Reproductive Pathology — MCQs

A 17-year-old primigravida complained of decreased fetal movements. She delivered a baby weighing 2000gms at 30 weeks of gestation. The Apgar scores of the baby were 4 and 5 at 1 and 5 minutes respectively. The baby died within an hour. A post-mortem examination revealed multiple, peripheral, radially arranged cysts in the kidney. What is the most common associated finding with this condition?

Q176Medium

Conventional cytogenetics are difficult in solid tumors, especially in cases of Ca Cx, due to what reason?

Q177Medium

Which of the following germ cell tumors is not common in young males?

Q178Easy

“Call-Exner bodies” are seen in which of the following tumors?

Q179Medium

A 49-year-old female presented with postmenopausal bleeding and a uterine cavity growth on sonography. During surgery, the growth is large, multicystic, and exceeds 10 cm in diameter. Granulosa cell tumor is suspected. What characteristic histological finding helps distinguish granulosa cell tumor from other uterine tumors?

Q180Easy

A blighted ovum is characterized by which of the following?

Reproductive Pathology Indian Medical PG Practice Questions and MCQs

Question 171: What is the most common carcinoma of the breast?

A. Ductal carcinoma (Correct Answer)
B. Mucinous carcinoma
C. Lobular carcinoma
D. Neuroendocrine carcinoma

Explanation: **Explanation:** **Ductal Carcinoma (Invasive Carcinoma of No Special Type - NST)** is the most common histological type of breast cancer, accounting for approximately **70–80%** of all invasive breast malignancies [1]. It originates from the terminal duct lobular unit (TDLU). On gross examination, it typically presents as a firm, hard, "scirrhous" mass with irregular borders due to a prominent stromal desmoplastic reaction [1]. **Analysis of Incorrect Options:** * **Lobular Carcinoma:** This is the second most common type (approx. 10–15%) [2]. It is characterized by a loss of **E-cadherin** expression, leading to the classic "single-file" or "indian file" pattern of cells [2]. It has a higher propensity for being bilateral and multicentric. * **Mucinous (Colloid) Carcinoma:** A rare subtype (approx. 2%) usually seen in elderly women. It is characterized by clusters of tumor cells floating in "lakes of extracellular mucin" and generally carries a better prognosis. * **Neuroendocrine Carcinoma:** An extremely rare primary breast malignancy. Most neuroendocrine tumors found in the breast are actually metastatic from other sites (e.g., lung or GI tract). **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Upper Outer Quadrant (50%). * **Molecular Subtypes:** Luminal A (ER+, PR+, HER2-) is the most common molecular subtype and has the best prognosis [3]. * **Staging:** The most important prognostic factor for breast cancer is **axillary lymph node metastasis**. * **Mammography:** Look for "stellate" lesions or "pleomorphic microcalcifications" as early signs of malignancy. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1068. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 454-455. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1056.

Question 172: Which of the following is associated with Paget's disease of the mammary gland?

A. S-100
B. HMB 45
C. CEA (Correct Answer)
D. Neuron specific enolase

Explanation: **Explanation:** **Paget’s disease of the breast** is a condition where malignant glandular cells (Paget cells) infiltrate the epidermis of the nipple and areola [1, 2]. These cells almost always arise from an underlying **ductal carcinoma in situ (DCIS)** or invasive ductal carcinoma [1]. **Why CEA is the correct answer:** Paget cells are of **glandular (epithelial) origin**. Therefore, they express markers typical of adenocarcinoma. **Carcinoembryonic Antigen (CEA)** is a classic oncofetal glycoprotein expressed by glandular cells. In immunohistochemistry (IHC), Paget cells typically stain positive for **CEA, EMA (Epithelial Membrane Antigen), and Low Molecular Weight Keratin (CAM 5.2)**. They are also frequently HER2/neu positive [1]. **Analysis of Incorrect Options:** * **A. S-100:** This is a marker for cells derived from the neural crest (e.g., melanocytes, Schwann cells) and chondrocytes. While it can be positive in melanoma, it is generally negative in Paget’s disease. * **B. HMB 45:** This is a highly specific marker for **Melanoma**. Since Paget’s disease can clinically mimic superficial spreading melanoma (both present as pigmented/crusted nipple lesions), HMB 45 is used to rule out melanoma. Paget cells are HMB 45 negative. * **C. Neuron Specific Enolase (NSE):** This is a marker for neuroendocrine tumors and small cell carcinomas. It has no diagnostic utility for mammary Paget’s disease. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Unilateral, eczematous, or crusting lesion of the nipple that does not heal with topical steroids [1]. * **Histology:** Large, pale cells with abundant cytoplasm and prominent nucleoli (Paget cells) found within the squamous epithelium [1, 2]. * **Staining:** Paget cells are **PAS positive** (due to mucin content), unlike melanoma cells. * **Extramammary Paget’s Disease:** Most commonly occurs on the **vulva**; unlike the breast version, it is less frequently associated with an underlying internal malignancy. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1061-1062. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 456-457.

