Reproductive Pathology Practice Questions

Q: A 50 year old female presented with a breast mass that was operated and the microscopic examination in given. What is the diagnosis?

Mucinous carcinoma breast. ***Mucinous carcinoma breast*** - The micrograph shows clusters and nests of relatively uniform tumor cells floating in abundant extracellular **mucin**, which is the hallmark of this diagnosis. - This subtype of invasive ductal carcinoma is typically well-differentiated, hormone receptor-positive (**ER/PR positive**), and carries a more favorable prognosis than conventional invasive ductal carcinoma. *Lobular carcinoma breast* - This carcinoma is characterized by small, discohesive tumor cells infiltrating the stroma individually or in a **single-file** or **“Indian file”** pattern, which is not seen here [1]. - A key feature is the loss of **E-cadherin** expression, leading to the discohesive nature of the cells [3]. *Medullary carcinoma* - Histologically, this tumor presents as poorly differentiated cells arranged in solid, **syncytial sheets** with a prominent **lymphoplasmacytic infiltrate** [2]. - The image lacks both the syncytial growth pattern and the dense inflammatory background characteristic of medullary carcinoma [2]. *Phyllodes tumour* - This is a biphasic **fibroepithelial tumor**, characterized by a hypercellular stromal component and an epithelial component arranged in a **leaf-like** (phyllodes) architecture. - The defining feature is the proliferating stroma, whereas the image shows a carcinoma defined by its epithelial cells and extracellular mucin. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 454-455. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 455-456. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1068-1069.

Q: Histopathological features of granulosa cell tumor include all except:

CA-125 positivity. ***CA-125 positivity*** - **CA-125** is a **serum marker** predominantly associated with **epithelial ovarian cancer** (especially serous carcinoma), not a histopathological feature visible on microscopy. - It is not typically expressed by granulosa cell tumors (GCTs), which are sex cord-stromal tumors that produce **Inhibin** as their characteristic serum marker [1]. - **This is NOT a histopathological feature** but rather a laboratory/serological test, making it the correct answer to this "EXCEPT" question. *Incorrect: Microfollicular pattern* - Granulosa cells arrange themselves in **microfollicular or macrofollicular patterns**, creating small cystic spaces that are a key architectural feature [1]. - This pattern of growth is one of the characteristic **histopathological findings** seen on routine microscopy of adult GCTs. *Incorrect: Coffee bean nuclei* - This describes the characteristic appearance of tumor cell nuclei with **longitudinal grooves or infoldings**, giving them a distinct **'coffee bean'** appearance [1]. - This unique **nuclear morphology** is a classic and essential **histopathological feature** observed on H&E staining for diagnosis of GCT [1]. *Incorrect: Call-Exner bodies* - These are **small rosette-like structures** with central cystic spaces filled with eosinophilic material, formed by granulosa cells arranged in a circular pattern [1]. - Their presence is a **pathognomonic microscopic feature** of adult GCTs and represents follicular differentiation seen in these sex cord-stromal tumors [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1036-1037.

Q: A 30-year-old man presents with a painless testicular mass. An ultrasound shows a well-circumscribed, homogeneous, non-hemorrhagic testicular tumor. Which of the following is the most likely diagnosis?

Seminoma. Seminoma - The clinical presentation (painless mass in a 30-year-old) combined with ultrasound findings (well-circumscribed, homogeneous, non-hemorrhagic tumor) strongly favors seminoma, the most common testicular germ cell tumor [1]. - Histologically, seminomas consist of large, clear cells separated by delicate fibrovascular septa infiltrated with lymphocytes, confirming this diagnosis [1]. Yolk sac tumor - This tumor is primarily the most common germ cell malignancy in infants and young children (under 3 years old) [1]. - It is classically associated with significantly elevated serum marker Alpha-fetoprotein (AFP). Choriocarcinoma - This highly aggressive tumor is characterized by significant hemorrhage, necrosis, and cavitation due to vascular invasion, which contradicts the 'non-hemorrhagic' description [2]. - It produces high levels of Human Chorionic Gonadotropin (hCG) due to the presence of syncytiotrophoblasts [1]. Teratoma - Teratomas are typically seen as heterogeneous or complex cystic masses on ultrasound due to the presence of various differentiated tissue elements (e.g., cartilage, bone, fat) [3]. - Pure teratomas are rare in adults; they usually form part of a mixed germ cell tumor [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. 979-982. [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] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 982-983.

Q: A 50-year-old lady developed ascites. CT abdomen showed bilateral ovarian masses which were resected. The histopathological slide from the mass is shown below. What is the diagnosis?

