Diseases of Male Genital Tract — MCQs
Prostatic cancer mostly seen in
All are true about seminomas except:
Identify the condition represented in the image of a testicular tumor.
Which among the following is not a premalignant lesion of vulva?
A 36-year-old man presents to his primary care physician complaining of painless enlargement of the testis. Further laboratory studies reveal an increase in serum hCG. Of the following, which is the most likely diagnosis?
A patient from the Ohio River valley presents with granulomatous prostatitis showing broad-based budding organisms on microscopy. What is the most likely infecting organism?
Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split. Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.
The following is a post-orchidectomy histopathological specimen. Diagnosis is:
A 24 -year-old male patient with undescended testis has a lump in the groin since birth which was increasing since last 6 months. The resected specimen is shown below. All are correct about the condition except:
Kinky hair disease is a disorder where an affected child has peculiar white stubby hair, does not grow, brain degeneration is seen and dies by age of two years. Mrs A is hesitant about having children because her two sisters had sons who died from kinky hair disease. Her mother's brother also died of the same condition. Which of the following is the possible mode of inheritance in her family?
Diseases of Male Genital Tract Indian Medical PG Practice Questions and MCQs
Question 1: Prostatic cancer mostly seen in
- A. Posterior (Correct Answer)
- B. Lateral
- C. Anterior
- D. Medial
Explanation: ***Posterior*** - The **peripheral zone** of the prostate, which is located posteriorly, is the most common site for the development of **prostatic adenocarcinoma**. - This anatomical location is why a **digital rectal exam (DRE)** is an important screening tool, as palpable nodules can be detected [1]. *Lateral* - While prostatic tissue extends laterally, this region is not the predominant site for cancer development. - Cancers originating here are less common than those in the posterior peripheral zone. *Anterior* - The **anterior fibromuscular stroma** and the anterior portion of the prostate are rarely the primary sites for prostate cancer. - Tumors found here are often extensions from more posteriorly located cancers. *Medial* - The **transition zone**, which is located medially and surrounds the urethra, is the most common site for **benign prostatic hyperplasia (BPH)**, not prostate cancer. - While cancer can occur in this zone, it is less frequent than in the peripheral zone.
Question 2: All are true about seminomas except:
- A. Spermatocytic seminoma is slow growing with good prognosis
- B. Almost never occur in infants
- C. Rarely responds to radiotherapy (Correct Answer)
- D. Anaplastic seminoma is associated with a worse prognosis
Explanation: ***Rarely responds to radiotherapy*** - **Seminomas** are highly **radiosensitive** and respond very well to radiotherapy, especially localized disease [3]. - This characteristic makes radiotherapy a primary treatment modality for seminomas with excellent outcomes. *Spermatocytic seminoma is slow growing with good prognosis* - **Spermatocytic seminomas** are a distinct histological subtype, typically seen in older men and are characterized by a **slow growth rate** and an **excellent prognosis** [1]. - They rarely metastasize and are managed with orchiectomy alone. *Anaplastic seminomas is associated with a worse prognosis* - **Anaplastic seminomas** exhibit increased mitotic activity and cellular atypia, suggesting a more aggressive biological behavior. - Although more aggressive than classic seminomas, they generally still respond well to treatment, though the prognosis might be slightly inferior to classic seminoma; however, some sources suggest it does not portend a worse prognosis when matched for stage [1]. *Almost never occur in infants* - **Seminomas** are testicular germ cell tumors that typically affect young to middle-aged adults, with a peak incidence in the third and fourth decades of life. - They are exceedingly rare in infants and children; other germ cell tumors like yolk sac tumors are more common in this age group [2]. **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. 980-982. [2] 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. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 480-481.
Question 3: Identify the condition represented in the image of a testicular tumor.
