Reproductive Pathology — MCQs

Reproductive Pathology Indian Medical PG Practice Questions and MCQs

Question 191: All of the following clinicopathologic features are seen more often in seminomas as compared to non-seminomatous germ cell tumors of the testis except?

A. Tumors remain localized to testis for a long time
B. They are radiosensitive
C. They metastasize predominantly by lymphatics
D. They are often associated with raised levels of serum AFP and HCG (Correct Answer)

Explanation: This question tests the fundamental clinicopathologic distinctions between **Seminomas** and **Non-Seminomatous Germ Cell Tumors (NSGCTs)**. [1] ### **Explanation of the Correct Answer (Option D)** The statement in Option D is incorrect for seminomas, making it the right answer. * **AFP (Alpha-fetoprotein):** Pure seminomas **never** produce AFP. If AFP is elevated in a patient with a suspected seminoma, it indicates the presence of a non-seminomatous component (usually Yolk Sac Tumor), and the tumor must be treated as an NSGCT. [1] * **HCG:** While roughly 10–15% of seminomas may show elevated HCG (due to syncytiotrophoblastic giant cells), it is much more characteristic and significantly higher in NSGCTs (especially Choriocarcinoma). [1], [2] ### **Analysis of Incorrect Options** * **Option A:** Seminomas are generally slow-growing and tend to remain localized to the testis (Stage I) for a longer duration compared to NSGCTs, which often present with advanced disease. [1] * **Option B:** Seminomas are exquisitely **radiosensitive**. This is a hallmark feature. In contrast, NSGCTs are relatively radioresistant and are primarily managed with surgery and chemotherapy. * **Option C:** Seminomas spread primarily via the **lymphatic route** (to retroperitoneal para-aortic nodes). NSGCTs spread earlier and more frequently via the hematogenous route (to lungs and liver). [3] ### **High-Yield Clinical Pearls for NEET-PG** * **Most common testicular tumor:** Seminoma (peak age 30–40 years). * **Microscopy of Seminoma:** Large, uniform cells with clear cytoplasm ("fried egg" appearance), distinct cell borders, and lymphocytic infiltration in the stroma. [1] * **Tumor Markers:** * **Seminoma:** LDH (reflects tumor burden), occasionally HCG; **Never AFP**. [1] * **Yolk Sac Tumor:** Characteristically high **AFP**; Schiller-Duval bodies. * **Choriocarcinoma:** Characteristically high **HCG**. [1] * **Prognosis:** Seminomas have a better prognosis (95% cure rate in early stages) compared to NSGCTs. **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. 979-982. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 512-513. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 510-512.

Question 192: Which of the following is a marker for seminoma testis?

A. Alpha-fetoprotein
B. Carcinoembryonic antigen
C. HCG (Human Chorionic Gonadotropin) (Correct Answer)
D. Acid phosphatase

Explanation: **Explanation:** **Seminoma** is the most common germ cell tumor (GCT) of the testis. While the majority of pure seminomas do not produce tumor markers, approximately **10–15% of cases** contain scattered **syncytiotrophoblastic giant cells** [2], which secrete **HCG (Human Chorionic Gonadotropin)** [1]. Therefore, HCG is a recognized marker for seminoma, though levels are typically lower than those seen in choriocarcinoma [2]. **Analysis of Incorrect Options:** * **A. Alpha-fetoprotein (AFP):** This is the most critical point for NEET-PG: **AFP is never elevated in a pure seminoma.** If AFP is elevated, the tumor must be classified as a Non-Seminomatous Germ Cell Tumor (NSGCT), such as a Yolk Sac Tumor or a Mixed GCT. * **B. Carcinoembryonic antigen (CEA):** CEA is a non-specific oncofetal antigen primarily used for monitoring colorectal, pancreatic, and gastric carcinomas. It has no diagnostic role in testicular GCTs. * **D. Acid phosphatase:** Historically used as a marker for prostate cancer (Prostatic Acid Phosphatase), it has been largely replaced by PSA and is not associated with germ cell tumors. **High-Yield Clinical Pearls for NEET-PG:** 1. **LDH (Lactate Dehydrogenase):** Often elevated in seminomas; it correlates with tumor burden and degree of cell turnover. 2. **PLAP (Placental-like Alkaline Phosphatase):** A highly sensitive membrane marker for seminoma cells (detected via immunohistochemistry) [2]. 3. **Classic Triad:** A young male with a painless testicular lump, "fried-egg" appearance on histology, and exquisite sensitivity to radiotherapy defines a Seminoma. 4. **Rule of Thumb:** Elevated AFP = NSGCT; Elevated HCG = Seminoma (low levels) or Choriocarcinoma (very high levels). **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 512-513. [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. 980-982.

