Reproductive Pathology Practice Questions

Q: Among the following causes of genital ulcers, which is MOST likely to show chronic inflammatory changes?

Primary syphilis. ***Primary syphilis*** - The primary chancre shows **classic chronic inflammatory infiltrate** with **dense lymphoplasmacytic infiltration** and prominent **plasma cells** [2] - Characterized by **endothelial proliferation** (endarteritis obliterans) and **perivascular chronic inflammation** [2] - This represents the **most characteristic chronic inflammatory pattern** among genital ulcer causes - Spirochetes (*Treponema pallidum*) can be identified with special stains [2] *Granuloma inguinale (Donovanosis)* - Despite its name, does **NOT** show true granulomatous inflammation - Shows **mixed inflammatory infiltrate** with mononuclear cells, plasma cells, and neutrophils - Contains **Donovan bodies** (*Klebsiella granulomatis* within macrophages) - The inflammation is more **subacute/mixed** rather than purely chronic *Genital herpes* - Caused by **herpes simplex virus (HSV)** with **vesicular lesions** that ulcerate [1] - Shows **acute inflammatory response** with lymphocytic infiltrate and viral cytopathic effects - Predominantly **acute inflammation**, not chronic *Chancroid* - Caused by *Haemophilus ducreyi*, producing **painful soft chancres** - Shows **suppurative (acute) inflammation** with extensive **neutrophilic infiltration** and tissue necrosis - Classic **acute inflammatory pattern**, not chronic **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. 503-504. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 386-388.

Q: How do chlamydial infections lead to fallopian tube damage and infertility?

By persistent immune response causing fibrosis and scarring. ***By persistent immune response causing fibrosis and scarring*** - **Chlamydial infections** can persist in the fallopian tubes, leading to a **chronic inflammatory response**. - This sustained inflammation results in **fibrosis** and **scar tissue formation**, which distorts the normal anatomy and function of the fallopian tubes, leading to infertility. *Through direct cellular lysis and tissue destruction* - While *Chlamydia* can infect and replicate within cells, its primary damage mechanism in the fallopian tubes is not through **extensive direct cellular lysis** or immediate widespread tissue destruction. - The damage is more insidious and chronic, driven by the host's immune response rather than acute cellular death. *By production of cytotoxins that damage cilia* - *Chlamydia trachomatis* does not primarily produce potent **cytotoxins** that directly devastate ciliary function in the way some bacterial pathogens might. - Ciliary damage occurs as a *consequence* of inflammation, rather than being the direct result of a specific chlamydial exotoxin. *By stimulating tubal spasm and stenosis* - While inflammation can indirectly affect tubal motility, **chlamydial infections** do not specifically cause primary **tubal spasm** or acute **stenosis** as their main mechanism of damage. - The long-term consequence of inflammation is scarring and stricture, which can lead to stenosis, but this is a secondary effect of chronic inflammation and fibrosis.

Q: Which of the following HPV types is MOST strongly associated with cervical cancer?

HPV 16. ***HPV 16*** - **HPV 16** is the most prevalent **high-risk HPV type**, accounting for approximately 50-60% of all cervical cancer cases globally. - It's highly effective at integrating its DNA into host cells and producing **oncoproteins E6 and E7**, which promote cell proliferation and inhibit tumor suppressor genes [1]. *HPV 18* - While **HPV 18** is also a **high-risk type** and the second most common cause of cervical cancer (around 10-15%), it is less frequently associated than HPV 16 [1]. - HPV 18 is more commonly linked to **adenocarcinomas** of the cervix, whereas HPV 16 is more often associated with **squamous cell carcinomas**. *HPV 6* - **HPV 6** is considered a **low-risk HPV type**, primarily associated with benign conditions such as **genital warts (condyloma acuminata)** [1]. - It rarely causes cervical cancer and is not considered an oncogenic type. *HPV 11* - Similar to HPV 6, **HPV 11** is also a **low-risk HPV type** and is a common cause of **genital warts**. - It is not associated with an increased risk of cervical cancer. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 334-335.