- A. Non-seminomatous germ cell tumor
- B. Teratoma (testicular tumor)
- C. Seminoma (Correct Answer)
- D. Leydig cell tumor
Explanation: ***Seminoma*** - Seminoma is a type of **germ cell tumor** that typically presents with a **painless testicular mass**, making it one of the common types of testicular cancer [1]. - This condition is characterized by the presence of **large, uniform cells** and is highly sensitive to **radiation therapy**, which aids in management [1]. *Non-seminoma* - Non-seminomas encompass a group of tumors including **embryonal carcinoma**, **choriocarcinoma**, and **yolk sac tumor**, which often present with more variable histological features [1]. - Generally considered more aggressive than seminomas, they may yield **higher levels of tumor markers** such as **AFP** or **hCG** [1]. *Teratoma* - Teratomas typically contain **multiple germ layers (ectoderm, mesoderm, and endoderm)**, often presenting with more complex histopathology compared to seminomas [1]. - They can occur in both children and adults, but in adults, they are often a component of a **non-seminomatous germ cell tumor** instead of a pure form [1,2]. *Germ cell differentiate tumor* - This term broadly refers to any tumor originating from **germ cells**, including both seminomas and non-seminomas, lacking specificity [1]. - It does not reflect the defined characteristics of seminoma and can encompass a range of histological types with diverse behaviors [1]. **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. 979-982. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 512-513.
Question 4: Which among the following is not a premalignant lesion of vulva?
- A. Paget's disease
- B. Bacterial Vaginosis (Correct Answer)
- C. Bowen's disease
- D. Lichen Sclerosus
Explanation: ***Bacterial Vaginosis*** - This is a common **vaginal infection** caused by an imbalance of normal vaginal bacteria, characterized by specific symptoms like increased discharge and odor. - Bacterial vaginosis is not considered a premalignant lesion and does not increase the risk of developing vulvar cancer. *Paget's disease* - This is a rare form of intraepithelial adenocarcinoma that can occur on the vulva, presenting as a red, itchy, scaly rash. - While it is a **carcinoma in situ**, it has the potential to become invasive, thus considered a premalignant or pre-invasive condition. *Bowen's disease* - This is a form of **squamous cell carcinoma in situ (SCCIS)**, typically appearing as a slow-growing, red, scaly patch on the skin. - It is considered a premalignant lesion because it can progress to invasive squamous cell carcinoma if left untreated. *Lichen Sclerosus* - This is a chronic inflammatory skin condition primarily affecting the anogenital region, leading to thinning, whitening, and scarring of the skin. - Although it is a benign condition, individuals with vulvar lichen sclerosus have an increased risk (3-5%) of developing **vulvar squamous cell carcinoma**, making it a premalignant condition.
Question 5: A 36-year-old man presents to his primary care physician complaining of painless enlargement of the testis. Further laboratory studies reveal an increase in serum hCG. Of the following, which is the most likely diagnosis?
- A. Seminoma
- B. Yolk sac tumor
- C. Embryonal carcinoma (Correct Answer)
- D. Dysgerminoma
Explanation: ***Embryonal carcinoma*** - This highly **malignant tumor** often presents with **elevated hCG** and a **firm, painless testicular mass**. - It frequently consists of mixed germ cell tumors, with embryonal components contributing to the hCG surge. - Among the options provided, this is the most likely diagnosis with elevated hCG (note: choriocarcinoma would show the highest hCG levels but is not listed). *Seminoma* - While it causes **painless testicular enlargement**, seminoma is typically associated with **elevated LDH and placental alkaline phosphatase (PLAP)**, not significant hCG elevation. - Pure seminomas occasionally show mild hCG elevation (~10-15% of cases), but this is not their characteristic tumor marker. *Yolk sac tumor* - These tumors are characterized by significantly **elevated alpha-fetoprotein (AFP)** levels. - While they can cause testicular enlargement, hCG elevation is not its primary tumor marker. *Dysgerminoma* - **Dysgerminomas** are a type of **ovarian germ cell tumor**, primarily found in females, and thus highly unlikely in a male patient. - The male equivalent is a **seminoma**, which does not typically show significant hCG elevation.
Question 6: A patient from the Ohio River valley presents with granulomatous prostatitis showing broad-based budding organisms on microscopy. What is the most likely infecting organism?
