Reproductive Pathology Practice Questions

Q: What is the unique histological feature of a Leydig cell tumor of the testis?

Reinke's crystals. **Explanation:** **Leydig cell tumors** are the most common type of sex cord-stromal tumors of the testis. The pathognomonic histological feature is the presence of **Reinke’s crystals**. These are elongated, eosinophilic, rod-shaped or rectangular cytoplasmic inclusions. While they are highly specific for Leydig cell tumors, they are only identified in approximately 25–40% of cases. Microscopically, these tumors also show large, polygonal cells with abundant granular eosinophilic cytoplasm [1] and distinct cell borders. **Analysis of Incorrect Options:** * **Psammoma bodies:** These are concentric lamellated calcifications. They are characteristic of papillary thyroid carcinoma, serous cystadenocarcinoma of the ovary, and meningiomas, but are not associated with Leydig cell tumors. * **Michaelis-Guttman bodies:** These are laminated mineralized inclusions (iron and calcium) found within macrophages (von Hansemann cells) in **Malakoplakia**, typically occurring in the urinary bladder due to chronic *E. coli* infections. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Leydig cell tumors are often hormonally active [1]. In children, they cause **precocious puberty** due to androgen production [1]. In adults, they may cause **gynecomastia** due to increased estrogen or aromatization of androgens [1]. * **Biological Behavior:** Most are benign (90%) [1]; malignancy is rare and usually suggested by large size (>5cm), increased mitotic activity, and vascular invasion. * **Tumor Markers:** Unlike germ cell tumors (GCTs), Leydig cell tumors do **not** show elevations in LDH, AFP, or beta-hCG [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. 510-514.

Q: What is true regarding a partial hydatidiform mole?

It is typically triploid or tetraploid.. **Explanation:** **1. Why the Correct Answer is Right:** A **Partial Hydatidiform Mole** is genetically characterized by **triploidy** (69,XXX; 69,XXY; or 69,XYY). This occurs when a single normal haploid egg is fertilized by two sperm (dispermy) or by one sperm that duplicates its chromosomes [1]. The presence of fetal tissue alongside hydropic villi is a hallmark of partial moles, unlike complete moles which are purely paternal in origin (diploid) [1]. **2. Why the Other Options are Incorrect:** * **Option A:** Partial moles have a **low risk (<5%)** of progressing to Gestational Trophoblastic Neoplasia (GTN) or Choriocarcinoma [1]. In contrast, Complete Moles have a much higher risk (15-20%) [1]. * **Option B:** While some trophoblastic proliferation exists, **cellular atypia is minimal** in partial moles [1]. Marked atypia and circumferential proliferation are characteristic features of Complete Moles. * **Option C:** Partial moles feature **scalloped villi** with focal trophoblastic proliferation [1]. The statement "trophoblastic proliferation without villi" is more descriptive of Choriocarcinoma, which is characterized by sheets of malignant cells without a villous pattern. **3. High-Yield Clinical Pearls for NEET-PG:** * **Complete Mole:** 46,XX (most common); "Snowstorm" appearance on USG; No fetal parts; High hCG; 20% risk of malignancy [1]. * **Partial Mole:** 69,XXY (most common); Fetal parts present; Scalloped villi with **cistern formation**; Low risk of malignancy [1]. * **p57 Expression:** This is a key IHC marker. Partial moles are **p57 positive** (maternal allele present), while Complete moles are **p57 negative** (maternal allele absent). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1043-1046.

Q: In what age group is seminoma most common?

3rd-4th decade of life. **Explanation:** Seminoma is the most common type of germ cell tumor (GCT) of the testis, accounting for approximately 50% of all cases [1]. **1. Why the Correct Answer is Right:** The peak incidence of seminoma occurs in the **3rd to 4th decade of life** (ages 30–40). While germ cell tumors as a group are the most common malignancy in young men, seminomas tend to occur slightly later than non-seminomatous germ cell tumors (NSGCTs), which peak in the 2nd to 3rd decade. **2. Why Incorrect Options are Wrong:** * **Option A & B (4th-6th decade):** While seminomas can occur in older men, they are significantly less common after age 50. The classic "pure" seminoma is a disease of young adulthood. * **Option D (6th-7th decade):** This age group is more characteristic of **Spermatocytic Tumor** (formerly Spermatocytic Seminoma) [1]. Unlike classic seminoma, spermatocytic tumors occur in men over age 65, are slow-growing, and do not metastasize. **3. NEET-PG High-Yield Clinical Pearls:** * **Morphology:** Characterized by large, uniform cells with distinct cell borders, clear cytoplasm (rich in glycogen), and large nucleoli [1]. A classic feature is the presence of **lymphocytic infiltrates** in the fibrous stroma. * **Tumor Markers:** Seminomas are typically negative for AFP. **hCG** may be mildly elevated in 10-15% of cases (due to syncytiotrophoblastic giant cells), and **LDH** is used to monitor tumor burden. * **Prognosis:** Highly radiosensitive and has an excellent prognosis. * **Risk Factor:** Cryptorchidism is the most significant risk factor. * **Ovarian Counterpart:** The histological equivalent in females is the **Dysgerminoma**. **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: Endodermal sinus tumour is associated with which of the following?