Q: Identify the pathological condition shown in the image:

Adenomyoma. ***Adenomyoma*** - The image distinctly shows **endometrial glands and stroma** embedded within the **myometrium** (smooth muscle layer of the uterus), which is the hallmark of adenomyoma [1]. - This condition is essentially a localized form of **adenomyosis**, presenting as a mass [1]. *Intramural fibroid* - An intramural fibroid (leiomyoma) is a **benign tumor of smooth muscle cells**, typically showing a proliferation of uniform spindle cells with characteristic swirling patterns [2]. - It would lack the presence of **endometrial glands and stroma** within the lesion [2]. *Endometriosis* - Endometriosis involves the presence of **endometrial tissue outside the uterus**, such as on the ovaries, peritoneum, or bowel. - While it involves similar tissue, its location is **extrauterine**, whereas the image depicts a lesion within the uterine wall. *Myomatous polyp* - A myomatous polyp (or submucosal fibroid) is a **fibroid that protrudes into the uterine cavity**, often covered by endometrial tissue [2]. - The image does not show a polypoid growth extending into the cavity but rather glandular tissue directly within the muscle wall. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 475-476. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1024-1025.

Q: A 49 year old female presents with a breast lump. Which of the following findings is in accordance with basal-like breast cancer?

ER-, PR-, HER2-. ***ER-, PR-, HER2-*** - **Basal-like breast cancer** is characterized by its **triple-negative** status, meaning it does not express estrogen receptor (ER), progesterone receptor (PR), or human epidermal growth factor receptor 2 (HER2) [1]. - This specific immunophenotype is crucial for diagnosis and influences treatment strategies, as these cancers do not respond to therapies targeting these receptors [1]. *ER+, PR-, HER2-* - This profile describes a **hormone-sensitive** cancer (ER positive) but without PR or HER2 expression. - While it responds to endocrine therapies, it is distinct from basal-like cancer due to its ER positivity. *ER-, PR-, HER2+* - This profile indicates a cancer that is **HER2-positive**, meaning it overexpresses HER2, and can be targeted with anti-HER2 therapies like trastuzumab. - This is a separate molecular subtype of breast cancer often referred to as HER2-enriched, which is distinct from basal-like [2]. *ER+, PR+, HER2-* - This is the most common subtype, known as **luminal A** or **luminal B** depending on grade and Ki-67 expression, characterized by sensitivity to endocrine therapy [2]. - This hormone receptor-positive and HER2-negative profile is very different from the triple-negative basal-like breast cancer. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1064-1066. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1060.

Q: A 32-year-old HIV-positive man presents with multiple flesh-colored, pedunculated lesions on his penis. Biopsy shows koilocytes and increased mitotic figures. Which of the following viral proteins is responsible for the cellular changes observed?

E6 and E7 proteins. ***E6 and E7 proteins*** - The presence of **koilocytes** and **increased mitotic figures** in penile lesions, particularly in an HIV-positive individual, strongly suggests **Human Papillomavirus (HPV)** infection leading to condyloma acuminata [2]. - **HPV E6 and E7 oncoproteins** are critical for HPV-induced cell proliferation and immortalization; E6 degrades **p53** (a tumor suppressor), and E7 inactivates **Rb protein** (retinoblastoma protein), leading to uncontrolled cell division and the observed cellular changes [1]. *Tax protein* - The **Tax protein** is associated with **Human T-lymphotropic virus type 1 (HTLV-1)**, which causes Adult T-cell Leukemia/Lymphoma and HTLV-1-associated myelopathy/tropical spastic paraparesis, not HPV-related lesions. - Tax acts as a transcriptional activator, promoting viral gene expression and cellular proliferation but through different mechanisms than HPV oncoproteins. *L1 protein* - The **L1 protein** is a major **capsid protein** of HPV and is used in HPV vaccines to induce protective antibodies. - While essential for viral structure and assembly, L1 itself does not directly cause the cellular proliferative changes or koilocytic atypia seen in infected cells; these are driven by the E6 and E7 oncoproteins. *EBNA-1* - **EBNA-1** (Epstein-Barr Nuclear Antigen 1) is a protein produced by the **Epstein-Barr virus (EBV)**, which is associated with various lymphomas (e.g., Burkitt lymphoma, Hodgkin lymphoma) and nasopharyngeal carcinoma. - It is crucial for the maintenance of the EBV episome in latently infected cells and does not cause penile lesions with koilocytes. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1007-1008. [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. 974-975.