- A. Escherichia coli
- B. Histoplasma capsulatum
- C. Pseudomonas aeruginosa
- D. Blastomyces dermatitidis (Correct Answer)
Explanation: ***Blastomyces dermatitidis*** - This organism is endemic to the **Ohio River valley** and is known to cause **granulomatous inflammation**, including in the prostate. - Its characteristic morphology is **broad-based budding yeast** on microscopy, fitting the description. *Escherichia coli* - While *E. coli* is a common cause of **bacterial prostatitis**, it does not present as granulomatous inflammation. - It is a **bacterium**, not a fungus, and would not show broad-based budding organisms. *Histoplasma capsulatum* - **Histoplasma** is also endemic to the Ohio River valley and causes granulomatous disease, but its yeast forms are **small**, intracellular, and do not exhibit broad-based budding. - It is often associated with a history of exposure to **bat or bird droppings** and commonly affects the lungs. *Pseudomonas aeruginosa* - *Pseudomonas aeruginosa* causes **bacterial infections**, often in immunocompromised individuals or associated with catheter use, and is not a fungus. - It causes **acute inflammation**, not chronic granulomatous inflammation, and does not show broad-based budding.
Question 7: Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split. Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.
- A. Statements 1 & 2 are correct, 2 is not explaining 1 (Correct Answer)
- B. Statements 1 and 2 are correct and 2 is the correct explanation for 1
- C. Statements 1 and 2 are incorrect
- D. Statement 1 is incorrect
Explanation: ***Correct: Statements 1 & 2 are correct, 2 is not explaining 1*** **Analysis of Statement 1:** - A 59-year-old patient with **flaccid bullae** and **suprabasal acantholytic split** on histopathology is the classic presentation of **Pemphigus vulgaris** - The flaccid (easily ruptured) nature of bullae distinguishes it from tense bullae seen in bullous pemphigoid - The suprabasal location of the split (just above the basal layer) with acantholysis (loss of cell-to-cell adhesion) is pathognomonic - **Statement 1 is CORRECT** ✓ **Analysis of Statement 2:** - The **"row of tombstones" or "tombstone appearance"** is indeed a diagnostic histopathological feature of Pemphigus vulgaris - This appearance results from basal keratinocytes remaining attached to the basement membrane while suprabasal cells separate due to acantholysis - The intact basal cells standing upright resemble a row of tombstones - **Statement 2 is CORRECT** ✓ **Does Statement 2 explain Statement 1?** - Statement 2 describes a **histopathological appearance** (tombstone pattern) that is a **consequence** of the suprabasal split - However, it does NOT explain the **underlying cause** of the flaccid bullae or the suprabasal split - The true explanation involves **IgG autoantibodies against desmoglein 3 (and desmoglein 1)**, which attack intercellular adhesion structures (desmosomes), causing **acantholysis** - Therefore, **Statement 2 does NOT explain Statement 1** ✗ *Incorrect: Statement 2 is the correct explanation for Statement 1* - While both statements describe features of Pemphigus vulgaris, the tombstone appearance is a descriptive finding, not an explanatory mechanism *Incorrect: Statements 1 and 2 are incorrect* - Both statements are medically accurate descriptions of Pemphigus vulgaris features *Incorrect: Statement 1 is incorrect* - Statement 1 correctly describes the cardinal clinical and histopathological features of Pemphigus vulgaris
Question 8: The following is a post-orchidectomy histopathological specimen. Diagnosis is:
- A. Seminoma (Correct Answer)
- B. Teratoma
- C. Lymphoma
- D. Yolk sac tumor
Explanation: ***Seminoma*** - The image shows a **monotonous population of large, clear cells** with prominent nucleoli and distinct cell borders, arranged in lobules separated by fibrous septa with **lymphocytic infiltration** [1]. - This classic histological appearance, along with the presence of **syncytiotrophoblasts** (though not explicitly mentioned as a key feature for diagnosis from this image alone, it can be seen in some seminomas), is characteristic of **seminoma**, the most common germ cell tumor of the testis [1]. *Teratoma* - Teratomas are characterized by the presence of **multiple germ layers** (ectoderm, mesoderm, endoderm) with various differentiated tissues like cartilage, bone, neural tissue, or glandular structures [1]. - The image does not show the **heterogeneous tissue differentiation** typical of a teratoma. *Lymphoma* - Testicular lymphoma typically presents with a **diffuse infiltrate of atypical lymphoid cells**, often with a high mitotic rate, and lacks the clear cell appearance and fibrous septa seen in the image. - It is more common in **older men** and can be bilateral, unlike the typical presentation of seminoma. *Yolk sac tumor* - Yolk sac tumors (endodermal sinus tumors) are characterized by various architectural patterns, including **reticular, microcystic, solid, and papillary**, often with **Schiller-Duval bodies** (glomeruloid structures) [1]. - The image does not display these specific patterns or the characteristic Schiller-Duval bodies. **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. 979-982.
