Reproductive Pathology Practice Questions

Q: Which of the following is NOT associated with arrhenoblastoma?

Call Exner bodies. **Explanation:** **Arrhenoblastoma** (also known as a **Sertoli-Leydig Cell Tumor**) is a rare sex cord-stromal tumor of the ovary [1]. The correct answer is **Call-Exner bodies**, as these are the pathognomonic histological hallmark of **Granulosa Cell Tumors**, not arrhenoblastomas. 1. **Why Call-Exner bodies is the correct answer:** Call-Exner bodies are small, gland-like spaces filled with eosinophilic material and basement membrane components, surrounded by granulosa cells. They are characteristic of adult-type Granulosa Cell Tumors. Their presence in a question regarding arrhenoblastoma represents a classic "distractor" between two different types of sex cord-stromal tumors. 2. **Analysis of Incorrect Options:** * **CD56:** This is a sensitive immunohistochemical marker for sex cord-stromal tumors, including Sertoli-Leydig cell tumors. * **Sex cord-stromal tumor:** Arrhenoblastoma belongs to this category of ovarian neoplasms, which arise from the ovarian mesenchyme (the precursors to Sertoli, Leydig, Granulosa, and Theca cells) [1]. * **Masculinizing tumor:** These tumors typically secrete androgens (testosterone). Clinically, patients present with **defeminization** (atrophy of breasts, amenorrhea) followed by **virilization** (hirsutism, clitoromegaly, and deepening of the voice) [1]. **High-Yield NEET-PG Pearls:** * **Reinke Crystals:** Characteristic rod-shaped inclusions found in the Leydig cell component of these tumors (though only present in about 35% of cases) [1]. * **DICER1 Mutation:** Frequently associated with moderately and poorly differentiated Sertoli-Leydig cell tumors. * **Tumor Marker:** Often associated with elevated **Alpha-fetoprotein (AFP)** in cases with heterologous elements (like hepatoid differentiation). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1037-1038.

Q: Which of the following is NOT associated with breast cancer?

Apocrine metaplasia. **Explanation:** The risk of developing breast cancer is categorized based on the histological findings of benign breast lesions [1]. **1. Why Apocrine Metaplasia is the correct answer:** Apocrine metaplasia is a feature of **Non-proliferative Breast Disease (Fibrocystic changes)** [1]. In this condition, the cuboidal epithelium of the acini undergoes transformation into large columnar cells with granular eosinophilic cytoplasm (resembling sweat glands). This change, along with simple cysts and fibrosis, carries **no increased risk (Relative Risk 1.0)** for developing invasive carcinoma. **2. Analysis of Incorrect Options:** * **BRCA 1 & BRCA 2 mutations:** These are high-penetrance germline mutations. BRCA1 (Chromosome 17q) and BRCA2 (Chromosome 13q) are tumor suppressor genes involved in DNA repair. Mutations significantly increase the lifetime risk of breast and ovarian cancer. * **Atypical Ductal Hyperplasia (ADH):** This falls under **Proliferative disease with atypia** [2]. It histologically resembles ductal carcinoma in situ (DCIS) but is limited in extent [2]. It carries a **high risk (Relative Risk 4.0–5.0)** of progressing to invasive cancer. **3. High-Yield Clinical Pearls for NEET-PG:** * **No Risk (RR 1.0):** Apocrine metaplasia, cysts, mild hyperplasia, fibroadenoma (without complex features). * **Slightly Increased Risk (RR 1.5–2.0):** Moderate to florid hyperplasia (without atypia), ductal papillomatosis, sclerosing adenosis. * **Significantly Increased Risk (RR 4.0–5.0):** Atypical ductal hyperplasia (ADH) and Atypical lobular hyperplasia (ALH) [2]. * **Highest Risk:** Carcinoma in situ (DCIS/LCIS) carries an RR of 8.0–10.0. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1052. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1054-1056.

Q: What defines true hermaphroditism?