Question 173: A 20-year-old female was diagnosed with granulosa cell tumor of the ovary. Which of the following biomarkers would be most useful for diagnosis and follow-up of the patient?

A. Neuron-specific enolase
B. Inhibin (Correct Answer)
C. CA 19-9
D. CA 50

Explanation: ### **Explanation** **Correct Option: B. Inhibin** Granulosa cell tumors (GCTs) are the most common malignant sex cord-stromal tumors of the ovary. They are derived from granulosa cells, which physiologically produce **Inhibin** (specifically Inhibin B) [1] to provide negative feedback on FSH. In patients with GCTs, Inhibin levels are significantly elevated due to the proliferation of these cells. It serves as a highly specific and sensitive marker for both the **initial diagnosis** and, more importantly, for **monitoring recurrence** after surgical resection [1]. **Incorrect Options:** * **A. Neuron-specific enolase (NSE):** This is a marker for neuroendocrine tumors (e.g., Small cell carcinoma of the lung, Neuroblastoma) and certain germ cell tumors like Dysgerminoma. * **C. CA 19-9:** This is primarily a marker for pancreatic, gallbladder, and bile duct cancers. In gynecology, it may be elevated in mucinous ovarian tumors. * **D. CA 50:** This is a non-specific carbohydrate antigen marker used occasionally for gastrointestinal and pancreatic malignancies, but it has no clinical utility in GCTs. ### **Clinical Pearls for NEET-PG** * **Histology:** Look for **Call-Exner bodies** (small follicles filled with eosinophilic material) and "coffee-bean" nuclei (longitudinal nuclear grooves). * **Hormonal Profile:** GCTs are **estrogen-secreting** tumors [2]. In young girls, they cause precocious puberty; in adults, they cause endometrial hyperplasia or postmenopausal bleeding [2]. * **Other Markers:** **Anti-Müllerian Hormone (AMH)** is another highly specific marker for GCTs used alongside Inhibin. * **FOXL2 Mutation:** A somatic missense mutation in the *FOXL2* gene (402C→G) is present in over 95% of adult-type GCTs [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1035-1037. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 481-482.

Question 174: What is the most common site of prostate carcinoma?

A. Anterior zone
B. Peripheral zone (Correct Answer)
C. Central zone
D. Transitional zone

Explanation: **Explanation:** Prostate carcinoma is the most common malignancy in men, and its anatomical distribution is a high-yield topic for NEET-PG [3]. The prostate is divided into distinct zones based on McNeal’s classification, each with different pathological predispositions. **1. Why Peripheral Zone is Correct:** Approximately **70-80% of prostate adenocarcinomas** originate in the **Peripheral Zone (PZ)** [1]. This zone constitutes the bulk of the glandular tissue and is located posteriorly. Because of this posterior location, these tumors are often palpable during a **Digital Rectal Examination (DRE)** [1], [2]. Furthermore, since the PZ is distant from the urethra, prostate cancer typically remains asymptomatic until advanced stages, unlike BPH. **2. Analysis of Incorrect Options:** * **Transitional Zone (TZ):** This is the most common site for **Benign Prostatic Hyperplasia (BPH)** [3]. Only about 10-20% of carcinomas arise here. Because the TZ surrounds the urethra, BPH presents early with obstructive voiding symptoms. * **Central Zone (CZ):** This zone surrounds the ejaculatory ducts. It is the site of origin for only about 5% of prostate cancers. * **Anterior Zone (Fibromuscular Stroma):** This area is primarily non-glandular (composed of muscle and fibrous tissue); therefore, primary epithelial carcinomas rarely originate here. **Clinical Pearls for NEET-PG:** * **Screening:** PSA (Prostate Specific Antigen) is the most useful tumor marker, but **Transrectal Ultrasound (TRUS) guided biopsy** is the gold standard for diagnosis [2]. * **Grading:** The **Gleason Grading System** (based on glandular architectural patterns, not cytologic features) is used to determine prognosis [2]. * **Metastasis:** Prostate cancer characteristically spreads to the bone (lumbar spine) via the **Batson venous plexus**, resulting in **osteoblastic (sclerotic) lesions** [2], [3]. **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. 989-990. [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. 993-994. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 497-498.