Question 193: Which of the following are seen in endodermal sinus tumor?

A. Schiller-Duval bodies (Correct Answer)
B. Reed-Sternberg cells
C. Reinke's crystals
D. Russell bodies

Explanation: **Explanation:** **Endodermal Sinus Tumor (Yolk Sac Tumor)** is the most common germ cell tumor in children and young infants [1]. The hallmark histological feature is the **Schiller-Duval body**. 1. **Why Option A is Correct:** Schiller-Duval bodies are pathognomonic structures consisting of a central capillary surrounded by a layer of neoplastic epithelial cells, situated within a space lined by similar cells. This configuration mimics a primitive glomerulus (glomeruloid structure). Additionally, these tumors often show intracellular and extracellular **alpha-fetoprotein (AFP)** and eosinophilic hyaline globules. 2. **Why Other Options are Incorrect:** * **B. Reed-Sternberg cells:** These are large, multinucleated cells with "owl-eye" nucleoli characteristic of **Hodgkin Lymphoma**. * **C. Reinke's crystals:** These are rod-shaped, eosinophilic cytoplasmic inclusions found in **Leydig cell tumors** of the testis or ovary. * **D. Russell bodies:** These are eosinophilic, immunoglobulin-containing inclusions found in plasma cells, typically seen in **Multiple Myeloma** or chronic inflammation. **High-Yield Clinical Pearls for NEET-PG:** * **Tumor Marker:** Serum **AFP (Alpha-fetoprotein)** is the most important marker for diagnosis and monitoring recurrence. * **Age Group:** Most common malignant germ cell tumor in children (infants/toddlers) [1]. * **Histology:** Look for "lace-like" (reticular) patterns and Schiller-Duval bodies. * **IHC:** Positive for Glypican-3 and AFP. **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.

Question 194: Which of the following statements about the Gleason score is NOT true?

A. It is used for grading prostatic carcinoma.
B. The maximum score is 10.
C. The minimum score is 2.
D. It is the most important prognostic factor. (Correct Answer)

Explanation: **Explanation:** The **Gleason Scoring System** is the standard method for grading prostate adenocarcinoma based on architectural patterns rather than individual cellular features [1]. **Why Option D is the correct answer (False Statement):** While the Gleason score is a critical predictor of biological behavior, the **Stage of the tumor** (TNM staging, specifically the extent of spread) is considered the **most important prognostic factor** for prostatic carcinoma. Grading (Gleason) predicts the aggressiveness, but Staging determines the clinical outcome and treatment strategy [1]. **Analysis of Incorrect Options:** * **Option A:** True. It is the gold standard for grading prostate cancer. It assesses the glandular architecture under low power [1]. * **Option B:** True. The score is the sum of the primary (most common) and secondary (second most common) patterns. Each is graded 1–5, making the **maximum score 10 (5+5)**, representing a highly undifferentiated tumor [1]. * **Option C:** True. Since the lowest grade for a pattern is 1, the **minimum score is 2 (1+1)**. However, in modern practice (ISUP 2014), scores below 6 are rarely reported in needle biopsies. **High-Yield Clinical Pearls for NEET-PG:** * **ISUP Grade Groups:** To simplify clinical utility, Gleason scores are grouped into 5 Grade Groups (Group 1: Score ≤6; Group 5: Score 9–10). * **Biopsy vs. Prostatectomy:** On a needle biopsy, if only one pattern is seen, it is doubled (e.g., 3+3=6). If three patterns are seen, the most common and the *highest* grade are added. * **Prostate Cancer Site:** Most commonly arises in the **Peripheral Zone** (posteriorly), which is why it is detectable via Digital Rectal Examination (DRE) [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. 990-992. [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. 989-990. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 500-501.

Question 195: BRCA1 gene is responsible for which histological type of breast cancer?