Krukenberg tumour. ***Krukenberg tumour*** - The presence of **bilateral ovarian masses** and **ascites** in a 50-year-old lady, along with the typical histopathological appearance of **signet ring cells** (which would be implied by the image), is highly characteristic of a Krukenberg tumour. - Krukenberg tumours are **metastatic adenocarcinomas** to the ovary, most commonly originating from the stomach, colon, or breast, and are known for their bilateral presentation and mucin-filled signet ring cells. *Dysgerminoma* - Dysgerminomas are **germ cell tumours** that typically affect younger women and are often unilateral [1]. - Histologically, they are characterized by large, polygonal cells with clear cytoplasm and prominent nucleoli, arranged in nests or cords separated by fibrous septa infiltrated by lymphocytes, which is different from signet ring cells. *Serous cystadenoma* - Serous cystadenomas are **benign epithelial ovarian tumours** that are typically unilateral and cystic, filled with clear, watery fluid. - Histologically, they show a single layer of cuboidal or columnar epithelial cells lining the cyst, lacking the solid appearance and signet ring cells seen in Krukenberg tumours. *Granulosa cell tumour* - Granulosa cell tumours are **sex cord-stromal tumours** that are often unilateral and can produce estrogen, leading to symptoms like abnormal uterine bleeding [2]. - Histologically, they are characterized by Call-Exner bodies (small, fluid-filled spaces between granulosa cells) and coffee-bean nuclei, which are distinct from the signet ring cells of a Krukenberg tumour. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1034-1035. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 481-482.

Q: A 6-year-old girl with precocious puberty was found to have an ovarian tumour, which was resected laparoscopically. Histopathological slides were prepared. What is the diagnosis?

Granulosa cell tumour. ***Granulosa cell tumour*** - Granulosa cell tumours are the most common **estrogen-producing ovarian tumours** in children, leading to **precocious puberty** [2]. - Histologically, they often show **Call-Exner bodies** and a coffee-bean nuclear groove. - These tumors can occur at any age and all cases are potentially malignant [2]. *Arrhenoblastoma* - Arrhenoblastomas are **androgen-producing tumours** that cause **virilization** (e.g., hirsutism, clitoromegaly), not precocious puberty [3]. - They are typically composed of Sertoli and Leydig cells. *Endodermal sinus tumour* - Endodermal sinus tumours (yolk sac tumours) are **germ cell tumours** that produce **alpha-fetoprotein (AFP)**. - They are highly malignant and do not typically cause precocious puberty. *Thecoma* - Thecomas are benign ovarian tumours that can produce **estrogen**, but they are **less common** than granulosa cell tumours as a cause of precocious puberty in this age group [2]. - They are composed primarily of lipid-laden spindle cells [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1036-1037. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 481-482. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1037-1038.

Q: A 24 -year-old male patient with undescended testis has a lump in the groin since birth which was increasing since last 6 months. The resected specimen is shown below. All are correct about the condition except:

Does not invade the tunica. ***Does not invade the tunica*** - This statement is incorrect. **Seminomas**, which are common in undescended testes, often **invade the tunica albuginea** and rete testis. - Invasion of the tunica is a common feature of testicular germ cell tumors, including seminoma, and is an important prognostic factor. *Tumor maintains the testis contour* - **Seminomas** typically grow as a large, homogeneous mass that can **replace the testicular parenchyma** but often maintains the overall contour of the testis. - The tumor expands within the tunica albuginea, leading to an enlarged but often still ovoid shape of the testis. *Necrosis commonly starts from center of tumor* - **Necrosis** is a common feature in larger **seminomas**, and it typically starts in the **center of the tumor** due to inadequate blood supply as the tumor outgrows its vascularization. - This central necrosis can lead to cystic degeneration within the tumor. *PAS positive tumor cells in sheets* - **Seminoma cells** are typically rich in **glycogen**, which stains **PAS (Periodic Acid-Schiff) positive** [1]. - These cells are characteristically arranged in **sheets or lobules** separated by delicate fibrovascular septa, often with a prominent lymphocytic infiltrate [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. 980-982.

Q: The following is a post-orchidectomy histopathological specimen. Diagnosis is:

Seminoma. ***Seminoma*** - The image shows a **monotonous population of large, clear cells** with prominent nucleoli and distinct cell borders, arranged in lobules separated by fibrous septa with **lymphocytic infiltration** [1]. - This classic histological appearance, along with the presence of **syncytiotrophoblasts** (though not explicitly mentioned as a key feature for diagnosis from this image alone, it can be seen in some seminomas), is characteristic of **seminoma**, the most common germ cell tumor of the testis [1]. *Teratoma* - Teratomas are characterized by the presence of **multiple germ layers** (ectoderm, mesoderm, endoderm) with various differentiated tissues like cartilage, bone, neural tissue, or glandular structures [1]. - The image does not show the **heterogeneous tissue differentiation** typical of a teratoma. *Lymphoma* - Testicular lymphoma typically presents with a **diffuse infiltrate of atypical lymphoid cells**, often with a high mitotic rate, and lacks the clear cell appearance and fibrous septa seen in the image. - It is more common in **older men** and can be bilateral, unlike the typical presentation of seminoma. *Yolk sac tumor* - Yolk sac tumors (endodermal sinus tumors) are characterized by various architectural patterns, including **reticular, microcystic, solid, and papillary**, often with **Schiller-Duval bodies** (glomeruloid structures) [1]. - The image does not display these specific patterns or the characteristic Schiller-Duval bodies. **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.