Q: Which of the following breast lesions characteristically shows central necrosis with calcification?

Comedo sub type of DCIS. ***Comedo sub type of DCIS*** - This subtype is characterized by high-grade pleomorphic tumor cells with **central necrosis** within the ducts [1]. - The necrotic debris often calcifies, leading to characteristic **microcalcifications** visible on mammograms [2]. *Cribriform sub type of DCIS* - This subtype features uniform cells forming gland-like spaces within the ducts, but **typically lacks significant central necrosis** and extensive calcification [1]. - It usually presents with a **low nuclear grade** and less aggressive features compared to comedo DCIS [1]. *Lobular carcinoma in situ* - Characterized by small, discohesive cells filling and expanding the acini of the lobules, but it **does not involve ductal necrosis or calcification**. - It is often an **incidental finding** and represents a marker for increased risk of invasive carcinoma in either breast, rather than an obligate precursor lesion visible with calcifications. *Colloid carcinoma* - This is a type of **invasive ductal carcinoma** where tumor cells float in abundant extracellular mucin. - While it is an invasive cancer, it does not typically present with the extensive **ductal necrosis and calcification** seen in comedo DCIS. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1062-1064. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 452-453.

Question 1

A 40-year-old female presents with an irregular 5 × 6 cm mass in the right breast. Histopathological examination reveals the image shown. What is the most likely diagnosis?

Accepted Answer

Phyllodes tumor

Answer

Fibroadenoma

Answer

Invasive ductal carcinoma

Answer

Intraductal papilloma

Question 2

Among the following causes of genital ulcers, which is MOST likely to show chronic inflammatory changes?

Accepted Answer

Primary syphilis

Answer

Granuloma inguinale (Donovanosis)

Answer

Genital herpes

Answer

Chancroid

Question 3

How do chlamydial infections lead to fallopian tube damage and infertility?

Accepted Answer

By persistent immune response causing fibrosis and scarring

Answer

Through direct cellular lysis and tissue destruction

Answer

By production of cytotoxins that damage cilia

Answer

By stimulating tubal spasm and stenosis

Question 4

Which of the following HPV types is MOST strongly associated with cervical cancer?

Accepted Answer

HPV 16

Answer

HPV 18

Answer

HPV 6

Answer

HPV 11

Question 5

How do high-risk HPV types contribute to cervical carcinogenesis?

Accepted Answer

By integration into host genome and expression of E6/E7 oncoproteins

Answer

Through direct mutagenic effects on host DNA

Answer

Through chronic inflammation and oxidative damage

Answer

By inducing apoptosis resistance through capsid proteins

Question 6

Identify the pathological condition shown in the image:

Accepted Answer

Adenomyoma

Answer

Intramural fibroid

Answer

Endometriosis

Answer

Myomatous polyp

Question 7

A 49 year old female presents with a breast lump. Which of the following findings is in accordance with basal-like breast cancer?

Accepted Answer

ER-, PR-, HER2-

Answer

ER+, PR-, HER2-

Answer

ER-, PR-, HER2+

Answer

ER+, PR+, HER2-

Question 8

A 32-year-old HIV-positive man presents with multiple flesh-colored, pedunculated lesions on his penis. Biopsy shows koilocytes and increased mitotic figures. Which of the following viral proteins is responsible for the cellular changes observed?

Accepted Answer

E6 and E7 proteins

Answer

Tax protein

Answer

L1 protein

Answer

EBNA-1

Question 9

Which of the following breast lesions characteristically shows central necrosis with calcification?

Accepted Answer

Comedo sub type of DCIS

Answer

Cribriform sub type of DCIS

Answer

Lobular carcinoma in situ

Answer

Colloid carcinoma

Question 10

Which patient has the best prognosis in breast cancer?

Accepted Answer

Luminal A

Answer

Luminal B

Answer

Triple negative breast cancer

Answer

HER2-positive breast cancer

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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