Reproductive Pathology Practice Questions

Q: A glomerulus-like structure composed of a central blood vessel enveloped by germ cells within a space lined by germ cells, is seen in which of the following?

Endodermal sinus tumor. **Explanation:** The structure described in the question is a **Schiller-Duval body**, which is the pathognomonic histological hallmark of an **Endodermal Sinus Tumor (Yolk Sac Tumor)**. **1. Why the Correct Answer is Right:** A Schiller-Duval body consists of a central capillary (blood vessel) surrounded by a layer of neoplastic germ cells, all situated within a space lined by a single layer of flattened or cuboidal cells [1]. This "glomerulus-like" appearance mimics the primitive gut or yolk sac structures. These tumors also characteristically show **alpha-fetoprotein (AFP)** positivity and the presence of eosinophilic, PAS-positive hyaline droplets [1]. **2. Why the Other Options are Wrong:** * **Sertoli-Leydig cell tumor:** Characterized by tubules lined by Sertoli cells and clusters of interstitial Leydig cells (Reinke crystals may be present). * **Granulosa cell tumor:** Known for **Call-Exner bodies**, which are small, follicle-like spaces filled with eosinophilic material and surrounded by granulosa cells with "coffee-bean" nuclei. * **Sex cord tumor with annular tubules (SCTAT):** Features ring-shaped tubules surrounding hyaline bodies; it is strongly associated with Peutz-Jeghers syndrome. **3. High-Yield Clinical Pearls for NEET-PG:** * **Yolk Sac Tumor:** Most common germ cell tumor in children; highly malignant but chemo-sensitive [1]. * **Tumor Marker:** Elevated **Serum AFP** is essential for diagnosis and monitoring recurrence [1]. * **Histology Keyword:** "Schiller-Duval bodies" = Yolk Sac Tumor. * **Age Group:** Typically affects young women (ovary) or young children (testis) [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. 979-980.

Q: Krukenberg adenocarcinoma of the ovary can occur as a result of metastases from all the following primary sites except:

Liver. **Explanation:** A **Krukenberg tumor** is a metastatic signet-ring cell adenocarcinoma of the ovary. The hallmark of this condition is the presence of mucin-secreting "signet-ring cells" within a cellular stroma derived from the ovarian medulla. **Why Liver is the Correct Answer:** The liver is not a primary site for Krukenberg tumors. While the liver is a common site for metastasis *from* GI cancers, it does not typically metastasize *to* the ovary in the form of a Krukenberg tumor. Metastatic spread to the ovaries usually occurs via retrograde lymphatic spread or transcoelomic seeding from organs with mucosal surfaces. **Analysis of Incorrect Options:** * **Stomach (Option A):** This is the **most common** primary site (approx. 70%). Gastric adenocarcinoma (diffuse type) frequently spreads to the ovaries [1]. * **Breast (Option B):** Lobular carcinoma of the breast is a well-documented primary source for Krukenberg tumors, often presenting bilaterally. * **Pancreas (Option D):** Along with the colon, gallbladder, and appendix, the pancreas is a recognized primary site for these metastatic lesions. **NEET-PG High-Yield Pearls:** 1. **Bilateralism:** 80% of Krukenberg tumors are bilateral, whereas primary ovarian surface epithelial tumors are more often unilateral. 2. **Microscopy:** Look for the **Signet-ring cell**—the nucleus is pushed to the periphery by a large cytoplasmic mucin vacuole (PAS positive) [1]. 3. **Primary vs. Secondary:** If a tumor is bilateral and composed of signet-ring cells, always look for a primary in the stomach (via endoscopy). 4. **Spread:** The most accepted mechanism of spread is **retrograde lymphatic drainage**, not just transcoelomic seeding. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 779.

Question 1

HPV-related cervical intraepithelial neoplasia can be diagnosed by the presence of which of the following histologic features?

Accepted Answer

Cytoplasmic vacuolization and nuclear enlargement of cells

Answer

Central, basophilic intranuclear cellular inclusions

Answer

Cowdry type A intranuclear cellular inclusions

Answer

Enlarged multinucleated cells

Question 2

Which of the following is a predisposing factor for carcinoma of the breast?

Accepted Answer

Epithelial hyperplasia

Answer

Sclerosing adenosis

Answer

Fibrocystic disease of breast

Answer

Fibroadenoma

Question 3

What is the most common testicular tumor in the fourth decade of life?

Accepted Answer

Seminoma

Answer

Teratoma

Answer

Dermoid cyst

Answer

All of the above

Question 4

A 34-year-old woman has noticed a bloody discharge from the nipple of her left breast for the past 3 days. On physical examination, the skin of the breasts appears normal, and no masses are palpable. There is no axillary lymphadenopathy. She has regular menstrual cycles and is using oral contraceptives. Excisional biopsy is most likely to show which of the following lesions in her left breast?

Accepted Answer

Intraductal papilloma

Answer

Acute mastitis

Answer

Fibroadenoma

Answer

Phyllodes tumor

Question 5

A 22-year-old woman nursing her newborn develops a tender erythematous area around the nipple of her left breast. A thick, yellow fluid is observed to drain from an open fissure. Examination of this breast fluid under the light microscope will most likely reveal an abundance of which of the following inflammatory cells?

Accepted Answer

Neutrophils

Answer

B lymphocytes

Answer

Eosinophils

Answer

Mast cells

Question 6

According to the Bethesda system, what does a low-grade squamous intraepithelial lesion (LSIL) of the cervix include?

Accepted Answer

CIN I

Answer

CIN II

Answer

CIN III

Answer

Squamous metaplasia

Question 7

A 13-year-old male presents with bilateral enlargement of his breasts. Physical exam is otherwise unremarkable, and the breast enlargement is thought to be a normal variation at puberty. What would histologic sections of breast tissue most likely reveal?

Accepted Answer

Proliferation of ducts in hyalinized fibrous tissue with periductal edema

Answer

Atrophic ductal structures with increased numbers of lipocytes

Answer

Dilated ducts filled with granular, necrotic, acidophilic debris

Answer

Granulomatous inflammation surrounding ducts with numerous plasma cells

Question 8

Which type of uterine cancer has a histological appearance that resembles epithelial ovarian cancer?

Accepted Answer

Uterine papillary serous carcinoma

Answer

Clear cell carcinoma

Answer

Endometroid adenocarcinoma

Answer

Mucinous carcinoma

Question 9

A glomerulus-like structure composed of a central blood vessel enveloped by germ cells within a space lined by germ cells, is seen in which of the following?

Accepted Answer

Endodermal sinus tumor

Answer

Sertoli-Leydig cell tumor

Answer

Granulosa cell tumor

Answer

Sex cord tumor with annular tubules

Question 10

Krukenberg adenocarcinoma of the ovary can occur as a result of metastases from all the following primary sites except:

Accepted Answer

Liver

Answer

Stomach

Answer

Breast

Answer

Pancreas

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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