Reproductive Pathology Practice Questions

Q: A 36-year-old man presents to his primary care physician complaining of painless enlargement of the testis. Further laboratory studies reveal an increase in serum hCG. Of the following, which is the most likely diagnosis?

Embryonal carcinoma. ***Embryonal carcinoma*** - This highly **malignant tumor** often presents with **elevated hCG** and a **firm, painless testicular mass**. - It frequently consists of mixed germ cell tumors, with embryonal components contributing to the hCG surge. - Among the options provided, this is the most likely diagnosis with elevated hCG (note: choriocarcinoma would show the highest hCG levels but is not listed). *Seminoma* - While it causes **painless testicular enlargement**, seminoma is typically associated with **elevated LDH and placental alkaline phosphatase (PLAP)**, not significant hCG elevation. - Pure seminomas occasionally show mild hCG elevation (~10-15% of cases), but this is not their characteristic tumor marker. *Yolk sac tumor* - These tumors are characterized by significantly **elevated alpha-fetoprotein (AFP)** levels. - While they can cause testicular enlargement, hCG elevation is not its primary tumor marker. *Dysgerminoma* - **Dysgerminomas** are a type of **ovarian germ cell tumor**, primarily found in females, and thus highly unlikely in a male patient. - The male equivalent is a **seminoma**, which does not typically show significant hCG elevation.

Q: The incidence of bilaterality in a dermoid cyst is approximately

10%. ***Correct: 10%*** - **Dermoid cysts** (mature cystic teratomas) are the most common ovarian germ cell tumors, accounting for up to 40% of all ovarian neoplasms [1, 2]. - While predominantly **unilateral**, approximately **10-15% of cases** demonstrate bilateral involvement, affecting both ovaries [1]. - This relatively low incidence of bilaterality is an important clinical feature that distinguishes dermoid cysts from some other ovarian pathologies. - The term "dermoid" refers to the presence of mature ectodermal tissues (skin, hair, teeth), though these teratomas may contain all three germ layers [1, 2]. *Incorrect: 70%* - This percentage is far higher than the actual incidence of bilaterality for dermoid cysts. - A 70% bilateral rate would suggest that most cases are symmetric, which is not characteristic of mature cystic teratomas. - No reputable source supports such a high bilateral incidence for this condition. *Incorrect: 30%* - This percentage significantly overestimates the bilateral involvement of dermoid cysts. - While some variation exists in reported figures, 30% exceeds the accepted range of 10-15%. - This would imply nearly one-third of cases are bilateral, which is not clinically observed. *Incorrect: 50%* - A 50% incidence would incorrectly suggest that bilateral presentation is as common as unilateral presentation. - This contradicts established pathology literature and clinical experience. - Such a high rate of bilaterality is not characteristic of dermoid cysts. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1033-1034. [2] 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 statements about seminomas is false?

Schiller-Duval bodies are commonly seen. ***Schiller-Duval bodies are commonly seen*** - **Schiller-Duval bodies** are pathognomonic for **yolk sac tumors**, a different type of germ cell tumor, not seminomas [1]. - Their presence would indicate a diagnosis other than pure seminoma. *Serum HCG levels are elevated* - While most pure seminomas do not produce tumor markers, about 10-15% of seminomas have **elevated beta-HCG** due to the presence of **syncytiotrophoblast-like cells** [1]. - This elevation is typically less pronounced than in choriocarcinoma but still occurs [1]. *Spermatocytic seminomas are usually slow growing* - **Spermatocytic seminoma** is a rare subtype of seminoma that typically affects older men and is known for its **indolent, slow-growing** nature [1]. - It usually has an excellent prognosis and rarely metastasizes. *Most common type of germ cell tumor* - **Seminoma** is indeed the most common type of **testicular germ cell tumor**, accounting for approximately 50-60% of all germ cell neoplasms. - It typically affects men in their 30s and 40s. **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. 979-982.

Q: A middle-aged female presented with a 4cm mass in the upper outer quadrant of the breast. Biopsy showed densely packed cells within large extracellular spaces. Which of the following is the most likely diagnosis of this patient?

Colloid carcinoma of breast. ***Colloid carcinoma of breast*** - This type of carcinoma is characterized by **malignant cells floating in abundant extracellular mucin (colloid)**, which aligns with the description "densely packed cells within large extracellular spaces." - It often presents as a **well-circumscribed mass** and has a generally **good prognosis**. *Tubular carcinoma of breast* - Characterized by **well-differentiated tubules** with open lumens and a single layer of epithelial cells. - It does not typically feature large extracellular spaces filled with mucin. *Medullary carcinoma of breast* - This typically presents as a **soft, fleshy tumor** with syncytial sheets of large anaplastic cells and a prominent lymphoid infiltrate [1]. - It does not involve significant extracellular mucin or large extracellular spaces. *Papillary carcinoma of breast* - This carcinoma is defined by **papillary growth patterns** with fibrovascular cores lined by epithelial cells. - While it can be associated with cystic spaces, these are not typically described as "large extracellular spaces" filled with mucinous material. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 455-456.

