Reproductive Pathology Practice Questions

Q: The histology given below is an example of:

Fibroadenoma. ***Fibroadenoma*** - This image exhibits the characteristic **biphasic proliferation** of both **glandular epithelial** and **stromal components**, with the stroma appearing loose and myxoid [1]. - The glandular structures are often compressed into slit-like spaces by the proliferating stromal tissue, a hallmark feature of **fibroadenomas** [1]. *Rhabdomyosarcoma* - This tumor is composed of malignant cells with features of **skeletal muscle differentiation**, such as **rhabdomyoblasts** with abundant eosinophilic cytoplasm and cross-striations. - It would not show the distinct biphasic epithelial and stromal architecture seen in the image. *Phyllodes tumor* - While also a biphasic tumor of the breast with epithelial and stromal components, **phyllodes tumors** typically display prominent **stromal hypercellularity** and **leaf-like architectural patterns** [2]. - The stroma in phyllodes tumors is often much more cellular and can show varying degrees of atypia and mitotic activity, which is not evident in the provided image [2]. *Intraductal papilloma* - This lesion primarily consists of **papillary growth of ductal epithelial cells** supported by fibrovascular cores within a dilated duct. - It lacks the significant stromal proliferation and compression of glandular structures observed in the provided histology. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 448-449. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1074.

Q: Most common radiosensitive ovarian tumour -

Dysgerminoma. ### Dysgerminoma - Dysgerminomas are highly radiosensitive germ cell tumors of the ovary, making radiation therapy a very effective treatment option [2]. - They are the most common malignant germ cell tumor of the ovary, typically affecting adolescents and young women [1]. *Theca cell tumour* - Theca cell tumors are typically benign, estrogen-producing stromal tumors of the ovary. - They are not generally treated with radiation due to their benign nature and infrequent recurrence. *Teratoma* - Teratomas are germ cell tumors that can be mature (benign) or immature (malignant) [2]. - While immature teratomas can be malignant, they are generally not as radiosensitive as dysgerminomas and surgical resection is the primary treatment. *Granulosa cell tumour* - Granulosa cell tumors are sex cord-stromal tumors that are typically estrogen-producing and have a low malignant potential. - They are not profoundly radiosensitive, and the primary treatment for these tumors is surgical. **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] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 480-481.

Q: A 3-month-old boy is brought to the physician because his parents cannot find one of his testicles. Physical examination confirms the parents' observation. The patient develops a urogenital tumor 30 years later. An abdominal-pelvic CT scan reveals metastases to lumbar periaortic lymph nodes. Which of the following is the most likely pathologic diagnosis?

Seminoma. No explanation provided for the urogenital tumor type and its specific risk factors; however, patients with a history of **cryptorchidism** have a significantly increased risk of developing **testicular cancer**, with seminoma being the most common type [1]. **Seminomas** typically metastasize to **retroperitoneal (lumbar periaortic) lymph nodes**, which aligns with the CT findings. *Leydig cell tumor* - This is a **sex cord-stromal tumor** of the testis, which accounts for a small percentage of testicular tumors [2]. - While it can occur in undescended testes, **seminoma** is far more prevalent in cases of cryptorchidism leading to malignancy. *Renal cell carcinoma* - This is a kidney tumor, and while it does metastasize to lymph nodes, the primary tumor location would be the **kidney**, not a urogenital tumor arising from the absent testicle. - The history of **cryptorchidism** points directly to a testicular origin for the malignancy. *Malignant lymphoma* - Testicular lymphoma is more common in **older men** and usually presents as a diffuse enlargement of the testis [2]. - While it can metastasize to regional lymph nodes, there's no direct link to **cryptorchidism** as a risk factor for primary testicular lymphoma. **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. 508-509. [2] 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.

Q: Subnuclear cytoplasmic vacuolization is seen in which stage of menstrual cycle?

