekan saluran hidung kiri.
36. Pasien tersebut kemungkinan menderita :
A. Hygroma colli
D. Rhabdomyosarcoma
B. Pleiomorfik adenoma kelenjar salivary
E. Hemangioma Juvenilis
C. Burkit lymphoma
37. Anak tersebut dikonsulkan ke klinik bedah kepala leher dan dikonsulkan pada ahli patologi
untuk di FNA, hasilnya ternyata didapatkan tumor dengan sel-sel kecil, intinya bulat,
hyperkromatik, sitoplasma tipis.
Dari gambaran FNA hasil tersebut dapat didiagnosa sebagai berikut :
A. Rhabdomyosarcoma
D. Desmoplastic Small Round Cell Tumor
B. Neuroblastoma
E. Leucemia acut
C. Ewing Sarcoma
PILIHAN UNTUK NO. 38 - 42
A. Fibro Sarcoma
B. Alveolar Soft Part Sarcoma
C. Embryonal Rhabdomyosarcoma
D. Angiosarcoma
E. Pleiomorfic Malignant Nerve Sheath Tumor
38. Pasien perempuan usia 70 tahun datang dengan keluhan sering hematemesis melena.
Pemeriksaan didapatkan hepatomegali, AFP negatif, penderita bekerja di pabrik yang
berhubungan dengan Poly Vinyl Chloride. Pemeriksaan PA ditemukan tumor yang kaya
vasculer dengan endothel atypic. Beberapa sel hepar dalam batas normal.
Kelainan pasien ini adalah :
39. Laki-laki usia 47 tahun dengan keluhan benjolan dibawah telinga sudah beberapa tahun, akhirakhir ini cepat membesar dan terasa nyeri, dilakukan biopsi dan ternyata tumor terdiri dari sel
spindle tersusun didalam fascicle, dengan inti berbentuk seperti gelombang / comma, beberapa
sel mitosis, sitoplasma cukup banyak.
Penyakit tersebut sesuai dengan :
40. Seorang pasien usia 39 tahun dengan keluhan benjolan yang makin membesar dipaha kanan.
Dengan pengecatan vimentin dan muscle specific actin, memberikan reaksi positif dan terhadap
marker epitel negatif. Ciri-ciri PAnya adalah pertumbuhan sel spindle homogen dengan
sitoplasma tipis dan tertimbun dalam matrix collagen.
Ciri pada pasien tersebut adalah :
41. Seorang anak usia 7 tahun, perempuan, dengan keluhan pada vesica urinaria yaitu kencing
berdarah, dibawa ke dokter ahli urologi didapatkan bentukan seperti buah anggur, dilakukan
biopsi pada vesica urinarianya, hasilnya didapatkan sel anaplastik, ukuran kecil sampai sedang,
bentuk bulat spindle, didalam sitoplasmanya terdapat bahan myoglobulin eosinofilik.
Anak tersebut diketahui menderita :
42. Pasien perempuan usia 16 tahun, dengan keluhan di paha depan, lama-lama membesar
membentuk benjolan dan terasa nyeri. Oleh dokter bedah dilakukan biopsi, hasilnya didapatkan
tumor dengan sel-sel yang membentuk sarang-sarang, selnya dengan sitoplasma mengandung
butir granul yang cukup banyak. Pemeriksaan tumor marker positif terhadap vimentin, actin
dan desmin. Keadaan pasien ini cocok untuk :

43. A 51-year-old woman has noticed an area of swelling with tenderness in her right breast that
has worsened over the past 2 months. On physical examination, the 7-cm area of erythematous
skin is tender and firm. There is swelling of the right breast, nipple retraction, and right axillary
lymphadenopathy. Excisional biopsy is most likely to show which of the following lesions ?
A. Infiltrating ductal carcinoma
D. Sclerosing adenosis
B. Phyllodes tumor
E. Atypical epithelial hyperplasia
C. Fat necrosis
44. Seorang wanita berumur 60 tahun dengan nodul tunggal tiroid dan kemudian dilakukan
operasi, pemeriksaan histologi dari nodul tunggal tiroid ditemukan tumor bersimpai sel-sel
epitel folikel menunjukkan tanda-tanda atipia.
Pernyataan berikut yang mana paling sesuai untuk karsinoma folikuler tiroid ?
A. Adanya invasi kapsul dan vaskuler
B. Jalan penyebarannya secara limfogen
C. Tumor sangat sering multipel dan bersembunyi
D. Prognosis berhubungan dengan adanya mutasi RAS
E .Metastase hematogen dengan otak sebagai target yang paling sering
45. A 45-year-old woman reports a feeling of fullness in her neck, but has no other complaints. The
enlargement has been gradual and painless for more than 1 year. Physical examination confirms
diffuse enlargement of the thyroid gland without any apparent masses. Laboratory studies of
thyroid function show a normal free T4 level and slightly increased TSH level.
What is the most likely cause of these findings?
A. Papillary Carcinoma
D. Toxic multinodular goiter
B. Hashimoto thyroiditis
E. Subacute granulomatous thyroiditis
C. Diffuse nontoxic goiter
46. Seorang laki-laki berumur 50 tahun dengan nodul leher bagian depan, ukuran 3X4 cm,
konsistensi padat. Datang ke Bag./SMF patologi Anatomi dan dilakukan FNA. Dari hasil FNA
tersebut disimpulkan : tampak sebaran dan kelompok sel-sel folikel sangat banyak sebagian
bentuk sheet, membentuk susunan jari tangan, dengan satu dua sel ada intra nuclear inclusion.
Tampak pula sebaran sel-sel radang lymposit.
Dari diskripsi tersebut disimpulkan diagnosa konsisten dengan :
A. Adeno Carcinoma
C. Folikular Carcinoma
E. Follicular neoplasm
B. Papillary Carcinoma
D. Limpositik tiroiditis
Untuk soal nomor 47 & 48, pilihlah diagnosa pemeriksaan FNA yang tepat pada nodul kelenjar
tiroid.
A. Folikular Ca
D. Tiroktosikosis
B. Papillary Ca
E. Limpositik tiroiditis
C. Adenomatous goiter
47. Seorang perempuan umur 50 tahun melakukan pemeriksaan FNA di Bagian/SMF Patologi
Anatomi dengan hasil diaganostik : Tampak hiperselular dari sel folikel dengan beberapa sel
tampak bentukan intra nuclear inclusion serta tersusun seperti jari tangan.
48. Seorang laki-laki umur 45 tahun dilakukan FNA di Bagian Patologi Anatomi dengan hasil
diagnostik tampak sel-sel folikel yang atrofi dengan latar belakang penuh cyst macrophag.
Diagnosa yg tepat adalah .......
49. A 30 years old women with Graves disease have protuberant appearance of eyes and diffuse
enlargement of the thyroid. Which one of these following options was consistent with Graves
disease?
A. Thyroiditis
D. Euthyroidism
B. Hypothyroidism
E. Neoplasia
C. Hyperthyroidism
7

