Reproductive Pathology Practice Questions

Q: The surgical registrar successfully performs a testicular biopsy and hands over the specimen to the attending nurse. The sister asks you how to send the specimen to the pathologist. What fluid will you tell the sister to put the specimen in?

Bouin's solution. ***Bouin's solution*** - **Bouin's solution is the preferred fixative for testicular biopsies**, particularly for infertility evaluation and detailed assessment of spermatogenesis. - It provides **superior preservation of testicular architecture** and excellent nuclear detail, which is critical for evaluating seminiferous tubule morphology and germ cell maturation. - While it may cause some tissue shrinkage, the **enhanced nuclear detail and better preservation of seminiferous epithelium** make it the gold standard for testicular tissue. - Bouin's is specifically recommended in standard pathology protocols for reproductive tissue. *10% formalin* - While 10% neutral buffered formalin is the most common fixative for general surgical pathology specimens, it is **not optimal for testicular biopsies**. - Formalin provides adequate preservation but **does not give the superior nuclear and cytoplasmic detail** needed for detailed evaluation of spermatogenesis. - For routine testicular tumor specimens, formalin may be acceptable, but for **diagnostic testicular biopsies (especially for infertility)**, Bouin's solution is preferred. *95% ethanol* - Ethanol is primarily a **dehydrating agent**, not a suitable primary fixative for histology specimens. - It causes significant **tissue shrinkage and distortion**, making histological interpretation challenging. - Not appropriate for testicular tissue preservation. *Zenker's solution* - Zenker's solution is a **mercuric chloride-based fixative** with significant drawbacks. - Contains **toxic mercury** requiring special handling and disposal. - Can interfere with certain special stains and cause **chromatin clumping**. - Largely obsolete in modern pathology practice due to mercury content.

Q: All are true about seminomas except:

Rarely responds to radiotherapy. ***Rarely responds to radiotherapy*** - **Seminomas** are highly **radiosensitive** and respond very well to radiotherapy, especially localized disease [3]. - This characteristic makes radiotherapy a primary treatment modality for seminomas with excellent outcomes. *Spermatocytic seminoma is slow growing with good prognosis* - **Spermatocytic seminomas** are a distinct histological subtype, typically seen in older men and are characterized by a **slow growth rate** and an **excellent prognosis** [1]. - They rarely metastasize and are managed with orchiectomy alone. *Anaplastic seminomas is associated with a worse prognosis* - **Anaplastic seminomas** exhibit increased mitotic activity and cellular atypia, suggesting a more aggressive biological behavior. - Although more aggressive than classic seminomas, they generally still respond well to treatment, though the prognosis might be slightly inferior to classic seminoma; however, some sources suggest it does not portend a worse prognosis when matched for stage [1]. *Almost never occur in infants* - **Seminomas** are testicular germ cell tumors that typically affect young to middle-aged adults, with a peak incidence in the third and fourth decades of life. - They are exceedingly rare in infants and children; other germ cell tumors like yolk sac tumors are more common in this age group [2]. **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] 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] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 480-481.

Q: Which of the following is sex cord stromal tumor?

Leydig cell tumor. ***Leydig cell tumor*** - **Leydig cells** are components of the **sex cords** in the testis and are primarily responsible for **testosterone production** [1]. - Tumors arising from these cells are therefore classified as **sex cord stromal tumors** [1]. *Seminoma* - **Seminomas** are a type of **germ cell tumor**, originating from primordial germ cells or intratubular germ cell neoplasia [2]. - They do not arise from the stromal components of the testis like Leydig cells. *Choriocarcinoma* - **Choriocarcinoma** is a highly aggressive **germ cell tumor** [4] characterized by the presence of both cytotrophoblast and syncytiotrophoblast cells [4]. - It produces **human chorionic gonadotropin (hCG)** [4] and is not derived from sex cord stroma. *Yolk sac tumor* - A **yolk sac tumor**, also known as an **endodermal sinus tumor**, is another type of **germ cell tumor** [3]. - It often produces **alpha-fetoprotein (AFP)** and is not considered a sex cord stromal tumor. **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. 513-514. [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. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1035-1036. [4] 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: Testicular involvement without epididymitis is a feature of -