Question 175: A 17-year-old primigravida complained of decreased fetal movements. She delivered a baby weighing 2000gms at 30 weeks of gestation. The Apgar scores of the baby were 4 and 5 at 1 and 5 minutes respectively. The baby died within an hour. A post-mortem examination revealed multiple, peripheral, radially arranged cysts in the kidney. What is the most common associated finding with this condition?

A. Holoprosencephaly
B. Congenital hepatic fibrosis (Correct Answer)
C. Ureteral agenesis
D. Medullary sponge kidney

Explanation: **Explanation:** The clinical presentation and autopsy findings describe **Autosomal Recessive Polycystic Kidney Disease (ARPKD)** [1]. The key diagnostic feature is the presence of multiple, small, radially arranged (cylindrical) cysts in the renal cortex and medulla, giving the kidney a "sponge-like" appearance [3]. This condition is caused by mutations in the **PKHD1 gene**, which encodes the protein **fibrocystin** [1]. **1. Why Congenital Hepatic Fibrosis is Correct:** ARPKD is almost universally associated with hepatobiliary involvement [3]. The same genetic defect (PKHD1) leads to **ductal plate malformation**, resulting in periportal fibrosis and bile duct proliferation [2]. This is known as **Congenital Hepatic Fibrosis** [2]. In older children, this can manifest as portal hypertension and splenomegaly [2]. **2. Why Incorrect Options are Wrong:** * **Holoprosencephaly:** This is a midline brain defect associated with Trisomy 13 or Meckel-Gruber syndrome (which also has cystic kidneys, but presents with polydactyly and encephalocele). * **Ureteral Agenesis:** This is typically associated with Renal Agenesis or Multicystic Dysplastic Kidney (MCDK), which is usually sporadic and unilateral, not the symmetrical radial cysts of ARPKD. * **Medullary Sponge Kidney:** This is a benign condition in adults characterized by ectasia of the collecting ducts. It does not cause neonatal death or the characteristic radial cystic pattern seen in ARPKD. **Clinical Pearls for NEET-PG:** * **Potter Sequence:** ARPKD often leads to oligohydramnios, resulting in pulmonary hypoplasia (cause of death), flattened facies, and limb deformities. * **ARPKD vs. ADPKD:** ARPKD presents in infancy with radial cysts and hepatic fibrosis; ADPKD (PKD1/2) presents in adults with large, irregular cysts and berry aneurysms. * **Imaging:** On ultrasound, ARPKD kidneys appear enlarged and "echogenic" due to the numerous small cyst interfaces. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 951-953. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, p. 868. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 544-545.

Question 176: Conventional cytogenetics are difficult in solid tumors, especially in cases of Ca Cx, due to what reason?

A. High mitotic rate
B. Bacterial contamination of the specimen (Correct Answer)
C. Good metaphase activity
D. Inadequate biopsy specimen

Explanation: **Explanation:** Conventional cytogenetics (karyotyping) requires the culturing of live cells to obtain metaphase spreads. In the case of **Carcinoma Cervix (Ca Cx)**, the primary reason for the difficulty in performing these studies is **Bacterial contamination of the specimen (Option B)**. The uterine cervix is an anatomical site naturally colonized by a diverse microflora. Furthermore, cervical cancers are often necrotic and ulcerated, providing an ideal environment for secondary bacterial and fungal overgrowth. When these specimens are placed in culture media, the rapidly growing bacteria outcompete the tumor cells and acidify the media, leading to culture failure before sufficient metaphase cells can be harvested. **Analysis of Incorrect Options:** * **Option A (High mitotic rate):** A high mitotic rate is actually *favorable* for cytogenetics, as it increases the yield of cells in the metaphase stage. * **Option C (Good metaphase activity):** Similar to option A, active cell division is a prerequisite for successful karyotyping, not a hindrance. * **Option D (Inadequate biopsy specimen):** While a small biopsy can be a challenge, the specific technical hurdle unique to the cervix compared to "sterile" solid tumors (like sarcomas) is the microbial load. **Clinical Pearls for NEET-PG:** * **Alternative:** Due to these culture difficulties, **FISH (Fluorescence In Situ Hybridization)** or **CGH (Comparative Genomic Hybridization)** are preferred as they do not require live cell cultures. * **Key Association:** Human Papillomavirus (HPV) types 16 and 18 are the primary drivers of Ca Cx, leading to chromosomal instability through E6/E7 oncoprotein-mediated inhibition of p53 and Rb. * **Specimen Handling:** To minimize contamination, biopsy samples for cytogenetics should be transported in specialized media (e.g., Hank’s Balanced Salt Solution) containing high-dose antibiotics.

