Reproductive Pathology Practice Questions

Q: In a histopathological examination, a tumor shows a hobnail appearance. Which of the following tumors is most likely associated with this finding?

Clear cell carcinoma. ***Clear cell carcinoma*** - The **hobnail appearance** describes tumor cells that protrude into the lumen, resembling a hobnail, which is a characteristic feature of **clear cell carcinoma** in various organs like the kidney, ovary, and uterus. - These cells often have **clear cytoplasm** and prominent apical nuclei, contributing to their distinct appearance. *Endodermal sinus tumor* - This tumor is known for forming **Schiller-Duval bodies**, which are pathognomonic glomeruloid structures, not a hobnail appearance. - It typically contains regions of a reticular pattern and often stains positive for **alpha-fetoprotein (AFP)**. *HCC* - **Hepatocellular carcinoma (HCC)** is characterized by cells resembling hepatocytes, forming trabecular, solid, or pseudoglandular patterns. - It does not typically exhibit the **hobnail cell morphology** described. *Choriocarcinoma* - **Choriocarcinoma** is composed of cytotrophoblasts and syncytiotrophoblasts, which are often arranged in a haphazard fashion without distinct hobnail features. - This tumor is characterized by high levels of **human chorionic gonadotropin (hCG)**.

Q: Which type of breast carcinoma exhibits the least desmoplastic reaction?

Lobular. ***Lobular*** - **Lobular carcinoma** tends to be less desmoplastic than other types, characterized by **small, non-cohesive cells** that invade the stroma with minimal reaction [1]. - It is frequently bilateral and can have a subtle histological presentation, making it less likely to elicit a strong desmoplastic response. *Medullary* - **Medullary carcinoma** is associated with a prominent **lymphocytic infiltrate** and notable desmoplastic stromal reaction [1]. - It presents with a large, well-circumscribed mass and often has a more aggressive nature, which contradicts the characteristics of desmoplastic carcinoma. *Tubular* - **Tubular carcinoma** shows abundant desmoplastic stroma, resulting in a firm consistency [2], contrary to the nature of least desmoplastic carcinoma. - It features distinctive tubular structures and is generally considered a subtype with a more significant desmoplastic reaction. *Ductal* - **Ductal carcinoma**, particularly infiltrating ductal carcinoma, often has a strong desmoplastic reaction, leading to significant stromal fibrosis. - This type frequently presents as a hard mass due to the involved desmoplastic response, differing from the lobular type's characteristics. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 454-456. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 453-454.

Q: Which of the following tumors is associated with elevated levels of Alpha-fetoprotein (AFP)?

Yolk sac tumor. ***a and c*** - **Alpha-fetoprotein (AFP)** is commonly elevated in certain germ cell tumors, specifically **non-seminomatous tumors** [1]. - This correctly includes conditions associated with raised AFP, indicating its relevance in testicular tumors beyond **seminoma**. *Seminoma* - Typically associated with elevated **beta-hCG** but not significantly with **AFP** levels; only very rarely can it show a slight increase. - It mainly presents as a **solid testicular mass** and is classified under germ cell tumors that do not usually raise AFP [1]. *Teratoma* - Teratomas can be associated with elevated AFP but predominantly in **mixed germ cell tumors** rather than pure teratomas [1]. - They may require surgical intervention and can produce a variety of germ cell components, complicating tumor markers interpretation. *Yolk sac tumor* - Specifically associated with significantly elevated **AFP** and is a common cause of raised levels in children and some adults [1]. - However, this does not adequately cover other conditions that may also elevate AFP levels, hence it's incomplete in the context of the question. **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.

Q: In the context of Endometrial carcinoma, which tumor suppressor gene is most commonly mutated?

PTEN. ***PTEN*** - The **PTEN gene** is frequently mutated in endometrial carcinoma, leading to loss of functional tumor suppression. - PTEN loss is associated with **hyperactivation of the PI3K/AKT pathway**, which promotes cell growth and survival, contributing to cancer development. *APC* - The **APC gene** is primarily associated with **colorectal cancer**, particularly familial adenomatous polyposis, not endometrial carcinoma. - APC mutations lead to **beta-catenin accumulation**, which is not a central event in endometrial tumorigenesis. *Rb* - The **Rb gene** is mainly related to retinoblastoma and other tumors but has a limited role in endometrial carcinoma. - Rb typically regulates the **cell cycle**, and its loss primarily affects other cancer types rather than endometrial tumors. *P53* - Although **P53 mutations** can occur in many cancers, including endometrial carcinoma, it is not the primary tumor suppressor gene associated with its development [1]. - P53 is more commonly linked with other malignancies and is considered a **late event** in endometrial carcinoma progression. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1021-1022.

