Reproductive Pathology Practice Questions

Q: Struma ovarii is

Teratoma of ovary. ***Teratoma of ovary*** - **Struma ovarii** is a rare form of **monodermal teratoma** that is composed predominantly of **thyroid tissue** (more than 50%) [1]. - As a teratoma, it originates from **germ cells** and can contain various mature or immature tissues, in this case, primarily thyroid [2]. *May present as hypothyroidism* - While composed of thyroid tissue, **struma ovarii** typically causes **hyperthyroidism** due to the autonomous production of thyroid hormones [1]. - Hypothyroidism would be an atypical presentation, as the ectopic thyroid tissue usually functions independently of pituitary control, leading to excess hormone production [1]. *Thyroid gland tumor in pregnancy* - Struma ovarii is a tumor of the **ovary**, not the thyroid gland itself, and it can occur independently of pregnancy, although it might be diagnosed during pregnancy due to increased screening. - While thyroid tumors can occur during pregnancy, this option describes the wrong anatomical location for struma ovarii. *Ovarian stromal hyperplasia* - **Ovarian stromal hyperplasia** involves an increase in the number of stromal cells within the ovary, often associated with androgen excess. - Struma ovarii, in contrast, is a **germ cell tumor** characterized by the presence of thyroid tissue, not hyperplasia of ovarian stromal cells [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, p. 1034. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 480-481.

Q: Germ cell tumor(s) of paediatric includes all except

Leydig cell tumor. Leydig cell tumor - Leydig cell tumors are sex cord-stromal tumors, not germ cell tumors, and are less common in the pediatric population compared to adulthood. - While they can occur in children, they originate from the interstitial cells of the testes and produce steroids, differentiating them from germ cell lines. Embryonal cell carcinoma - This is a highly malignant germ cell tumor that can occur in pediatric patients, particularly in the testes or ovaries [1], [2]. - It is characterized by primitive, undifferentiated cells with significant pleomorphism and frequent mitoses [1]. Choriocarcinoma - Although rare, choriocarcinoma is a highly aggressive germ cell tumor that can affect children, particularly in the gonads or mediastinum [2], [3]. - It is characterized by the presence of syncytiotrophoblastic and cytotrophoblastic cells and elevated human chorionic gonadotropin (hCG) [2]. Pure yolk sac tumor - The yolk sac tumor, also known as an endodermal sinus tumor, is the most common malignant germ cell tumor in infants and young children [1]. - It is often associated with elevated alpha-fetoprotein (AFP) levels and can be found in the gonads or sacrococcygeal region. **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 Female Genital Tract, pp. 1035-1036. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1140-1141.

Q: Most common radiosensitive ovarian tumour -

Dysgerminoma. ### Dysgerminoma - Dysgerminomas are highly radiosensitive germ cell tumors of the ovary, making radiation therapy a very effective treatment option [2]. - They are the most common malignant germ cell tumor of the ovary, typically affecting adolescents and young women [1]. *Theca cell tumour* - Theca cell tumors are typically benign, estrogen-producing stromal tumors of the ovary. - They are not generally treated with radiation due to their benign nature and infrequent recurrence. *Teratoma* - Teratomas are germ cell tumors that can be mature (benign) or immature (malignant) [2]. - While immature teratomas can be malignant, they are generally not as radiosensitive as dysgerminomas and surgical resection is the primary treatment. *Granulosa cell tumour* - Granulosa cell tumors are sex cord-stromal tumors that are typically estrogen-producing and have a low malignant potential. - They are not profoundly radiosensitive, and the primary treatment for these tumors is surgical. **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. 480-481.

Q: Which of the following is the karyotype of male who is sexually under developed with rudimentary testes and prostate glands, sparse pubic and facial hair, long arms and legs and large hands & feet?

