Reproductive Pathology Practice Questions

Q: Which of the following statements about benign prostatic hyperplasia (BPH) is true?

Occurs in the periurethral region. ***Occurs in the periurethral region*** - **Benign prostatic hyperplasia (BPH)** typically originates in the **transition zone**, which is a part of the periurethral region of the prostate gland [1]. - This growth pattern explains why BPH commonly leads to **compression of the urethra** and subsequent lower urinary tract symptoms (LUTS) [1]. *Increased risk of carcinoma* - BPH is a **benign condition** and is not considered a premalignant lesion; it does **not increase the risk of prostate carcinoma** [1]. - Although both conditions are common in older men, they are distinct and BPH does not evolve into cancer [1]. *Commonly causes hematuria as the initial symptom* - While microscopic or macroscopic **hematuria** can occur in BPH due to friable blood vessels in the enlarged prostate, it is **not typically the initial or most common symptom**. - The most common initial symptoms are related to **urinary obstruction**, such as frequency, urgency, nocturia, and a weak stream [1]. *Primarily affects the peripheral zone* - The **peripheral zone** is the region of the prostate where **prostate carcinoma** most commonly originates [1, 2]. - BPH primarily affects the **transition zone** and, to a lesser extent, the central zone, leading to different clinical presentations and anatomical locations of disease [1]. **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. 496-501. [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. 993-994.

Q: A 23-year-old male presents with a testicular mass. A biopsy shows a mixture of syncytiotrophoblasts and cytotrophoblasts. Which tumor marker is likely to be elevated?

Beta-human chorionic gonadotropin. ***Beta-human chorionic gonadotropin*** - In cases of germ cell tumors like **seminomas**, which exhibit **large clear cells**, beta-hCG is often elevated [1]. - This marker is particularly associated with **testicular tumors**, including those with clear cell morphology [1,2]. *Prostate-specific antigen* - Typically elevated in **prostate cancer** and benign prostatic conditions, not applicable to testicular tumors. - Lacks correlation with the clinical presentation of a testicular mass in a young male. *Alpha-fetoprotein* - Generally associated with **hepatocellular carcinoma** and some germ cell tumors such as **yolk sac tumors**, but not in most seminomas. - In this scenario, the presence of clear cells makes beta-hCG a more likely marker. *Carcinoembryonic antigen* - Primarily used as a tumor marker for **colorectal cancer**, not typically elevated in testicular tumors. - Its relevance is limited, particularly in cases involving testicular masses with clear cells. **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] 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.

Q: A 40-year-old man presents with a painless testicular mass. Laboratory results show high AFP and high hCG levels. Biopsy reveals sheets of large anaplastic cells with abundant cytoplasm. What is the likely diagnosis?

Embryonal carcinoma. ***Embryonal carcinoma*** - This tumor is characterized histologically by **sheets of large anaplastic cells with abundant cytoplasm**, often showing glandular or papillary differentiation, and is associated with elevated **AFP** and **hCG** levels [1]. - Embryonal carcinoma is a highly malignant germ cell tumor that commonly presents as a **painless testicular mass** and can produce both AFP and hCG [1]. *Seminoma* - While seminomas also present as painless testicular masses, they are typically associated with normal **AFP** levels and may have mildly elevated **hCG** in about 15% of cases [1]. - Histologically, seminomas are characterized by large clear cells with a central nucleus, often with fibrous septa and lymphocytic infiltration, which differs from the description provided [1]. *Choriocarcinoma* - This highly aggressive tumor is defined by significantly elevated **hCG** levels due to the presence of syncytiotrophoblastic cells, but it typically has normal or only slightly elevated **AFP** (unless mixed with other germ cell elements) [2]. - Choriocarcinoma histology includes a biphasic pattern of cytotrophoblasts and syncytiotrophoblasts, which does not match the description of "sheets of large anaplastic cells" [2]. *Yolk sac tumor* - Yolk sac tumors are characterized by consistently very high levels of **AFP**, but usually normal **hCG** levels. - Histologically, they feature **Schiller-Duval bodies** (glomeruloid structures), reticular patterns, and endodermal sinus structures, which are not described in the biopsy findings. **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.