Q: In a case of Dysgerminoma of ovary one of the following tumor markers is likely to be raised :

Serum lactic dehydrogenase. ***Serum lactic dehydrogenase*** - **Dysgerminoma** is a germ cell tumor of the ovary, and about 40-50% of cases are associated with elevated **serum lactic dehydrogenase (LDH)** levels, especially in advanced stages. - Elevated LDH is a general marker of **cellular turnover** and tumor burden, and while not specific to dysgerminomas, it is commonly used in their monitoring and prognosis. *Serum HCG* - While some dysgerminomas can produce a small amount of **human chorionic gonadotropin (HCG)** if they contain syncytiotrophoblastic giant cells [1][2], a significant elevation of HCG is more characteristic of **choriocarcinoma** [1] or mixed germ cell tumors. - A markedly raised HCG in the context of an ovarian germ cell tumor would typically prompt consideration of other tumor types before solely attributing it to a pure dysgerminoma. *Serum alphafetoprotein* - **Alpha-fetoprotein (AFP)** is a primary tumor marker for **yolk sac tumors (endodermal sinus tumors)** and is also elevated in **embryonal carcinoma** and some mixed germ cell tumors. - Pure dysgerminomas do not produce AFP [1], so its elevation would indicate a different germ cell tumor component. *Serum inhibin* - **Inhibin** (specifically inhibin A and B) is a classic tumor marker for **granulosa cell tumors** of the ovary, which are sex cord-stromal tumors, not germ cell tumors. - It plays a role in regulating FSH secretion and is not produced by dysgerminomas. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1034-1036. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 480-481.

Q: What is the most common type of penile carcinoma?

Squamous cell carcinoma. ***Squamous cell carcinoma*** - This is by far the most common type, accounting for over **95% of all penile cancers** [1]. - It arises from the **epithelial cells** of the penis, particularly the glans or inner foreskin [2]. *Basal cell carcinoma* - While it is a common skin cancer, **basal cell carcinoma is extremely rare on the penis**, accounting for less than 1% of cases. - It usually presents as a **slow-growing papule or nodule** with rolled borders on sun-exposed skin [3]. *Adenocarcinoma* - This type of cancer originates from **glandular tissue**, which is not the predominant tissue type in the penile shaft or glans. - Adenocarcinoma of the penis is exceptionally rare, usually associated with **Paget's disease** of the glans or urethra. *Small cell carcinoma* - Small cell carcinoma is a highly aggressive neuroendocrine tumor, most commonly found in the **lungs**. - Its occurrence in the penis is **extremely rare** and carries a very poor prognosis. **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. 975-976. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 505-506. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Disorders Involving Inflammatory And Haemopoietic Cells, pp. 643-644.

Q: In which condition is the 'Swiss cheese pattern' typically observed in pathology?

Endometrial hyperplasia. ***Metropathica hemorrhagica*** - Characterized by a **Swiss cheese pattern** due to multiple cystic changes in the endometrium [1], often associated with chronic endometrial irritation. - The pattern arises from **irregular endometrial proliferation** and is indicative of disturbances in menstrual function. *Mucinous cystadenoma* - Typically presents as a **smooth, multilocular cyst** with mucin production, but does not exhibit a Swiss cheese morphology. - Often associated with **abdominal masses** rather than the specific endometrial patterns seen in metropathica hemorrhagica. *Dermoid* - Consists of **teratoma-like tissues** and may show cystic areas, but lacks the Swiss cheese appearance associated with endometrial pathology. - Commonly found in **ovarian masses**, characterized by a variety of tissue types instead of the specific cystic changes related to metropathica hemorrhagica. *Serous cystadenoma* - Features a **serous fluid-filled cyst**, often uniform in appearance, without the Swiss cheese pattern. - Primarily occurs in the ovaries and is noted for its **smooth surface** rather than the cystic irregularities typical of metropathica hemorrhagica. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 473-475.

Q: In which condition are Call-Exner bodies seen?

Granulosa cell tumors. ***Granulosa cell tumors*** - **Call Exner bodies** are characteristic of granulosa cell tumors, usually appearing as small, round structures resembling immature Graafian follicles [1]. - These tumors produce **estrogens**, leading to symptoms like abnormal uterine bleeding due to endometrial hyperplasia [1]. *Dysgerminoma* - Dysgerminoma typically features **solid, homogeneous tissue** and does not form Call Exner bodies. - It is more common in **younger women** and usually associated with elevated **LDH levels**. *Serous cystadenomas* - These tumors are generally **cystic** and do not exhibit Call Exner bodies, focusing instead on serous fluid production. - They are one of the most common types of ovarian tumors but lack the characteristic features of granulosa cell tumors. *Krukenberg tumor* - Krukenberg tumors are metastatic lesions of the ovaries, often resulting from **gastric carcinoma** and do not produce Call Exner bodies. - They typically present with **bilateral ovarian masses** and may be associated with **mucin-secreting histology**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1036-1037.

