Reproductive Pathology Practice Questions

Q: Oestrogen causes proliferation of which cells in the vaginal epithelium?

Superficial cells. The vaginal epithelium is a non-keratinized stratified squamous epithelium that undergoes cyclic changes under the influence of ovarian hormones. **Explanation of the Correct Answer:** **Estrogen** is the primary hormone responsible for the **maturation and proliferation** of the vaginal squamous epithelium. It stimulates the maturation of cells from the basal layer up to the **superficial layer**. Therefore, a high estrogenic state (like the ovulatory phase) is characterized by a predominance of **superficial cells** (large, flat cells with pyknotic nuclei). These cells are rich in glycogen, which is fermented by Doderlein’s bacilli to maintain an acidic vaginal pH. **Analysis of Incorrect Options:** * **Intermediate cells:** These cells predominate under the influence of **Progesterone**. In the luteal phase of the menstrual cycle or during pregnancy, the maturation process stops at the intermediate level. * **Basal/Parabasal cells:** These are the least mature cells. They predominate in **low-estrogen states**, such as prepuberty or menopause (atrophic vaginitis). * **Both superficial and intermediate cells:** While estrogen promotes the transition through all layers, its specific "end-point" effect and the hallmark of high estrogenic activity is the presence of superficial cells. **High-Yield Clinical Pearls for NEET-PG:** * **Maturation Index (MI):** Reported as a ratio of (Parabasal : Intermediate : Superficial cells). * **Shift to the Right:** High Estrogen (e.g., 0:40:60) → Predominance of Superficial cells. * **Shift to the Mid:** High Progesterone (e.g., 0:90:10) → Predominance of Intermediate cells. * **Shift to the Left:** Low Estrogen (e.g., 80:20:0) → Predominance of Parabasal cells (Atrophy). * **Fern Test:** Estrogen causes "ferning" of cervical mucus; Progesterone inhibits it.

Q: What is the interpretation of the given cervix biopsy of a 50-year-old lady?

Carcinoma in situ. ***Carcinoma in situ*** - Shows **full-thickness dysplasia** (CIN 3) with complete loss of cellular maturation from basal to surface epithelium, maintaining an **intact basement membrane**. - Characterized by **hyperchromatic nuclei**, increased **nuclear-to-cytoplasmic ratio**, and numerous **mitotic figures** throughout all epithelial layers. *CMV infection* - Would show characteristic **owl's eye inclusions** (large eosinophilic intranuclear inclusions with clear halos) in infected cells. - Associated with **inflammatory infiltrate** and **cytomegaly**, not the organized dysplastic changes seen in CIN 3. *Cervical carcinoma* - Would demonstrate **invasion through the basement membrane** into underlying stroma, which is not present in carcinoma in situ. - Shows **stromal desmoplastic reaction** and **inflammatory response** around invasive tumor nests. *HPV induced koilocytosis* - Characterized by **koilocytes** - cells with enlarged nuclei surrounded by **perinuclear halos** and **wrinkled nuclear membranes**. - Represents **low-grade dysplasia** (CIN 1) with preserved epithelial maturation, unlike the full-thickness involvement in CIN 3.

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

Granulosa cell tumor. **Explanation:** **Call-Exner bodies** are the pathognomonic histological feature of **Granulosa Cell Tumors (GCT)**, specifically the adult type. These are small, fluid-filled spaces surrounded by granulosa cells in a rosette-like or follicular arrangement. The eosinophilic fluid within these spaces represents basement membrane-like material. On microscopy, the cells also exhibit characteristic "coffee-bean" nuclei due to prominent longitudinal grooves. **Analysis of Options:** * **A. Yolk sac tumor:** Characterized by **Schiller-Duval bodies** (glomeruloid structures with a central vessel) and elevated levels of Alpha-Fetoprotein (AFP). * **C. Hilus cell tumor:** These are pure Leydig cell tumors of the ovary. They are characterized by **Reinke crystals** (intracytoplasmic eosinophilic inclusions) [1] and typically cause virilization [1]. * **D. Brenner tumor:** A surface epithelial tumor composed of transitional cells (urothelium). It is characterized by **Walthard cell nests** and "coffee-bean" nuclei, but it does *not* form Call-Exner bodies. **Clinical Pearls for NEET-PG:** * **Granulosa Cell Tumor:** The most common malignant sex cord-stromal tumor. It is clinically significant for secreting **Estrogen**, leading to endometrial hyperplasia or carcinoma and precocious puberty in children. Elevated levels of inhibin are associated with these tumors [1]. * **Tumor Marker:** **Inhibin** (specifically Inhibin B) is the most reliable marker for diagnosis and monitoring recurrence [1]. * **Histology Summary:** Call-Exner bodies + Coffee-bean nuclei + Inhibin positivity = Granulosa Cell Tumor. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1036-1038.

