ABPath Anatomic Pathology Primary Certification Examination Practice Test
Anatomic pathology applies microscopic tissue assessment, immunohistochemistry, and ancillary findings to diagnose disease in biopsies and resection specimens. This practice bank samples tumor classification, renal and skin pathology, inflammatory patterns, and organ-specific histology. Cases ask you to connect morphology with clinical context and marker profiles, including epithelial, hematolymphoid, endocrine, pulmonary, hepatic, and glomerular findings.
Exam overview
About the ABPath Anatomic Pathology Primary Certification Examination Exam
The cases emphasize interpreting tissue architecture and cytologic features: invasion versus in-situ growth, characteristic cellular arrangements, granulomatous inflammation, and patterns of immune deposits. They also test how immunohistochemical and immunofluorescence results refine a differential diagnosis, such as distinguishing tumor lineages or identifying a blistering disorder. Electron microscopy findings, serum results, and patient history provide additional diagnostic context. For each case, identify the decisive morphologic feature, assess whether ancillary findings support it, and select the most coherent diagnosis or tissue process. These tasks reflect routine anatomic pathology work, where a final interpretation must integrate gross or microscopic appearance with relevant stains and clinical information.
Sample Practice Questions
Review a selection from this exam's published US Practice Tests practice bank.
A 67-year-old patient has painless hematuria. A bladder biopsy shows nests of malignant epithelial cells invading the lamina propria. The cells are positive for GATA3 and uroplakin II. Which tumor type is most likely?
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Correct answer: AUrothelial carcinoma is the most common primary malignancy of the bladder. GATA3 and uroplakin II support urothelial differentiation; invasion of the lamina propria establishes an invasive component.
A renal biopsy from a patient with nephrotic syndrome shows diffuse capillary-wall thickening. Immunofluorescence demonstrates granular IgG and C3 along the glomerular basement membranes, and electron microscopy shows subepithelial deposits with intervening basement-membrane spikes. Which diagnosis is most likely?
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Correct answer: AMembranous nephropathy is characterized by subepithelial immune deposits, granular capillary-wall IgG and C3, and basement-membrane spike formation. Minimal change disease lacks immune deposits, while the other listed entities have different dominant patterns.
A skin biopsy from a sun-exposed site shows an atypical epidermal proliferation with full-thickness keratinocyte atypia and numerous mitoses, but the basement membrane remains intact. Which diagnosis is most appropriate?
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Correct answer: BFull-thickness epidermal atypia without dermal invasion is squamous cell carcinoma in situ. Actinic keratosis usually shows atypia concentrated in the lower epidermis, invasive squamous cell carcinoma crosses the basement membrane, and seborrheic keratosis is benign.
A surgical lung biopsy shows interstitial thickening by atypical pneumocytes lining alveolar walls, with preservation of the underlying architecture and no destructive stromal invasion. Which growth pattern is present?
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Correct answer: ALepidic growth describes neoplastic cells spreading along pre-existing alveolar septa without destructive invasion of the underlying lung architecture. This pattern is characteristic of a subset of pulmonary adenocarcinomas.
A lymph node biopsy shows necrotizing granulomas. Acid-fast organisms are identified, and culture grows Mycobacterium tuberculosis. Which inflammatory pattern best describes the tissue response?
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Correct answer: ATuberculosis commonly produces granulomatous inflammation with central caseous necrosis. The organism identification and culture establish the cause; the other patterns describe different forms of tissue injury.
A well-circumscribed pituitary-region mass is composed of monotonous cells arranged in nests and trabeculae. The cells express synaptophysin and chromogranin, and serum prolactin is markedly elevated. Which tumor is most likely?
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Correct answer: BPituitary neuroendocrine tumors show neuroendocrine-marker expression, and a markedly elevated prolactin level supports a lactotroph tumor (prolactinoma). The other choices do not account for the endocrine findings and neuroendocrine phenotype.
A breast carcinoma shows uniform, small, discohesive cells infiltrating in single-file strands. Loss of membranous E-cadherin expression is demonstrated. Which diagnosis is most likely?
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Correct answer: AInvasive lobular carcinoma characteristically shows discohesive cells infiltrating individually or in single-file patterns, often with loss of E-cadherin due to disruption of CDH1-mediated adhesion.
How to use this practice test
Access is free. The practice session draws up to 20 random questions from the 50 published items in this bank and displays results after completion. Use each result to identify patterns you misread, then revisit the case’s morphology, stain profile, and diagnostic rationale before attempting another session.
Preparation tips
- For epithelial tumors, distinguish in-situ disease from stromal invasion and connect growth patterns such as single-file infiltration or lepidic growth with the relevant tissue architecture.
- Practice interpreting immunohistochemical panels as a set: relate markers such as GATA3, uroplakin II, E-cadherin, CD30, CD15, PAX5, and CD45 to the morphology rather than relying on one stain alone.
- Compare renal biopsy findings across light microscopy, immunofluorescence, and electron microscopy; map deposit location and basement-membrane changes to the observed pattern.
- Review inflammatory and blistering patterns by combining the dominant inflammatory cell, tissue compartment, and immunofluorescence distribution.
- In each case, separate the key diagnostic evidence from contextual clues such as age, symptoms, serum findings, or prior infection.