50. A 57-year-old woman presents with difficulty swallowing, drooping eyelids, double vision.
From X-ray examination shows a mass in the anterior mediastinum. Biopsies from this mass
reveal thymus tissue having scattered reactive lymphoid follicles with germinal centers.
Which of the following is the most likely diagnosis?
A. Malignant thymoma
C. Thymic carcinoma
E. Thymic lymphoma
B. Thymic hyperplasia
D. Thymic hypoplasia
51. Perdarahan di kepala yang bisa dideteksi melalui pemeriksaan liquor cerebrospinalis adalah:
A. Perdarahan epidural
D. Perdarahan intracerebellum
B. Perdarahan subdural
E. Perdarahan subarachnoid
C. Perdarahan intracerebral
52. A 25-year-old female presents with a 2.2 cm mass in her left breast. The mass is exised, and
histologic sections reveal a tumor composed of a mixture of ducts and cells, and shows a leaflike appearance the epithelial cells within the ducts are not atypical in appearance. There is a
marked increase in the stromal cellularity, but the stromal cells are not atypical in appearance
and mitoses are not found. What is the correct diagnosis for this breast lesion?
A. Fibroadenoma mamma
D. Benign phyllodes tumor
B. Malignant phyllodes tumor
E. Fibrocystic change
C. Giant fibroadenoma mamma
53. Seorang gadis 17 tahun, mengalami rasa tidak nyaman pada panggul selama beberapa bulan.
Pemeriksaan pelvik tampak massa pada adneksa kiri dengan diameter 10 cm. Pada pencitraan
abdomen tampak massa solid dan berbatas tegas. Setelah dilakukan operasi, makroskopik
tampak massa solid berwarna putih dengan sedikit area nekrosis. Mikroskopik terdiri dari selsel mesenchymal primitif, bersama-sama dengan kartilago, otot, fokus-fokus neuroepithelial.
Diagnosis apakah yang paling mungkin? (robin review-458)
A. Teratoma immatur
D. Malignant mixed mullerian tumor
B. Dysgerminoma
E. Yolk Sac tumour
C. Teratoma matur
54. Seorang laki-laki berusia 50 tahun datang ke poliklinik RS dengan keluhan sulit bernapas sejak
4 bulan yang lalu disertai nyeri di wajahnya. Pada pemeriksaan fisik ditemukan massa di
cavum nasi kanan. CT Scan kepala menunjukkan massa 4 cm di nasofaring yang disertai
destruksi tulang sekitarnya. Massa tersebut dieksisi dan mikroskopik tampak sel epitel besar,
pleomorfik, dengan batas sel tidak jelas dan nukleoli prominent, tumbuh infiltratif di antara
limfosit matur. Apakah diagnosis yang paling tepat?
A. Nasopharyngeal carcinoma
D. Mucoepidermoid carcinoma
B. Adenoid cystic carcinoma
E. Non Hodgkin malignant lymphoma
C. Olfactory neuroblastoma
55. Seorang perempuan berusia 49 tahun datang ke dokter dengan keluhan dada terasa penuh dan
nyeri sejak 6 bulan yang lalu. Pada pemeriksaan fisik suhu tubuh normal dan normotensif.
Kekuatan motorik ekstremitas 5/5 tetapi berkurang menjadi 4/5 bila disuruh melakukan
gerakan berulang. Tidak ada nyeri atau massa di otot. CT-Scan thorax menunjukkan massa di
mediastinum anterior, ireguler, ukuran 10 x 12 cm. Dilakukan biopsi, tampak tumor terdiri atas
sel epitel besar, spindel, atipik yang disertai sedikit sel limfoid. Apakah diagnosis yang paling
sesuai?
A. Bronchioloalveolar carcinoma
D. Diffuse large B cell lymphoma
B. Plasmacytoma
E. Malignant thymoma
C. Malignant Mesothelioma

