67. Breast invasive carcinoma with medullary features 除了常見 tumor infiltrating lymphocyte (TIL)外，還常會有何種基因異常？
(A)KRAS
(B)BRAF
(C)HER2
(D)BRCA1/2

63. 以下關於 ovarian high-grade serous carcinoma 的描述，何者為非？(A) Either a defective homologous recombination DNA repair pathway or amplification of CCNE1. (B)Some high-grade serous carcinomas arise from serous tubal intraepithelial carcinoma (STIC). (C) BRCA1 and BRCA2 mutations are common in sporadic high-grade serous carcinoma.(D)The biological behavior depends on the extent and distribution of peritoneal disease and lymph node metastasis.

64. 下列何者錯誤? (A) The most common sites of endometriosis are ovaries, uterine ligaments, rectovaginal septum, cul de sac and pelvic peritoneum. (B)Peritoneal and ovarian endometriosis may be a precursor to endometrioid and clear cell carcinomas.(C)Mutations in KRAS, PIK3CA, PPP2R1A and ARID1A have been identified in the epithelial cells of endometriosis of distant sites. (D)The proposed pathogenesis of endometriosis including regurgitation, benign metastasis, metaplastic and extrauterine stem/progenitor cell theories.

65. 乳癌中的 tubular carcinoma 經常是 ER positive、PR positive、HER2 negative、MIB1 labeling index low (usual ＜10%)，請問 tubular carcinoma 是屬於 intrinsic type 中的哪一型？(A) Luminal A type (B)luminal B type(C)HER2 type(D)Basal type type

66. 根據現行 WHO 的診斷標準，用 size criteria 來區分 atypical ductal hyperplasia (ADH) 和 low grade ductal carcinoma in situ(DCIS)的標準，是用多少 mm？ (A) 1mm(B)2mm (C)3mm(D)4mm

68. Breast secretory carcinoma 是一種罕見但有特殊基因變異的腫瘤。此特殊變異 不但可以做為診斷上使用，目前也是標靶藥物針對的目標,請問這特殊的基因變異 是甚麼？可做為診斷的重要依據甚至於治療的標的? (A)EGFR L858R (B)BRAF V600E (C)ETV6-NTRK3 (D)EWSR1-ATF1

69. Breast intraductal papilloma with atypical ductal cells proliferation 如何區分 papilloma with ADH 和 papilloma with low grade DCIS 有時是困難的。 但根據現 行 WHO 的診斷標準，用 size criteria 來區分 papilloma with ADH 和 papilloma with low grade DCIS 的標準，是用多少 mm 大小的 atypical ductal focus 來區分？ (A)1mm (B)2mm (C)3mm (D)4mm

70. 病人有乳癌淋巴結轉移，被轉移的一個淋巴結中分別有三個轉移癌，其大小 分別是 0.3mm、0.5mm 及 2.5 mm，依照 AJCC 第八版乳癌病理分期，此病人 pN 為何？ (A)pN0, 標示有 isolated tumor cells (B)pN1micro (C)pN1 (D)pN2

71. HER2 的評估對於是否用 anti-HER2 的標靶藥物選用上至關重要，在 HER2 immunohistochemical stain 為 2+/ equivocal 時，是需要作 HER2 FISH/DISH 來確 認是否有 HER2 amplification。請問根據最新 ASCO/CAP guideline HER2 signal/CEP 17 signal 的比值(Ratio)要為多少時，才算 HER2 amplification？ (A)＞=2.0 (B)＞=2.2 (C)＞=4.0 (D)＞=6.0

72. Triple negative breast carcinoma(TNBC)包含一群異質性乳癌，並非全部都是預後很差。請問下列何者的預後是屬於比較好的 TNBC？ (A)Pleomorphic ILC (B)High grade spindle cell carcinoma (C) Tubular carcinoma (D)Low grade adenosquamous carcinoma

73. 關於甲狀腺毒症(thyrotoxicosis)之成因，下列何者最不可能(A)葛瑞夫茲氏病(Graves disease) (B)濾泡癌(follicular carcinoma) (C)橋本氏甲狀腺炎(Hashimoto thyroiditis) (D)結節性甲狀腺腫(multinodular goiter)