47, XXY. 47, XXY - This karyotype describes **Klinefelter syndrome**, the most common chromosomal disorder affecting males. - The extra X chromosome leads to **primary hypogonadism** with testicular dysgenesis, causing rudimentary testes with small, firm consistency and azoospermia (infertility) [1]. - Clinical features include **sparse body hair** (pubic, facial, and axillary), **eunuchoid body proportions** (long limbs, large hands and feet due to delayed epiphyseal closure), **gynecomastia**, and elevated gonadotropins (FSH/LH) [1]. - Patients have **decreased testosterone** levels and are at increased risk of metabolic syndrome, osteoporosis, and breast cancer [1]. *Incorrect: 45, X* - This karyotype describes **Turner syndrome**, which affects phenotypic females, not males [1]. - Characterized by **short stature** (opposite of the long limbs described), webbed neck, shield chest, and **gonadal dysgenesis** with streak ovaries. - Does not present with male characteristics or testicular development. *Incorrect: 47, XYY* - This karyotype describes **XYY syndrome** (Jacob's syndrome). - Individuals are typically **tall with normal male sexual development** and normal fertility. - May have mild learning difficulties or behavioral issues, but do NOT present with hypogonadism, sparse body hair, or rudimentary testes. *Incorrect: 46, XY* - This is the **normal male karyotype** with standard male sexual development. - Would present with normal secondary sexual characteristics, normal testicular size, and normal testosterone levels—completely contrary to the clinical picture described. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 173-175.

Q: Subnuclear cytoplasmic vacuolization is seen in which stage of menstrual cycle?

Secretory phase. ***Secretory phase*** - **Subnuclear cytoplasmic vacuolization** is a characteristic histological feature of the **early secretory phase** (days 16-18), occurring immediately after ovulation [1]. - This change reflects **progesterone-mediated differentiation** of endometrial glands, with glycogen accumulation creating vacuoles beneath the nucleus [1]. - This is the **most reliable histological marker** for dating the early secretory endometrium [1]. *Proliferative phase* - This phase (days 5-14) is characterized by **estrogen-driven endometrial growth** with straight, tubular glands and mitotic activity [1]. - No subnuclear vacuolization is present; glands show pseudostratified columnar epithelium without secretory changes [1]. *During menstruation* - During menstruation (days 1-5), the endometrium undergoes **tissue breakdown and shedding** [1]. - No organized glandular architecture or subnuclear vacuolization is seen; instead, there is necrosis, hemorrhage, and inflammatory infiltrate [1]. *None of the options* - Subnuclear cytoplasmic vacuolization is a well-defined histological feature specifically associated with the early secretory phase of the menstrual cycle. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1011-1013.

Q: Seminoma corresponds to

Dysgerminoma. ***Dysgerminoma*** - **Dysgerminoma** is the ovarian equivalent of a testicular **seminoma**, both originating from **germ cells** and exhibiting similar histological features [1], [3]. - They tend to be sensitive to **radiotherapy** and **chemotherapy**, often presenting as solid, lobulated tumors. *Granulosa tumour* - **Granulosa cell tumors** are sex cord-stromal tumors, not germ cell tumors, and are characterized by **estrogen production**. - They do not share the same cellular origin or histological features with seminoma. *Choriocarcinoma* - **Choriocarcinoma** is a highly malignant germ cell tumor that differentiates towards trophoblastic tissue and produces **human chorionic gonadotropin (hCG)** [2], [5]. - While it is a type of germ cell tumor, it is distinct from seminoma/dysgerminoma due to its unique differentiation and aggressive nature [4]. *Luteal cyst* - A **luteal cyst** is a benign functional ovarian cyst that forms from the corpus luteum after ovulation, not a neoplastic germ cell tumor. - It is a physiological structure, distinct from cancerous growths like seminoma or dysgerminoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1140-1141. [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. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1034-1035. [4] 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. [5] 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: All of the following may cause testicular atrophy except :

Torsion testis. ***Torsion testis*** - Testicular torsion, if **promptly treated**, may not lead to atrophy as blood flow can be restored before irreversible damage occurs [1]. - While prolonged torsion causes **ischemia and necrosis**, leading to atrophy; acute, successful detorsion would prevent it [1]. *Hypopituitarism* - Leads to decreased production of **gonadotropins** (LH and FSH), which are essential for testicular function and size [2]. - This hormonal deficiency results in **reduced spermatogenesis** and testosterone production, causing atrophy [2]. *Irradiation* - **Radiation therapy** to the pelvic area can directly damage the germinal epithelium and Leydig cells of the testes [2]. - This damage leads to impaired sperm production and **testosterone synthesis**, causing irreversible testicular atrophy [2]. *Cryptorchidism* - Refers to the **undescended testis**, which is exposed to higher temperatures in the abdomen or inguinal canal [3]. - This elevated temperature impairs germ cell development and can lead to **fibrosis and atrophy** of the seminiferous tubules over time [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. 978-979. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 514-515. [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. 976-977.

