Reproductive Pathology Practice Questions

Q: Krukenberg tumour of the ovary is most commonly due to a primary carcinoma of which organ?

Stomach. **Explanation:** **Krukenberg tumor** is a specific type of metastatic signet-ring cell carcinoma of the ovary. The correct answer is **Stomach** because approximately 70% of Krukenberg tumors originate from a primary gastric malignancy (typically the diffuse type, characterized by *CDH1* mutations) [1]. * **Underlying Concept:** The tumor is characterized histologically by **signet-ring cells** (mucin-filled cells that displace the nucleus to the periphery) infiltrating a dense, reactive fibroblastic stroma [1]. The spread is traditionally thought to occur via lymphatics rather than direct peritoneal seeding, often presenting as bilateral, multinodular ovarian masses. **Analysis of Incorrect Options:** * **B. Lung:** While lung cancer can metastasize to the ovary, it is rare and does not typically present with the classic signet-ring morphology of a Krukenberg tumor. * **C. Central Nervous System:** Primary CNS tumors (like glioblastoma) almost never metastasize outside the cranium to the ovaries. * **D. Thyroid:** Thyroid malignancies (like papillary or follicular carcinoma) spread to cervical lymph nodes or bone/lung, but not typically to the ovaries. **NEET-PG High-Yield Pearls:** 1. **Primary Sites:** Stomach (most common) > Colon > Breast > Appendix. 2. **Laterality:** Usually **bilateral** (80% of cases), which helps distinguish it from primary ovarian surface epithelial tumors. 3. **Histology:** Look for the "Signet-ring" appearance and a positive **PAS stain** (due to intracellular mucin) [1]. 4. **Clinical Presentation:** Patients may present with an adnexal mass before the primary gastric lesion is even symptomatic. Always perform an upper GI endoscopy if a bilateral signet-ring ovarian tumor is found. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 779.

Q: All of the following are true about Krukenberg's tumor except?

Presence of large cystic spaces. **Explanation:** A **Krukenberg tumor** is a metastatic signet-ring cell carcinoma of the ovary, most commonly originating from a primary site in the gastrointestinal tract. **1. Why Option A is the correct answer (False statement):** Krukenberg tumors are characteristically **solid** and firm upon gross examination. They do not typically present with large cystic spaces; instead, they have a multinodular surface and a variegated cut surface that may show areas of necrosis or hemorrhage, but the overall architecture remains solid due to the dense stromal reaction (desmoplasia) induced by the infiltrating signet-ring cells. **2. Analysis of Incorrect Options (True statements):** * **Option B (Maintains ovarian shape):** Despite significant enlargement, these tumors characteristically preserve the general **kidney-shaped or ovoid contour** of the ovary. * **Option C (Bilateral involvement):** Metastatic tumors to the ovary are classically **bilateral** (seen in >80% of cases), which helps distinguish them from primary ovarian surface epithelial tumors, which are more frequently unilateral. * **Option D (Arises from stomach carcinoma):** The most common primary site is the **stomach** (specifically gastric adenocarcinoma, linitis plastica type). Other sites include the colon, appendix, and breast. **Clinical Pearls for NEET-PG:** * **Microscopy:** Look for **Signet-ring cells** (mucin-filled cytoplasm displacing the nucleus to the periphery) and a dense **sarcomatoid stroma**. * **Staining:** Positive for **PAS** and **Mucicarmine** (due to intracellular mucin). * **Route of Spread:** Traditionally thought to be via retrograde lymphatic spread rather than transcoelomic seeding. * **Rule of Thumb:** If an ovarian mass is bilateral and solid, always suspect a Krukenberg tumor and investigate the GI tract.

Question 1

Ovarian hyperthecosis is characterized by

Accepted Answer

Nests of luteinized theca cells in ovarian stroma.

Answer

Enlarged ovaries.

Answer

A less severe variant of PCOS.

Answer

Less severe hyperandrogenism.

Question 2

The BRCA1 gene is associated with which type of breast carcinoma?

Accepted Answer

Mucinous carcinoma

Answer

Lobular carcinoma

Answer

Tubular carcinoma

Answer

Papillary carcinoma

Question 3

Which is the most common germ cell tumor?

Accepted Answer

Seminoma

Answer

Embryonal teratoma

Answer

Dermoid

Answer

Rhabdomyosarcoma

Question 4

A postmenopausal woman presents with pruritic white lesions on the vulva. A punch biopsy of a representative area is obtained. Which of the following histologic findings is consistent with the diagnosis of Lichen sclerosis?

Accepted Answer

Blunting or loss of rete pegs

Answer

Excessive hyalinization

Answer

Acute inflammatory infiltration

Answer

Increased number of cellular layers in the epidermis

Question 5

Intratubular germ cell neoplasia unclassified (ITGCNU) is typically found adjacent to which of the following testicular tumors?

Accepted Answer

Dysgerminoma

Answer

Spermatocytic seminoma

Answer

Yolk sac tumor

Answer

All of the above

Question 6

A 35-year-old woman presents with a 2.2-cm mass in her left breast. The mass is excised, and histologic sections reveal a tumor composed of a mixture of ducts and cells. The epithelial cells within the ducts are not atypical in appearance. There is a marked increase in the stromal cellularity, but the stromal cells are not atypical in appearance and mitoses are not found. Which of the following is the most likely diagnosis?

Accepted Answer

Benign phyllodes tumor

Answer

Atypical epithelial hyperplasia

Answer

Fibroadenoma

Answer

Malignant phyllodes tumor

Question 7

A patient presents with suspected ovarian tumors. On laparotomy, bilaterally enlarged ovaries with a smooth surface are observed. What is the most likely diagnosis?

Accepted Answer

Krukenberg tumor

Answer

Granulosa cell tumor

Answer

Dysgerminoma

Answer

Primary adenocarcinoma

Question 8

Krukenberg tumour of the ovary is most commonly due to a primary carcinoma of which organ?

Accepted Answer

Stomach

Answer

Lung

Answer

Central nervous system

Answer

Thyroid

Question 9

Congenital adrenal hyperplasia (CAH) is associated with which of the following?

Accepted Answer

Female pseudohermaphroditism

Answer

Male pseudohermaphroditism

Answer

True hermaphroditism

Answer

Cushing syndrome

Question 10

All of the following are true about Krukenberg's tumor except?

Accepted Answer

Presence of large cystic spaces

Answer

Maintains ovarian shape

Answer

Bilateral involvement

Answer

Usually arises from stomach carcinoma

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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