​Pathology Image Based Questions for NEET PG 2026

Q1. A 45-year-old man presents to the clinic with a persistent cough, weight loss, and night sweats. A chest X-ray shows cavitary lesions in the upper lobes of the lungs. Sputum analysis is positive for acid-fast bacilli. A biopsy is taken, and a cut section of the lung is shown below.What type of necrosis is most likely present in this patient's lung tissue?​ 

1. ​Coagulative necrosis
2. Caseous necrosis
3. Fatty necrosis
4. Liquefactive necrosis

Ans. 2) Caseous necrosis

Also read: Physiology ​Image Based Questions for NEET PG

Q2. Based on the provided image, which features are indicative of the type of gangrene depicted?​ 

1. ​Presence of gas bubbles in the affected tissue
2. Formation of bullae filled with fluid
3. Dry, shrunken, and mummified appearance with a clear demarcation
4. Presence of foul-smelling discharge and crepitus on palpation

Ans. 3) Dry, shrunken, and mummified appearance with a clear demarcation

Q3. A 60-year-old woman presents with bone pain and tenderness over her lower back. Imaging reveals multiple lytic lesions in the vertebral column. Laboratory tests indicate anemia, elevated serum calcium levels, and monoclonal gammopathy. A bone marrow biopsy confirms plasma cell proliferation. Microscopic examination of the biopsy reveals intracellular inclusions, as shown in the image. What is the composition of the intracellular inclusions marked in the image?

1. ​Aggregates of misfolded proteins
2. Clusters of ribosomes
3. Accumulations of immunoglobulins
4. Vacuoles containing lipids

Ans. 3) Accumulations of immunoglobulins​

​​Q4. Which sequence accurately identifies lymphocytes, epithelioid cells, Langhan's  giant cells, and caseous necrosis in the image given below?

1. ​b, d, a, c
2. d, b, a, c
3. d, b, c, a
4. b, d, c, a​

Ans. 3) d, b, c, a

Q5. A 40-year-old woman presents with a persistent dry cough, shortness of breath, and bilateral enlargement of the lymph nodes in her chest, incidentally detected on a routine chest X-ray given below. Physical examination reveals fine crackles in her lung bases. Pulmonary function tests show reduced lung volumes and a decreased diffusion capacity for carbon monoxide. Which type of granuloma is commonly associated with the histopathological findings in this patient? 

​ 

1. Naked granuloma
2. Stellate granuloma
3. Eosinophilic granuloma
4. Durck granuloma

 Ans. 1) Naked granuloma​ ​

​Q6. A young male patient presented with recurrent episodes of acute neurologic dysfunction, cognitive changes, muscle weakness, and lactic acidosis. There is a family history of similar conditions depicted in the pedigree chart below. What is the most likely diagnosis?

1. MELAS
2. MERRF
3. Metachromatic leukodystrophy
4. Adrenoleukodystrophy

Ans. 1) MELAS

Q7. A 58-year-old male smoker presents with a persistent cough and mild shortness of breath. Chest imaging reveals a solitary pulmonary nodule. A biopsy is performed, and a histopathological examination of the lung tissue is shown in the image below. What is the most likely diagnosis?

​

1. Carcinoma in situ
2. Adenomatous hyperplasia
3. Adenocarcinoma in situ
4. Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia

Ans. 3) Adenocarcinoma in situ

Q8. A 60-year-old man on long-term proton pump inhibitor therapy for acid reflux undergoes an upper gastrointestinal endoscopy for recurrent epigastric discomfort. The endoscopy reveals smooth-surfaced lesions in the gastric body and fundus. Which statement about these findings is likely correct?

​

1. PPIs decrease gastrin secretion, reducing the risk of fundic gland polyps
2. Fundic gland polyps are commonly associated with H. pylori infection.
3. Composed of cystically dilated glands lined by parietal, chief, and foveolar cells.
4. Sporadic fundic gland polyps carry a significant risk of neoplasia.

