Reproductive Pathology — MCQs

Reproductive Pathology Indian Medical PG Practice Questions and MCQs

Question 281: In the context of Endometrial carcinoma, which tumor suppressor gene is most commonly mutated?

A. P53
B. Rb
C. PTEN (Correct Answer)
D. APC

Explanation: ***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 282: In which condition are Call-Exner bodies seen?

A. Granulosa cell tumors (Correct Answer)
B. Serous cystadenomas
C. Dysgerminoma
D. Krukenberg tumor

Explanation: ***Granulosa cell tumors*** - **Call Exner bodies** are characteristic of granulosa cell tumors, usually appearing as small, round structures resembling immature Graafian follicles [1]. - These tumors produce **estrogens**, leading to symptoms like abnormal uterine bleeding due to endometrial hyperplasia [1]. *Dysgerminoma* - Dysgerminoma typically features **solid, homogeneous tissue** and does not form Call Exner bodies. - It is more common in **younger women** and usually associated with elevated **LDH levels**. *Serous cystadenomas* - These tumors are generally **cystic** and do not exhibit Call Exner bodies, focusing instead on serous fluid production. - They are one of the most common types of ovarian tumors but lack the characteristic features of granulosa cell tumors. *Krukenberg tumor* - Krukenberg tumors are metastatic lesions of the ovaries, often resulting from **gastric carcinoma** and do not produce Call Exner bodies. - They typically present with **bilateral ovarian masses** and may be associated with **mucin-secreting histology**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1036-1037.

Question 283: What is the risk of malignancy associated with duct ectasia?

A. No risk of malignancy (Correct Answer)
B. 1.5% risk of malignancy
C. 7% risk of malignancy
D. 10% risk of malignancy

Explanation: ***No risk of malignancy*** - **Duct ectasia** is characterized by the dilation of subareolar ducts and is a **benign condition** with no direct association with an increased risk of developing breast cancer [1]. - While it can present with clinical symptoms that *mimic* breast cancer, such as nipple discharge or a palpable mass, it is not considered a **premalignant lesion** [1]. *1.5% risk of malignancy* - This value is not recognized as a typical risk for malignancy associated with duct ectasia; it may be applicable to other benign breast conditions. - Many benign conditions have varying degrees of malignancy risk, but duct ectasia itself is **not one of them** [1]. *7% risk of malignancy* - This percentage is significantly higher than any established risk for malignancy in benign duct ectasia. - This value is not appropriate for a condition that is considered entirely **benign**. *10% risk of malignancy* - A 10% risk would indicate a substantial predisposition to cancer, which is not characteristic of duct ectasia. - This figure might be more relevant to **atypical hyperplasias** or other high-risk breast lesions. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1052.

Question 284: Which karyotype is associated with true hermaphroditism?

A. 45 X0 streaked gonads
B. 46 XY (Testicular tissue only)
C. 46 XX/46 XY (Mosaic) (Correct Answer)
D. 46 XX

Explanation: ***46 XX/46 XY (Mosaic)*** - **True hermaphroditism** (now often called **ovotesticular disorder of sex development**) is characterized by the presence of both **ovarian and testicular tissue** in the same individual. - A **mosaic karyotype** such as **46 XX/46 XY** allows for the development of both types of gonadal tissue, as different cell lines with different sex chromosomes are present [1]. *45 X0 streaked gonads* - This karyotype is characteristic of **Turner syndrome**, which presents with **gonadal dysgenesis** (streaked gonads) and lacks functional ovarian or testicular tissue [2]. - Individuals with Turner syndrome are typically female in appearance but infertile due to the absence of a second X chromosome [2]. *46 XY (Testicular tissue only)* - While a **46 XY karyotype** typically leads to the development of **testicular tissue**, the presence of testicular tissue *only* does not constitute true hermaphroditism [3]. - This karyotype is associated with male sexual development, though variations can occur in disorders of sex development affecting testosterone synthesis or androgen insensitivity. *46 XX* - A **46 XX karyotype** typically leads to **female development** with the presence of ovarian tissue. - While **46 XX males** can occur due to translocation of the SRY gene, this does not result in true hermaphroditism (presence of both ovarian and testicular tissue). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 168-169. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 175-177. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 167-168.

