Reproductive Pathology Practice Questions

Q: A patient with chronic pelvic pain undergoes a hysterectomy. The resected uterus is filled with nodules composed of benign smooth muscle cells. Which of the following terms best describes these nodules?

Leiomyoma. ### **Explanation** **Correct Answer: B. Leiomyoma** **Concept:** The question describes a common benign tumor of the uterus. In pathology, the suffix **"-oma"** denotes a benign neoplasm, while the prefix **"leiomyo-"** refers to smooth muscle. Since the uterus is primarily composed of smooth muscle (myometrium) and the nodules are described as **benign**, the correct term is **Leiomyoma** (commonly known as fibroids) [1]. These are the most common tumors in women of reproductive age. **Analysis of Incorrect Options:** * **A. Angiosarcoma:** This is a highly malignant neoplasm arising from vascular endothelial cells (blood vessels), not smooth muscle. * **C. Leiomyosarcoma:** The suffix **"-sarcoma"** indicates a malignant tumor of mesenchymal origin. While it arises from smooth muscle, the question explicitly states the cells are "benign." Note: Leiomyosarcomas typically arise *de novo*, not from pre-existing leiomyomas [1]. * **D. Rhabdomyoma:** The prefix **"rhabdomyo-"** refers to striated (skeletal or cardiac) muscle. These are rare in the uterus and are more commonly associated with the heart (e.g., in Tuberous Sclerosis). **Clinical Pearls for NEET-PG:** * **Gross Appearance:** Classically described as firm, grey-white, **whorled** (bundles of smooth muscle) nodules with a distinct "pseudo-capsule" [1]. * **Estrogen Dependency:** They are sensitive to estrogen; they often enlarge during pregnancy and shrink after menopause. * **Microscopy:** Characterized by bundles of spindle-shaped smooth muscle cells with "cigar-shaped" nuclei and minimal mitotic activity. * **Key Distinction:** Unlike Leiomyomas, **Leiomyosarcomas** show nuclear atypia, high mitotic index, and **zonal necrosis** [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1024-1025.

Q: What is true about Yolk sac tumors?

All of the above.. **Explanation:** Yolk Sac Tumor (YST), also known as **Endodermal Sinus Tumor**, is the most common germ cell tumor in infants and children (typically under 3 years of age) [1]. In adults, it is frequently seen as a component of mixed germ cell tumors [2]. * **Option A:** It is histologically characterized by structures resembling the primitive yolk sac or the **endodermal sinus** of the rat placenta, hence the synonym. * **Option B:** YST is a highly vascular and aggressive tumor that characteristically produces **Alpha-Fetoprotein (AFP)**. Serum AFP levels are a sensitive marker for diagnosis, monitoring treatment response, and detecting recurrence. * **Option C:** The pathognomonic histological feature is the **Schiller-Duval body**. This consists of a central blood vessel surrounded by germ cells, situated within a space lined by flattened cells (resembling a primitive glomerulus). Clinically, these tumors are **highly malignant** and aggressive but respond well to chemotherapy (e.g., BEP regimen). **High-Yield Clinical Pearls for NEET-PG:** * **Microscopic appearance:** Apart from Schiller-Duval bodies, look for **eosinophilic hyaline droplets** (containing AFP and Alpha-1-antitrypsin). * **Immunohistochemistry (IHC):** Positive for **AFP** and **Glypican-3**. * **Age Distribution:** Pure YST is common in children (good prognosis); mixed YST is common in adults (worse prognosis) [1]. * **Gross Appearance:** Large, non-encapsulated, multicystic mass with areas of hemorrhage and necrosis. **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. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1035-1036.

Q: A Krukenberg tumor originates from which of the following?

Stomach. **Explanation:** A **Krukenberg tumor** is a specific type of metastatic signet-ring cell carcinoma of the ovary. The defining feature of this tumor is that it is **secondary** (metastatic) rather than primary. 1. **Why Stomach is Correct:** The most common primary site of origin for a Krukenberg tumor is the **Stomach** (specifically gastric adenocarcinoma). The cancer cells typically spread via retrograde lymphatic dissemination or transcoelomic seeding to involve both ovaries [1]. Histologically, these tumors are characterized by **signet-ring cells** (mucin-filled cells that displace the nucleus to the periphery) within a cellular spindle cell stroma [1]. 2. **Why Incorrect Options are Wrong:** * **Ovary:** While the tumor is *located* in the ovary, it does not *originate* there. A primary ovarian signet-ring cell carcinoma is extremely rare; by definition, a Krukenberg tumor refers to the metastatic form. * **Liver & Gallbladder:** While these are GI-related organs, they are rare primary sites for Krukenberg tumors. After the stomach, the next most common sites are the colon, appendix, and breast. **High-Yield Clinical Pearls for NEET-PG:** * **Bilateral Involvement:** Krukenberg tumors are classically **bilateral** (80% of cases). If a signet-ring tumor is unilateral, clinicians should investigate for a primary ovarian origin. * **Histology:** Look for the "Signet-ring" appearance (PAS positive mucin) [1]. * **Route of Spread:** Though traditionally thought to be transcoelomic (seeding across the peritoneal cavity), **retrograde lymphatic spread** is now considered the most likely pathway. * **Sister Mary Joseph Nodule:** Often associated with the same primary (gastric cancer), referring to metastasis to the umbilicus. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 779.

Question 1

Paget's disease of the nipple is classified as which of the following?

Accepted Answer

Neoplasia

Answer

Infection

Answer

Dermatitis

Answer

Hypopigmentation

Question 2

A patient with chronic pelvic pain undergoes a hysterectomy. The resected uterus is filled with nodules composed of benign smooth muscle cells. Which of the following terms best describes these nodules?

Accepted Answer

Leiomyoma

Answer

Angiosarcoma

Answer

Leiomyosarcoma

Answer

Rhabdomyoma

Question 3

Vaginal adenocarcinomas in children are caused by what?

Accepted Answer

Administration of diethylstilbestrol (DES) to pregnant mothers

Answer

Virus

Answer

Hormonal changes

Answer

All of the above

Question 4

What is true about Yolk sac tumors?

Accepted Answer

All of the above.

Answer

Also called endodermal sinus tumor.

Answer

Always have elevated AFP levels.

Answer

Schiller-Duval bodies are seen, and they are highly malignant.

Question 5

What is the tumor marker for seminoma of the testis?

Accepted Answer

Lactate dehydrogenase

Answer

Alpha-fetoprotein

Answer

Carcinoembryonic antigen

Answer

Alpha HCG

Question 6

Which of the following is not a marker of seminoma?

Accepted Answer

Alpha fetoprotein

Answer

PLAP

Answer

Beta HCG

Answer

LDH

Question 7

Sarcoma botryoides is also known as?

Accepted Answer

Embryonal Rhabdomyosarcoma

Answer

Alveolar Rhabdomyosarcoma

Answer

Leiomyosarcoma

Answer

Lipoblastomatosis

Question 8

Blood chimerism is most likely to occur in which of the following types of twin pregnancies?

Accepted Answer

Monochorionic dizygotic twins

Answer

Monochorionic monozygotic twins

Answer

Dichorionic dizygotic twins

Answer

Singleton pregnancy

Question 9

A female patient reports smoking 20 cigarettes a day. To which of the following conditions is she maximally predisposed?

Accepted Answer

Squamous metaplasia of lactiferous ducts

Answer

Acute mastitis

Answer

Granulomatous mastitis

Answer

Fat necrosis

Question 10

A Krukenberg tumor originates from which of the following?

Accepted Answer

Stomach

Answer

Liver

Answer

Ovary

Answer

Gallbladder

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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