Reproductive Pathology Practice Questions

Q: Which of the following conditions of the endometrium is associated with a significantly increased risk of development of cancer?

Complex hyperplasia with atypia. ***Complex hyperplasia with atypia*** - This condition carries the highest risk of progression to **endometrial carcinoma**, with approximately a 29% chance of concurrent or subsequent carcinoma [1], [2]. - The presence of **atypia** (abnormal cellular architecture and nuclear features) is the critical factor indicating a high malignant potential [1], [2]. *Complex hyperplasia* - While a form of endometrial hyperplasia, it lacks the **atypical cellular features** that significantly elevate the risk of malignancy [1]. - The risk of progression to endometrial carcinoma is much lower, around 3%, compared to atypical forms [1]. *Simple atypical hyperplasia* - This condition features **atypia** but with a less complex glandular architectural proliferation than complex atypical hyperplasia [2]. - Although it has a lower risk of malignancy than complex atypical hyperplasia (around 8%), it still has a significantly higher risk than non-atypical hyperplasias. *Simple hyperplasia* - This is the **least severe** form of endometrial hyperplasia, characterized by glandular and stromal proliferation without architectural complexity or cellular atypia [1]. - The risk of progression to endometrial carcinoma is very low, approximately 1%, making it far less concerning than atypical forms [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 473-475. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1016-1018.

Q: Among the following causes of genital ulcers, which is MOST likely to show chronic inflammatory changes?

Primary syphilis. ***Primary syphilis*** - The primary chancre shows **classic chronic inflammatory infiltrate** with **dense lymphoplasmacytic infiltration** and prominent **plasma cells** [2] - Characterized by **endothelial proliferation** (endarteritis obliterans) and **perivascular chronic inflammation** [2] - This represents the **most characteristic chronic inflammatory pattern** among genital ulcer causes - Spirochetes (*Treponema pallidum*) can be identified with special stains [2] *Granuloma inguinale (Donovanosis)* - Despite its name, does **NOT** show true granulomatous inflammation - Shows **mixed inflammatory infiltrate** with mononuclear cells, plasma cells, and neutrophils - Contains **Donovan bodies** (*Klebsiella granulomatis* within macrophages) - The inflammation is more **subacute/mixed** rather than purely chronic *Genital herpes* - Caused by **herpes simplex virus (HSV)** with **vesicular lesions** that ulcerate [1] - Shows **acute inflammatory response** with lymphocytic infiltrate and viral cytopathic effects - Predominantly **acute inflammation**, not chronic *Chancroid* - Caused by *Haemophilus ducreyi*, producing **painful soft chancres** - Shows **suppurative (acute) inflammation** with extensive **neutrophilic infiltration** and tissue necrosis - Classic **acute inflammatory pattern**, not chronic **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. 503-504. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 386-388.

Q: Which of the following HPV types is MOST strongly associated with cervical cancer?

HPV 16. ***HPV 16*** - **HPV 16** is the most prevalent **high-risk HPV type**, accounting for approximately 50-60% of all cervical cancer cases globally. - It's highly effective at integrating its DNA into host cells and producing **oncoproteins E6 and E7**, which promote cell proliferation and inhibit tumor suppressor genes [1]. *HPV 18* - While **HPV 18** is also a **high-risk type** and the second most common cause of cervical cancer (around 10-15%), it is less frequently associated than HPV 16 [1]. - HPV 18 is more commonly linked to **adenocarcinomas** of the cervix, whereas HPV 16 is more often associated with **squamous cell carcinomas**. *HPV 6* - **HPV 6** is considered a **low-risk HPV type**, primarily associated with benign conditions such as **genital warts (condyloma acuminata)** [1]. - It rarely causes cervical cancer and is not considered an oncogenic type. *HPV 11* - Similar to HPV 6, **HPV 11** is also a **low-risk HPV type** and is a common cause of **genital warts**. - It is not associated with an increased risk of cervical cancer. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 334-335.