Secretory phase. ***Secretory phase*** - **Subnuclear cytoplasmic vacuolization** is a characteristic histological feature of the **early secretory phase** (days 16-18), occurring immediately after ovulation [1]. - This change reflects **progesterone-mediated differentiation** of endometrial glands, with glycogen accumulation creating vacuoles beneath the nucleus [1]. - This is the **most reliable histological marker** for dating the early secretory endometrium [1]. *Proliferative phase* - This phase (days 5-14) is characterized by **estrogen-driven endometrial growth** with straight, tubular glands and mitotic activity [1]. - No subnuclear vacuolization is present; glands show pseudostratified columnar epithelium without secretory changes [1]. *During menstruation* - During menstruation (days 1-5), the endometrium undergoes **tissue breakdown and shedding** [1]. - No organized glandular architecture or subnuclear vacuolization is seen; instead, there is necrosis, hemorrhage, and inflammatory infiltrate [1]. *None of the options* - Subnuclear cytoplasmic vacuolization is a well-defined histological feature specifically associated with the early secretory phase of the menstrual cycle. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1011-1013.

Q: Seminoma corresponds to

Dysgerminoma. ***Dysgerminoma*** - **Dysgerminoma** is the ovarian equivalent of a testicular **seminoma**, both originating from **germ cells** and exhibiting similar histological features [1], [3]. - They tend to be sensitive to **radiotherapy** and **chemotherapy**, often presenting as solid, lobulated tumors. *Granulosa tumour* - **Granulosa cell tumors** are sex cord-stromal tumors, not germ cell tumors, and are characterized by **estrogen production**. - They do not share the same cellular origin or histological features with seminoma. *Choriocarcinoma* - **Choriocarcinoma** is a highly malignant germ cell tumor that differentiates towards trophoblastic tissue and produces **human chorionic gonadotropin (hCG)** [2], [5]. - While it is a type of germ cell tumor, it is distinct from seminoma/dysgerminoma due to its unique differentiation and aggressive nature [4]. *Luteal cyst* - A **luteal cyst** is a benign functional ovarian cyst that forms from the corpus luteum after ovulation, not a neoplastic germ cell tumor. - It is a physiological structure, distinct from cancerous growths like seminoma or dysgerminoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1140-1141. [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 Female Genital Tract, pp. 1034-1035. [4] 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. [5] 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.

Q: All of the following may cause testicular atrophy except :

Torsion testis. ***Torsion testis*** - Testicular torsion, if **promptly treated**, may not lead to atrophy as blood flow can be restored before irreversible damage occurs [1]. - While prolonged torsion causes **ischemia and necrosis**, leading to atrophy; acute, successful detorsion would prevent it [1]. *Hypopituitarism* - Leads to decreased production of **gonadotropins** (LH and FSH), which are essential for testicular function and size [2]. - This hormonal deficiency results in **reduced spermatogenesis** and testosterone production, causing atrophy [2]. *Irradiation* - **Radiation therapy** to the pelvic area can directly damage the germinal epithelium and Leydig cells of the testes [2]. - This damage leads to impaired sperm production and **testosterone synthesis**, causing irreversible testicular atrophy [2]. *Cryptorchidism* - Refers to the **undescended testis**, which is exposed to higher temperatures in the abdomen or inguinal canal [3]. - This elevated temperature impairs germ cell development and can lead to **fibrosis and atrophy** of the seminiferous tubules over time [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. 978-979. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 514-515. [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. 976-977.

Q: Ovarian tumours commonly arise from:

Surface epithelium. ***Surface epithelium*** - The **surface epithelium** of the ovary, which is derived from the coelomic epithelium, is the origin of the **vast majority** (approximately 65-70%) of ovarian tumors, including **serous, mucinous, endometrioid, clear cell, and Brenner tumors** [1]. - These epithelial cells are prone to genetic mutations and proliferation due to constant ovulation and repair processes, increasing their susceptibility to malignant transformation. - **Epithelial ovarian cancers** are the most common type and account for most ovarian cancer deaths. *Germ cell* - **Germ cell tumors** account for approximately **15-20%** of ovarian neoplasms, typically seen in **younger individuals** and adolescents [1]. - Examples include **dysgerminomas**, **teratomas** (mature and immature), **yolk sac tumors**, and **choriocarcinomas**. - These tumors arise from the primordial germ cells of the ovary. *Metastatic tumors* - **Metastatic tumors** to the ovary account for approximately **5-10%** of ovarian malignancies. - The most common primary sites include the **gastrointestinal tract** (Krukenberg tumor from stomach/colon), **breast**, and **endometrium**. - Krukenberg tumors characteristically show **signet-ring cells** on histology. *Stroma of the ovary* - Tumors arising from the ovarian **stroma** (sex cord-stromal tumors) are less common, accounting for approximately **5-8%** of ovarian neoplasms. - These include **granulosa cell tumors**, **thecomas**, **fibromas**, and **Sertoli-Leydig cell tumors**. - These tumors are often associated with **hormone production** and may present with endocrine manifestations. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1026-1028.