Question 177: Which of the following germ cell tumors is not common in young males?

A. Spermatocytic seminoma
B. Teratoma
C. Chorio-carcinoma
D. Lymphoma (Correct Answer)

Explanation: **Explanation:** The core of this question lies in differentiating between **Germ Cell Tumors (GCTs)** and non-germ cell malignancies based on age demographics. **Why Lymphoma is the correct answer:** While Lymphoma is the most common testicular tumor in men **over the age of 60**, it is not a Germ Cell Tumor. In the context of "young males" (typically aged 15–35), GCTs dominate the clinical picture [1]. Testicular lymphoma (usually Diffuse Large B-Cell Lymphoma) is considered a systemic disease or a late-onset primary tumor, making it an outlier for the young male demographic. **Analysis of Incorrect Options:** * **Spermatocytic Seminoma:** Although it occurs in slightly older men (average age 50+) compared to classic seminoma, it is a distinct **Germ Cell Tumor** [1]. However, in the context of this specific question, it is categorized under GCTs, whereas Lymphoma is not. * **Teratoma:** In adults, these are considered malignant GCTs and are common components of mixed germ cell tumors in young males [1]. * **Choriocarcinoma:** A highly aggressive non-seminomatous GCT that typically affects young adults (20–30 years) and is characterized by high levels of hCG [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Most common testicular tumor in young men:** Mixed Germ Cell Tumor [1]. * **Most common pure GCT:** Seminoma (Peak age: 30s) [1]. * **Most common testicular tumor >60 years:** Lymphoma (Always consider this in an elderly male with a testicular mass). * **Tumor Markers:** Yolk Sac Tumor (↑AFP), Choriocarcinoma (↑hCG), Seminoma (↑LDH) [1]. * **Spermatocytic Seminoma:** Excellent prognosis, rarely metastasizes, and is *not* associated with ITGCN (Intratubular Germ Cell Neoplasia) [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. 979-984.

Question 178: “Call-Exner bodies” are seen in which of the following tumors?

A. Yolk sac tumor
B. Granulosa cell tumor (Correct Answer)
C. Hilus cell tumor
D. Brenner tumor

Explanation: **Explanation:** **Call-Exner bodies** are the pathognomonic histological hallmark of **Granulosa Cell Tumors (GCT)**, specifically the adult type. These are small, fluid-filled spaces (microfollicular pattern) containing eosinophilic material and basement membrane components, surrounded by granulosa cells with characteristic "coffee-bean" nuclei (due to longitudinal nuclear grooves). **Why the other options are incorrect:** * **Yolk sac tumor:** Characterized by **Schiller-Duval bodies**, which are glomerulus-like structures with a central vessel. It is also associated with elevated Alpha-Fetoprotein (AFP). * **Hilus cell tumor:** A type of Leydig cell tumor characterized by **Reinke crystals** (rectangular, eosinophilic cytoplasmic inclusions) [1]. These tumors typically secrete androgens, leading to virilization [1]. * **Brenner tumor:** Characterized by nests of transitional epithelium (resembling bladder epithelium) within a dense fibromatous stroma. The cells also show "coffee-bean" nuclei, but they do not form Call-Exner bodies. **High-Yield Clinical Pearls for NEET-PG:** * **Granulosa Cell Tumor:** It is the most common clinically malignant sex cord-stromal tumor. It is **estrogen-secreting**, which can lead to endometrial hyperplasia or carcinoma in postmenopausal women and precocious puberty in young girls. * **Tumor Marker:** **Inhibin** (specifically Inhibin B) is the most sensitive marker for diagnosis and monitoring recurrence [1]. * **Genetics:** FOXL2 mutation is highly specific for adult-type GCT [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1036-1038.