Q: Identify the pathological condition shown in the image:

Adenomyoma. ***Adenomyoma*** - The image distinctly shows **endometrial glands and stroma** embedded within the **myometrium** (smooth muscle layer of the uterus), which is the hallmark of adenomyoma [1]. - This condition is essentially a localized form of **adenomyosis**, presenting as a mass [1]. *Intramural fibroid* - An intramural fibroid (leiomyoma) is a **benign tumor of smooth muscle cells**, typically showing a proliferation of uniform spindle cells with characteristic swirling patterns [2]. - It would lack the presence of **endometrial glands and stroma** within the lesion [2]. *Endometriosis* - Endometriosis involves the presence of **endometrial tissue outside the uterus**, such as on the ovaries, peritoneum, or bowel. - While it involves similar tissue, its location is **extrauterine**, whereas the image depicts a lesion within the uterine wall. *Myomatous polyp* - A myomatous polyp (or submucosal fibroid) is a **fibroid that protrudes into the uterine cavity**, often covered by endometrial tissue [2]. - The image does not show a polypoid growth extending into the cavity but rather glandular tissue directly within the muscle wall. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 475-476. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1024-1025.

Q: Most common benign breast tumour:

Fibroadenoma. ***Fibroadenoma*** - **Fibroadenomas** are the **most common benign breast tumors**, typically presenting as mobile, firm, and non-tender masses [1]. - They are composed of both **glandular and stromal tissue** and are more prevalent in younger women [1]. *Phyllodes tumour* - **Phyllodes tumors** are much **rarer** than fibroadenomas and can be benign, borderline, or malignant [3]. - They tend to grow **rapidly** and are characterized by a leaf-like stromal pattern [3]. *Fibroadenosis* - **Fibroadenosis** (or fibrocystic changes) refers to a collection of **benign changes** in the breast tissue, including cysts, fibrosis, and epithelial hyperplasia, rather than a single tumor [2]. - It is a common condition causing lumpy and painful breasts, especially before menstruation [4]. *DCIS* - **Ductal Carcinoma In Situ (DCIS)** is a **non-invasive form of breast cancer** where abnormal cells are confined to the milk ducts. - It is not a benign tumor and carries a risk of progression to invasive breast cancer. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 448-449. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 445-446. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1074. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1052.

Q: Germ cell tumour not seen in males:

Sertoli cell tumour. ***Correct: Sertoli cell tumour*** - Sertoli cell tumours are **sex cord-stromal tumours**, NOT germ cell tumours - They arise from specialized supporting cells in the testes (Sertoli cells) that normally nurture developing germ cells - These tumours produce hormones (estrogen, inhibin) and are distinct from germ cell neoplasias - Account for <1% of testicular tumours *Incorrect: Seminoma* - Seminoma IS a germ cell tumour - the **most common type** in males (40-50% of testicular germ cell tumours) [1] - Originates from malignant germ cells in the testes [1] - Characterized by uniform cells, lymphocytic infiltrate, and excellent prognosis with radiation sensitivity [3] *Incorrect: Choriocarcinoma* - Choriocarcinoma IS a highly aggressive **germ cell tumour** that occurs in males (testicular origin) [1] - Produces **human chorionic gonadotropin (hCG)** - important tumor marker [2] - Can occur as pure choriocarcinoma or as part of mixed germ cell tumour [2] - Characterized by syncytiotrophoblast and cytotrophoblast cells [2] *Incorrect: Teratoma* - Teratoma IS a germ cell tumour composed of tissues from all three embryonic germ layers (ectoderm, mesoderm, endoderm) [1] - Common in males (testicular teratoma) - can be mature or immature [1] - In adult males, even mature teratomas have malignant potential unlike in children [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. [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.

Q: Chimney Sweeper cancer is the other name for

Carcinoma scrotum. ***Carcinoma scrotum*** - **Chimney sweepers' cancer** is a historical term for **squamous cell carcinoma of the scrotum**, first described by Percivall Pott in 1775. - It was linked to prolonged exposure to **soot**, a known carcinogen, in young chimney sweeps. *Carcinoma testis* - This is a cancer of the **testicles**, not typically associated with occupational exposure to soot or referred to as "chimney sweeper cancer." - It commonly presents as a **painless lump** in the testis. *Carcinoma lung* - While lung cancer can be linked to occupational exposures (e.g., asbestos, smoking), it is not called "chimney sweeper cancer." - It primarily affects the **respiratory system**. *Carcinoma skin* - Skin cancer can be caused by various factors, including **UV radiation**, but the term "chimney sweeper cancer" specifically refers to scrotal carcinoma due to soot exposure. - It can occur on any skin surface, unlike the specific scrotal location.