Q: Ovarian tumours commonly arise from:

Surface epithelium. ***Surface epithelium*** - The **surface epithelium** of the ovary, which is derived from the coelomic epithelium, is the origin of the **vast majority** (approximately 65-70%) of ovarian tumors, including **serous, mucinous, endometrioid, clear cell, and Brenner tumors** [1]. - These epithelial cells are prone to genetic mutations and proliferation due to constant ovulation and repair processes, increasing their susceptibility to malignant transformation. - **Epithelial ovarian cancers** are the most common type and account for most ovarian cancer deaths. *Germ cell* - **Germ cell tumors** account for approximately **15-20%** of ovarian neoplasms, typically seen in **younger individuals** and adolescents [1]. - Examples include **dysgerminomas**, **teratomas** (mature and immature), **yolk sac tumors**, and **choriocarcinomas**. - These tumors arise from the primordial germ cells of the ovary. *Metastatic tumors* - **Metastatic tumors** to the ovary account for approximately **5-10%** of ovarian malignancies. - The most common primary sites include the **gastrointestinal tract** (Krukenberg tumor from stomach/colon), **breast**, and **endometrium**. - Krukenberg tumors characteristically show **signet-ring cells** on histology. *Stroma of the ovary* - Tumors arising from the ovarian **stroma** (sex cord-stromal tumors) are less common, accounting for approximately **5-8%** of ovarian neoplasms. - These include **granulosa cell tumors**, **thecomas**, **fibromas**, and **Sertoli-Leydig cell tumors**. - These tumors are often associated with **hormone production** and may present with endocrine manifestations. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1026-1028.

Question 1

A 27-year-old man has surgery for a testicular mass. Histologic sections reveal the mass to be a testicular yolk sac tumor. Which of the substances listed below is most likely to be increased in this patient's serum?

Accepted Answer

Alpha-fetoprotein

Answer

Acid phosphatase

Answer

Human chorionic gonadotropin

Answer

Alkaline phosphatase

Question 2

Struma ovarii is

Accepted Answer

Teratoma of ovary

Answer

May present as hypothyroidism

Answer

Thyroid gland tumor in pregnancy

Answer

Ovarian stromal hyperplasia

Question 3

Germ cell tumor(s) of paediatric includes all except

Accepted Answer

Leydig cell tumor

Answer

Embryonal cell carcinoma

Answer

Choriocarcinoma

Answer

Pure yolk sac tumor

Question 4

Most common radiosensitive ovarian tumour -

Accepted Answer

Dysgerminoma

Answer

Theca cell tumour

Answer

Teratoma

Answer

Granulosa cell tumour

Question 5

Which of the following is the karyotype of male who is sexually under developed with rudimentary testes and prostate glands, sparse pubic and facial hair, long arms and legs and large hands & feet?

Accepted Answer

47, XXY

Answer

45, X

Answer

47, XYY

Answer

46, XY

Question 6

Subnuclear cytoplasmic vacuolization is seen in which stage of menstrual cycle?

Accepted Answer

Secretory phase

Answer

Proliferative phase

Answer

During menstruation

Answer

None of the options

Question 7

Seminoma corresponds to

Accepted Answer

Dysgerminoma

Answer

Granulosa tumour

Answer

Choriocarcinoma

Answer

Luteal cyst

Question 8

All of the following may cause testicular atrophy except :

Accepted Answer

Torsion testis

Answer

Hypopituitarism

Answer

Irradiation

Answer

Cryptorchidism

Question 9

Ovarian tumours commonly arise from:

Accepted Answer

Surface epithelium

Answer

Germ cell

Answer

Stroma of the ovary

Answer

Metastatic tumors

Question 10

Lesions affecting the terminal duct lobular unit (TDLU) in breast are all except

Accepted Answer

Nipple adenoma

Answer

Intraductal papilloma

Answer

Fibroadenoma

Answer

Blunt duct adenosis

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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