Presence of both ovarian and testicular tissues. **Explanation:** **True Hermaphroditism** (now clinically termed **Ovotesticular Disorder of Sex Development**) is defined strictly by the histological presence of **both ovarian and testicular tissue** in the same individual. This can occur in three patterns: 1. **Lateral:** A testis on one side and an ovary on the other. 2. **Bilateral:** Ovotestes (gonads containing both elements) on both sides. 3. **Unilateral:** An ovotestis on one side and an ovary or testis on the other. **Analysis of Options:** * **Option A (Correct):** The defining feature is the gonadal tissue, not the external appearance. The most common karyotype is **46,XX** (approx. 60%), followed by mosaicism (e.g., 46,XX/46,XY). * **Option B (Incorrect):** Ambiguous external genitalia are common in many Disorders of Sex Development (DSDs), such as Congenital Adrenal Hyperplasia (Female Pseudohermaphroditism) or Androgen Insensitivity Syndrome (Male Pseudohermaphroditism), and are not pathognomonic for true hermaphroditism. * **Option C (Incorrect):** This describes **Gender Dysphoria** or gender identity disorders, which are psychological/behavioral and not defined by gonadal histology. **High-Yield Clinical Pearls for NEET-PG:** * **Most common karyotype:** 46,XX. * **Most common gonad:** The **Ovotestis** is the most frequent finding. * **Internal structures:** Usually follow the adjacent gonad (e.g., a fallopian tube is present on the side of an ovary). * **Malignancy risk:** There is an increased risk of **gonadoblastoma**, especially if a Y chromosome is present. * **Distinction:** Pseudohermaphroditism is defined by a mismatch between *chromosomal/gonadal sex* and *phenotypic sex* (e.g., a 46,XX individual with ovaries but virilized external genitalia).

Question 1

Which of the following is NOT associated with arrhenoblastoma?

Accepted Answer

Call Exner bodies

Answer

CD56

Answer

Sex cord stromal tumor

Answer

Musculanising tumor

Question 2

What is the most common malignant germ cell tumor of the testis?

Accepted Answer

Choriocarcinoma

Answer

Seminoma

Answer

Teratoma

Answer

Embryonal carcinoma

Question 3

A 32-year-old male presents with a few weeks' history of progressive breast tissue enlargement. On examination, a painless testicular mass is noted. Hormonal investigations reveal low serum LH and testosterone levels. What is the likely cause in this case?

Accepted Answer

Sertoli cell tumor

Answer

Spermatocytic tumor

Answer

Androgen resistance state

Answer

Gonadotropin-secreting tumor

Question 4

Which of the following is NOT associated with breast cancer?

Accepted Answer

Apocrine metaplasia

Answer

BRCA 1 & BRCA 2 mutations

Answer

Atypical ductal hyperplasia

Answer

All of the above

Question 5

Koilocytes with perinuclear halo on Pap smear are pathognomic of which condition?

Accepted Answer

HPV infection

Answer

Metaplasia

Answer

Dysplasia

Answer

Bacterial vaginosis

Question 6

Singnet ring appearance in an ovarian tumour is characteristic of which of the following?

Accepted Answer

Krukenberg's tumour

Answer

Dysgerminoma

Answer

Granulosa cell carcinoma

Answer

Papillary cystadenocarcinoma

Question 7

What defines true hermaphroditism?

Accepted Answer

Presence of both ovarian and testicular tissues

Answer

Presence of both male and female external genitalia

Answer

Behavioral sex incongruence with chromosomal sex

Answer

None of the above

Question 8

An obese diabetic woman presents with menorrhagia. Endometrial biopsy demonstrates endometrial carcinoma. What is the most probable gene associated with this carcinoma?

Accepted Answer

PTEN

Answer

TP53

Answer

CDH4

Answer

C-myc

Question 9

Which of the following causes orchitis without epididymitis?

Accepted Answer

Syphilis

Answer

Tuberculosis

Answer

Gonorrhoea

Answer

Chlamydia trachomatis

Question 10

What is the most common type of testicular tumor?

Accepted Answer

Seminoma

Answer

Teratoma

Answer

Sertoli cell tumor

Answer

Choriocarcinoma

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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