Reproductive Pathology Practice Questions

Q: Reinke's crystals are found in -

Hilus cell tumor. ***Hilus cell tumor*** - **Reinke's crystals** are **eosinophilic, rod-shaped cytoplasmic inclusions** that are **pathognomonic of Leydig cells** [1]. - **Hilus cell tumors** (also called Leydig cell tumors) are composed of pure Leydig cells and are typically found in the ovarian hilum, producing androgens [1]. - This is the **classic and primary association** with Reinke's crystals in pathology [1]. *Dysgerminoma* - This is a **malignant germ cell tumor** of the ovary, histologically identical to testicular seminoma [2]. - It consists of uniform large cells with clear cytoplasm and prominent nuclei, not Leydig cells or Reinke's crystals [2]. *Arrhenoblastoma* - Also known as a **Sertoli-Leydig cell tumor**, this tumor contains both Sertoli and Leydig cells. - While Reinke's crystals may occasionally be seen due to the Leydig cell component, they are **far less common and less prominent** than in hilus cell tumors. - **Hilus cell tumor remains the classic answer** for questions about Reinke's crystals. *Granulosa cell tumor* - This is a **sex cord-stromal tumor** characterized by granulosa cells and often presents with **estrogen production**. - It frequently exhibits features like **Call-Exner bodies** (small, fluid-filled spaces resembling immature follicles), not Reinke's crystals. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1037-1038. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1034-1035.

Q: The surgical registrar successfully performs a testicular biopsy and hands over the specimen to the attending nurse. The sister asks you how to send the specimen to the pathologist. What fluid will you tell the sister to put the specimen in?

Bouin's solution. ***Bouin's solution*** - **Bouin's solution is the preferred fixative for testicular biopsies**, particularly for infertility evaluation and detailed assessment of spermatogenesis. - It provides **superior preservation of testicular architecture** and excellent nuclear detail, which is critical for evaluating seminiferous tubule morphology and germ cell maturation. - While it may cause some tissue shrinkage, the **enhanced nuclear detail and better preservation of seminiferous epithelium** make it the gold standard for testicular tissue. - Bouin's is specifically recommended in standard pathology protocols for reproductive tissue. *10% formalin* - While 10% neutral buffered formalin is the most common fixative for general surgical pathology specimens, it is **not optimal for testicular biopsies**. - Formalin provides adequate preservation but **does not give the superior nuclear and cytoplasmic detail** needed for detailed evaluation of spermatogenesis. - For routine testicular tumor specimens, formalin may be acceptable, but for **diagnostic testicular biopsies (especially for infertility)**, Bouin's solution is preferred. *95% ethanol* - Ethanol is primarily a **dehydrating agent**, not a suitable primary fixative for histology specimens. - It causes significant **tissue shrinkage and distortion**, making histological interpretation challenging. - Not appropriate for testicular tissue preservation. *Zenker's solution* - Zenker's solution is a **mercuric chloride-based fixative** with significant drawbacks. - Contains **toxic mercury** requiring special handling and disposal. - Can interfere with certain special stains and cause **chromatin clumping**. - Largely obsolete in modern pathology practice due to mercury content.

Q: All are true about seminomas except:

Rarely responds to radiotherapy. ***Rarely responds to radiotherapy*** - **Seminomas** are highly **radiosensitive** and respond very well to radiotherapy, especially localized disease [3]. - This characteristic makes radiotherapy a primary treatment modality for seminomas with excellent outcomes. *Spermatocytic seminoma is slow growing with good prognosis* - **Spermatocytic seminomas** are a distinct histological subtype, typically seen in older men and are characterized by a **slow growth rate** and an **excellent prognosis** [1]. - They rarely metastasize and are managed with orchiectomy alone. *Anaplastic seminomas is associated with a worse prognosis* - **Anaplastic seminomas** exhibit increased mitotic activity and cellular atypia, suggesting a more aggressive biological behavior. - Although more aggressive than classic seminomas, they generally still respond well to treatment, though the prognosis might be slightly inferior to classic seminoma; however, some sources suggest it does not portend a worse prognosis when matched for stage [1]. *Almost never occur in infants* - **Seminomas** are testicular germ cell tumors that typically affect young to middle-aged adults, with a peak incidence in the third and fourth decades of life. - They are exceedingly rare in infants and children; other germ cell tumors like yolk sac tumors are more common in this age group [2]. **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. [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] 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 sex cord stromal tumor?