Q: Streak gonads are seen in which of the following conditions?

Turner syndrome. **Explanation:** **Turner Syndrome (45, XO)** is the most common cause of primary amenorrhea and is characterized by the presence of **streak gonads** [1]. In this condition, the accelerated loss of oocytes occurs during fetal development (oocyte attrition). By birth, the ovaries are replaced by fibrous tissue strands devoid of follicles, appearing as "streaks." Because these gonads fail to produce estrogen, there is a lack of secondary sexual characteristics and a compensatory rise in LH and FSH (hypergonadotropic hypogonadism). **Analysis of Incorrect Options:** * **Klinefelter’s Syndrome (47, XXY):** This condition affects males [2]. The gonads are not "streaks" but are typically **small, firm testes** characterized by hyalinization of seminiferous tubules and Leydig cell hyperplasia. * **Down’s Syndrome (Trisomy 21):** This is a chromosomal disorder involving autosomes, not sex chromosomes [2]. While it can be associated with reduced fertility, it does not characteristically present with streak gonads. **High-Yield Clinical Pearls for NEET-PG:** * **Karyotype:** 45, XO is the most common, but mosaicism (e.g., 45,X/46,XX) can occur. * **Cardiovascular:** Bicuspid aortic valve (most common) and Coarctation of the aorta. * **Renal:** Horseshoe kidney. * **Physical Findings:** Short stature, webbed neck (cystic hygroma remnant), widely spaced nipples (shield chest), and increased carrying angle (cubitus valgus) [1]. * **Tumor Risk:** If a Y chromosome fragment is present (e.g., 45,X/46,XY mosaicism), there is a high risk of **Gonadoblastoma** in the streak gonads, necessitating prophylactic gonadectomy. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 175-177. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 174-175.

Question 1

Oestrogen causes proliferation of which cells in the vaginal epithelium?

Accepted Answer

Superficial cells

Answer

Intermediate cells

Answer

Basal cells

Answer

Both superficial and intermediate cells

Question 2

Which of the following is NOT true about spermatocytic seminoma?

Accepted Answer

It is characterized by three distinct cell types.

Answer

It is typically seen in individuals around 65 years of age.

Answer

It behaves as a slow-growing tumor.

Answer

It is clinically and histologically unrelated to classical seminoma.

Question 3

What is the most common testicular tumor in the prepubertal age group?

Accepted Answer

Yolk sac tumors

Answer

Seminomas

Answer

Sertoli cell tumors

Answer

Leydig cell tumors

Question 4

What is the interpretation of the given cervix biopsy of a 50-year-old lady?

Accepted Answer

Carcinoma in situ

Answer

CMV infection

Answer

Cervical carcinoma

Answer

HPV induced koilocytosis

Question 5

What is the earliest morphological evidence of ovulation?

Accepted Answer

Basal vacuolation

Answer

Pseudo stratification

Answer

Decrease in glycogen content

Answer

Predecidual reaction

Question 6

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 7

Which testicular tumor is associated with high HCG levels?

Accepted Answer

Choriocarcinoma

Answer

Seminoma

Answer

Endodermal sinus tumor

Answer

All of the above

Question 8

Women carrying the BRCA1 gene are more likely to develop which type of breast carcinoma?

Accepted Answer

Medullary

Answer

Lobular

Answer

Colloid

Answer

Secretory

Question 9

Streak gonads are seen in which of the following conditions?

Accepted Answer

Turner syndrome

Answer

Klinefelter's syndrome

Answer

Klinefelter's syndrome

Answer

Down's syndrome

Question 10

Which of the following predisposes to breast cancer?

Accepted Answer

Epitheliosis

Answer

Adenosis

Answer

Fibrosis

Answer

Blue domed cysts

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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