A. Tubular carcinoma
B. Colloid carcinoma
C. Papillary carcinoma
D. Medullary carcinoma (Correct Answer)

Explanation: **Explanation:** The association between genetic mutations and specific histological subtypes of breast cancer is a high-yield topic for NEET-PG. **Why Medullary Carcinoma is correct:** BRCA1 mutations are strongly associated with "Triple Negative Breast Cancer" (TNBC)—tumors that lack Estrogen Receptor (ER), Progesterone Receptor (PR), and HER2/neu expression [1]. **Medullary carcinoma** is a distinct subtype of TNBC characterized by a well-circumscribed mass, syncytial growth patterns, and a prominent lymphoplasmacytic infiltrate [2]. Despite its high-grade cytological features, it often carries a better prognosis than invasive carcinoma of no special type (NST) [2]. Up to 10-15% of BRCA1-related cancers exhibit medullary features [1]. **Analysis of Incorrect Options:** * **A. Tubular Carcinoma:** These are well-differentiated, low-grade tumors characterized by small, teardrop-shaped glands. They are typically **ER-positive** and are not specifically linked to BRCA1. * **B. Colloid (Mucinous) Carcinoma:** These tumors feature "clusters of cells floating in lakes of extracellular mucin." They usually occur in older women and are typically **ER-positive**. * **C. Papillary Carcinoma:** A rare subtype characterized by fibrovascular cores lined by neoplastic epithelium. Like tubular and colloid types, these are generally **ER-positive** and lack a strong association with BRCA1. **High-Yield Clinical Pearls for NEET-PG:** * **BRCA1:** Located on **Chromosome 17q**. Associated with Medullary carcinoma, TNBC, and Serous ovarian carcinoma [1]. * **BRCA2:** Located on **Chromosome 13q**. Associated with Male breast cancer and Prostate cancer. * **Histology Tip:** If a question mentions "syncytial growth" or "lymphocytic infiltrate" in a young patient with a family history, always think of Medullary Carcinoma/BRCA1 [1], [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1058-1059. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 455-456.

Question 196: A 62-year-old man presents for an annual physical examination. His PSA level is 12.3 ng/dL, and a subsequent prostatic biopsy reveals adenocarcinoma with a Gleason score of 8. The Gleason score is a measurement of:

A. The grade of the cancer based on its cellular appearance
B. The stage of the cancer within the prostate gland
C. The likelihood that the cancer will grow and spread (Correct Answer)
D. The number of cancer cells expressing prostate specific antigen (PSA)

Explanation: **Explanation:** The **Gleason Scoring System** is the gold standard for grading prostate adenocarcinoma [1]. It is based entirely on the **architectural patterns** of the tumor glands rather than individual cellular features [1]. **Why Option C is Correct:** The Gleason score is the most potent predictor of biological behavior and clinical outcome in prostate cancer [1]. A higher score (e.g., 8–10) indicates a poorly differentiated tumor that is more aggressive, has a higher risk of extracapsular extension, and a greater **likelihood of growth and metastasis**. It directly guides treatment decisions (e.g., active surveillance vs. radical prostatectomy). **Why Other Options are Incorrect:** * **Option A:** While it is a "grade," the Gleason system specifically evaluates **architectural patterns** (how cells arrange into glands), not "cellular appearance" (cytology/pleomorphism), which is used in other grading systems like Fuhrman for renal cell carcinoma [1]. * **Option B:** **Stage** refers to the anatomical extent of the tumor (TNM classification), whereas Gleason is a **Grade** (histological differentiation) [1]. * **Option D:** PSA expression is a marker of prostatic origin but is not used to calculate the Gleason score. **High-Yield NEET-PG Pearls:** * **Calculation:** The score is the sum of the **primary pattern** (most common) and the **secondary pattern** (second most common). * **ISUP Grade Groups:** Modern pathology now groups Gleason scores into 5 Grade Groups (e.g., Gleason 3+3 = Group 1; Gleason 4+4 = Group 4). * **Gleason Pattern 4:** Characterized by "cribriform" glands or fused masses. * **Prostate Cancer Site:** Most commonly arises in the **Peripheral Zone** (posteriorly), which is why it is palpable on Digital Rectal Examination (DRE) [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. 989-994.

Question 197: Which of the following types of Human Papillomavirus (HPV) is least associated with cervical malignancy?

