RCPA · Royal College of Pathologists of Australasia; Anatomical Pathology Fellowship

RCPA AP / diagnose it.

Written exam grader with RCPA examiner-style marking, glass slide viva simulator with IHC panel construction and tumour grading, spaced-repetition flashcards, and sourced study notes across all 237 anatomical pathology curriculum learning objectives. Built for the precision the RCPA fellowship demands.

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Pass rate

~60%

per sitting (combined components)

Sittings per year

1–2

Part I and Part II annually

Format

Written + Practical + Viva

Part I: MCQ + SAQ · Part II: clinical scenarios · Practical: glass slides · Viva

Topics covered

131

study notes · 237 LOs

Organising college

RCPA

Not affiliated with PRIMEX

· Exam domains ·

Four pathology domains.
From specimen bench to viva room.

~30%

Surgical Pathology & Tumour Classification

Lung IHC panels (adenocarcinoma TTF-1/Napsin A vs SCC p40/CK5/6 vs SCLC synaptophysin/chromogranin), colorectal carcinoma MSI/MMR testing and Lynch syndrome, breast biomarkers (ER Allred, HER2 3+ or FISH ratio ≥2, Ki67), prostate Gleason/ISUP Grade Groups (GG1=6 → GG5=9-10), WHO 2021 CNS classification (IDH wild-type GBM: TERT/EGFR/+7/-10), endometrial TCGA molecular subtypes.

TTF-1 vs p40 · ER Allred scoring · Gleason/ISUP · IDH wild-type GBM criteria · TCGA endometrial · GIST (CD117/DOG1)

~25%

Immunohistochemistry & Molecular Diagnostics

IHC panel construction (minimum 3-marker panels with positive and negative controls), FISH indications (HER2 dual ISH, MDM2 liposarcoma, ALK/ROS1, MYC/BCL2/BCL6, 1p/19q glioma, ploidy for POC), PCR for somatic variants (BRAF V600E, IDH1, EGFR, KRAS), HPV genotyping, NGS, and MRD monitoring.

HER2 FISH dual ISH · ALK/ROS1 FISH · BRAF V600E IHC/PCR · MMR panel (MLH1/MSH2/MSH6/PMS2) · IDH1 R132H IHC

~25%

Organ System Pathology

Skin (melanoma: Breslow depth, mitotic count, Clark level, BRAF V600E reflex for pT1b+), liver (HCC: HepPar-1/Arginase-1/GPC-3, FNH vs hepatocellular adenoma), mesothelioma (calretinin/WT-1/CK5/6/D2-40 positive; CEA/CD15/MOC-31/BerEP4 negative), thyroid (TIRADS, papillary carcinoma nuclear features), lymphoma IHC (DLBCL vs Hodgkin vs metastatic; CD20/CD3/CD30/CD15/AE1-AE3/SOX11 minimum panel).

Breslow + mitotic count · Mesothelioma vs adenocarcinoma · HCC vs FNH · Lymphoma minimum panel · Papillary carcinoma nuclei

~20%

Laboratory Management, Frozen Section & Reporting

RCPA structured synoptic reporting protocols (cancer), frozen section limitations and intraoperative communication, cut-up and block selection, specimen management (FNA adequacy, SNOMED CT/LOINC coding), QA and digital pathology/AI integration, medicolegal reporting obligations, cultural safety in pathology practice.

Frozen section limitations · Synoptic reporting · FNA adequacy · SNOMED CT · Complete vs partial mole (p57) · Intraoperative communication

· Feature 01 · Written Exam Grader

MCQ and clinical scenario feedback at RCPA examiner standard.

The RCPA Anatomical Pathology Part I Written combines MCQ (4 options, single best answer) and SAQs on general pathology principles and IHC interpretation. Part II features extended clinical scenarios with histological descriptions requiring WHO-classified diagnosis, IHC panel construction, and management. PRIMEX grades responses for specific IHC marker combinations, numerical staging thresholds, and correct tumour classification; the errors RCPA examiners most commonly cite.

Part I MCQ and SAQ grading with IHC marker combination feedback
Part II clinical scenario feedback: histological description → differential → IHC panel → diagnosis → management
Common errors flagged: p63 vs p40 confusion (p40 is superior for squamous), missing synchronous carcinoma in adenoma, FAB vs WHO terminology
Numerical thresholds checked: Gleason/ISUP grade groups, Breslow depth cut-offs, Nottingham grade elements

Written exam grader showing MCQ and SAQ feedback

· Feature 02 · Flashcards

237 LOs. Spaced repetition for IHC panels and tumour classification.

RCPA AP requires precision on IHC panel construction, tumour grading criteria, and molecular markers. PRIMEX flashcards are designed around the specific recall format the viva demands: "What is your IHC panel for X?" and "What result would confirm your diagnosis?"