Q: Identify the condition represented in the image of a testicular tumor.

Seminoma. ***Seminoma*** - Seminoma is a type of **germ cell tumor** that typically presents with a **painless testicular mass**, making it one of the common types of testicular cancer [1]. - This condition is characterized by the presence of **large, uniform cells** and is highly sensitive to **radiation therapy**, which aids in management [1]. *Non-seminoma* - Non-seminomas encompass a group of tumors including **embryonal carcinoma**, **choriocarcinoma**, and **yolk sac tumor**, which often present with more variable histological features [1]. - Generally considered more aggressive than seminomas, they may yield **higher levels of tumor markers** such as **AFP** or **hCG** [1]. *Teratoma* - Teratomas typically contain **multiple germ layers (ectoderm, mesoderm, and endoderm)**, often presenting with more complex histopathology compared to seminomas [1]. - They can occur in both children and adults, but in adults, they are often a component of a **non-seminomatous germ cell tumor** instead of a pure form [1,2]. *Germ cell differentiate tumor* - This term broadly refers to any tumor originating from **germ cells**, including both seminomas and non-seminomas, lacking specificity [1]. - It does not reflect the defined characteristics of seminoma and can encompass a range of histological types with diverse behaviors [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.

Q: Which karyotype is most commonly associated with true hermaphroditism?

46,XX. ***46,XX*** - While other karyotypes can be seen, **46,XX** is the most frequent chromosomal constitution in individuals with true hermaphroditism (ovotesticular DSD), where both ovarian and testicular tissue are present. - This karyotype suggests a genetic female who has developed testicular tissue due to a translocated **SRY gene** onto an X chromosome or an autosomal chromosome, or other genetic aberrations. *45,X0* - This karyotype is associated with **Turner syndrome**, characterized by primary amenorrhea, short stature, and other developmental abnormalities, without the presence of both ovarian and testicular tissue [1]. - Individuals with Turner syndrome are typically phenotypic females with streak gonads, not true hermaphrodites [1]. *47,XY+9* - This karyotype indicates an extra copy of chromosome 9 (trisomy 9) in an individual, which is extremely rare and typically lethal or associated with severe developmental abnormalities and mosaic patterns. - Trisomy 9 is not associated with true hermaphroditism but rather causes multiple congenital anomalies including craniofacial defects, cardiac malformations, and developmental delays. *47,XXY* - This karyotype is characteristic of **Klinefelter syndrome**, where individuals are phenotypic males with impaired testicular function, infertility, and often gynecomastia. - They possess male gonads (testes) but do not typically have ovarian tissue, thus ruling out true hermaphroditism. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 175-177.

Q: Dysgerminoma spreads mainly via ?

Lymphatic route. ***Lymphatic route*** - Dysgerminoma, a germ cell tumor of the ovary, primarily spreads via the **lymphatic system** [1]. - It commonly metastasizes to the **peritoneal lymph nodes**, especially the paraaortic and pelvic nodes, making lymphadenectomy a crucial part of staging. *Hematogenous route* - While possible in advanced stages, **hematogenous spread** is not the primary or most common route for dysgerminoma. - This route typically leads to distant metastases in organs like the lung or liver, which are less frequent primary sites of spread for dysgerminoma. *Direct spread* - **Direct extension** to adjacent pelvic structures can occur, but it is not considered the main mode of dissemination for dysgerminoma beyond the local compartment. - This type of spread is more common in advanced, bulky tumors that have breached the ovarian capsule. *Does not spread* - This option is incorrect as dysgerminoma, like most malignant tumors, has the potential to **metastasize** and spread from its primary site. - Its excellent prognosis is attributed to its high sensitivity to chemotherapy and radiation, not its inability to spread. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1034-1035.