Untuk soal nomor 56 - 59, pilihlah jenis infeksi pada pemeriksaan pap smear seorang perempuan
yang mengeluh keputihan.
A. Trichomonas Infection
D. HPV infection
B. Coccoid Infection
E. Herpes Simplex
C .Candida Albicans
56. Seorang perempuan umur 30 tahun mengeluh keputihan selanjutnya melakukan pemeriksaan
Pap-smear dengan hasil pemeriksaan Pap-smear tampak bentukan pseudo hyphae dan sebaran
spora cukup banyak diantara sel-sel intermediate. Diagnosa yang sesuai adalah : (C. Candida
albicans).
57. Seorang perempuan berumur 27 tahun mengeluh keputihan melakukan pemeriksaan Pap-smear
dengan hasil tampak bentukan koilositosis, binucleation dan dyskeratosis.
58. Seorang perempuan umur 30 tahun mengeluh keputihan melakukan pemeriksaan Pap-smear
dengan hasil tampak bentukan sel dengan inti sebagai buah peer dengan latar leukosit boll dan
sediaan sangat kotor.
59. Seorang perempuan umur 35 tahun mengeluh keputihan melakukan pemeriksaan Pap-smear
dengan hasil tampak bentukan ground glass, mouding dengan latar belakang PMN padat.
60. Persistent infection of HPV increases the risk of the development of cervical precancer and
subsequent carcinoma. What are the most common type of HPV that have high risk for
development of cervical cancer ?
A. HPV 16 and 18
C. HPV 17 and 18
E. HPV 17 and 18
B. HPV 15 and 16
D. HPV 16 and 17
61. Pernyataan yang benar adalah:
A. Kista Bartholin berada di vagina
B. Abses Bartholin adalah kelenjar Bartholin yang berisi nanah
C. Kista Bartholin hanya terjadi pada orang dewasa yang sudah menikah
D. Kista Bartholin dilapisi oleh epitel kuboid selapis
E. Kista Bartholin yang sudah sampai diameter 5 cm tidak sakit lagi
62. Tumor ovarium yang ditandai dengan adanya Schiller Duval body ialah:
A. Dysgerminoma
C. Choriocarcinoma
E. Granulosa cell tumor
B. Yolk sac tumor
D. Embryonal carcinoma
63. Seorang bayi umur 11 bulan sedang belajar jalan lalu terjatuh, tiba-tiba tidak sadarkan diri,
koma dan meninggal. Pada lumbal pungsi terdapat darah pada LCS. Kemungkinan penyakit
apa yang paling cocok diderita bayi tersebut.
A. Kontusio serebri.
D. Pecahnya arteri meningea media.
B. Komosio serebri.
E. Pecahnya aneurisma Berry
C. Pecahnya arteri lenticulo striata.
64. Gambaran kelompok sel tumor pada mammae berupa Indian file ditemukan pada : (board
review-333)
A. Insitu ductal carcinoma
D. Invasive lobular carcinoma
B. Insitu lobular carcinoma
E. Medullary carcinoma
C. Invasive ductal carcinoma
65. Derajat proliferasi sel tumor pada carcinoma payudara bisa ditentukan dengan :
A. Jauhnya infiltrasi sel tumor
D. Jumlah kgb yang terlibat
B. Banyaknya nekrosis yang terjadi
E. Kadar hormon estrogen
C. Tingginya kadar Ki-67
66. Karsinoma payudara pada laki-laki mempunyai kesamaan sifat/tanda dengan karsinoma
payudara pada wanita, KECUALI :
A. Gambaran mikroskopik tumornya
D. Umurnya
9

B. Lokasi pertumbuhannya
E. Prognosisnya
C. Ekspresi estrogen reseptornya
67. Endometrial tissue inside the myometrial tissue is called: (board review-324)
A. Adenomyoma
D. Adenosis
B. External endometriosis
E. Chocolate cyst (Brown cyst)
C. Adenomyosis
68. Teratoma of the ovary is derived from: (board review-327)
A. Survace epithelium of the ovary
D. Hematopoietic stem cells
B. Sexcord-stromal cells
E. The rest of mesenchymal cells
C. Germ cell
69. A 35-year-old male presents with a 0.3-cm flat light brown lesion on his left forearm. The
lesion is excised, and microscopy reveals nests of round nevus cells within the lower epidermis
at the dermal-epidermal junction. There is no fusion present of adjacent nests of nevus cells.
Cytologic atypia is not present, nor are nevus cells seen in the superficial or deep dermis. What
is the correct diagnosis for this lesion?
A. Compound nevus
C. Halo nevus
E. Spitz nevus
B. Dysplastic nevus
D. Junctional nevus
Ans:
Melanocytic hyperplasia, which causes hyperpigmentation of the skin, can be classified into
several types of lesions. A lentigo consists of melanocytic hyperplasia in the basal layers of
the epidermis along with elongation and thinning of the rete ridges. Two types of lentigines
are lentigo simplex and lentigo senilis (liver spots). Increased numbers of melanocytes
may form clusters located at the tips of the rete ridges in the epidermis (junctional nevus),
within the dermis (intradermal nevus), or both at the tips of the rete ridges and within the
dermis (compound nevus). A blue nevus is composed of highly dendritic melanocytes that
penetrate more deeply into the dermis. This deep location gives the lesion its characteristic
blue color. The Spitz tumor (epithelioid cell nevus) is a benign lesion composed of groups of
epithelioid and spindle melanocytes and is found in children and young adults. It may be
mistaken histologically for a malignant melanoma. A freckle (ephelis) is a pigmented lesion
caused by increased melanin pigmentation within keratinocytes of the basal layer of the
epidermis. There is no increase in the number of melanocytes. These lesions fade with lack
of sun exposure.
70. A 23-year-old female presents with a 0.4-cm nodule within the skin of the left side of her neck.
The clinician removes the lesion and sends it to the pathology lab, calling it a sebaceous cyst.
Histologic sections reveal a cystic structure in the dermis that is filled with keratin and lined by
a stratified squamous epithelium, which has a granular cell layer. This cyst is not ruptured, no
adnexal structures are seen within the wall of the cyst, and no atypia is present. What is the
correct diagnosis? (USMLE hal 469)
A. Acrochordon
D. Intradermal nevus
B. Cystic hygroma
E. Pilar cyst
C. Epithelial inclusion cyst
Ans:
Skin lesions may be polypoid or cystic. The most common polyp of the skin is called an
acrochordon (skin tag), which histologically reveals a large polyp lined by squamous
epithelium. Skin tags are polypoid or pedunculated. Epithelial cysts are also very common
lesions, but are not pedunculated. Epidermal inclusion cysts are keratin-filled cysts that are
lined by squamous epithelium having a granular cell layer. No adnexal structures are
attached to this type of cyst. Clinically these very common cysts are called sebaceous cysts.
This in fact is a misnomer, as these cysts have no sebaceous component. Other types of cysts
include pilar cysts, which are keratin-filled cysts (lined by squamous epithelium not having
a granular cell layer) found typically on the scalp, and dermoid cysts, which are similar to
10