Q: A 60-year-old woman presents with a 2-week history of uterine bleeding. Gynecologic examination reveals an enlarged uterus. The hysterectomy specimen shows a large polypoid mass involving the endometrium and myometrium. Histologic examination reveals malignant glands and malignant stromal elements, including striated muscle and cartilage. What is the appropriate diagnosis?

Carcinosarcoma. ***Carcinosarcoma*** - Carcinosarcomas (also known as **Malignant Mixed Mullerian Tumors**) are characterized by a biphasic histology, containing both **malignant epithelial (carcinomatous)** and **malignant mesenchymal (sarcomatous)** components [1], [2]. - The presence of **malignant glands** (epithelial component) and **malignant stromal elements**, including **striated muscle** and **cartilage** (both heterologous mesenchymal components), is pathognomonic for carcinosarcoma [1]. *Endometrioid adenocarcinoma* - This is a **pure epithelial malignancy** composed of malignant glandular structures resembling normal endometrial glands [2]. - It **lacks the malignant mesenchymal (stromal) elements** that are a key feature in the patient's presentation. *Pleomorphic adenoma* - This tumor is typically found in **salivary glands** not the uterus, and is a **benign mixed tumor** with both epithelial and stromal components, usually without malignant transformation in the initial presentation. - The uterine bleeding, enlarged uterus, and malignant histologic findings are **inconsistent with a pleomorphic adenoma**, which is also a type of salivary gland tumor. *Leiomyosarcoma* - This is a **pure mesenchymal malignancy** composed of smooth muscle cells with evidence of malignancy, such as increased mitotic activity, nuclear atypia, and coagulative necrosis. - It **lacks the malignant glandular (epithelial) component** found in this patient's tumor. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 475-476. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1022-1024.

Question 1

Which of the following are correct regarding pathology of stress urinary incontinence?

1. Hypermobility of urethra
2. Descent of bladder neck and proximal urethra below pelvic diaphragm
3. Lowered urethral pressure
4. Increased detrusor activity

Accepted Answer

1, 2 and 3

Answer

2 and 4

Answer

3 and 4

Answer

1, 2 and 4

Answer

1 and 2

Question 2

Which of the following conditions of the endometrium is associated with a significantly increased risk of development of cancer?

Accepted Answer

Complex hyperplasia with atypia

Answer

Complex hyperplasia

Answer

Simple atypical hyperplasia

Answer

Simple hyperplasia

Question 3

Among the following causes of genital ulcers, which is MOST likely to show chronic inflammatory changes?

Accepted Answer

Primary syphilis

Answer

Granuloma inguinale (Donovanosis)

Answer

Genital herpes

Answer

Chancroid

Question 4

Which of the following HPV types is MOST strongly associated with cervical cancer?

Accepted Answer

HPV 16

Answer

HPV 18

Answer

HPV 6

Answer

HPV 11

Question 5

Identify the pathological condition shown in the image:

Accepted Answer

Adenomyoma

Answer

Intramural fibroid

Answer

Endometriosis

Answer

Myomatous polyp

Question 6

All of the following are tests done for Turner mosaic screening except?

Accepted Answer

Serum FSH

Answer

Karyotype

Answer

FISH

Answer

Buccal smear

Question 7

Most common benign breast tumour:

Accepted Answer

Fibroadenoma

Answer

Phyllodes tumour

Answer

Fibroadenosis

Answer

DCIS

Question 8

Germ cell tumour not seen in males:

Accepted Answer

Sertoli cell tumour

Answer

Seminoma

Answer

Choriocarcinoma

Answer

Teratoma

Question 9

Chimney Sweeper cancer is the other name for

Accepted Answer

Carcinoma scrotum

Answer

Carcinoma testis

Answer

Carcinoma lung

Answer

Carcinoma skin

Question 10

A 60-year-old woman presents with a 2-week history of uterine bleeding. Gynecologic examination reveals an enlarged uterus. The hysterectomy specimen shows a large polypoid mass involving the endometrium and myometrium. Histologic examination reveals malignant glands and malignant stromal elements, including striated muscle and cartilage. What is the appropriate diagnosis?

Accepted Answer

Carcinosarcoma

Answer

Endometrioid adenocarcinoma

Answer

Pleomorphic adenoma

Answer

Leiomyosarcoma

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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