Reproductive Pathology Practice Questions

Q: Reinke's crystals are seen in which cells?

Leydig cells. **Explanation:** **Reinke’s crystals** are pathognomonic histological findings found in the cytoplasm of **Leydig cells** (interstitial cells of the testes). These are eosinophilic, rod-shaped, or rectangular cytoplasmic inclusions. While their exact function is unknown, they are composed of protein and are most characteristically seen in **Leydig cell tumors**, though they can occasionally be found in normal adult Leydig cells. **Analysis of Options:** * **Option A (Correct):** Leydig cells are the primary site for Reinke’s crystals. Their presence is a definitive diagnostic marker for Leydig cell tumors (a type of Sex Cord-Stromal Tumor), which often present with precocious puberty in children or gynecomastia in adults due to androgen/estrogen production [1]. * **Option B (Incorrect):** **Sertoli cells** are characterized by **Charcot-Böttcher crystals** (spindle-shaped crystalloids), not Reinke’s crystals [1]. * **Option C (Incorrect):** **Curschmann spirals** are microscopic findings in the sputum of patients with **Bronchial Asthma**, representing mucus plugs from distal airways. * **Option D (Incorrect):** **Creola bodies** are ciliated columnar epithelial cell clusters also found in the sputum of **Asthmatic** patients. **High-Yield Clinical Pearls for NEET-PG:** * **Leydig Cell Tumors:** Most common type of non-germ cell testicular tumor. Only 25-40% of these tumors actually demonstrate Reinke’s crystals on biopsy [1]. * **Hilus Cell Tumors:** These are the ovarian equivalent of Leydig cell tumors and **also** contain Reinke’s crystals. * **Crystalloid Summary:** * Reinke’s = Leydig/Hilus cells. * Charcot-Leyden = Eosinophils (Asthma/Parasites). * Charcot-Böttcher = Sertoli cells. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 513-514.

Q: Microscopic examination of a specimen shows 'Schiller-Duval bodies'. What is the most probable diagnosis?

Yolk sac tumor. ### Explanation **Correct Answer: C. Yolk sac tumor** **Why it is correct:** The **Schiller-Duval body** is the pathognomonic histological hallmark of a **Yolk Sac Tumor** (also known as Endodermal Sinus Tumor). It consists of a central capillary surrounded by a layer of neoplastic cells, situated within a space that is also lined by a layer of neoplastic cells. This structure mimics a primitive glomerulus (glomeruloid body). Yolk sac tumors are the most common testicular tumor in children under 3 years of age and are characterized by the production of **Alpha-fetoprotein (AFP)** [1]. **Why the other options are incorrect:** * **A. Seminoma:** Characterized by large, uniform cells with clear cytoplasm ("fried-egg" appearance) and well-defined cell borders, separated by fibrous septa containing a lymphocytic infiltrate [1]. * **B. Choriocarcinoma:** Composed of a mixture of syncytiotrophoblasts and cytotrophoblasts, often associated with extensive hemorrhage and necrosis. It characteristically secretes **hCG**. * **C. Embryonal carcinoma:** Shows pleomorphic cells arranged in sheets, cords, or papillary patterns [1]. It lacks Schiller-Duval bodies and is more aggressive than seminoma. **High-Yield Clinical Pearls for NEET-PG:** * **Tumor Marker:** AFP is elevated in Yolk Sac Tumors (useful for diagnosis and monitoring). * **Hyaline Globules:** Eosinophilic, PAS-positive hyaline globules (containing AFP and alpha-1-antitrypsin) are also frequently seen in these tumors. * **Age Distribution:** Most common germ cell tumor in infants/children; in adults, it usually occurs as a component of a **mixed germ cell tumor** [1]. * **Ovarian Counterpart:** In females, it is a highly malignant germ cell tumor usually presenting in young women. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 979-980.

Q: Which ovarian tumor is characterized by lymphocytic infiltration?

Dysgerminoma. **Explanation:** **Dysgerminoma** is the most common malignant germ cell tumor of the ovary, occurring primarily in young women [1]. Histologically, it is characterized by large, uniform, "clear" cells (rich in glycogen) arranged in nests or cords, separated by **thin fibrous septa**. A hallmark diagnostic feature is the presence of a **prominent lymphocytic infiltrate** within these fibrous septa. This immune response is a key morphological marker and is thought to correlate with a better prognosis. **Analysis of Incorrect Options:** * **Brenner’s Tumor:** A surface epithelial tumor characterized by "Walthard cell nests" (transitional epithelium) resembling bladder mucosa, often set in a dense fibromatous stroma. It does not typically feature lymphocytic infiltration. * **Dermoid Cyst (Mature Cystic Teratoma):** The most common germ cell tumor, composed of mature tissues from all three germ layers (skin, hair, teeth, sebum). While inflammation can occur if the cyst ruptures, lymphocytic infiltration is not a defining histological characteristic. * **Struma Ovarii:** A specialized monodermal teratoma composed entirely of mature thyroid tissue. It is identified by thyroid follicles filled with colloid, not lymphocytic septa. **High-Yield Clinical Pearls for NEET-PG:** * **Counterpart:** Dysgerminoma is the female equivalent of the testicular **Seminoma** (which also features lymphocytic infiltration) [1]. * **Tumor Markers:** Characteristically associated with elevated **LDH** (Lactate Dehydrogenase) and occasionally hCG [1]. * **Associations:** Frequently seen in patients with gonadal dysgenesis (e.g., Swyer syndrome) [1]. * **Radiosensitivity:** It is highly radiosensitive and has an excellent prognosis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1034-1035.