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: Which of the following is a testicular tumor marker?

HCG. ***HCG*** - **Human Chorionic Gonadotropin (HCG)** is a key tumor marker for **germ cell tumors** of the testis, especially **choriocarcinoma** and some **seminomas** [1]. - Its levels correlate with tumor burden and are used for diagnosis, staging, and monitoring response to treatment. *CA-125* - **CA-125** is primarily used as a tumor marker for **ovarian cancer**, not testicular tumors. - Elevated levels can also be seen in other conditions affecting the peritoneum or pleura. *a-1 antitrypsin* - **Alpha-1 antitrypsin** is a protein involved in inhibiting proteases, and its deficiency is linked to **emphysema** and **liver disease**, not testicular cancer. - It is not considered a tumor marker for any specific cancer. *PSA (Prostate Specific Antigen)* - **PSA** is a well-known tumor marker for **prostate cancer**, primarily used for screening, diagnosis, and monitoring treatment efficacy in men [1], [2]. - It is produced by the prostate gland and is not associated with testicular tumors.

Question 1

The histology given below is an example of:

Accepted Answer

Fibroadenoma

Answer

Rhabdomyosarcoma

Answer

Phyllodes tumor

Answer

Intraductal papilloma

Question 2

Most common radiosensitive ovarian tumour -

Accepted Answer

Dysgerminoma

Answer

Theca cell tumour

Answer

Teratoma

Answer

Granulosa cell tumour

Question 3

A 3-month-old boy is brought to the physician because his parents cannot find one of his testicles. Physical examination confirms the parents' observation. The patient develops a urogenital tumor 30 years later. An abdominal-pelvic CT scan reveals metastases to lumbar periaortic lymph nodes. Which of the following is the most likely pathologic diagnosis?

Accepted Answer

Seminoma

Answer

Leydig cell tumor

Answer

Renal cell carcinoma

Answer

Malignant lymphoma

Question 4

Subnuclear cytoplasmic vacuolization is seen in which stage of menstrual cycle?

Accepted Answer

Secretory phase

Answer

Proliferative phase

Answer

During menstruation

Answer

None of the options

Question 5

Seminoma corresponds to

Accepted Answer

Dysgerminoma

Answer

Granulosa tumour

Answer

Choriocarcinoma

Answer

Luteal cyst

Question 6

All of the following may cause testicular atrophy except :

Accepted Answer

Torsion testis

Answer

Hypopituitarism

Answer

Irradiation

Answer

Cryptorchidism

Question 7

Ovarian tumours commonly arise from:

Accepted Answer

Surface epithelium

Answer

Germ cell

Answer

Stroma of the ovary

Answer

Metastatic tumors

Question 8

Lesions affecting the terminal duct lobular unit (TDLU) in breast are all except

Accepted Answer

Nipple adenoma

Answer

Intraductal papilloma

Answer

Fibroadenoma

Answer

Blunt duct adenosis

Question 9

Reinke's crystals are found in -

Accepted Answer

Hilus cell tumor

Answer

Dysgerminoma

Answer

Arrhenoblastoma

Answer

Granulosa cell tumor

Question 10

Which of the following is a testicular tumor marker?

Accepted Answer

HCG

Answer

CA-125

Answer

a-1 antitrypsin

Answer

PSA (Prostate Specific Antigen)

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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