Reproductive Pathology — MCQs
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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?
Struma ovarii is
Germ cell tumor(s) of paediatric includes all except
Most common radiosensitive ovarian tumour -
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?
Subnuclear cytoplasmic vacuolization is seen in which stage of menstrual cycle?
Seminoma corresponds to
All of the following may cause testicular atrophy except :
Ovarian tumours commonly arise from:
Lesions affecting the terminal duct lobular unit (TDLU) in breast are all except
Reproductive Pathology Indian Medical PG Practice Questions and MCQs
Question 251: 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?
- A. Acid phosphatase
- B. Human chorionic gonadotropin
- C. Alkaline phosphatase
- D. Alpha-fetoprotein (Correct Answer)
Explanation: ***Alpha-fetoprotein*** - **Yolk sac tumors**, also known as endodermal sinus tumors, are characterized by the production and elevation of **alpha-fetoprotein (AFP)** [2]. - AFP levels are crucial for both the **diagnosis** and **monitoring** of treatment response in patients with yolk sac tumors [2]. *Acid phosphatase* - **Acid phosphatase** is primarily associated with **prostatic carcinoma**, particularly in bone metastases, and would not be elevated in a testicular yolk sac tumor. - While it can be found in other tissues, it is not a specific or sensitive marker for germ cell tumors. *Human chorionic gonadotropin* - **Human chorionic gonadotropin (hCG)** is primarily elevated in **choriocarcinoma** and some **seminomas**, but not typically in pure yolk sac tumors [1]. - Mixed germ cell tumors can have elevated hCG if they contain a choriocarcinomatous component [1]. *Alkaline phosphatase* - **Alkaline phosphatase (ALP)** is a marker often elevated in conditions affecting the **liver** (e.g., cholestasis) or **bones** (e.g., Paget's disease, osteoblastic activity), but not specifically associated with testicular yolk sac tumors. - It is a general enzyme involved in various metabolic processes and not a specific tumor marker for this type of cancer. **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] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 254-255.
Question 252: Struma ovarii is
- A. May present as hypothyroidism
- B. Teratoma of ovary (Correct Answer)
- C. Thyroid gland tumor in pregnancy
- D. Ovarian stromal hyperplasia
Explanation: ***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.
Question 253: Germ cell tumor(s) of paediatric includes all except
- A. Embryonal cell carcinoma
- B. Choriocarcinoma
- C. Leydig cell tumor (Correct Answer)
- D. Pure yolk sac tumor
Explanation: 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.
Question 254: Most common radiosensitive ovarian tumour -
- A. Theca cell tumour
- B. Teratoma
- C. Granulosa cell tumour
- D. Dysgerminoma (Correct Answer)
Explanation: ### 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.
Question 255: 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?
- A. 45, X
- B. 47, XYY
- C. 46, XY
- D. 47, XXY (Correct Answer)
Explanation: 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.
Question 256: Subnuclear cytoplasmic vacuolization is seen in which stage of menstrual cycle?
- A. Proliferative phase
- B. During menstruation
- C. None of the options
- D. Secretory phase (Correct Answer)
Explanation: ***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.
Question 257: Seminoma corresponds to
- A. Dysgerminoma (Correct Answer)
- B. Granulosa tumour
- C. Choriocarcinoma
- D. Luteal cyst
Explanation: ***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.
Question 258: All of the following may cause testicular atrophy except :
- A. Hypopituitarism
- B. Irradiation
- C. Torsion testis (Correct Answer)
- D. Cryptorchidism
Explanation: ***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.
Question 259: Ovarian tumours commonly arise from:
- A. Germ cell
- B. Surface epithelium (Correct Answer)
- C. Stroma of the ovary
- D. Metastatic tumors
Explanation: ***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 260: Lesions affecting the terminal duct lobular unit (TDLU) in breast are all except
- A. Intraductal papilloma
- B. Fibroadenoma
- C. Blunt duct adenosis
- D. Nipple adenoma (Correct Answer)
Explanation: ***Nipple adenoma*** - **Nipple adenomas** (or florid papillomatosis of the nipple) are uncommon benign epithelial proliferations that specifically originate from the **major lactiferous ducts in the nipple**. - They do **NOT** arise from the **terminal duct lobular unit (TDLU)**, which is the functional unit of the breast parenchyma located peripherally in the breast tissue. - This makes nipple adenoma the correct answer to this "EXCEPT" question. *Intraductal papilloma* - **Intraductal papillomas** can be classified as central (large duct) or peripheral types. - While large solitary papillomas arise from major ducts, **peripheral/multiple papillomas** commonly involve the **smaller ducts and TDLU**. - In the context of breast pathology classification, papillomas are generally considered among lesions that can affect the **TDLU and ductal system**. - They are characterized by **papillary growths** [1] with fibrovascular cores within the ductal lumen. *Fibroadenoma* - **Fibroadenomas** are biphasic benign tumors that classically arise from the **terminal duct lobular unit (TDLU)** [3]. - They result from proliferation of both the **stromal and epithelial components** within the TDLU [3]. - This is the most common benign breast tumor in young women. *Blunt duct adenosis* - **Blunt duct adenosis** is a benign proliferative lesion characterized by an increase in the number of **small ducts and acini within the lobules**, which are components of the TDLU [2]. - It represents proliferation of the **glandular tissue** arising from the TDLU. - It is commonly seen as part of **fibrocystic changes** of the breast [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1052-1054. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 445-446. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 448-449.
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Diseases of Male Genital Tract
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Testicular Tumors
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Prostate Pathology
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Diseases of Female Genital Tract
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Cervical Pathology and Neoplasia
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Endometrial Pathology
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Ovarian Diseases and Tumors
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Gestational Trophoblastic Disease
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Placental Pathology
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Sexually Transmitted Infections
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