​Ans. 3) Composed of cystically dilated glands lined by parietal, chief, and foveolar cells.

Q9. A 45-year-old woman presents with a dark, irregularly shaped mole on her back that has rapidly increased in size over the past few months. On examination, the lesion has uneven borders and varying shades of colour. Which of the following is true regarding its pathogenesis?

​

1. Associated with TERT mutations
2. Spreads radially with metastatic potential
3. Spreads vertically with no metastatic potential
4. Associated with mutations that decrease telomerase activity

​Ans. 1) Associated with TERT mutations

Q10. A 70-year-old woman presents with a finding as shown in the image. A biopsy confirms basal cell carcinoma. Which molecular pathway is primarily involved?

​

1. ​Hippo pathway signaling
2. Hedgehog signaling pathway
3. WNT signaling
4. RAS/MAPK signaling

Ans. 2) Hedgehog signaling pathway

Q11. An 18-year-old female has multiple itchy silvery scales on her knees and elbows. A biopsy of the lesion revealed the presence of nuclei and neutrophilic infiltration in the stratum corneum. Match the following with their appropriate answers.​

​

a. Auspitz sign	1. Nucleated stratum corneum
b. Munro’s microabscess	2. Pinpoint bleed after scraping off old lesion
c. Spongiform pustules of kogoj	3. Neutrophilic infiltrate in stratum corneum
d. Parakeratosis	4. Neutrophilic infiltrate in stratum spinosum

1. ​a-2, b-4, c-3, d-1
2. a-2, b-3, c-4, d-1
3. a-1, b-3, c-4, d-2
4. a-2, b-4, c-3, d-1​

Ans. 2) a-2, b-3, c-4, d-1​​

Q12. A 28-year-old female presents with a painless, bluish, fluctuant and translucent swelling on the lower lip that enlarges with eating or pressure, as shown in the image below. She reports a history of accidentally biting her lip frequently. What histopathological feature would be expected on biopsy of the lesion?
​

1. ​Cystic structure lined by stratified squamous epithelium with mucin extravasation
2. Proliferation of ductal cells within fibrous connective tissue
3. Epithelial dysplasia and atypical cells.
4. Eosinophilic granuloma with multinucleated giant cells

Ans. 1) Cystic structure lined by stratified squamous epithelium with mucin extravasation

Q13. A 45-year-old female presents with a painless, slowly growing mass in her left parotid gland. Examination reveals a firm, mobile mass. Biopsy confirms pleomorphic adenoma with characteristic islands of cartilage and foci of bone in a myxoid stroma. Which of the following is incorrect regarding this condition?

 ​

1. ​Mostly found in the parotid gland
2. Mixed tumours with ductal, myoepithelial and mesenchymal cells
3. Radiation exposure is a risk factor
4. Down-regulation of PLAG1 results in abnormal cell proliferation

Ans. 4) Down-regulation of PLAG1 results in abnormal cell proliferation

Q14. A 50-year-old male smoker presents with painless swelling in the parotid region. Fine needle aspiration cytology (FNAC) reveals murky fluid. Which of the following histopathological features is true regarding this condition?

​

1. Proliferation of squamous epithelial cells with keratinisation
2. Oncocytic cells with double-layered lining
3. Neuroendocrine differentiation
4. Papillary architecture with psammoma bodies

​Ans. 2) Oncocytic cells with double-layered lining

Q15. A 45-year-old female presents with a slow-growing painless mass in the left submandibular gland region. Imaging studies reveal a solid lesion with cystic components. Fine needle aspiration cytology (FNAC) shows a mixture of mucin-producing, epidermoid, and intermediate cells. A histopathology image is given below. Which of the following features is true regarding this condition? 

​

1. Most commonly found in the sublingual salivary glands.
2. Most are associated with a (11;19) translocation.
3. Encapsulated tumours.
4. Histologically characterized by the presence of spindle cells

​Ans. 2) Most are associated with a (11;19) translocation.

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