Syphilis. ***Syphilis*** - Testicular involvement in syphilis, known as **gumma of the testis**, typically occurs in the **tertiary stage** and can present as a painless, firm mass **without epididymitis** [1]. - This is due to the spirochete *Treponema pallidum* directly invading the testicular parenchyma, leading to **granulomatous inflammation**. *Tuberculosis* - **Tuberculous epididymo-orchitis** is the characteristic presentation, where the **epididymis is almost always involved first**, often with a beaded or nodular feel. - Isolated testicular tuberculosis without epididymal involvement is **rare** and usually accompanies systemic disease. *Granuloma inguinale* - This sexually transmitted infection is caused by *Klebsiella granulomatis* and primarily causes **painless, progressive ulcerative lesions** of the genitourinary and perineal skin. - It does **not typically involve the testis** or epididymis; the lesions are superficial. *Gonorrhoea* - **Gonococcal epididymitis** is the most common manifestation of gonococcal infection in the male genitourinary tract, often associated with urethritis. - **Orchitis without epididymitis is extremely rare** in gonorrhoea and usually only occurs in severe, untreated cases where the infection has ascended.

Q: Grape-like, polypoid, bulky mass protruding through vagina in 4-year old girl is characteristic of

Sarcoma botryoides. ***Sarcoma botryoides*** - This is a highly characteristic presentation of **embryonal rhabdomyosarcoma (sarcoma botryoides)** in young girls, where the tumor forms a **grape-like (botryoid) mass** protruding from the vagina [1]. - It typically arises from the **vagina wall or cervix** in infants and young children, often presenting with bleeding or a mass [1]. *Leiomyosarcoma* - Leiomyosarcoma is a malignant tumor of **smooth muscle**, occurring more commonly in older women [2]. - It typically presents as a **solitary, firm mass** in the uterus or vagina, not typically with a grape-like appearance [2]. *Inflammatory polyp* - An inflammatory polyp is a **benign, non-malignant outgrowth** of tissue, often associated with chronic inflammation. - While it can protrude, it lacks the **destructive, bulky, and invasive nature** implied by "grape-like, polypoid, bulky mass" in the context of a child. *Fibrosarcoma* - Fibrosarcoma is a malignant tumor of **fibrous connective tissue**, which can occur anywhere in the body. - It is uncommon in the vagina, especially in young children, and generally presents as a **firm, infiltrative mass** rather than the distinctive grape-like pattern. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1004-1005. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1024-1025.

Q: Common differential diagnosis of verrucous carcinoma is -

Condylomata acuminata. ***Condylomata acuminata*** - **Verrucous carcinoma** is a rare, well-differentiated squamous cell carcinoma that often presents as a large, exophytic, warty mass, making it clinically similar to **condylomata acuminata (genital warts)** [1]. - Both conditions can appear as **cauliflower-like lesions** on mucosal surfaces, especially in the anogenital region, necessitating **biopsy** for definitive differentiation [1]. *Adenocarcinoma* - **Adenocarcinoma** typically arises from glandular tissue and presents as a mass or ulcer, but rarely as a **verrucous (warty)** lesion [2]. - Its histological features, characterized by **glandular differentiation**, are distinct from the acanthotic, hyperkeratotic pattern of verrucous carcinoma [2]. *Tuberculosis* - **Tuberculosis** can cause granulomatous lesions, but these are typically **ulcerative** or **nodular**, rather than large, exophytic, warty growths characteristic of verrucous carcinoma. - Diagnosis involves identifying **acid-fast bacilli** and characteristic granulomas with caseous necrosis, which are absent in verrucous carcinoma. *Condylomata lata* - **Condylomata lata** are broad, flat, moist papules associated with **secondary syphilis**, which are distinct from the exophytic, warty appearance of verrucous carcinoma [3]. - These lesions are typically **non-pruritic** and reveal spirochetes on dark-field microscopy, unlike verrucous carcinoma [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. 974-975. [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. 973-974. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1000-1002.