Question 179: A 49-year-old female presented with postmenopausal bleeding and a uterine cavity growth on sonography. During surgery, the growth is large, multicystic, and exceeds 10 cm in diameter. Granulosa cell tumor is suspected. What characteristic histological finding helps distinguish granulosa cell tumor from other uterine tumors?

A. Call-Exner bodies (Correct Answer)
B. Asbestos bodies
C. Amyloid bodies
D. None of the above

Explanation: **Explanation:** **Granulosa Cell Tumor (GCT)** is a sex cord-stromal tumor that often presents with postmenopausal bleeding due to its ability to secrete **estrogen**, leading to endometrial hyperplasia or carcinoma [2]. 1. **Why Call-Exner bodies are correct:** The pathognomonic histological feature of Adult Granulosa Cell Tumors is the **Call-Exner body**. These are small, gland-like spaces filled with eosinophilic material and surrounded by granulosa cells with "coffee-bean" nuclei (due to prominent longitudinal nuclear grooves). These structures represent an attempt by the tumor cells to mimic the appearance of a developing Graafian follicle. 2. **Why the other options are incorrect:** * **Asbestos bodies (Ferruginous bodies):** These are golden-brown, rod-like structures coated with iron, found in the lungs of patients with asbestos exposure. They are associated with mesothelioma and asbestosis. * **Amyloid bodies (Corpora amylacea):** These are small hyaline masses found in the prostate, neuroglia, or lungs, typically associated with aging or chronic inflammation, not ovarian/uterine neoplasms. **High-Yield Clinical Pearls for NEET-PG:** * **Tumor Marker:** **Inhibin** is the most sensitive and specific marker for monitoring GCT recurrence [1]. * **Genetics:** Somatic mutation in the **FOXL2** gene (402C→G) is present in over 95% of adult GCTs [1]. * **Clinical Association:** Always check the endometrium in patients with GCT, as the hyperestrogenism can lead to concurrent **Endometrial Carcinoma** [2]. * **Prognosis:** GCTs are considered "low-grade malignancies" because they can recur many years (even decades) after the initial diagnosis [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1036-1037. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 481-482.

Question 180: A blighted ovum is characterized by which of the following?

A. Avascular villi (Correct Answer)
B. Syncytial knots
C. Intervillous hemorrhage
D. Intracerebral hemorrhage

Explanation: **Explanation:** A **blighted ovum** (also known as an anembryonic pregnancy) occurs when a fertilized egg attaches to the uterine wall, but the embryo fails to develop or resorbs [1]. This condition is a common cause of early spontaneous abortion. **Why Avascular Villi is Correct:** In a blighted ovum, the fetal pole never develops or dies very early [1]. Since the fetal circulatory system is never established, there is no blood flow into the placental tissue. Pathologically, this manifests as **avascular villi** (chorionic villi lacking fetal blood vessels). These villi often appear hydropic or edematous because they continue to absorb fluid from the maternal decidua but cannot transport it away due to the absence of a functional fetal circulation. **Analysis of Incorrect Options:** * **B. Syncytial knots:** These are aggregations of syncytiotrophoblast nuclei on the villous surface. While they increase with placental age or in conditions like pre-eclampsia (maternal hypoperfusion), they are not the defining feature of a blighted ovum. * **C. Intervillous hemorrhage:** This refers to bleeding between the villi, often associated with placental abruption or trauma, rather than the intrinsic developmental failure seen in anembryonic pregnancies. * **D. Intracerebral hemorrhage:** This is a neonatal or fetal complication (often due to prematurity or trauma) and is irrelevant to a condition where no embryo/fetus is present. **High-Yield NEET-PG Pearls:** * **Most common cause:** Chromosomal abnormalities (e.g., autosomal trisomy) are responsible for approximately 50-60% of blighted ova. * **Ultrasonography (USG) Diagnosis:** A "Mean Sac Diameter" (MSD) of **>25 mm** without a visible embryo is diagnostic of a blighted ovum. * **Histology:** Look for large, cystic, avascular villi with a lack of fetal red blood cells (nucleated RBCs) [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1043-1044.

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Diseases of Male Genital Tract

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Testicular Tumors

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Prostate Pathology

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Diseases of Female Genital Tract

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Cervical Pathology and Neoplasia

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Endometrial Pathology

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Ovarian Diseases and Tumors

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Gestational Trophoblastic Disease

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Placental Pathology

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Sexually Transmitted Infections

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