Q: Inhibin is a tumor marker associated with which of the following tumors?

Granulosa cell tumor. ***Granulosa cell tumor (a type of ovarian tumor)*** - **Inhibin** is a polypeptide hormone primarily produced by the **granulosa cells** of the ovary and Sertoli cells of the testis [1]. - Granulosa cell tumors, being composed of granulosa cells, often **overproduce inhibin**, making it a valuable tumor marker for diagnosis, monitoring recurrence, and treatment response [1]. *Serous cystadenoma (a type of ovarian epithelial tumor)* - While serous cystadenomas are common ovarian tumors, they are of **epithelial origin** and typically do not produce inhibin. - Markers like **CA-125** are more commonly associated with epithelial ovarian cancers, though not typically with benign serous cystadenomas. *Krukenberg tumor (a metastatic ovarian tumor)* - Krukenberg tumors are **metastatic neoplasms to the ovary**, most commonly originating from the gastrointestinal tract (especially the stomach). - Their marker profile reflects the primary tumor, and **inhibin is not a typical marker** for these metastatic lesions. *Dysgerminoma (a type of ovarian germ cell tumor)* - Dysgerminomas are **germ cell tumors** of the ovary, analogous to seminomas in males. - Tumor markers associated with dysgerminomas include **lactate dehydrogenase (LDH)**, and sometimes **beta-hCG**, but not inhibin. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1036-1037.

Q: Most common malignant ovarian tumor is?

Serous cystadenocarcinoma. ***Serous cystadenocarcinoma*** - This is the **most common type of malignant ovarian tumor**, accounting for approximately 40-50% of all ovarian cancers. - It is typically characterized by **cystic and solid components** and is often bilateral. *Mucinous cystadenocarcinoma* - This is the **second most common type** of epithelial ovarian cancer, less frequent than serous types. - Mucinous tumors are often **larger** and more commonly unilateral than serous tumors. *Malignant teratoma* - This is a rare type of ovarian germ cell tumor, which is distinct from the more common epithelial ovarian cancers. - Malignant teratomas include immature teratomas and are far less common than epithelial tumors like serous cystadenocarcinomas. *Sarcoma* - **Ovarian sarcomas** are exceedingly rare primary ovarian malignancies, forming a very small percentage of all ovarian cancers. - Most ovarian malignancies originate from the **surface epithelium** of the ovary, not stromal tissue.

Question 1

In a histopathological examination, a tumor shows a hobnail appearance. Which of the following tumors is most likely associated with this finding?

Accepted Answer

Clear cell carcinoma

Answer

Endodermal sinus tumor

Answer

HCC

Answer

Choriocarcinoma

Question 2

Which type of breast carcinoma exhibits the least desmoplastic reaction?

Accepted Answer

Lobular

Answer

Ductal

Answer

Tubular

Answer

Medullary

Question 3

Which of the following tumors is associated with elevated levels of Alpha-fetoprotein (AFP)?

Accepted Answer

Yolk sac tumor

Answer

Teratoma

Answer

Seminoma

Answer

None of the options

Question 4

In the context of Endometrial carcinoma, which tumor suppressor gene is most commonly mutated?

Accepted Answer

PTEN

Answer

P53

Answer

Rb

Answer

APC

Question 5

In a case of Dysgerminoma of ovary one of the following tumor markers is likely to be raised :

Accepted Answer

Serum lactic dehydrogenase

Answer

Serum HCG

Answer

Serum inhibin

Answer

Serum alpha-fetoprotein

Question 6

What is the most common type of penile carcinoma?

Accepted Answer

Squamous cell carcinoma

Answer

Basal cell carcinoma

Answer

Adenocarcinoma

Answer

Small cell carcinoma

Question 7

In which condition is the 'Swiss cheese pattern' typically observed in pathology?

Accepted Answer

Endometrial hyperplasia

Answer

Disseminated intravascular coagulation (DIC)

Answer

Acute myocardial infarction

Answer

Chronic gastritis

Question 8

In which condition are Call-Exner bodies seen?

Accepted Answer

Granulosa cell tumors

Answer

Serous cystadenomas

Answer

Dysgerminoma

Answer

Krukenberg tumor

Question 9

Inhibin is a tumor marker associated with which of the following tumors?

Accepted Answer

Granulosa cell tumor

Answer

Krukenberg tumor

Answer

Dysgerminoma

Answer

Serous cystadenoma

Question 10

Most common malignant ovarian tumor is?

Accepted Answer

Serous cystadenocarcinoma

Answer

Malignant teratoma

Answer

Sarcoma

Answer

Mucinous cystadenocarcinoma

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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