Q: Increased incidence of breast carcinoma is seen with which of the following benign breast lesions?

Atypical hyperplasia. The risk of developing invasive breast carcinoma depends on the histological features of the benign breast lesion. These are categorized into three groups based on their relative risk (RR): [1] 1. **Atypical Hyperplasia (Correct Answer):** This category includes Atypical Ductal Hyperplasia (ADH) and Atypical Lobular Hyperplasia (ALH). These lesions demonstrate some, but not all, features of carcinoma in situ [1]. They carry a **high risk (RR: 4.0–5.0)** of progressing to invasive cancer. If a patient has a family history of breast cancer along with atypical hyperplasia, the risk increases significantly (RR: ~10.0). 2. **Proliferative Disease without Atypia (Options A & D):** * **Sclerosing adenosis** and **Duct papilloma** (along with complex sclerosing lesions/radial scars) fall into this category [2]. * These lesions carry a **mildly increased risk (RR: 1.5–2.0)** [2]. While they increase the risk compared to the general population, it is substantially lower than that of atypical hyperplasia. 3. **Non-proliferative Breast Changes (Option C):** * **Apocrine metaplasia**, cysts, and mild hyperplasia of the usual type carry **no increased risk (RR: 1.0)** [1]. Apocrine metaplasia is a common finding in fibrocystic changes and is considered a benign transformation. **High-Yield Clinical Pearls for NEET-PG:** * **Highest Risk:** BRCA1/BRCA2 mutations (RR >10.0) > CIS (RR 8.0–10.0) > Atypical Hyperplasia (RR 4.0–5.0). * **Atypical Hyperplasia** is a "pre-cancerous" marker; the subsequent cancer can occur in either breast, not just the site of the biopsy. * **Most common benign tumor** of the breast is Fibroadenoma (No increased risk unless complex). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1052-1056. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1052-1054.

Question 1

Fibroadenoma is most commonly encountered in which age group?

Accepted Answer

Young females

Answer

Elderly females

Answer

Reproductive age group

Answer

Neonates

Question 2

A 37-year-old woman presents with cyclical premenstrual breast pain and a "lumpy-bumpy" texture on palpation. A biopsy reveals histopathologic features including small cysts lined by epithelial cells with apocrine metaplasia, calcium deposits, areas of fibrosis, increased number of acini (adenosis), and foci of florid hyperplasia of ductal epithelium. Which of these findings increase the risk of breast cancer?

Accepted Answer

Florid epithelial hyperplasia

Answer

Adenosis

Answer

Apocrine metaplasia

Answer

Calcium deposits

Question 3

Which of the following statements regarding neoplasms of the ovary is TRUE?

Accepted Answer

The presence of ascites and pleural effusion in Brenner tumour indicates a poor prognosis.

Answer

Stromal invasion is commonly present in ovarian tumours of borderline malignancy.

Answer

Lymphocytic infiltration is characteristic of dysgerminoma.

Answer

Endometrioid carcinoma of the ovary may coexist with endometrial adenocarcinoma.

Question 4

Reinke's crystals are seen in which cells?

Accepted Answer

Leydig cells

Answer

Sertoli cells

Answer

Curschmann spirals

Answer

Creola bodies

Question 5

Microscopic examination of a specimen shows 'Schiller-Duval bodies'. What is the most probable diagnosis?

Accepted Answer

Yolk sac tumor

Answer

Seminoma

Answer

Choriocarcinoma

Answer

Embryonal carcinoma

Question 6

Which ovarian tumor is characterized by lymphocytic infiltration?

Accepted Answer

Dysgerminoma

Answer

Brenner's tumor

Answer

Dermoid cyst

Answer

Struma ovarii

Question 7

Increased incidence of breast carcinoma is seen with which of the following benign breast lesions?

Accepted Answer

Atypical hyperplasia

Answer

Sclerosing adenosis

Answer

Apocrine metaplasia

Answer

Duct papilloma

Question 8

Thymoma is associated with which of the following conditions?

Accepted Answer

Myasthenia gravis

Answer

Scleroderma

Answer

Oesophageal atresia

Answer

Hypergammaglobulinemia

Question 9

A 2-year-old boy presents with a palpable mass on his right testicle. After orchiectomy, microscopic examination of the specimen reveals neoplastic cells forming glomeruloid Schiller-Duval bodies. Which serum marker is most useful for monitoring tumor recurrence in this patient?

Accepted Answer

a-Fetoprotein

Answer

CA-125

Answer

Carcinoembryonic antigen

Answer

Estrogen

Question 10

Condyloma acuminata is reported on Pap smear as:

Accepted Answer

LSIL

Answer

Inflammatory condition

Answer

Carcinoma

Answer

Carcinoma in situ

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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