IHC panel cards: primary lung (TTF-1/Napsin A/p40/CK5-6/synaptophysin/CD56/INSM1), mesothelioma, metastatic carcinoma differentials, lymphoma minimum panels
Tumour grading cards: Gleason/ISUP (GG1–5), Nottingham Grade (tubules/nuclei/mitoses 3+3+3), Breslow depth thresholds, WHO CNS 2021 grade criteria
Molecular marker cards: MSI vs microsatellite stable, IDH1/2 mutation implications, 1p/19q co-deletion for oligodendroglioma, POLE ultramutated endometrial
Staging cards: AJCC 8e pT/pN staging for lung, colorectal, breast, prostate, melanoma

Flashcard interface showing revealed answer

· Feature 03 · Viva Simulator

Glass slides. Frozen sections. The full RCPA AP viva.

The RCPA AP Viva presents histological descriptions (or glass slide scenarios) and expects a systematic report approach: specimen type → macroscopic → microscopic → IHC → molecular → integrated WHO-classified diagnosis → clinicopathological correlation. PRIMEX's viva simulator replicates this exactly; presenting histological descriptions and probing at every step.

Systematic viva structure: specimen → macroscopic → microscopic → IHC → molecular → diagnosis → correlation
High-yield scenarios: lung biopsy (primary vs metastatic), lymph node biopsy (DLBCL vs Hodgkin vs reactive vs metastatic carcinoma), prostate needle core (systematic Gleason grading per core), frozen section thyroid (when to defer vs proceed)
Examiner probes: "What additional stain would you perform and what result would confirm your diagnosis?"
Frozen section communication: how to report findings to surgeons and communicate limitations

· Feature 04 · Study Notes

131 topics. Every RCPA anatomical pathology curriculum domain mapped.

Every PRIMEX RCPA AP study note follows a structured format: pathophysiology/biology, WHO classification, IHC panel with specific markers, molecular features, staging criteria, and reporting implications. Each note maps to its RCPA Trainee Handbook 2025 curriculum LO.

131 topics covering the full RCPA AP curriculum; surgical pathology, IHC/molecular, organ systems, laboratory management
WHO classification criteria with specific numerical thresholds in every relevant note
IHC panel tables: markers, expected results, and positive/negative controls
References to WHO Blue Books (CNS 2021, Digestive System 2019, Thoracic Tumours 2021), RCPA structured reporting protocols, and AJCC 8e staging

Study note interface showing structured content

· Feature 05 · RCPA Curriculum Tracker

237 learning objectives. Progress across all 7 curriculum domains.

The RCPA Anatomical Pathology Trainee Handbook (January 2025) defines 237 LOs across 7 domains including discipline-specific (Sections 1.1–1.5), laboratory management (2), research (3), and professional qualities (4). PRIMEX maps every LO with per-domain progress tracking.

All 237 RCPA AP LOs mapped across 7 curriculum domains
Appendix 13 Molecular Competencies tracked separately (FISH, IHC for oncoproteins, PCR for somatic variants)
Checkbox completion persisted to localStorage
Per-domain progress bars showing Part I, Part II, and viva coverage

Curriculum tracker with progress indicators

· About this exam ·

The RCPA Anatomical Pathology Fellowship Examination

The RCPA Anatomical Pathology Fellowship Examination is conducted by the Royal College of Pathologists of Australasia. It comprises Part I Written (MCQ and SAQ on general and organ system pathology, IHC interpretation, and tumour classification), Part II Written (extended clinical scenarios with histological descriptions requiring integrated diagnosis and management), a Practical (glass slide interpretation with systematic reporting), and a Viva.

The Viva presents histological scenarios with clinical context and requires candidates to demonstrate a systematic reporting approach; from specimen type and macroscopic description through microscopic features, IHC construction, molecular testing, and WHO-classified diagnosis to clinicopathological correlation and management implications. The 2025 curriculum explicitly includes Appendix 13 Molecular Competencies covering FISH, IHC for oncoproteins, and PCR for somatic variants.