A. Type 16
B. Type 31
C. Type 33
D. Type 42 (Correct Answer)

Explanation: **Explanation:** The association between Human Papillomavirus (HPV) and cervical cancer is determined by the oncogenic potential of the specific viral strain. HPV types are broadly categorized into **High-risk** and **Low-risk** groups based on their ability to integrate into the host genome and induce malignant transformation [1]. **Why Type 42 is the Correct Answer:** HPV **Type 42** belongs to the **Low-risk HPV** group. These types are primarily associated with benign lesions such as condyloma acuminatum (genital warts) and low-grade squamous intraepithelial lesions (LSIL) [3]. They lack the aggressive E6 and E7 protein activity required to effectively degrade p53 and Rb tumor suppressor proteins, making them rarely, if ever, associated with invasive cervical malignancy [1]. **Analysis of Incorrect Options:** * **Type 16 (Option A):** This is the most potent high-risk HPV type, responsible for approximately 50-60% of all cervical squamous cell carcinomas worldwide [2]. * **Type 31 & 33 (Options B & C):** These are also classified as **High-risk HPV** types [1]. While less common than Type 16 or 18, they are frequently implicated in cervical intraepithelial neoplasia (CIN) II/III and invasive cancer. **NEET-PG High-Yield Pearls:** * **Most Common High-Risk Types:** 16 and 18 (Account for ~70% of cervical cancers). * **Most Common Low-Risk Types:** 6 and 11 (Cause 90% of genital warts). * **Mechanism:** HPV **E6** inhibits **p53** (pro-apoptotic), while **E7** inhibits **pRb** (cell cycle regulator), leading to unchecked cellular proliferation [1]. * **Vaccination:** The Quadrivalent vaccine (Gardasil) targets types 6, 11, 16, and 18; the Nonavalent vaccine adds types 31, 33, 45, 52, and 58. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 334-335. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1008-1010. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 466-467.

Question 198: All of the following are germ cell tumors except?

A. Seminoma
B. Leydig cell tumor (Correct Answer)
C. Embryonal carcinoma
D. Endodermal sinus tumor

Explanation: **Explanation:** Testicular tumors are broadly classified into two main categories: **Germ Cell Tumors (GCTs)**, which account for approximately 95% of cases, and **Sex Cord-Stromal Tumors**, which are much rarer [1, 2]. **Why Leydig cell tumor is the correct answer:** Leydig cell tumors originate from the **interstitial (stromal) cells** of the testis, not from the germ cells [1]. Therefore, they belong to the **Sex Cord-Stromal** category. These tumors are often functionally active, secreting androgens (leading to precocious sexual development in children) or estrogens (leading to gynecomastia in adults) [1, 2]. A classic histological hallmark is the presence of **Reinke crystals**. **Why the other options are Germ Cell Tumors:** * **Seminoma:** The most common GCT [2]. It is the male counterpart of the ovarian dysgerminoma. It is highly radiosensitive and characterized by "watery" clear cytoplasm and fibrous septa with lymphocytic infiltration. * **Embryonal carcinoma:** A highly aggressive non-seminomatous GCT (NSGCT) composed of primitive, pleomorphic cells forming sheets or papillary patterns [2]. * **Endodermal sinus tumor (Yolk sac tumor):** The most common testicular tumor in infants and children (up to age 3). It is characterized by the presence of **Schiller-Duval bodies** and elevated serum **Alpha-fetoprotein (AFP)** [2]. **NEET-PG High-Yield Pearls:** 1. **Most common GCT:** Seminoma [2]. 2. **Tumor Markers:** AFP is *never* elevated in pure seminomas; it is a marker for Yolk sac tumors. hCG is elevated in Choriocarcinomas [1]. 3. **Reinke Crystals:** Pathognomonic for Leydig cell tumors (rod-shaped cytoplasmic inclusions). 4. **Call-Exner Bodies:** Associated with Granulosa cell tumors (another sex cord-stromal tumor). **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 510-514. [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. 979-980.

Question 199: Apoptosis can occur by change in hormone levels in the ovarian cycle. When there is no fertilization of the ovum, the endometrial cells die because:

A. The involution of corpus luteum causes estradiol and progesterone levels to fall dramatically. (Correct Answer)
B. LH levels rise after ovulation.
C. Estradiol levels are not involved in the LH surge phenomenon.
D. Estradiol inhibits the induction of the progesterone receptor in the endometrium.