Question 9: A 24 -year-old male patient with undescended testis has a lump in the groin since birth which was increasing since last 6 months. The resected specimen is shown below. All are correct about the condition except:
- A. Does not invade the tunica (Correct Answer)
- B. Tumor maintains the testis contour
- C. Necrosis commonly starts from center of tumor
- D. PAS positive tumor cells in sheets
Explanation: ***Does not invade the tunica*** - This statement is incorrect. **Seminomas**, which are common in undescended testes, often **invade the tunica albuginea** and rete testis. - Invasion of the tunica is a common feature of testicular germ cell tumors, including seminoma, and is an important prognostic factor. *Tumor maintains the testis contour* - **Seminomas** typically grow as a large, homogeneous mass that can **replace the testicular parenchyma** but often maintains the overall contour of the testis. - The tumor expands within the tunica albuginea, leading to an enlarged but often still ovoid shape of the testis. *Necrosis commonly starts from center of tumor* - **Necrosis** is a common feature in larger **seminomas**, and it typically starts in the **center of the tumor** due to inadequate blood supply as the tumor outgrows its vascularization. - This central necrosis can lead to cystic degeneration within the tumor. *PAS positive tumor cells in sheets* - **Seminoma cells** are typically rich in **glycogen**, which stains **PAS (Periodic Acid-Schiff) positive** [1]. - These cells are characteristically arranged in **sheets or lobules** separated by delicate fibrovascular septa, often with a prominent lymphocytic infiltrate [1]. **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. 980-982.
Question 10: Kinky hair disease is a disorder where an affected child has peculiar white stubby hair, does not grow, brain degeneration is seen and dies by age of two years. Mrs A is hesitant about having children because her two sisters had sons who died from kinky hair disease. Her mother's brother also died of the same condition. Which of the following is the possible mode of inheritance in her family?
- A. X-linked recessive (Correct Answer)
- B. Autosomal dominant
- C. X-linked dominant
- D. Autosomal recessive
Explanation: ***X-linked recessive*** - Kinky hair disease (Menkes disease) is an **X-linked recessive disorder**, meaning that males are predominantly affected, and females are carriers. - The pattern of inheritance in the family (sons of sisters, and a maternal uncle affected) is highly suggestive of **X-linked recessive inheritance**, as healthy female carriers can pass the gene to their sons. *Autosomal dominant* - In **autosomal dominant** inheritance, the disease would affect individuals in every generation, and both males and females would be affected equally. - This pattern of inheritance does not explain why only sons are dying and why sisters (who are likely carriers) are unaffected but have affected children. *X-linked dominant* - In **X-linked dominant** inheritance, affected fathers would pass the trait to all their daughters, and affected mothers would pass it to half of their children. - The disease would also be more common in females, which contradicts the described pattern of only sons being affected and dying. *Autosomal recessive* - In **autosomal recessive** inheritance, both parents must be carriers for a child to be affected, and typically, there would be a 25% chance of recurrence in each pregnancy. - This mode doesn't explain the observation of affected maternal uncles and sons from sisters, which points more directly to an X-linked pattern where females are carriers.
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