Q: Most common karyotype of partial mole?

69 XXY. ***69 XXY*** - A **partial mole** is characterized by **triploidy**, meaning it has three sets of chromosomes (69 total). - **69 XXY** is the **most common karyotype** in partial moles, accounting for approximately **60% of cases**. - This typically results from the fertilization of a single egg (23 X) by **two sperm** (23 X and 23 Y), leading to one maternal and two paternal sets of chromosomes. *46 XX* - This is the normal diploid karyotype for a **female** and is associated with a **normal pregnancy**, not a partial molar pregnancy. - A **complete hydatidiform mole** can have a 46 XX karyotype, but this arises from fertilization of an "empty" egg by a single sperm that then duplicates its chromosomes (androgenetic origin). *69 XXX* - While **69 XXX** is also a triploid karyotype seen in partial moles (approximately **37% of cases**), it is **less common** than 69 XXY. - This results from fertilization of a single egg (23 X) by two sperm (both 23 X), or by a diploid sperm (46 XX). - The question asks for the **most common** karyotype, which is 69 XXY. *46 XY* - This is the normal diploid karyotype for a **male** and is associated with a **normal pregnancy**, not a molar pregnancy. - Like 46 XX, it represents a healthy, non-molar chromosomal constitution with the normal 46 chromosomes.

Q: Which of the following is the ovarian counterpart of testicular seminoma?

Dysgerminoma. ***Dysgerminoma*** - **Dysgerminoma** is the most common malignant germ cell tumor of the ovary and is histologically identical to testicular **seminoma** [1]. - Both tumors arise from **primordial germ cells** and share similar morphology, including large, uniform cells with clear cytoplasm and prominent nucleoli, often arranged in nests and separated by fibrous septa with lymphocytic infiltration [1], [3]. *Dermoid* - **Dermoid cysts**, also known as mature cystic teratomas, are germ cell tumors composed of well-differentiated tissues from all three germ layers (ectoderm, mesoderm, endoderm) [2]. - They are typically benign and do not have a direct testicular counterpart that is histologically identical to seminoma. *Brenner tumor* - **Brenner tumors** are uncommon epithelial ovarian tumors characterized by nests of transitional epithelial cells resembling urothelium, separated by a fibrous stroma. - They are not germ cell tumors and do not have a testicular counterpart to seminoma. *Endodermal sinus tumor* - The **endodermal sinus tumor** (yolk sac tumor) is another type of malignant germ cell tumor of the ovary, but it is characterized by structures resembling the primitive yolk sac and the presence of **Schiller-Duval bodies**. - While it has a testicular counterpart, it is not histologically identical to seminoma; its testicular counterpart is also called a yolk sac tumor and is distinct from seminoma [3]. **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] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1035-1036. [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. 979-980.

Q: Chimney sweeper's cancer is also known as

Carcinoma scrotum. ***Carcinoma scrotum*** - **Chimney Sweeper's cancer** is a historical term for **squamous cell carcinoma** of the scrotum, first described by Percivall Pott in 1775. - It was highly prevalent among chimney sweepers due to prolonged occupational exposure to **soot** (coal tar), which contains **polycyclic aromatic hydrocarbons (PAHs)**. *Carcinoma colon* - This cancer affects the **large intestine** and is linked to polyps, genetic factors, and lifestyle, not specifically soot exposure to external skin. - While PAHs can be ingested and metabolized, the direct association with "Chimney Sweeper's cancer" is specific to external skin carcinogenicity [1]. *Carcinoma penis* - This is a rare cancer associated with **HPV infection**, poor hygiene, and phimosis, primarily affecting the penile shaft or glans [2]. - It is not historically linked to occupational soot exposure in the way scrotal cancer is. *Carcinoma lung* - **Lung cancer** is strongly associated with **smoking** and exposure to airborne carcinogens like asbestos and radon, or general air pollution [1]. - While chimney sweepers might inhale soot, the term "Chimney Sweeper's cancer" specifically refers to the external **scrotal carcinoma** due to direct skin contact. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 217-218. [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. 975-976.