Question 285: Which of the following testicular tumours is NOT a germ cell tumour?

A. Seminoma
B. Teratoma
C. Choriocarcinoma
D. Sertoli cell tumour (Correct Answer)

Explanation: ***Sertoli cell tumour*** - This is a **sex-cord stromal tumour**, not a germ cell tumour, hence it does not arise from germ cells. - Sertoli cell tumours typically present with abnormal hormone levels, but not the classic germ cell tumour markers. *Choriocarcinoma* - This is a **germ cell tumour** that is aggressive and associated with high levels of **beta-hCG** [1][2]. - It derives from the placental tissue and is characterized by **trophoblastic differentiation** [2]. *Seminoma* - A well-known type of **germ cell tumour**, often presenting as a **homogeneous testicular mass** [1]. - It usually manifests with elevated **LDH** and is associated with a more favorable prognosis compared to non-seminomatous germ cell tumours [1]. *Teratoma* - Teratomas are also classified as **germ cell tumours**, containing differentiated tissues like hair, muscle, and bone [1][2]. - They can be **mature** (benign) or **immature** (malignant), and are typically found in younger patients [2][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. 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, pp. 982-983. [3] 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.

Question 286: What is the number of Barr bodies present in Klinefelter's syndrome?

A. 0
B. 1 (Correct Answer)
C. 2
D. 3

Explanation: ***1*** - **Klinefelter's syndrome** typically has a 47,XXY karyotype, meaning there are two X chromosomes [1]. - The number of Barr bodies is calculated as **N-1**, where N is the total number of X chromosomes. In this case, 2-1 = **1 Barr body** [1]. - This follows the principle that one X chromosome remains active while additional X chromosomes are inactivated [1]. *0* - **No Barr bodies** are found in individuals with a normal male karyotype (46,XY) or in Turner syndrome (45,XO), neither of which describes Klinefelter's syndrome [1]. - The presence of at least one Barr body indicates the presence of at least two X chromosomes. *2* - **Two Barr bodies** would be indicative of a karyotype with three X chromosomes (e.g., 47,XXX syndrome or Triple X syndrome), which is not Klinefelter's syndrome. - This calculation follows the N-1 rule: 3 X chromosomes - 1 = 2 Barr bodies. *3* - **Three Barr bodies** would correspond to a karyotype with four X chromosomes (e.g., 48,XXXX), which is an even rarer sex chromosome aneuploidy not associated with Klinefelter's syndrome. - The N-1 rule applies: 4 X chromosomes - 1 = 3 Barr bodies. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 173-174.

Question 287: What is the appropriate time for semen examination post-ejaculation?

A. More than 2 hours after ejaculation
B. After 20-30 minutes of liquefaction (Correct Answer)
C. Within 1.5 to 2 hours after ejaculation
D. Immediately after ejaculation

Explanation: ***After 20-30 minutes of liquefaction*** - Semen should be analyzed after **liquefaction**, which typically occurs within 20-30 minutes. This allows for accurate assessment of sperm motility and concentration. - **Liquefaction** is the process where the seminal coagulum (gel-like state) breaks down into a liquid form, enabling sperm to move freely. *Immediately after ejaculation* - Analysis immediately after ejaculation is not appropriate because the semen is still in a **coagulated, gel-like state**, which impedes sperm motility assessment. - In this state, sperm are not freely motile, making it difficult to accurately count them or assess their movement. *Within 1.5 to 2 hours after ejaculation* - While liquefaction should have occurred by this time, waiting this long may lead to a decrease in **sperm motility** due to energy depletion and environmental factors. - Prolonged waiting can also affect the integrity of sperm, potentially leading to inaccurate results for other parameters. *More than 2 hours after ejaculation* - An analysis performed more than 2 hours after ejaculation would likely show significantly **reduced sperm viability and motility**, leading to an underestimation of fertility potential. - Beyond this timeframe, the sample may also be susceptible to **bacterial contamination** and changes in pH, further compromising the accuracy of the results.

Question 288: Which of the following is not a germ cell tumor?

