Reproductive Pathology Practice Questions

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

Bacterial contamination of the specimen. **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.

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

Lymphoma. **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.

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

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 (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 1

What is the most common carcinoma of the breast?

Accepted Answer

Ductal carcinoma

Answer

Mucinous carcinoma

Answer

Lobular carcinoma

Answer

Neuroendocrine carcinoma

Question 2

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

Accepted Answer

CEA

Answer

S-100

Answer

HMB 45

Answer

Neuron specific enolase

Question 3

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?

Accepted Answer

Inhibin

Answer

Neuron-specific enolase

Answer

CA 19-9

Answer

CA 50

Question 4

What is the most common site of prostate carcinoma?

Accepted Answer

Peripheral zone

Answer

Anterior zone

Answer

Central zone

Answer

Transitional zone

Question 5

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?

Accepted Answer

Congenital hepatic fibrosis

Answer

Holoprosencephaly

Answer

Ureteral agenesis

Answer

Medullary sponge kidney

Question 6

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

Accepted Answer

Bacterial contamination of the specimen

Answer

High mitotic rate

Answer

Good metaphase activity

Answer

Inadequate biopsy specimen

Question 7

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

Accepted Answer

Lymphoma

Answer

Spermatocytic seminoma

Answer

Teratoma

Answer

Chorio-carcinoma

Question 8

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

Accepted Answer

Granulosa cell tumor

Answer

Yolk sac tumor

Answer

Hilus cell tumor

Answer

Brenner tumor

Question 9

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?

Accepted Answer

Call-Exner bodies

Answer

Asbestos bodies

Answer

Amyloid bodies

Answer

None of the above

Question 10

A blighted ovum is characterized by which of the following?

Accepted Answer

Avascular villi

Answer

Syncytial knots

Answer

Intervillous hemorrhage

Answer

Intracerebral hemorrhage

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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