Reproductive Pathology Practice Questions

Q: An obese woman with type 2 diabetes and hypertension is diagnosed with endometrioid type of endometrial carcinoma. What is the most likely gene defect in this patient?

PTEN. **Explanation:** Endometrial carcinoma is broadly classified into two types. This patient presents with the classic profile for **Type I (Endometrioid) Adenocarcinoma** [1]. **1. Why PTEN is correct:** Type I endometrial carcinoma is estrogen-dependent and typically arises in the setting of obesity, diabetes, and hypertension (the "metabolic syndrome" triad). These factors lead to chronic unopposed estrogen stimulation and endometrial hyperplasia [1]. The most common genetic mutation in Type I carcinoma (seen in 30-80% of cases) is the **PTEN tumor suppressor gene** mutation on chromosome 10q23 [1]. This mutation leads to increased PI3K/AKT pathway signaling, promoting cell survival and proliferation [1]. **2. Why other options are incorrect:** * **P53:** Mutations in TP53 are the hallmark of **Type II (Serous) Endometrial Carcinoma** [1]. Type II tumors are estrogen-independent, occur in older, thin women, and are highly aggressive [1]. * **MSH2:** This is a DNA mismatch repair (MMR) gene associated with **Lynch Syndrome** (HNPCC). While Lynch syndrome increases the risk of endometrioid cancer, PTEN is the more frequent sporadic mutation associated with the clinical triad described [1]. * **BRCA2:** Primarily associated with hereditary breast and ovarian cancer syndromes, not typically the primary driver for endometrioid endometrial carcinoma. **Clinical Pearls for NEET-PG:** * **Precursor Lesion:** Type I arises from *Atypical Hyperplasia*; Type II arises from *Serous Endometrial Intraepithelial Carcinoma (SEIC)* [1]. * **PTEN** is also the mutated gene in **Cowden Syndrome**, which presents with multiple hamartomas and increased risk of endometrial and breast cancers. * **KRAS and ARID1A** are other high-yield mutations associated with Type I (Endometrioid) carcinoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1016-1022.

Q: Call Exner bodies are seen in which of the following conditions?

Granulosa cell tumor. **Explanation:** **Call-Exner bodies** are the pathognomonic histological hallmark of **Granulosa Cell Tumors (GCT)**, specifically the adult type. These are small, fluid-filled spaces surrounded by granulosa cells arranged in a rosette-like pattern. The spaces contain eosinophilic material (secreted basement membrane components) and often resemble primitive follicles. * **Granulosa Cell Tumor (Correct):** These are sex cord-stromal tumors. Histologically, they show "coffee-bean" nuclei (due to longitudinal grooves) and Call-Exner bodies. Clinically, they are known for producing **estrogen**, leading to precocious puberty in children or endometrial hyperplasia/carcinoma in postmenopausal women. **Inhibin** is the specific serum marker used for diagnosis and monitoring recurrence [1]. **Why other options are incorrect:** * **Mature Teratoma:** A germ cell tumor containing tissues from all three germ layers (ectoderm, mesoderm, endoderm). Characteristic findings include hair, sebum, and teeth, but not Call-Exner bodies. * **Endodermal Sinus Tumor (Yolk Sac Tumor):** Characterized by **Schiller-Duval bodies** (glomeruloid-like structures) and elevated **Alpha-Fetoprotein (AFP)** levels. * **Sertoli-Leydig Cell Tumor:** These typically show tubules lined by Sertoli cells and clusters of Leydig cells containing **Reinke crystals**. They usually present with virilization due to androgen production. **High-Yield Clinical Pearls for NEET-PG:** * **Schiller-Duval bodies:** Yolk Sac Tumor. * **Reinke Crystals:** Leydig cell tumor. * **Psammoma bodies:** Serous cystadenocarcinoma. * **Hobnail cells:** Clear cell carcinoma of the ovary. * **Coffee-bean nuclei:** Granulosa cell tumor and Brenner tumor. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1036-1037.

Question 1

What is the cause for nipple retraction in breast carcinoma?

Accepted Answer

Infiltration of ducts

Answer

Blocking of lymphatics

Answer

Involvement of the Cooper's ligament

Answer

Skin infiltration

Question 2

A 21-year-old woman is in the third trimester of an uncomplicated pregnancy. She has noted an enlarging nodule in her mouth for the past 2 weeks. On physical examination, there is a 1-cm red nodule on the left lateral gingiva below the first molar. The nodule regresses following delivery. What is this nodule most likely to be?

Accepted Answer

Capillary hemangioma

Answer

Bacillary angiomatosis

Answer

Cavernous lymphangioma

Answer

Glomus tumor

Question 3

An obese woman with type 2 diabetes and hypertension is diagnosed with endometrioid type of endometrial carcinoma. What is the most likely gene defect in this patient?

Accepted Answer

PTEN

Answer

P53

Answer

MSH2

Answer

BRCA2

Question 4

With regard to the malignant behavior of leiomyosarcoma, what is the most important criterion?

Accepted Answer

The number of mitoses per high power field

Answer

Blood vessel penetration by tumor cells

Answer

Tumor cells in lymphatic channels

Answer

Lymphocyte infiltration

Question 5

Ingestion of which of the following drugs during pregnancy increases the risk of vaginal adenocarcinoma in a female offspring?

Accepted Answer

Diethyl stilbestrol

Answer

Chlorpropamide

Answer

Progesterone

Answer

Chloramphenicol

Question 6

Which of the following tumors shows increased -kit expression?

Accepted Answer

Seminoma

Answer

Yolk sac tumor

Answer

Embryonal carcinoma

Answer

Choriocarcinoma

Question 7

Call Exner bodies are seen in which of the following conditions?

Accepted Answer

Granulosa cell tumor

Answer

Mature teratoma

Answer

Endodermal sinus tumor

Answer

Sertoli-Leydig cell tumor

Question 8

A 25-year-old woman died shortly after childbirth. Autopsy revealed the presence of hair, fat, and epithelial cells within the pulmonary vessels. What is the probable cause of death?

Accepted Answer

Amniotic fluid embolism

Answer

Fat embolism

Answer

Disseminated intravascular coagulation (DIC)

Answer

Pulmonary thromboembolism

Question 9

A patient develops an ovarian mass that is picked up on pelvic examination. Resection of the mass demonstrates a lymphoma composed of small lymphocytes with interspersed macrophages surrounded by clear spaces. This lesion would be most likely to be associated with which of the following?

Accepted Answer

c-MYC activation

Answer

ABL-BCR hybrid

Answer

BCL-2 activation

Answer

t(9;22)

Question 10

Which of the following substances is secreted by non-seminomatous germ cell tumors of the testis?

Accepted Answer

Alpha-fetoprotein (AFP)

Answer

Carcinoembryonic antigen (CEA)

Answer

Acid phosphatase

Answer

Cytokeratin

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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