Reproductive Pathology Practice Questions

Q: A hysterectomy specimen from a 38-year-old woman shows the following gross appearance. What is the most likely diagnosis?

Leiomyoma Uterus. ***Leiomyoma Uterus*** - **Well-circumscribed** nodular masses with a **whorled, white-grey appearance** and **pseudocapsule** are characteristic of leiomyomas on gross examination. - Common in **reproductive-age women** (like this 38-year-old), representing the most frequent **benign smooth muscle tumor** of the uterus. *Endometrial Carcinoma* - Typically presents as a **friable, hemorrhagic mass** arising from the **endometrial cavity**, not as circumscribed nodules in the myometrium. - More common in **postmenopausal women** and would show **irregular, soft tissue** rather than the firm, whorled appearance of leiomyomas. *Leiomyosarcoma* - Shows **irregular borders**, **areas of necrosis**, and **hemorrhage** on gross examination, unlike the well-demarcated appearance described. - Typically presents as a **large, soft mass** with **fish-flesh appearance** and lacks the characteristic whorled pattern of benign leiomyomas. *Mixed Mullerian Tumor* - Presents as a **large, polypoid mass** protruding into the **endometrial cavity** with **necrotic and hemorrhagic areas**. - Primarily occurs in **elderly postmenopausal women** (mean age 60-70 years) and shows **heterogeneous appearance** rather than circumscribed nodules.

Q: What is the origin of cancer cells in a Krukenberg tumour?

Gastric carcinoma. **Explanation:** A **Krukenberg tumour** refers to a metastatic signet-ring cell carcinoma of the ovary. The hallmark of this pathology is the presence of mucin-secreting "signet-ring" cells infiltrating the ovarian stroma, typically presenting as bilateral, solid ovarian masses. **Why Gastric Carcinoma is correct:** The most common primary site for a Krukenberg tumour is the **stomach** (specifically the diffuse type of gastric adenocarcinoma). Malignant cells spread to the ovaries most commonly via **retrograde lymphatic dissemination**, though transcoelomic (peritoneal) seeding is also a recognized pathway. **Why other options are incorrect:** * **Ovarian carcinoma:** This refers to a primary malignancy arising from the ovary itself (e.g., Serous cystadenocarcinoma). By definition, a Krukenberg tumour is a *metastatic* lesion, not a primary one. * **Duodenal/Pancreatic carcinoma:** While these GI malignancies can occasionally metastasize to the ovary, they are significantly less common causes and do not typically present with the classic signet-ring morphology associated with the Krukenberg definition. **High-Yield NEET-PG Pearls:** 1. **Bilateralism:** Approximately 80% of Krukenberg tumours are bilateral. 2. **Microscopy:** Look for **Signet-ring cells** (nucleus pushed to the periphery by a large mucin vacuole) and a dense, reactive fibroblastic stroma (sarcomatoid reaction). 3. **Primary Sites:** Stomach (>70%) is #1, followed by the colon, breast (lobular carcinoma), and appendix [1]. 4. **Clinical Sign:** Often presents as a palpable pelvic mass in a patient with a history of dyspepsia or weight loss. 5. **Stain:** Mucin can be highlighted using **PAS (Periodic Acid-Schiff)** or **Mucicarmine** stains. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 478-480.

Question 1

A hysterectomy specimen from a 38-year-old woman shows the following gross appearance. What is the most likely diagnosis?

Accepted Answer

Leiomyoma Uterus

Answer

Endometrial Carcinoma

Answer

Leiomyosarcoma

Answer

Mixed Mullerian Tumor

Question 2

Which of the following is not a sex cord-stromal tumor?

Accepted Answer

Yolk sac tumor

Answer

Granulosa cell tumor

Answer

Leydig cell tumor

Answer

Sertoli cell tumor

Question 3

According to the Bethesda System, in 'LSIL' histologic changes are observed in which part of the cervix?

Accepted Answer

Basal one-third

Answer

Basal half to two-thirds

Answer

Whole thickness except superficial layers

Answer

Whole thickness

Question 4

Biopsy from a testicular mass following orchidectomy showed sheets of uniform cells containing abundant clear cytoplasm with prominent nucleus. Which is the histopathological diagnosis?

Accepted Answer

Seminoma

Answer

Embryonal Carcinoma

Answer

Lymphoma

Answer

Teratoma

Question 5

What is the origin of cancer cells in a Krukenberg tumour?

Accepted Answer

Gastric carcinoma

Answer

Ovarian carcinoma

Answer

Duodenal carcinoma

Answer

Pancreatic carcinoma

Question 6

What is true about the histology of infiltrating lobular breast carcinoma?

Accepted Answer

Single file pattern

Answer

Pleomorphic cells in sheets

Answer

Cribriform pattern

Answer

Pinwheel pattern

Question 7

What condition presents the maximum risk of invasive breast carcinoma?

Accepted Answer

Atypical ductal hyperplasia

Answer

Complex fibroadenoma

Answer

Sclerosing adenosis

Answer

Intraductal papilloma

Question 8

What is the most common age group for leiomyosarcoma?

Accepted Answer

40 - 60 years

Answer

20 - 40 years

Answer

30 - 50 years

Answer

50 - 70 years

Question 9

Gleason's classification is used for which of the following conditions?

Accepted Answer

Carcinoma of the prostate

Answer

Carcinoma of the breast

Answer

Carcinoma of the pancreas

Answer

Carcinoma of the rectum

Question 10

Which among the following are testicular tumor markers?

Accepted Answer

b-hCG, AFP, and LDH are true markers, while CA-125 and CEA are false.

Answer

b-hCG, AFP, and LDH are false markers, while CA-125 and CEA are true.

Answer

b-hCG, AFP, and CEA are false markers, while LDH and CA-125 are true.

Answer

b-hCG, AFP, and CEA are true markers, while LDH and CA-125 are false.

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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