epidermal inclusion cysts with the addition of multiple adnexal structures, such as sebaceous
glands or hair follicles.
71. A 65-year-old male farmer presents with a small, scaly erythematous lesion on the helix of his
left ear. A biopsy from this lesion reveals marked degeneration of the dermal collagen (solar
elastosis) along with atypia of the squamous epidermal cells. The atypia, however, does not
involve the full thickness of the epidermis, and no invasion into the underlying tissue is seen.
What is the correct diagnosis for this skin lesion? (USMLE hal 471)
A. Actinic keratosis
D. Seborrheic keratosis
B. Bowens disease
E. Squamous cell carcinoma
C. Keratoacanthoma
Ans:
Actinic (solar) keratoses, found on sun-damaged skin, microscopically show hyperkeratosis,
parakeratosis, atypia of the epidermal keratinocytes, and degeneration of the elastic fibers in
the dermis (referred to as solar elastosis). Clinically, actinic keratoses appear as irregular
erythematous brown papules. When the atypia of the intraepidermal keratinocytes is extreme
(full thickness), the lesion is referred to as Bowens disease (carcinoma in situ). Obviously
in this lesion there is no invasion into the underlying dermis, which, if present, would be
diagnostic of a squamous cell carcinoma. Keratoacanthoma, a benign tumor, may resemble
squamous cell carcinoma both clinically and histologically, but penetration of the dermis
never extends deeper than adjacent hair follicles. The lesion is cup-shaped with central
keratin; biopsy or excision excludes squamous carcinoma.
72. A 23-year-old female presents with a 0.4-cm firm brown lesion on her upper right thigh.
Histologic sections from this lesion reveal an irregular area in the upper dermis that is
composed of a mixture of fibroblasts, histiocytes, stromal cells, and capillaries. The majority of
cells in this mixture are fibroblasts. The overlying epidermis reveals hyperplasia of the basal
layers. What is the correct diagnosis? (USMLE)
A. Dermatofibroma
D. Pyogenic granuloma
B. Dermatofibrosarcoma protuberans
E. Sclerosing hemangioma
C. Fibroxanthoma
Ans:
Two tumors that arise from fibroblasts in the dermis of the skin are the benign fibrous
histiocytoma and the malignant dermatofibrosarcoma protuberans (DFSP). Benign fibrous
histiocytomas are composed of a mixture of fibroblasts, histiocytes (some of which are lipidladen), mesenchymal cells, and capillaries. Depending on which element predominates,
these lesions have also been called dermatofibromas (mainly fibroblasts), fibroxanthomas
(mainly histiocytes), and sclerosing hemangiomas (mainly blood vessels). Hyperplasia of
the epidermis overlying a dermatofibroma is quite characteristic. In contrast, the lesions of
dermatofibrosarcoma protuberans are cellular lesions composed of fibroblasts that form a
characteristic pinwheel (storiform) pattern. They have irregular, infiltrative margins and are
locally aggressive.They frequently extend into the underlying fat and complete excision is
difficult. The overlying epidermis is characteristically thinned.
73. Laki-laki 52 tahun dengan bula multiple pada kulit tanpa keterlibatan mukosa mulut.
Pemeriksaan fisik tidak tampak ada bula yang sudah pecah, dan tanda Nikolsky negatif. Pada
biopsi tampak akantolitik intraepidermal bula. Tidak terdapat deposisi IgA pada teknik
pewarnaan khusus. Diagnosis apa yang tepat pada kelainan kulit tersebut? (USMLE)
A. Pemphigus vulgaris
C. Dermatitis herpetiformis
E. Lichen planus
B. Bullous pemphigoid
D. Psoriasis
Ans:
Numerous skin diseases result in the formation of vesicles and bullae (blisters). These
vesiculobullous diseases include pemphigus vulgaris, bullous pemphigoid, and dermatitis
herpetiformis. These bullae may have characteristic locations and microscopic appearances.
11