Q: Which of the following is true about prostate cancer?

Grading is based on Gleason score. ***Grading is based on Gleason score*** - The **Gleason score** is a widely used system to grade the aggressiveness of prostate cancer based on its microscopic appearance [1]. - It assesses the architectural patterns of the tumor, assigning a grade from 1 to 5 to the two most prevalent patterns, which are then summed to yield a final score (ranging from 2-10), indicating the **prognosis** and guiding treatment [1]. *Most common region involved is central zone* - The most common region for prostate cancer to develop is the **peripheral zone**, accounting for about 70-80% of cases [1]. - The **central zone** accounts for less than 5% of prostate cancers. *It is not a hormone dependent cancer* - Prostate cancer is largely a **hormone-dependent cancer**, with its growth stimulated by androgens like testosterone [1]. - **Androgen deprivation therapy (ADT)** is a cornerstone of prostate cancer treatment, demonstrating its dependency on hormones [1]. *Most common type is squamous cell Carcinoma* - The most common type of prostate cancer is **adenocarcinoma**, which originates from the glandular cells of the prostate [1]. - **Squamous cell carcinoma** of the prostate is exceedingly rare, accounting for less than 1% of all prostate malignancies. **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. 988-994.

Q: Most specific marker for distinguishing seminoma from embryonal carcinoma?

CD30. ***CD30*** - **CD30** is highly specific for **embryonal carcinoma** among germ cell tumors, showing strong and diffuse positivity. - Its presence helps differentiate embryonal carcinoma from seminoma, which is consistently **CD30-negative**. *SALL4* - **SALL4** is a pan-germ cell marker, meaning it is expressed in both **seminoma** and **embryonal carcinoma**, so it cannot distinguish between them. - It is useful for identifying germ cell tumors in general but lacks specificity for subtyping. *OCT3/4* - **OCT3/4** is also a pan-germ cell marker expressed in both **seminoma** and **embryonal carcinoma** [1]. - Its utility lies in confirming germ cell origin but not in differentiating between specific subtypes [1]. *PLAP* - **PLAP (Placental alkaline phosphatase)** is typically positive in both **seminoma** and **embryonal carcinoma**, thus not useful for distinguishing these two entities [1]. - While helpful in diagnosing germ cell tumors, it lacks the specificity needed for subtyping in this context [1]. **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. 979-982.

Q: Female presents with bloody nipple discharge. Most likely pathological finding?

Intraductal papilloma. ***Intraductal papilloma*** - This is the **most common cause of bloody nipple discharge**, particularly if it is unilateral and from a single duct [1]. - It is a benign epithelial proliferation located within a **lactiferous duct**, and the friable nature of the papilloma can lead to bleeding [1]. *Fibrocystic change* - While fibrocystic changes are common, they typically present with **lumpy, painful breasts** and sometimes non-bloody, multiple duct discharge (e.g., milky or clear) [1]. - **Bloody discharge** is not a characteristic feature of uncomplicated fibrocystic change. *Fibroadenoma* - Fibroadenomas are benign **stromal and epithelial tumors** that present as well-defined, moveable breast lumps [1]. - They are not typically associated with **nipple discharge**, especially bloody discharge. *Phyllodes tumor* - Phyllodes tumors are rare fibroepithelial tumors that can grow rapidly and form a **palpable mass**. - While they can be large, **bloody nipple discharge** is not a primary or common presenting symptom for phyllodes tumors. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 439-449.

Q: Which of the following statements about benign prostatic hyperplasia (BPH) is true?

Occurs in the periurethral region. ***Occurs in the periurethral region*** - **Benign prostatic hyperplasia (BPH)** typically originates in the **transition zone**, which is a part of the periurethral region of the prostate gland [1]. - This growth pattern explains why BPH commonly leads to **compression of the urethra** and subsequent lower urinary tract symptoms (LUTS) [1]. *Increased risk of carcinoma* - BPH is a **benign condition** and is not considered a premalignant lesion; it does **not increase the risk of prostate carcinoma** [1]. - Although both conditions are common in older men, they are distinct and BPH does not evolve into cancer [1]. *Commonly causes hematuria as the initial symptom* - While microscopic or macroscopic **hematuria** can occur in BPH due to friable blood vessels in the enlarged prostate, it is **not typically the initial or most common symptom**. - The most common initial symptoms are related to **urinary obstruction**, such as frequency, urgency, nocturia, and a weak stream [1]. *Primarily affects the peripheral zone* - The **peripheral zone** is the region of the prostate where **prostate carcinoma** most commonly originates [1, 2]. - BPH primarily affects the **transition zone** and, to a lesser extent, the central zone, leading to different clinical presentations and anatomical locations of disease [1]. **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. 496-501. [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. 993-994.