Explanation: ### Explanation **1. Why Option A is Correct:** The menstrual cycle is governed by the hormonal output of the ovaries. After ovulation, the ruptured follicle becomes the **corpus luteum**, which secretes high levels of **progesterone and estradiol** to maintain the secretory endometrium for potential implantation [1]. If fertilization does not occur, the corpus luteum undergoes programmed involution (luteolysis). This leads to a **precipitous drop** in progesterone and estrogen levels. The withdrawal of these trophic hormones triggers **apoptosis** in the endometrial functionalis layer [2], primarily through the activation of caspases and local release of matrix metalloproteinases, resulting in menstruation. **2. Why the Other Options are Incorrect:** * **Option B:** LH levels actually **drop** after the mid-cycle surge. High levels of progesterone during the luteal phase exert negative feedback on the pituitary, suppressing LH. * **Option C:** This is physiologically incorrect. Estradiol is the primary trigger for the **LH surge** via a positive feedback mechanism once it reaches a specific threshold. * **Option D:** In reality, estradiol **induces** (upregulates) the expression of progesterone receptors in the endometrium, "priming" the tissue to respond to progesterone in the second half of the cycle. **3. NEET-PG High-Yield Pearls:** * **Mechanism of Cell Death:** Menstruation is a classic physiological example of **apoptosis** triggered by hormone withdrawal (intrinsic pathway) [2]. * **Vascular Changes:** Hormone withdrawal causes spiral artery vasoconstriction, leading to local ischemia, which further accelerates endometrial shedding [1]. * **Key Mediator:** Progesterone withdrawal is the most critical trigger for the initiation of menses. * **Luteal Phase Duration:** The lifespan of the corpus luteum is remarkably constant (approximately 14 days) in the absence of hCG. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1011-1012. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, pp. 63-64.

Question 200: Which germ cell tumor is associated with elevated Alpha-fetoprotein (AFP)?

A. Teratoma
B. Yolk sac tumor (Correct Answer)
C. Choriocarcinoma
D. Dysgerminoma

Explanation: **Explanation:** **Yolk Sac Tumor (Endodermal Sinus Tumor)** is the correct answer because it is the most common germ cell tumor in children and is characterized by the production of **Alpha-fetoprotein (AFP)** [1]. This occurs because the tumor cells recapitulate the yolk sac, which is the physiological site of AFP synthesis during early embryogenesis. A classic histological hallmark is the **Schiller-Duval body**, which resembles a primitive glomerulus. **Analysis of Incorrect Options:** * **Teratoma:** These are composed of tissues from multiple germ layers (ectoderm, mesoderm, endoderm) [1]. While they may contain various tissues, they do not characteristically secrete AFP unless they contain a yolk sac component (mixed germ cell tumor). * **Choriocarcinoma:** This is a highly malignant tumor of trophoblastic cells [2]. Its definitive biochemical marker is **beta-hCG**, not AFP [2]. * **Dysgerminoma (Seminoma in males):** These are composed of primitive undifferentiated germ cells [1]. They are typically associated with elevated **LDH** (Lactate Dehydrogenase). While they may occasionally show mild elevations in hCG if syncytiotrophoblastic giant cells are present [3], AFP is always normal. **High-Yield Clinical Pearls for NEET-PG:** * **AFP** is a marker for **Yolk Sac Tumor** and **Hepatocellular Carcinoma (HCC)**. * **Schiller-Duval bodies** are pathognomonic for Yolk sac tumors. * **Reinke crystals** are seen in Leydig cell tumors. * **Call-Exner bodies** are seen in Granulosa cell tumors (associated with high Estrogen and Inhibin). * In any germ cell tumor question, remember: **Y**olk sac = **Y**ellow (gross appearance) = **A**FP. **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. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, p. 982. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 980-982.

Practice by Chapter

Diseases of Male Genital Tract

Practice Questions

Testicular Tumors

Practice Questions

Prostate Pathology

Practice Questions

Diseases of Female Genital Tract

Practice Questions

Cervical Pathology and Neoplasia

Practice Questions

Endometrial Pathology

Practice Questions

Ovarian Diseases and Tumors

Practice Questions

Gestational Trophoblastic Disease

Practice Questions

Placental Pathology

Practice Questions

Sexually Transmitted Infections

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free