Pemphigus vulgaris is a chronic, severe, possibly fatal skin disease that is characterized by
the formation of large bullae in the skin and oral mucosa. It is an autoimmune disease (type
II hypersensitivity) caused by IgG antibodies to keratinocyte antigens involved in
intercellular attachment. Immunofluorescence reveals a uniform chicken-wire appearance.
Pemphigus vulgaris is characterized by acantholysis (separation of the keratinocytes) that
produces intraepidermal (suprabasal) bullae. Clinically the bullae are large, flaccid, and
easily ruptured because of their thin roof. Rupture produces denuded areas. Physical
examination is positive for Nikolskys sign (pressure extends the bullae). Systemic
symptoms such as fever and weight loss are also present.
74. Which of the following changes does not occur in primary tuberculosis? (Board hal 250)
A. Calcification
C. Cavitation
E. Positive tuberculin test
B. Caseating granulomas
D. Langhans giant cells
Ans:
Cavitation occurs only in secondary tuberculosis. Both primary and secondary tuberculosis
are characterized by caseating granulomas, often with Langhan Giant Cells, that heal by
scaring and calcification. The skin test result for tuberculin sensitivity is both forms.
75. All of the following forms of lung cancer are correctly with the appropriate characteristic
EXCEPT: (Board hal 250)
A. Squamous cell carcinoma central location
B. Small cell carcinoma almost never respectable
C. Large cell carcinoma lung tumor most clearly related to cigarette smoking
D. Adeno carcinoma peripheral location
E. Bronchioloalveolar carcinoma tumor cells lining alveolar walls
Ans:
Large cell carcinomas are poorly differentiated carcinomas, some of which prove to be
squamous cell carcinoma or adenocarcinoma on electron microscopy. Because the
relationship of cigarette smoking to adenocarcinoma is not clear as with squamous cell or
small cell carcinoma, large cell carcinomas display a somewhat less clear relationship
cigarette smoking then other forms of bronchogenic carcinoma.
76. Histologic examination of an excision specimen from a lesion on the dorsal surface of the penis
reveals a papillary lesion with clear vacuolization of epithelial cells on the surface and
extension of the hyperplastic epithelium into the underlying tissue along a broad front.
The correct dianosis for this lesion is : (USMLE)
A. Condyloma acuminatum
D. Verrucous carcinoma
B. Bowens disease
E. Squamous cell carcinoma
C. Erythroplasia of Queyrat
Ans:
Clear vacuolization of the superficial layers of the epithelial cells (koilocytosis) is
characteristic of infection by human papillomavirus (HPV). These changes are found in both
condyloma acuminatum and verrucous carcinoma, but condyloma is a benign papillary
lesion that does not grow into the underlying tissue, while verrucous carcinoma, also known
as giant condyloma or Buschke-Lwenstein tumor, invades the underlying tissue along a
broad front. This type of invasion is in contrast to squamous cell carcinomas, which invade
tissue as finger-like projections of atypical squamous epithelial cells. Three dysplastic,
precancerous intraepithelial lesions of the penis that do not invade into the underlying tissue
are Bowens disease, erythroplasia of Queyrat, and Bowenoid papulosis.
77. Which of the following testicular tumors is most radiosensitive? (USMLE hal 398)
A. Seminoma
D. Yolk sac tumor
B. Embryonal carcinoma
E. Immature teratoma
C. Choriocarcinoma
Ans:
12

Germ cell tumors of the testis are clinically divided into two categoriesseminomas and
nonseminomatous germ cell tumors (NSGCTs)because of their differences in
presentation, metastasis, prognosis, and therapy. The NSGCTs include embryonal
carcinomas, yolk sac tumors (infantile embryonal carcinomas or endodermal sinus tumors),
choriocarcinomas, and immature teratomas. When compared with NSGCTs, seminomas are
extremely radiosensitive, and they are more commonly present with stage I disease.
NSGCTs are relatively radioresistant, are more aggressive, and have a worse prognosis.
Seminomas typically spread via lymphatics after having remained localized for a long time.
Embryonal carcinoma, choriocarcinoma, and mixed tumors with an element of
choriocarcinoma tend to metastasize early via the blood. Choriocarcinomas are the most
aggressive variant.
78. A 27-year-old male presents with a testicular mass, which is resected and diagnosed as being a
yolk sac tumor. Which one of the listed substances is most likely to be increased in the patients
serum as a result of being secreted from the cells of this tumor? (USMLE hal 398)
A. Acid phosphatase
D. human chorionic gonadotropin
B. fetoprotein (AFP)
E. Prostate-specific antigen (PSA)
C. Alkaline phosphatase
Ans:
Germ cell tumors of the testis often secrete enzymes or polypeptide hormones, examples of
which include fetoprotein (AFP) and human chorionic gonadotropin (hCG). AFP is
synthesized by the fetal gut, liver, and yolk sac. It may be secreted by either yolk sac tumors
(endodermal sinus tumors) or embryonal carcinomas. AFP may also be secreted by liver cell
carcinomas. -hCG is a glycoprotein that is normally synthesized by placental
syncytiotrophoblasts. Markedly elevated serum levels are most often associated with
choriocarcinomas, which are characterized histologically by a mixture of malignant
cytotrophoblasts and syncytiotrophoblasts. Mildly elevated serum levels of -hCG may be
found in patients with other types of germ cell tumors if they contain syncytiotrophoblastlike giant cells. This is found in about 10% of classic seminomas, which are characterized
histologically by large cells with distinct cell membranes and clear cytoplasm. An important,
distinct variant of seminoma is the spermatocytic seminoma. It is characterized by being
found in older individuals and by the fact that it does not metastasize. Histologically, a
spermatocytic seminoma is characterized by maturation of the tumor cells, some of which
histologically resemble secondary spermatocytes. To summarize: markedly elevated levels
of hCG are associated with choriocarcinomas, while elevated levels of AFP are most
characteristic of yolk sac tumors and embryonal carcinomas. But there are many areas of
overlap between tumors, and many tumors are composed of multiple types of germ cell
cancers. The only definitive statement that can be made is that elevated serum levels of AFP
cannot be seen in a tumor that is a pure seminoma.
79. A 49-year-old male who is a long term smoker presents with frequency and hematuria.
Histologic examination of sections taken from an exophytic lesion of the urinary bladder reveal
groups of atypical cells with frequent mitoses forming finger-like projections that have thin,
fibrovascular cores. These groups of atypical cells do not extend into the lamina propria and
muscularis. No glands or keratin production are found.
What is the most accurate diagnosis for this bladder tumor? (USMLE hal 380)
A. Adenocarcinoma, noninvasive
B. Inverted papilloma
C. Transitional cell carcinoma insitu
D. Papillary transitional cell carcinoma (TCC), noninvasive
E. Squamous cell carcinoma in situ
Ans:

13

Neoplastic lesions of the urinary bladder may either be benign or malignant. There is some
controversy involving some types of benign lesions of the bladder. In particular, there is
disagreement as to whether papillary lesions may be benign (papillomas). Many pathologists
would classify papillary transitional lesions that lack cellular atypia or numerous mitoses as
grade I (low-grade) papillary transitional cell carcinomas (TCCs) and not papillomas.
Pathologists do agree, however, on the existence of a rare type of benign lesion called an
inverted papilloma, which is characterized by nodular mucosal lesions that histologically
have an endophytic growth pattern. Malignant neoplasms of the bladder may be transitional
cell carcinomas, which are by far the most common type of tumor of the urinary bladder;
squamous cell carcinomas which produce keratin; or adenocarcinomas, which form
glandular structures. TCCs may be either papillary or flat lesions. Papillary TCCs, which are
the most common type of bladder cancer, may be either invasive or noninvasive.
Noninvasive papillary TCCs are not referred to as being in situ, as that term implies a
noninvasive, nonpapillary lesion. Nonpapillary (flat) TCCs may also be invasive (into the
lamina propria or muscularis) or noninvasive (in situ). In contrast, squamous cell carcinomas
of the urinary bladder are quite rare except in Egypt and other areas of the Middle East,
where they are associated with schistosomiasis. Similarly, adenocarcinomas of the urinary
bladder are quite rare, except that they may be associated with urachal epithelial remnants
located in the dome of the bladder, glandular metaplasia, or cystitis glandularis.
80. Histologic sections of a kidney reveal patchy necrosis of epithelial cells of both the proximal
and distal tubulus with flattening of the epithelial cells, rupture of the basement membrane, and
marked interstitial edema. Acute inflammatory cells are not seen. What is the best diagnosis?
A. Acute pyelonephritis
D. Chronic pyelonephritis
B. Acute tubular necrosis
E. Diffuse cortical necrosis
C. Chronic glomerulonephritis
81. A sexually active man who has had a negative evaluation for gonococcal infection and
complains of persistent dysuria :
A. Prostatic hypertrophy
C. Orchitis
E. Renal stones
B. Epididymitis
D. Nonspecific urethritis
82. Malacoplakia of the urinary bladder, is considered to be associated with:
A. Tuberculosis
D. Staphylococcal infections
B. Urothelial carcinoma
E. Defects in phagocytosis
C. Schistosomiasis
83. Keadaan ginjal di bawah ini dapat menyebabkan hipertensi, KECUALI:
A. Infark ginjal bilateral berukuran kecil
D. Hidronefrosis
B. Arteriosklerosis pada arteri renalis
E. Pyelonefritis
C. Displasia fibromuskular pada arteri renalis
84. Pernyataan di bawah ini mengenai batu pada saluran kencing adalah benar, KECUALI:
A. Banyak mengenai laki-laki
D. Berhubungan dengan infeksi Pseudomonas
B. Sebanyak 40% ditemukan bilateral
E. Insidensi meningkat pada penderita leukemia
C. Radioopaque pada 90% kasus
85. Pernyataan di bawah ini adalah benar untuk prostatic intraepithelial neoplasia (PIN),
KECUALI:
A. Hiperselular
D. Nukleoli jelas
B. Tidak ditemukan lapisan sel basal
E. Hiperkromatis
C. Ukuran inti bervariasi
86. The development of atheromatous plaque formation with subsequent complications is observed
in an experiment. Atherosclerotic plaques are shown to change slowly but constantly in ways

14

that can promote clinical events, including acute coronary syndromes. In some cases, changes
occurred that were not significantly associated with acute coronary syndromes.
Which of the following plaque alterations is most likely to have such an association ?
A. Thinning of the media
D. Hemorrhage into the plaque substance
B. Ulceration of the plaque surface
E. Intermittent platelet aggregation
C. Thrombosis
87. A 3mm mass from anterior lobe of pituitary of a 35 year-old woman was sent to Pathology
laboratory for microscopic examination. Microscopic findings shows uniform polygonal cells
arrays in sheets among normal reticular network. Cytoplasm is granular and shows weakly
acidophilic. Clinical symptoms of this patient are amenorrhea, galactorrhoea, loss of libido and
infertility.
Which of the most likely diagnosis of this mass?
A. Pituitary hyperplasia
D. Hyperpituitarism
B. Pituitary carcinoma
E. Pituitary adenoma
C. Hypopituitarism
88. Seorang perempuan berusia 28 tahun datang ke praktek dokter dengan keluhan bengkak di
payudara kanan yang ditemukan sejak 1 bulan yang lalu. Sejak 1 minggu yang lalu juga keluar
cairan dari putting susu. Pasien belum menikah. Pada pemeriksaan fisik ditemukan massa di
areola, diameter 2.5 cm, tidak terfiksir. Keluar cairan kekuningan dari nipple. Dilakukan FNAB
dan diambil sekret nipple. Mikroskopik sediaan FNAB tampak kelompokan sel yang
monomorf, kohesif sel kuat, beberapa agak besar, tersusun berkelompok, inti gelap dan
kromatin halus.
Apakah diagnosis yang paling sesuai?
A. Intraductal papilloma
D. Papillary carcinoma
B. Fibrocystic disease
E. Atypical ductal hyperplasia
C. Duct ectasia