Schiller-Duval body. **Explanation:** **Endodermal Sinus Tumour (Yolk Sac Tumour)** is the most common germ cell tumour in children and young infants [1]. The correct answer is **Schiller-Duval bodies**, which are the pathognomonic histological hallmark of this condition. 1. **Why Option A is correct:** A **Schiller-Duval body** consists of a central capillary surrounded by visceral and parietal layers of neoplastic cells within a cystic space, resembling a primitive glomerulus. These structures mimic the "endodermal sinuses" seen in the developing rat placenta. Additionally, these tumours characteristically show **Alpha-Fetoprotein (AFP)** elevation in serum and eosinophilic hyaline globules on histology. 2. **Why the other options are incorrect:** * **B. Multinucleate giant cells:** These are characteristic of **Choriocarcinoma** (Syncytiotrophoblasts) or certain granulomatous inflammations [1]. * **C. R-S cells (Reed-Sternberg cells):** These are the diagnostic hallmark of **Hodgkin Lymphoma**, appearing as "owl-eye" nuclei. * **D. Plasma cells:** These are mature B-lymphocytes seen in chronic inflammation, Multiple Myeloma, or Syphilitic lesions. **High-Yield Clinical Pearls for NEET-PG:** * **Tumour Marker:** AFP (Alpha-Fetoprotein) is used for both diagnosis and monitoring recurrence. * **Histology:** Look for "Lace-like" (reticular) patterns and Schiller-Duval bodies. * **Age Group:** Most common testicular tumour in children under 3 years; in adults, it usually presents as a component of a mixed germ cell tumour [1]. * **Ovarian counterpart:** Presents as a rapidly growing painful mass in young females. **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.

Question 1

A 62-year-old woman presents with a breast lump that she discovered 6 days ago. A breast biopsy shows lobular carcinoma in situ. Compared to normal epithelial cells of the breast lobule, these malignant cells would most likely show decreased expression of which of the following proteins?

Accepted Answer

E-cadherin

Answer

Desmin

Answer

Lysyl hydroxylase

Answer

P selectin

Question 2

Schiller-Duval bodies are seen in which of the following tumors?

Accepted Answer

Yolk sac tumor

Answer

Teratoma

Answer

Seminoma

Answer

Choriocarcinoma

Question 3

What is the unique histological feature of a Leydig cell tumor of the testis?

Accepted Answer

Reinke's crystals

Answer

Psammoma bodies

Answer

Michaelis-Guttman bodies

Answer

None of the above

Question 4

A baby is born with a testicular mass. Histologic sections of the mass demonstrate epithelial-lined spaces with flattened-to-cuboidal epithelial cells containing vacuolated cytoplasm with eosinophilic, hyaline-like globules. Scattered structures resembling primitive glomeruli (endodermal sinuses) are also seen. If appropriate immunohistochemical stains are performed, the eosinophilic cytoplasmic globules would most likely contain which of the following?

Accepted Answer

Alpha-fetoprotein

Answer

Estrogen receptors

Answer

Human chorionic gonadotropin

Answer

Human papilloma virus

Question 5

Bilateral, multicentric carcinoma of the breast is usually associated with which histological type?

Accepted Answer

Invasive lobular carcinoma

Answer

Mucoid carcinoma

Answer

Infiltrating ductal carcinoma

Answer

Non-infiltrating ductal carcinoma

Question 6

What is true regarding a partial hydatidiform mole?

Accepted Answer

It is typically triploid or tetraploid.

Answer

It has a higher chance of developing into malignancy.

Answer

Cellular atypia is a characteristic feature.

Answer

There is trophoblastic proliferation without villi.

Question 7

In what age group is seminoma most common?

Accepted Answer

3rd-4th decade of life

Answer

5th-6th decade of life

Answer

4th-5th decade of life

Answer

6th-7th decade of life

Question 8

What is the term for a female patient with adenocarcinoma of the uterus along with sarcoma of the uterus?

Accepted Answer

Wedge Mullerian carcinogenesis

Answer

Homologous sarcoma

Answer

Sarcoma uterus

Answer

Heterologous sarcoma

Question 9

Adenoacanthoma is which type of uterine cancer?

Accepted Answer

Well-differentiated adenocarcinoma

Answer

Poorly differentiated adenocarcinoma

Answer

Mucinous carcinoma

Answer

Papillary serous carcinoma

Question 10

Endodermal sinus tumour is associated with which of the following?

Accepted Answer

Schiller-Duval body

Answer

Multinucleate giant cells

Answer

R-S cells

Answer

Plasma cells

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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