Reproductive Pathology Practice Questions

Q: In a patient with breast cancer, the following are poor prognostic factors except

Absence of epidermal growth factor receptor. ***Absence of epidermal growth factor receptor*** - The **absence of epidermal growth factor receptor (EGFR/HER1) overexpression** is associated with a **better prognosis** in breast cancer. - **EGFR overexpression** is more commonly seen in aggressive breast cancers, particularly **triple-negative breast cancers** (ER-negative, PR-negative, HER2-negative), and is associated with poor outcomes [2]. - When EGFR is absent or not overexpressed, the tumor tends to have less aggressive biological behavior. *Aneuploid status* - **Aneuploid status** (abnormal chromosome number) is a well-recognized **poor prognostic factor** in breast cancer, indicating genetic instability and aggressive tumor behavior [2]. - It is associated with **increased risk of recurrence** and poorer response to therapy. *Age less than 35 years* - **Younger age** (less than 35 years) at diagnosis is a **poor prognostic factor** for breast cancer. - This is often due to more aggressive tumor biology, **higher grade tumors**, hormone receptor negativity, and delayed diagnosis in younger women. *High grade* - A **high histological grade** (Grade III) indicates a more aggressive tumor with rapid cell division, marked nuclear pleomorphism, and poor differentiation, signifying a **poor prognosis** [1]. - High-grade tumors are more likely to metastasize and have higher recurrence rates. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 458-459. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1064-1066.

Q: Out of the following, select the histologic type of endometrial cancer which has the worst prognosis:

Papillary serous carcinoma. ***Papillary serous carcinoma*** - This subtype is considered a **Type II endometrial cancer**, which is often **aggressive**, poorly differentiated, and has a high metastatic potential. [1] - It frequently presents at an advanced stage and has a **poor prognosis** due to its rapid growth and tendency for widespread peritoneal dissemination. [1] *Clear cell carcinoma* - While also a **Type II endometrial cancer** with an aggressive course, it generally has a slightly better prognosis than papillary serous carcinoma. - It is characterized by polygonal cells with **clear cytoplasm** and often presents with more localized disease compared to serous carcinoma. *Mucinous adenocarcinoma* - This is typically classified as a **Type I endometrial cancer**, which is low-grade and generally associated with a **favorable prognosis**. [1] - It is characterized by cells producing **mucin**, often resembling endocervical adenocarcinoma. *Well differentiated endometrioid adenocarcinoma* - This is the **most common type of endometrial cancer** and is typically a **Type I cancer**, associated with a very **good prognosis**. [1] - It is characterized by glandular differentiation that closely resembles normal endometrial glands, driven by unopposed estrogen exposure. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1021-1024.

Q: Which one of the following statements regarding seminoma testis is correct ?

It is the most common type of testicular cancer. ***It is the most common type of testicular cancer*** - **Seminoma** accounts for approximately **50% of all germ cell tumors** of the testis, making it the most common type [1]. - It typically affects men between the ages of **30 and 40 years**. *It frequently metastasizes to the liver and bones* - While seminoma can metastasize, its most common sites of spread are the **retroperitoneal lymph nodes** first, then distant sites like the lungs [2]. - Metastasis to the **liver and bones** is less frequent, especially in earlier stages. *Its five-year survival rates approach 50 per cent* - **Seminoma** generally has an **excellent prognosis**, with 5-year survival rates ranging from **95% for localized disease** to about 70-80% for metastatic disease [1]. - A 50% survival rate is significantly lower than actual outcomes for seminoma. *It does not respond to radiation* - **Seminoma is highly radiosensitive**, making radiation therapy a cornerstone of treatment for localized disease and regional lymph node involvement. - This characteristic distinguishes it from non-seminomatous germ cell tumors, which are generally less responsive to radiation. **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. 979-984. [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.

Q: Which of the following breast cancers is most often bilateral ?

Lobular carcinoma of the breast. ***Lobular carcinoma of the breast*** - **Invasive lobular carcinoma (ILC)** is the breast cancer subtype most frequently associated with **bilateral disease**, occurring in 5% to 28% of cases. [1] - This higher rate of bilaterality is partly due to the diffuse growth pattern of lobular carcinoma, which can make it more challenging to detect and may lead to synchronous or metachronous involvement of both breasts. [1] *Medullary carcinoma of the breast* - **Medullary carcinoma** is a rare and often well-circumscribed type of breast cancer that typically presents as a solitary mass and is not characteristically bilateral. [1] - It has a generally better prognosis than other invasive ductal carcinomas and is often associated with a BRCA1 mutation. [1] *Ductal carcinoma of the breast* - **Invasive ductal carcinoma (IDC)**, also known as no special type (NST), is the most common form of breast cancer, but it is less frequently bilateral than lobular carcinoma. [1] - While bilateral IDC can occur, it is a less defining characteristic compared to ILC. *Colloid carcinoma of the breast* - **Colloid (mucinous) carcinoma** is a distinct and relatively rare subtype of invasive ductal carcinoma, characterized by tumor cells floating in pools of mucin. - It usually presents as a solitary mass and is not known for a higher incidence of bilaterality. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 454-456.