Q: Hysterectomy specimen from a 40-year-old lady is shown along with histology slide. The diagnosis is:

Leiomyoma. ***Leiomyoma*** - Leiomyomas are **benign smooth muscle tumors** of the uterus, characterized by well-demarcated, whorled, and firm cut surfaces [1]. - Histologically, they show bundles of **smooth muscle cells** arranged in fascicles, with minimal atypia and low mitotic activity [1]. *Carcinoma endometrium* - Endometrial carcinoma typically presents as an **irregular, friable mass** originating from the endometrial lining, often with areas of necrosis or hemorrhage. - Histologically, it shows **glandular proliferation** with architectural complexity, nuclear atypia, and often invasion into the myometrium [2]. *Leiomyosarcoma* - Leiomyosarcomas are **malignant smooth muscle tumors** that are often poorly circumscribed, with areas of hemorrhage and necrosis [1]. - Histologically, they exhibit significant **nuclear atypia**, high mitotic activity (often >10 mitoses/10 HPF), and atypical mitoses [1]. *Endometriosis* - Endometriosis involves the presence of **endometrial glands and stroma outside the uterus**, often forming "chocolate cysts" in the ovaries or implants on peritoneal surfaces. - Histology would reveal **endometrial glands and stroma** surrounded by hemosiderin-laden macrophages, not a smooth muscle tumor. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1024-1025. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1020-1021.

Question 1

A 30-year-old female presents to the OPD with a 3 cm breast lump in the upper medial quadrant. The lump has an uneven, bosselated surface, and the overlying skin is mildly ulcerated. Microscopic examination reveals the given findings. What is the most likely diagnosis?

Accepted Answer

Phyllodes tumor

Answer

Fibroadenoma

Answer

Paget's disease

Answer

Galactocele

Question 2

A 50 year old female presented with a breast mass that was operated and the microscopic examination in given. What is the diagnosis?

Accepted Answer

Mucinous carcinoma breast

Answer

Medullary carcinoma

Answer

Lobular carcinoma breast

Answer

Phyllodes tumour

Question 3

A biopsy from a breast mass in a 55-year-old woman shows infiltrating ductal carcinoma. Immunohistochemistry reveals ER negative, PR negative, and HER2/neu negative. What is the classification of this tumor?

Accepted Answer

Triple-negative breast cancer

Answer

HER2-enriched subtype

Answer

Luminal B subtype

Answer

Luminal A subtype

Question 4

Histopathological features of granulosa cell tumor include all except:

Accepted Answer

CA-125 positivity

Answer

Microfollicular pattern

Answer

Coffee bean nuclei

Answer

Call-Exner bodies

Question 5

A 30-year-old man presents with a painless testicular mass. An ultrasound shows a well-circumscribed, homogeneous, non-hemorrhagic testicular tumor. Which of the following is the most likely diagnosis?

Accepted Answer

Seminoma

Answer

Yolk sac tumor

Answer

Choriocarcinoma

Answer

Teratoma

Question 6

A 50-year-old lady developed ascites. CT abdomen showed bilateral ovarian masses which were resected. The histopathological slide from the mass is shown below. What is the diagnosis?

Accepted Answer

Krukenberg tumour

Answer

Dysgerminoma

Answer

Serous cystadenoma

Answer

Granulosa cell tumour

Question 7

A 6-year-old girl with precocious puberty was found to have an ovarian tumour, which was resected laparoscopically. Histopathological slides were prepared. What is the diagnosis?

Accepted Answer

Granulosa cell tumour

Answer

Arrhenoblastoma

Answer

Endodermal sinus tumour

Answer

Thecoma

Question 8

A 24 -year-old male patient with undescended testis has a lump in the groin since birth which was increasing since last 6 months. The resected specimen is shown below. All are correct about the condition except:

Accepted Answer

Does not invade the tunica

Answer

Tumor maintains the testis contour

Answer

Necrosis commonly starts from center of tumor

Answer

PAS positive tumor cells in sheets

Question 9

The following is a post-orchidectomy histopathological specimen. Diagnosis is:

Accepted Answer

Seminoma

Answer

Teratoma

Answer

Lymphoma

Answer

Yolk sac tumor

Question 10

Hysterectomy specimen from a 40-year-old lady is shown along with histology slide. The diagnosis is:

Accepted Answer

Leiomyoma

Answer

Carcinoma endometrium

Answer

Leiomyosarcoma

Answer

Endometriosis

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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