Leydig cell tumor. ***Leydig cell tumor*** - **Leydig cells** are components of the **sex cords** in the testis and are primarily responsible for **testosterone production** [1]. - Tumors arising from these cells are therefore classified as **sex cord stromal tumors** [1]. *Seminoma* - **Seminomas** are a type of **germ cell tumor**, originating from primordial germ cells or intratubular germ cell neoplasia [2]. - They do not arise from the stromal components of the testis like Leydig cells. *Choriocarcinoma* - **Choriocarcinoma** is a highly aggressive **germ cell tumor** [4] characterized by the presence of both cytotrophoblast and syncytiotrophoblast cells [4]. - It produces **human chorionic gonadotropin (hCG)** [4] and is not derived from sex cord stroma. *Yolk sac tumor* - A **yolk sac tumor**, also known as an **endodermal sinus tumor**, is another type of **germ cell tumor** [3]. - It often produces **alpha-fetoprotein (AFP)** and is not considered a sex cord stromal tumor. **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. 513-514. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 510-512. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1035-1036. [4] 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.

Q: Grape-like, polypoid, bulky mass protruding through vagina in 4-year old girl is characteristic of

Sarcoma botryoides. ***Sarcoma botryoides*** - This is a highly characteristic presentation of **embryonal rhabdomyosarcoma (sarcoma botryoides)** in young girls, where the tumor forms a **grape-like (botryoid) mass** protruding from the vagina [1]. - It typically arises from the **vagina wall or cervix** in infants and young children, often presenting with bleeding or a mass [1]. *Leiomyosarcoma* - Leiomyosarcoma is a malignant tumor of **smooth muscle**, occurring more commonly in older women [2]. - It typically presents as a **solitary, firm mass** in the uterus or vagina, not typically with a grape-like appearance [2]. *Inflammatory polyp* - An inflammatory polyp is a **benign, non-malignant outgrowth** of tissue, often associated with chronic inflammation. - While it can protrude, it lacks the **destructive, bulky, and invasive nature** implied by "grape-like, polypoid, bulky mass" in the context of a child. *Fibrosarcoma* - Fibrosarcoma is a malignant tumor of **fibrous connective tissue**, which can occur anywhere in the body. - It is uncommon in the vagina, especially in young children, and generally presents as a **firm, infiltrative mass** rather than the distinctive grape-like pattern. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1004-1005. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1024-1025.

Q: In a survey, many children are examined and were found to have urogenital abnormalities. Which congenital anomaly is associated with increased risk of bladder carcinoma?

Bladder exstrophy. ***Bladder exstrophy*** - **Bladder exstrophy** involves the bladder being open and exposed on the abdominal surface, leading to chronic inflammation and irritation of the urothelium [1]. - This chronic irritation significantly increases the risk of developing **adenocarcinoma** of the bladder (approximately 4-5% lifetime risk), and less commonly, squamous cell carcinoma [1]. - The persistent exposure and metaplastic changes in the bladder epithelium are the primary mechanisms for malignant transformation [1]. *Double ureter* - A **double ureter** is a duplication of the ureter draining a single kidney, which usually has two separate renal pelves. - While it can be associated with issues like **vesicoureteral reflux** or obstruction, it generally does not increase the risk of bladder carcinoma. *Medullary sponge kidney* - **Medullary sponge kidney** is a congenital malformation characterized by dilation of the collecting ducts in the renal pyramids. - It is primarily associated with **recurrent kidney stones** and urinary tract infections, but not with an increased risk of bladder carcinoma. *Unilateral renal agenesis* - **Unilateral renal agenesis** is a condition where one kidney fails to develop. The other kidney is typically hypertrophied to compensate. - While it can be associated with other urogenital anomalies, it does not directly increase the risk of developing bladder carcinoma. **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, p. 966.

Q: Which of the following is the ovarian counterpart of testicular seminoma?

Dysgerminoma. ***Dysgerminoma*** - **Dysgerminoma** is the most common malignant germ cell tumor of the ovary and is histologically identical to testicular **seminoma** [1]. - Both tumors arise from **primordial germ cells** and share similar morphology, including large, uniform cells with clear cytoplasm and prominent nucleoli, often arranged in nests and separated by fibrous septa with lymphocytic infiltration [1], [3]. *Dermoid* - **Dermoid cysts**, also known as mature cystic teratomas, are germ cell tumors composed of well-differentiated tissues from all three germ layers (ectoderm, mesoderm, endoderm) [2]. - They are typically benign and do not have a direct testicular counterpart that is histologically identical to seminoma. *Brenner tumor* - **Brenner tumors** are uncommon epithelial ovarian tumors characterized by nests of transitional epithelial cells resembling urothelium, separated by a fibrous stroma. - They are not germ cell tumors and do not have a testicular counterpart to seminoma. *Endodermal sinus tumor* - The **endodermal sinus tumor** (yolk sac tumor) is another type of malignant germ cell tumor of the ovary, but it is characterized by structures resembling the primitive yolk sac and the presence of **Schiller-Duval bodies**. - While it has a testicular counterpart, it is not histologically identical to seminoma; its testicular counterpart is also called a yolk sac tumor and is distinct from seminoma [3]. **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] 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 Lower Urinary Tract and Male Genital System, pp. 979-980.

Q: Which of the following statements about seminomas is false?