Q: Which tumour marker is most often elevated in ovarian granulosa cell tumour?

Inhibin. ***Inhibin*** - **Inhibin** is a polypeptide hormone produced by granulosa cells, making it a highly specific and sensitive marker for **granulosa cell tumors** of the ovary [1]. - Its levels correlate with tumor burden and can be used for monitoring treatment response and detecting recurrence [1]. *Alpha fetoprotein* - **Alpha-fetoprotein (AFP)** is a tumor marker more commonly associated with **yolk sac tumors (endodermal sinus tumors)**, which are a type of germ cell tumor, not granulosa cell tumors. - Elevated AFP can also be seen in hepatocellular carcinoma and some testicular tumors. *CA 125* - **CA 125** is the most widely used tumor marker for **epithelial ovarian cancer**, which is the most common type of ovarian cancer. - While it can be mildly elevated in other conditions, it is not specifically elevated in granulosa cell tumors. *Beta-HCG* - **Beta-human chorionic gonadotropin (β-HCG)** is primarily elevated in **gestational trophoblastic disease** (e.g., choriocarcinoma) and some germ cell tumors, such as dysgerminomas and embryonal carcinomas, if they have syncytiotrophoblastic elements [2]. - It is not a typical marker for granulosa cell tumors. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1036-1037. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1034-1036.

Q: Which of the following conditions of the endometrium is associated with a significantly increased risk of development of cancer?

Complex hyperplasia with atypia. ***Complex hyperplasia with atypia*** - This condition carries the highest risk of progression to **endometrial carcinoma**, with approximately a 29% chance of concurrent or subsequent carcinoma [1], [2]. - The presence of **atypia** (abnormal cellular architecture and nuclear features) is the critical factor indicating a high malignant potential [1], [2]. *Complex hyperplasia* - While a form of endometrial hyperplasia, it lacks the **atypical cellular features** that significantly elevate the risk of malignancy [1]. - The risk of progression to endometrial carcinoma is much lower, around 3%, compared to atypical forms [1]. *Simple atypical hyperplasia* - This condition features **atypia** but with a less complex glandular architectural proliferation than complex atypical hyperplasia [2]. - Although it has a lower risk of malignancy than complex atypical hyperplasia (around 8%), it still has a significantly higher risk than non-atypical hyperplasias. *Simple hyperplasia* - This is the **least severe** form of endometrial hyperplasia, characterized by glandular and stromal proliferation without architectural complexity or cellular atypia [1]. - The risk of progression to endometrial carcinoma is very low, approximately 1%, making it far less concerning than atypical forms [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 473-475. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1016-1018.

Q: Which one of the following is not an epithelial tumour of the ovary?

Endodermal sinus tumour. ***Endodermal sinus tumour*** - This is a type of **germ cell tumor** of the ovary, not an epithelial tumor. - It is characterized by the presence of **Schiller-Duval bodies** and elevated **alpha-fetoprotein (AFP)** levels. *Clear cell tumour* - This is a well-recognized sub-type of **epithelial ovarian cancer**, often associated with **endometriosis** [1]. - The histology typically shows cells with clear cytoplasm, sometimes arranged in glandular or tubulocystic patterns [1]. *Serous cystadenoma* - This is a common **benign epithelial tumor** of the ovary, characterized by cysts lined by serous epithelium [2]. - It arises from the **surface epithelium** of the ovary. *Brenner's tumour* - This is a less common but distinct type of **epithelial ovarian tumor**, characterized by nests of **transitional epithelial cells** resembling bladder urothelium [3]. - It is usually **benign** and often discovered incidentally [3]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, p. 1032. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 478-480. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1032-1033.