Soal untuk No. 89 dan 90

Seorang anak laki-laki usia 10 tahun, datang bersama ibunya ke rumah sakit dengan keluhan ada
beberapa benjolan di leher kanan anaknya. Benjolan ini diketahui dua minggu ini dan sudah makan
obat, tapi tidak sembuh. Oleh dokter setelah dilakukan pemeriksaan diianjurkan untuk aspirasi
biopsy. Hasil sitologi dari aspirasi biopsy didapatkan antara lain : kelompok sel-sel epiteloid, massa
nekrosis di beberapa lapangan pandangan, sebaran sel-sel limfosit dan tampak satu dua sel-sel besar
dengan inti banyak dan terletak di pinggir.
89. Apakah kemungkinan diagnosa yang paling tepat pada kasus diatas ?
A. Lymphadenitis chronis
D. Lymphocitic lymphoma
B. Burkit lymphoma
E. Lymphadenitis tuberculosa
C. Lymphadenitis acute.
90. Untuk memastikan diagnosa tersebut diatas sebaiknya dilakukan pemeriksaan :
A. Kultur spesimen
C. Foto thorax
E. Matoux test
B. Kultur darah
D. IHC

15

Soal untuk No. 91 dan 92

Seorang wanita usia 45 tahun, datang ke rumah sakit dengan keluhan sakit kepala, hidung sering
tersumbat dan adanya benjolan di leher kanan selama kurang lebih 1 tahun. Benjolan bertambah
besar. Setelah dilakukan pemeriksaan oleh dokter, dianjurkan untuk dilakukan FNAB. Hasil sitologi
dari FNAB didapatkan kelompokan sel-sel bentuk polimorfik, inti membesar, kromatin kasar
berkelompok, sitoplasma sedikit. Latar belakang smir terdiri dari sebaran sel-sel darah.
91. Apakah kemungkinan diagnosa kasus diatas yang paling tepat ?
A. Non hodgkin lymphoma.
D. Lymphadenitis chronis
B. Metastase carcinoma
E. Lymphadenitis tuberculose
C. Lymphoma malignant.
92. Untuk mendukung diagnosa tersebut diatas sebaiknya dilakukan :
A. Foto thorax.
C. Matoux test
B. Head CT Scan
D. Darah lengkap

E. IHC

Soal untuk No. 93 dan 94

Seorang wanita usia 50 tahun, datang ke rumah sakit dengan keluhan ada benjolan di leher depan,
selama lebih kurang 2 tahun. Mula-mula kecil dan semakin membesar. Sekarang sudah sebesar telur
ayam. Oleh dokter dianjurkan untuk dilakukan FNAB.
Hasil sitopatologi dari FNAB didapatkan; kohesi sel renggang, sel-sel bentuk bulat dan spindel,
sitoplasma relatip banyak, kromatin abu-abu serta dijumpai adanya massa amyloid.
93. Diagnosa yang paling tepat untuk kasus diatas adalah :
A. Metastase carcinoma
D. Parathyroid adenoma
B. Hurtle cell carcinoma
E. Follicular carcinoma
C. Medullary carcinoma
94. Keberadaan amyloid pada kasus diatas dapat dilihat jelas dengan :
A. Pengecatan PAP.
C. Giemsa
B. Pengecatan congored
D. Reticulin

E. PAS

95. A 38-year-old women who fell to the ground and hit her head is taken to the emergency
department. There are no remarkable findings on physical examination. CT scan of the head
shows no hemorrhage or fracture, but there is a 5-cm mass beneath dura that compresses the
underlying left superolateral parietal lobe. The mass is surgically removed. Histologic analysis
shows elongated cells with pale, oblong nuclei and pink cytoplasm with occasional psammoma
bodies. What is the most likely diagnosis ?
A. Schwannoma
C. Medulloblastoma
E. Ependymoma
B. Tuberculoma
D. Meningioma
Ans:
(A) Meningiomas typically are circumscribed lesions that arise from meningothelial cells of
the arachnoid and appear grossly attached to the overlying dura. They are most often seen in
women. A parasagittal, sphenoid ridge, or subfrontal location is typical. Tuberculomas from
disseminated tuberculosis are rare and usually occur at the base of the brain.
Medulloblastomas are tumors of the posterior fossa that occur in children. The most typical
location for a schwannoma is at the cerebellopontine angle, involving cranial nerve VIII.
Ependymomas arise in ventricles.
96. A 28-year-old man who is a singer/songwriter has been experiencing hard times for the past 3
years. He has played at a couple of clubs a night to earn enough to avoid homelessness. He
comes to the free clinic because he has noticed that his voice quality has become progressively
hoarser over the past year. On physical examination, he is afebrile. There are no palpable
masses in the head and neck area. He does not have a cough or significant sputum production,
but he has been advised on previous visits to give up smoking.
Which of the following is most likely to produce these findings ? (R.R hal 343)
16