Schiller-Duval bodies are commonly seen. ***Schiller-Duval bodies are commonly seen*** - **Schiller-Duval bodies** are pathognomonic for **yolk sac tumors**, a different type of germ cell tumor, not seminomas [1]. - Their presence would indicate a diagnosis other than pure seminoma. *Serum HCG levels are elevated* - While most pure seminomas do not produce tumor markers, about 10-15% of seminomas have **elevated beta-HCG** due to the presence of **syncytiotrophoblast-like cells** [1]. - This elevation is typically less pronounced than in choriocarcinoma but still occurs [1]. *Spermatocytic seminomas are usually slow growing* - **Spermatocytic seminoma** is a rare subtype of seminoma that typically affects older men and is known for its **indolent, slow-growing** nature [1]. - It usually has an excellent prognosis and rarely metastasizes. *Most common type of germ cell tumor* - **Seminoma** is indeed the most common type of **testicular germ cell tumor**, accounting for approximately 50-60% of all germ cell neoplasms. - It typically affects men in their 30s and 40s. **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: Female presents with bloody nipple discharge. Most likely pathological finding?

Intraductal papilloma. ***Intraductal papilloma*** - This is the **most common cause of bloody nipple discharge**, particularly if it is unilateral and from a single duct [1]. - It is a benign epithelial proliferation located within a **lactiferous duct**, and the friable nature of the papilloma can lead to bleeding [1]. *Fibrocystic change* - While fibrocystic changes are common, they typically present with **lumpy, painful breasts** and sometimes non-bloody, multiple duct discharge (e.g., milky or clear) [1]. - **Bloody discharge** is not a characteristic feature of uncomplicated fibrocystic change. *Fibroadenoma* - Fibroadenomas are benign **stromal and epithelial tumors** that present as well-defined, moveable breast lumps [1]. - They are not typically associated with **nipple discharge**, especially bloody discharge. *Phyllodes tumor* - Phyllodes tumors are rare fibroepithelial tumors that can grow rapidly and form a **palpable mass**. - While they can be large, **bloody nipple discharge** is not a primary or common presenting symptom for phyllodes tumors. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 439-449.

Question 1

Reinke's crystals are found in -

Accepted Answer

Hilus cell tumor

Answer

Dysgerminoma

Answer

Arrhenoblastoma

Answer

Granulosa cell tumor

Question 2

The surgical registrar successfully performs a testicular biopsy and hands over the specimen to the attending nurse. The sister asks you how to send the specimen to the pathologist. What fluid will you tell the sister to put the specimen in?

Accepted Answer

Bouin's solution

Answer

95% ethanol

Answer

Zenker's solution

Answer

10% formalin

Question 3

All are true about seminomas except:

Accepted Answer

Rarely responds to radiotherapy

Answer

Spermatocytic seminoma is slow growing with good prognosis

Answer

Almost never occur in infants

Answer

Anaplastic seminoma is associated with a worse prognosis

Question 4

Which of the following is sex cord stromal tumor?

Accepted Answer

Leydig cell tumor

Answer

Seminoma

Answer

Choriocarcinoma

Answer

Yolk sac tumor

Question 5

Grape-like, polypoid, bulky mass protruding through vagina in 4-year old girl is characteristic of

Accepted Answer

Sarcoma botryoides

Answer

Leiomyosarcoma

Answer

Inflammatory polyp

Answer

Fibrosarcoma

Question 6

In a survey, many children are examined and were found to have urogenital abnormalities. Which congenital anomaly is associated with increased risk of bladder carcinoma?

Accepted Answer

Bladder exstrophy

Answer

Double ureter

Answer

Medullary sponge kidney

Answer

Unilateral renal agenesis

Question 7

Which of the following is the ovarian counterpart of testicular seminoma?

Accepted Answer

Dysgerminoma

Answer

Dermoid

Answer

Endodermal sinus tumor

Answer

Brenner tumor

Question 8

Sections from a solid-cystic unilateral ovarian tumor in a 30-year old female show a tumor composed of diffuse sheets of small cells with doubtful nuclear grooving and scanty cytoplasm. No Call-Exner bodies are seen. The ideal immunohistochemistry panel would include

Accepted Answer

Vimentin, epithelial membrane antigen, inhibin, CD99

Answer

CD3, chromagranin, CD 45, synaptophysin

Answer

Chromogranin, CD45, CD99, CD20

Answer

Desmin, S- 100 protein, smooth muscle antigen, cytokeratin

Question 9

Which of the following statements about seminomas is false?

Accepted Answer

Schiller-Duval bodies are commonly seen

Answer

Serum HCG levels are elevated

Answer

Spermatocytic seminomas are usually slow growing

Answer

Most common type of germ cell tumor

Question 10

Female presents with bloody nipple discharge. Most likely pathological finding?

Accepted Answer

Intraductal papilloma

Answer

Fibrocystic change

Answer

Fibroadenoma

Answer

Phyllodes tumor

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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