Q: Alpha-fetoprotein is a marker of

Yolk sac carcinoma. ***Yolk sac carcinoma*** - **Alpha-fetoprotein (AFP)** is a **glycoprotein** normally produced by the fetal liver and yolk sac. - In adults, elevated AFP levels are a key tumor marker for **yolk sac tumors (endodermal sinus tumors)**, hepatocellular carcinoma, and some germ cell tumors [1]. *Choriocarcinoma* - **Choriocarcinoma** is primarily associated with elevated levels of **human chorionic gonadotropin (hCG)**, not AFP [2]. - hCG is a hormone produced by the placenta and is a marker for various germ cell tumors, especially those with syncytiotrophoblastic differentiation [3]. *Embryonal carcinoma* - **Embryonal carcinoma** can produce various tumor markers, including **hCG** and sometimes **AFP**, but it is generally less consistently associated with high AFP compared to yolk sac tumors [2]. - Its histological features are more primitive and undifferentiated than yolk sac carcinoma [1]. *Dysgerminoma* - **Dysgerminoma** is associated with elevated levels of **lactate dehydrogenase (LDH)** and, occasionally, mildly elevated hCG. - It is histologically analogous to seminoma in males and typically does not produce AFP [4]. **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 Female Genital Tract, pp. 1035-1036. [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. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1140-1141.

Question 1

The surgical registrar successfully performs a testicular biopsy and hands over the specimen to the attending nurse. The sister asks you how to send the specimen to the pathologist. What fluid will you tell the sister to put the specimen in?

Accepted Answer

Bouin's solution

Answer

95% ethanol

Answer

Zenker's solution

Answer

10% formalin

Question 2

All are true about seminomas except:

Accepted Answer

Rarely responds to radiotherapy

Answer

Spermatocytic seminoma is slow growing with good prognosis

Answer

Almost never occur in infants

Answer

Anaplastic seminoma is associated with a worse prognosis

Question 3

Which of the following is sex cord stromal tumor?

Accepted Answer

Leydig cell tumor

Answer

Seminoma

Answer

Choriocarcinoma

Answer

Yolk sac tumor

Question 4

Testicular involvement without epididymitis is a feature of -

Accepted Answer

Syphilis

Answer

Tuberculosis

Answer

Granuloma inguinale

Answer

Gonorrhoea

Question 5

Grape-like, polypoid, bulky mass protruding through vagina in 4-year old girl is characteristic of

Accepted Answer

Sarcoma botryoides

Answer

Leiomyosarcoma

Answer

Inflammatory polyp

Answer

Fibrosarcoma

Question 6

Common differential diagnosis of verrucous carcinoma is -

Accepted Answer

Condylomata acuminata

Answer

Adenocarcinoma

Answer

Tuberculosis

Answer

Condylomata lata

Question 7

Most common karyotype of partial mole?

Accepted Answer

69 XXY

Answer

46 XX

Answer

69 XXX

Answer

46 XY

Question 8

Which of the following is the ovarian counterpart of testicular seminoma?

Accepted Answer

Dysgerminoma

Answer

Dermoid

Answer

Endodermal sinus tumor

Answer

Brenner tumor

Question 9

Chimney sweeper's cancer is also known as

Accepted Answer

Carcinoma scrotum

Answer

Carcinoma colon

Answer

Carcinoma penis

Answer

Carcinoma lung

Question 10

Alpha-fetoprotein is a marker of

Accepted Answer

Yolk sac carcinoma

Answer

Choriocarcinoma

Answer

Embryonal carcinoma

Answer

Dysgerminoma

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?