A. Reactive nodule (Singers node)

D. Squamous cell carcinoma
B. Epiglottitis
E. Squamous papillomatosis
C. Croup
Ans:
Reactive nodules (vocal cord polyps, or singer's nodules) occur most often in men who are
heavy smokers or who strain their vocal cords. The nodules are generally only a few
millimeters in size and have a fibrovascular core covered by hyperplastic and hyperkeratotic
squamous epithelium. They are not premalignant. Croup is an acute
laryngotracheobronchitis that occurs in children. It produces airway narrowing with
inspiratory stridor. Epiglottitis is an acute inflammatory process that may cause airway
obstruction. Squamous cell carcinomas of the pharynx and larynx are more common in
smokers, but generally are seen in individuals older than this patient. Squamous
papillomatosis usually first appears in childhood; if it is extensive, it can produce airway
obstruction.
97. A 3-year-old boy has been observed by his parents to be increasingly clumsy for the past 6
months. Her is brought to the physician, who notes leukocoria with absence of the red reflex in
the left eye. The eye is enucleated; the microscopic appearance : tumor composed of small,
round cells with large hyperchromatic nuclei resembling undifferentiated retinoblast and
flexner wintersteiner rosette structures.
Which of the following is most likely to produce these findings ? (R.R hal 606)
A. Metastatic adenocarcinoma
D. Retinoblastoma
B. Medulloblastoma
E. Neuroblastoma
C. Squamous cell carcinoma
Ans:
Retinoblastoma is the most common malignant ocular neoplasm in children. Histologically,
there is clustering of cuboidal or short columnar cells around a central lumgen. These
clusters are sometimes called Flexner-Wintersteiner rosettes. This tumor can spread to the
orbit or along the optic nerve. Adenocarcinomas and squamous cell carcinomas are
uncommon neoplasms in children. Gliomas may affect the optic nerve in a child, but the
microscopic pattern does not include the rosettes shown. Melanomas of the eye are seen in
adults and have spindle or polygonal cell patterns. Medulloblastomas are cerebellar
malignancies in children. Neuroblastomas are pediatric neoplasms arising in adrenal or
extra-adrenal paraganglia. Retinoblastomas, medulloblastomas, and neuroblastomas all are
forms of small, round, blue cell tumors seen in children.
98. A 17-year-old girl is concerned about a bump on her neck that she has noticed for several
months. It does not seem to have increased in size during that time. On physical examination,
there is a discrete, slightly movable nodule in the midline of the neck just above the thyroid
gland. The nodule is excised, and microscopic examination shows a cystic mass lined by
squamous and respiratory epithelium. Which of the following additional histologic elements
would most likely be located adjacent to this cyst ? (R.R hal 342)
A. Malignant lymphoma
D. Squamous cell carcinoma
B. Noncaseating granulomas
E. Thyroid
C. Serous salivary glands
Ans :
The location of this nodule is classic for a thyroglossal duct (tract) cyst, which is a
developmental abnormality that arises from elements of the embryonic thyroglossal duct
extending from the foramen cecum of the tongue down to the thyroid gland. One or more
remnants of this tract may enlarge to produce a cystic mass. Although lymphoid tissue often
surrounds these cysts, malignant transformation does not occur. The cysts may contain
squamous epithelium, but squamous cell carcinoma does not arise from such a cyst. If there
is a cystic lesion with lymphoid tissue and squamous carcinoma in the neck, it is probably a
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metastasis from an occult primary tumor of the head and neck. Salivary gland choristomas
are unlikely at this site. Granulomatous disease is more likely to involve lymph nodes in the
typical locations in the lateral neck regions.
99. For the past 4 months, a 50-years-old man has had difficulty breathing through his nose and has
experienced dull facial pain. On physical examination, there is a mass filling the right nasal
cavity. CT scan of the head shows a 4-cm mass in the nasopharynx on the right that erodes
adjacent bone. The mass is excised, and microscopic examination shows that it is composed of
large epithelial cells with indistinct borders and prominent nuclei. Mature lymphocytes are
scattered throughout the undifferentiated neoplasm. Which of the following etiologic factors
most likely played the greatest role in the development of this lesion ? (R.R hal 345)
A. Allergic rhinitis
D. Epstein-Barr virus infection
B. Sjogren syndrome
E. Wegener granulomatosis
C. Smoking tobacco
Ans:
This patient has a nasopharyngeal carcinoma. There is a strong association with EpsteinBarr virus infection, which contributes to the transformation of squamous epithelial cells.
Sjgren syndrome is associated with malignant lymphomas, but these typically arise in the
salivary gland, not the nasal cavity. Smoking is not associated with nasopharyngeal
carcinoma, although it does contribute to oral and esophageal cancers. Allergic rhinitis is
associated with development of nasal polyps, but these do not become malignant. Wegener
granulomatosis can involve the respiratory tract, causing granulomatous inflammation and
vasculitis, but the nasopharyngeal region is not commonly affected, and there is no risk of
malignant growth.
100. Over the past 10 years, a 60-year-old man has had progressive difficulty hearing, particularly
with the left ear. Audiometric testing shows that he has a bone conduction type of deafness. CT
scan of the head shows no abnormal findings. The patients brother and mother are similarly
affected. What is the most likely diagnosis ?
A. Chondrosarcoma
D. Otitis media
B. Schwannoma
E. Otosclerosis
C. Cholesteatoma
Ans:
Otosclerosis can be familial, particularly when it is severe. It results from fibrous ankylosis
followed by bony overgrowth of the little ossicles of the middle ear. A schwannoma
typically involves the vestibulocochlear nerve and results in a nerve conduction form of
deafness. Schwannomas are usually unilateral, although familial neurofibromatosis could
result in multiple schwannomas. A cholesteatoma is typically a unilateral process that
complicates chronic otitis media in a child or young adult. Uncomplicated otitis media is
usually self-limited and is uncommon in adults. Chondrosarcomas may involve the skull in
older adults, but are rare, solitary, bulky masses in the region of the jaw.
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