Q: Presence of signet-ring cells in a cellular or myxomatous stroma is diagnostic of:

Krukenberg tumour. ***Krukenberg tumour*** - **Krukenberg tumours** are characterized by mucin-filled **signet-ring cells** within a fibrous or myxomatous stroma. [1] - They represent metastatic adenocarcinomas, commonly originating from the **gastrointestinal tract**, particularly the stomach. [1] *Gynandroblastoma* - This is a rare **sex cord-stromal tumour** of the ovary that contains both female **(granulosa/theca cells)** and male **(Sertoli/Leydig cells)** components. - It does not typically feature signet-ring cells. *Hilus cell tumour* - **Hilus cell tumours** are **Leydig cell tumours** found in the ovarian hilum, characterized by cells containing **Reinke crystals**. - These tumours are associated with **androgen production** and virilization, and do not contain signet-ring cells. *Struma ovarii* - **Struma ovarii** is a specialized form of **ovarian teratoma** in which **thyroid tissue** is the predominant component (more than 50%). - While it can be functional and cause hyperthyroidism, it is not characterized by the presence of signet-ring cells. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 779.

Q: Common trisomies resulting in spontaneous abortion are all EXCEPT:

Trisomy 1. ***Trisomy 1*** - **Trisomy 1** is considered **lethal** and results in very early embryonic demise, often before a pregnancy is recognized, making it an extremely rare finding in spontaneous abortions. - The presence of an extra copy of such a large, gene-rich chromosome is **incompatible with early development**. *Trisomy 21* - **Trisomy 21 (Down syndrome)** is the most common autosomal trisomy that can result in a live birth, but it is also a frequent cause of **spontaneous abortion**. - While many pregnancies with Trisomy 21 result in live births, a significant proportion (approximately **75-80%**) end in miscarriage. *Trisomy 18* - **Trisomy 18 (Edwards syndrome)** is a common trisomy found in spontaneous abortions, second only to Trisomy 16. - While it can result in live births, the majority of fetuses with Trisomy 18 **miscarry spontaneously**. *Trisomy 16* - **Trisomy 16** is the most common trisomy identified in early spontaneous abortions, accounting for a large percentage of all chromosomal abnormalities leading to miscarriage. - It is considered **lethal** and is almost exclusively found in miscarried fetuses, with very rare exceptions of mosaic forms.

Question 1

In a patient with breast cancer, the following are poor prognostic factors except

Accepted Answer

Absence of epidermal growth factor receptor

Answer

Aneuploid status

Answer

Age less than 35 years

Answer

High grade

Question 2

Out of the following, select the histologic type of endometrial cancer which has the worst prognosis:

Accepted Answer

Papillary serous carcinoma

Answer

Clear cell carcinoma

Answer

Mucinous adenocarcinoma

Answer

Well differentiated endometrioid adenocarcinoma

Question 3

Which one of the following statements regarding seminoma testis is correct ?

Accepted Answer

It is the most common type of testicular cancer

Answer

It frequently metastasizes to the liver and bones

Answer

Its five-year survival rates approach 50 per cent

Answer

It does not respond to radiation

Question 4

Which of the following breast cancers is most often bilateral ?

Accepted Answer

Lobular carcinoma of the breast

Answer

Medullary carcinoma of the breast

Answer

Ductal carcinoma of the breast

Answer

Colloid carcinoma of the breast

Question 5

Which tumour marker is most often elevated in ovarian granulosa cell tumour?

Accepted Answer

Inhibin

Answer

Alpha fetoprotein

Answer

CA 125

Answer

Beta-HCG

Question 6

Which of the following conditions of the endometrium is associated with a significantly increased risk of development of cancer?

Accepted Answer

Complex hyperplasia with atypia

Answer

Complex hyperplasia

Answer

Simple atypical hyperplasia

Answer

Simple hyperplasia

Question 7

Which one of the following is not an epithelial tumour of the ovary?

Accepted Answer

Endodermal sinus tumour

Answer

Clear cell tumour

Answer

Serous cystadenoma

Answer

Brenner’s tumour

Question 8

Presence of signet-ring cells in a cellular or myxomatous stroma is diagnostic of:

Accepted Answer

Krukenberg tumour

Answer

Gynandroblastoma

Answer

Hilus cell tumour

Answer

Struma ovarii

Question 9

No increased relative risk of invasive breast carcinoma based on histopathological examination of benign breast tissue is for all of the following EXCEPT:

Accepted Answer

Solitary papilloma of lactiferous sinus

Answer

Squamous metaplasia

Answer

Usual ductal hyperplasia

Answer

Periductal mastitis

Question 10

Common trisomies resulting in spontaneous abortion are all EXCEPT:

Accepted Answer

Trisomy 1

Answer

Trisomy 21

Answer

Trisomy 18

Answer

Trisomy 16

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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