Q: In Grade 1 endometrial cancer, what is the percentage of solid growth pattern typically observed?

<5. ***<5%*** - Grade 1 endometrial cancer is characterized by **well-differentiated** glandular patterns and **minimal solid growth**. - According to the **FIGO grading system**, Grade 1 endometrial carcinomas exhibit **5% or less non-squamous solid growth**. - This represents the best-differentiated form with the most favorable prognosis. *6-25%* - This percentage range of solid growth corresponds to **Grade 2 endometrial cancer** (6-50% solid growth), indicating a moderately differentiated tumor. - Grade 2 tumors have an intermediate prognosis and greater architectural atypia compared to Grade 1. - The entire range of 6-50% solid growth falls within Grade 2 classification. *25-50%* - This range still represents **Grade 2 endometrial cancer**, not Grade 3, as the FIGO system classifies 6-50% solid growth as Grade 2. - Grade 2 indicates moderate differentiation with intermediate prognosis. - Only when solid growth exceeds 50% does it become Grade 3. *>50%* - Greater than 50% solid growth is classified as **Grade 3 endometrial cancer**, representing a poorly differentiated and aggressive tumor. - Grade 3 tumors show significant loss of glandular architecture and have the worst prognosis. - These tumors have higher potential for metastasis and recurrence.

Q: What is the approximate percentage of cases in which simple hyperplasia with atypia progresses to endometrial cancer?

8-9%. ***8-9%*** - **Simple hyperplasia with atypia** has an approximate **8% progression risk** to **endometrial adenocarcinoma**. - The presence of **cytological atypia** significantly increases the malignant potential compared to simple hyperplasia without atypia [2]. - Atypical hyperplasia is a recognized **precursor lesion** requiring close surveillance or treatment [1]. *1-2%* - This lower percentage represents the progression risk for **simple hyperplasia WITHOUT atypia**, not with atypia [2]. - The absence of cytological atypia confers a much lower risk of malignant transformation. - This distinction between atypical and non-atypical hyperplasia is crucial for management decisions. *3-4%* - This percentage is more consistent with **complex hyperplasia without atypia** [2]. - While architectural complexity increases risk compared to simple hyperplasia, the absence of atypia keeps the progression rate relatively low. *20%* - This high percentage is more characteristic of **complex hyperplasia with atypia** (also called endometrial intraepithelial neoplasia, EIN), which has a progression rate of approximately **29%** [2]. - Complex atypical hyperplasia represents the highest-risk precursor lesion and often warrants definitive treatment such as hysterectomy in appropriate candidates [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1016-1020. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 473-475.

Q: In a case of Dysgerminoma of ovary one of the following tumor markers is likely to be raised :

Serum lactic dehydrogenase. ***Serum lactic dehydrogenase*** - **Dysgerminoma** is a germ cell tumor of the ovary, and about 40-50% of cases are associated with elevated **serum lactic dehydrogenase (LDH)** levels, especially in advanced stages. - Elevated LDH is a general marker of **cellular turnover** and tumor burden, and while not specific to dysgerminomas, it is commonly used in their monitoring and prognosis. *Serum HCG* - While some dysgerminomas can produce a small amount of **human chorionic gonadotropin (HCG)** if they contain syncytiotrophoblastic giant cells [1][2], a significant elevation of HCG is more characteristic of **choriocarcinoma** [1] or mixed germ cell tumors. - A markedly raised HCG in the context of an ovarian germ cell tumor would typically prompt consideration of other tumor types before solely attributing it to a pure dysgerminoma. *Serum alphafetoprotein* - **Alpha-fetoprotein (AFP)** is a primary tumor marker for **yolk sac tumors (endodermal sinus tumors)** and is also elevated in **embryonal carcinoma** and some mixed germ cell tumors. - Pure dysgerminomas do not produce AFP [1], so its elevation would indicate a different germ cell tumor component. *Serum inhibin* - **Inhibin** (specifically inhibin A and B) is a classic tumor marker for **granulosa cell tumors** of the ovary, which are sex cord-stromal tumors, not germ cell tumors. - It plays a role in regulating FSH secretion and is not produced by dysgerminomas. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1034-1036. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 480-481.