Q: ER positivity is used as which of the following in the context of breast carcinoma?

Prognostic marker. ***Prognostic marker*** - **ER positivity** in **breast carcinoma** is primarily used as a **prognostic marker** indicating more favorable disease outcome [1]. - ER-positive tumors generally **grow more slowly**, are **less aggressive**, and have **better overall survival** compared to ER-negative tumors [2]. - While ER status also has **predictive value** for endocrine therapy response, its classification as a prognostic indicator reflects its association with inherently better tumor biology and patient outcomes [1]. - ER positivity correlates with **well-differentiated tumors** and **lower grade** malignancies. *Treatment option* - ER positivity is not a treatment itself, but rather a **biomarker** that guides treatment selection. - It identifies patients who may benefit from **endocrine therapy** (tamoxifen, aromatase inhibitors) [1]. *Molecular marker* - While ER is indeed a molecular marker (receptor protein detected by immunohistochemistry), this term is too **broad and non-specific**. - The question asks for the **specific clinical utility** of ER positivity, not its general classification. *Diagnostic marker* - ER status is **not used for initial diagnosis** of breast carcinoma. - Diagnosis requires **histopathological examination** of tissue biopsy. - ER testing is performed **after diagnosis** to characterize the tumor and guide management. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1059-1060. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1064-1066.

Question 1

A 36-year-old man presents to his primary care physician complaining of painless enlargement of the testis. Further laboratory studies reveal an increase in serum hCG. Of the following, which is the most likely diagnosis?

Accepted Answer

Embryonal carcinoma

Answer

Seminoma

Answer

Yolk sac tumor

Answer

Dysgerminoma

Question 2

The incidence of bilaterality in a dermoid cyst is approximately

Accepted Answer

10%

Answer

70%

Answer

30%

Answer

50%

Question 3

Sections from a solid-cystic unilateral ovarian tumor in a 30-year old female show a tumor composed of diffuse sheets of small cells with doubtful nuclear grooving and scanty cytoplasm. No Call-Exner bodies are seen. The ideal immunohistochemistry panel would include

Accepted Answer

Vimentin, epithelial membrane antigen, inhibin, CD99

Answer

CD3, chromagranin, CD 45, synaptophysin

Answer

Chromogranin, CD45, CD99, CD20

Answer

Desmin, S- 100 protein, smooth muscle antigen, cytokeratin

Question 4

Which of the following statements about seminomas is false?

Accepted Answer

Schiller-Duval bodies are commonly seen

Answer

Serum HCG levels are elevated

Answer

Spermatocytic seminomas are usually slow growing

Answer

Most common type of germ cell tumor

Question 5

A middle-aged female presented with a 4cm mass in the upper outer quadrant of the breast. Biopsy showed densely packed cells within large extracellular spaces. Which of the following is the most likely diagnosis of this patient?

Accepted Answer

Colloid carcinoma of breast

Answer

Tubular carcinoma of breast

Answer

Medullary carcinoma of breast

Answer

Papillary carcinoma of breast

Question 6

Which of the following is true about prostate cancer?

Accepted Answer

Grading is based on Gleason score

Answer

Most common region involved is central zone

Answer

It is not a hormone dependent cancer

Answer

Most common type is squamous cell Carcinoma

Question 7

Most specific marker for distinguishing seminoma from embryonal carcinoma?

Accepted Answer

CD30

Answer

OCT3/4

Answer

SALL4

Answer

PLAP

Question 8

Female presents with bloody nipple discharge. Most likely pathological finding?

Accepted Answer

Intraductal papilloma

Answer

Fibrocystic change

Answer

Fibroadenoma

Answer

Phyllodes tumor

Question 9

Which of the following statements about benign prostatic hyperplasia (BPH) is true?

Accepted Answer

Occurs in the periurethral region

Answer

Increased risk of carcinoma

Answer

Commonly causes hematuria as the initial symptom

Answer

Primarily affects the peripheral zone

Question 10

ER positivity is used as which of the following in the context of breast carcinoma?

Accepted Answer

Prognostic marker

Answer

Treatment option

Answer

Molecular marker

Answer

Diagnostic marker

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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