OrganiserRoyal College of Pathologists of Australasia (RCPA)
Part I WrittenMCQ (4-option, single best answer) + SAQ; general and organ system pathology, IHC
Part II WrittenExtended clinical scenarios; histological description → differential → IHC → diagnosis → management
PracticalGlass slide systematic interpretation with RCPA structured synoptic reporting protocols
VivaHistological scenarios requiring systematic report approach with clinicopathological correlation
CurriculumRCPA AP Trainee Handbook January 2025; 237 LOs across 7 domains including Appendix 13 Molecular Competencies

· Pricing ·

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✓ All 21 specialist exams: SAQ, MCQ, Viva & Voice
✓ Flashcards with spaced repetition & MCQ drill
✓ Study notes for every curriculum topic
✓ SAQ question bank & sessions
✓ Study plan with pace tracking
✓ Community feed

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✓ All 21 specialist exams: SAQ, MCQ, Viva & Voice
✓ Flashcards with spaced repetition & MCQ drill
✓ Study notes for every curriculum topic
✓ SAQ question bank & sessions
✓ Study plan with pace tracking
✓ Save 20% vs monthly

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✓ All 21 specialist exams: SAQ, MCQ, Viva & Voice
✓ Flashcards with spaced repetition & MCQ drill
✓ Study notes for every curriculum topic
✓ SAQ question bank & sessions
✓ Study plan with pace tracking
✓ Save 40% vs monthly plan

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· FAQ ·

Common questions

What are the components of the RCPA Anatomical Pathology examination?

The examination consists of: Part I Written (MCQ + SAQ covering general pathology, organ system pathology, IHC, and tumour classification), Part II Written (extended clinical scenarios integrating histological descriptions with diagnosis and management), Practical (glass slide interpretation with systematic reporting), and Viva (histological scenarios requiring systematic report approach and clinicopathological correlation). Candidates must pass Part I before sitting Part II.

What is the correct IHC panel for a lung biopsy with glandular and solid areas?

The minimum panel is TTF-1, Napsin A, p40, and CK5/6. Adenocarcinoma: TTF-1 positive/Napsin A positive/p40 negative/CK5-6 negative. Squamous cell carcinoma: p40 positive/CK5-6 positive/TTF-1 negative/Napsin A negative. For SCLC: synaptophysin, chromogranin, CD56/INSM1 positive. If metastasis is suspected, add CK7/CK20 and site-specific markers (CDX2 for colorectal, ER/GATA3 for breast). A common RCPA examiner error is using p63 instead of p40; p63 can also stain myoepithelial and urothelial cells and is therefore less specific.

How does Gleason/ISUP Grade Group grading work?

The ISUP Grade Group system replaced Gleason scoring: GG1 = Gleason 6 (3+3), GG2 = Gleason 3+4=7, GG3 = Gleason 4+3=7, GG4 = Gleason 8 (4+4, 3+5, or 5+3), GG5 = Gleason 9–10. Critical reporting elements per RCPA protocol: Grade Group per core, percentage of core involved, percentage of Gleason pattern 4 (for GG2/3), tertiary pattern if >5% of cancer, presence of perineural invasion, extracapsular extension. RCPA examiner reports note candidates who report Gleason 3+3=6 as "well differentiated"; the grade simply indicates the lowest ISUP group, not true well-differentiation.

What are the frozen section limitations I need to know?

Frozen section limitations include: (1) Follicular thyroid lesions; capsular invasion is difficult to assess on frozen, defer to paraffin; (2) Lymphoma classification; cannot be made on frozen alone without flow cytometry and IHC; (3) Small biopsies; freezing artefact may obscure diagnostic features; (4) Fatty tissue; fat artefact on frozen is severe. When reporting frozen sections to surgeons (RCPA curriculum Section 1.5.4), candidates must communicate both the diagnosis and its limitations; "consistent with" versus "confirmed"; and indicate when a deferred diagnosis is necessary.

What does the Appendix 13 Molecular Competencies cover?

Appendix 13 (RCPA AP Trainee Handbook 2025) specifies the molecular tests candidates must know how to order, interpret, and act on: IHC for MMR proteins (MLH1/MSH2/MSH6/PMS2), BRAF V600E, IDH1 R132H, ATRX, TP53, p16, SDH; Dual ISH for HER2 (MBS 73332/73342), ISH for MDM2 in liposarcoma (73374), FISH for ALK/ROS1 (73341/73344), FISH for MYC/BCL2/BCL6/CCND1 in lymphoma, ISH for 1p/19q in glioma (73371), ploidy ISH for products of conception (73389); PCR for BRAF V600E, IDH1 R132H, EGFR, and KRAS somatic variants; HPV genotyping (73070-73075).

How should I approach the diagnosis of a complete vs partial mole?

Complete hydatidiform mole: androgenetic diploid (46,XX or 46,XY), no fetal tissue, diffuse villous hydrops, diffuse trophoblast proliferation, p57 immunostaining absent (p57 is a paternally imprinted, maternally expressed gene; absent in complete mole). Partial mole: typically triploid (69,XXX or 69,XXY), fetal tissue present, focal villous changes, p57 positive. FISH for ploidy (73389) confirms triploidy in partial moles. A common error is failing to perform p57 as part of the initial workup for a suspected molar pregnancy; the RCPA examiners note this explicitly.

Is RCPA Haematology content also available?

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