Q: In the context of Endometrial carcinoma, which tumor suppressor gene is most commonly mutated?

PTEN. ***PTEN*** - The **PTEN gene** is frequently mutated in endometrial carcinoma, leading to loss of functional tumor suppression. - PTEN loss is associated with **hyperactivation of the PI3K/AKT pathway**, which promotes cell growth and survival, contributing to cancer development. *APC* - The **APC gene** is primarily associated with **colorectal cancer**, particularly familial adenomatous polyposis, not endometrial carcinoma. - APC mutations lead to **beta-catenin accumulation**, which is not a central event in endometrial tumorigenesis. *Rb* - The **Rb gene** is mainly related to retinoblastoma and other tumors but has a limited role in endometrial carcinoma. - Rb typically regulates the **cell cycle**, and its loss primarily affects other cancer types rather than endometrial tumors. *P53* - Although **P53 mutations** can occur in many cancers, including endometrial carcinoma, it is not the primary tumor suppressor gene associated with its development [1]. - P53 is more commonly linked with other malignancies and is considered a **late event** in endometrial carcinoma progression. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1021-1022.

Question 1

Which of the following statements about benign prostatic hyperplasia (BPH) is true?

Accepted Answer

Occurs in the periurethral region

Answer

Increased risk of carcinoma

Answer

Commonly causes hematuria as the initial symptom

Answer

Primarily affects the peripheral zone

Question 2

A 23-year-old male presents with a testicular mass. A biopsy shows a mixture of syncytiotrophoblasts and cytotrophoblasts. Which tumor marker is likely to be elevated?

Accepted Answer

Beta-human chorionic gonadotropin

Answer

Alpha-fetoprotein

Answer

Carcinoembryonic antigen

Answer

Prostate-specific antigen

Question 3

A 40-year-old man presents with a painless testicular mass. Laboratory results show high AFP and high hCG levels. Biopsy reveals sheets of large anaplastic cells with abundant cytoplasm. What is the likely diagnosis?

Accepted Answer

Embryonal carcinoma

Answer

Choriocarcinoma

Answer

Seminoma

Answer

Yolk sac tumor

Question 4

Identify the condition represented in the image of a testicular tumor.

Accepted Answer

Seminoma

Answer

Non-seminomatous germ cell tumor

Answer

Teratoma (testicular tumor)

Answer

Leydig cell tumor

Question 5

Which karyotype is most commonly associated with true hermaphroditism?

Accepted Answer

46,XX

Answer

45,X0

Answer

47,XXY

Answer

47,XY+9

Question 6

Dysgerminoma spreads mainly via ?

Accepted Answer

Lymphatic route

Answer

Hematogenous route

Answer

Direct spread

Answer

Does not spread

Question 7

In Grade 1 endometrial cancer, what is the percentage of solid growth pattern typically observed?

Accepted Answer

<5

Answer

6-25

Answer

25-50

Answer

>50

Question 8

What is the approximate percentage of cases in which simple hyperplasia with atypia progresses to endometrial cancer?

Accepted Answer

8-9%

Answer

3-4%

Answer

1-2%

Answer

20%

Question 9

In a case of Dysgerminoma of ovary one of the following tumor markers is likely to be raised :

Accepted Answer

Serum lactic dehydrogenase

Answer

Serum HCG

Answer

Serum inhibin

Answer

Serum alpha-fetoprotein

Question 10

In the context of Endometrial carcinoma, which tumor suppressor gene is most commonly mutated?

Accepted Answer

PTEN

Answer

P53

Answer

Rb

Answer

APC

Reproductive Pathology — MCQs

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