A. Embryonal carcinoma
B. Endodermal sinus
C. Seminoma
D. Leydig cell tumor (Correct Answer)

Explanation: ***Leydig cell tumor*** - Leydig cell tumors are classified as **sex-cord stromal tumors**, not germ cell tumors [1]. - These tumors are derived from **Leydig cells** which produce androgens, affecting the endocrine function rather than germ cell lineage [1]. *Endodermal sinus* - Endodermal sinus tumors, or **yolk sac tumors**, are indeed germ cell tumors characterized by **alpha-fetoprotein (AFP)** production [2]. - They typically arise in the testis or ovaries and are known for rapid growth and aggressiveness. *Embryonal carcinoma* - Embryonal carcinoma is a type of **germ cell tumor** commonly associated with elevated levels of **beta-hCG** [2]. - It primarily affects the testes in males and can occur in the ovaries, and it is known for its aggressive behavior. *Seminoma* - Seminomas are classic examples of **germ cell tumors**, noted for their sensitivity to radiation and chemotherapy [3]. - They usually present with **increased beta-hCG** levels and can coexist with non-seminomatous germ cell tumors [3]. **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. 510-514. [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 Lower Urinary Tract and Male Genital System, pp. 980-982.

Question 289: What is the most common type of degeneration observed in uterine fibroids?

A. Calcareous
B. Hyaline (Correct Answer)
C. Red
D. Cystic

Explanation: ***Hyaline*** - **Hyaline degeneration** is the most frequent type of degeneration in uterine fibroids, occurring in about **60% of cases** [1]. - It involves the replacement of smooth muscle and connective tissue with **acellular, glassy, eosinophilic hyaline material** [1]. *Calcareous* - **Calcareous degeneration** (calcification) occurs when hyaline degeneration calcifies, typically seen in **postmenopausal women** or older fibroids. - While it can occur, it is a **secondary change** following hyaline degeneration rather than the primary and most common form. *Red* - **Red degeneration** (carneous degeneration) is acute, often occurring during **pregnancy** due to rapid growth and hemorrhagic infarction. - It presents with **acute pain** and is less common than hyaline degeneration. *Cystic* - **Cystic degeneration** is characterized by liquefaction within the fibroid, leading to the formation of **cysts**. - This typically results from advanced **hyaline degeneration** and is less common than hyaline degeneration itself. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1024-1025.

Question 290: Which of the following is the most likely proliferating breast mass?

A. Duct ectasia
B. Adenosis
C. Papilloma
D. Fibroadenoma (Correct Answer)

Explanation: **Fibroadenoma** - A **fibroadenoma** is a benign **biphasic breast tumor** composed of both glandular and stromal tissue, making it a common proliferating mass [3]. - It is often seen in **young women** and typically presents as a firm, movable, non-tender lump [3]. *Duct ectasia* - **Duct ectasia** is a non-proliferative condition characterized by dilation of the **subareolar ducts**, often with inflammation and fibrosis. - It is more commonly associated with **nipple discharge** and **periductal inflammation** rather than being a primary proliferating mass. *Adenosis* - **Adenosis** refers to an increase in the number of **glands or lobules** within the breast parenchyma, which can be sclerosing or florid [2]. - While it involves increased glandular elements, it is generally considered a **benign proliferative change** and less likely to form a distinct, palpable mass compared to a fibroadenoma [1], [4]. *Papilloma* - A **papilloma** is a benign epithelial proliferation within a **duct**, characterized by a central fibrovascular core [2]. - It commonly presents with **nipple discharge**, often bloody, and is typically a smaller lesion within the ductal system rather than a large, palpable proliferating mass [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. 446-447. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 448-449. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1052.

Practice by Chapter

Diseases of Male Genital Tract

Practice Questions

Testicular Tumors

Practice Questions

Prostate Pathology

Practice Questions

Diseases of Female Genital Tract

Practice Questions

Cervical Pathology and Neoplasia

Practice Questions

Endometrial Pathology

Practice Questions

Ovarian Diseases and Tumors

Practice Questions

Gestational Trophoblastic Disease

Practice Questions

Placental Pathology

Practice Questions

Sexually Transmitted Infections

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