Reproductive Pathology — MCQs

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?

Q35Medium

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

Q36Medium

What is true regarding a partial hydatidiform mole?

Q37Easy

In what age group is seminoma most common?

Q38Medium

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

Q39Easy

Adenoacanthoma is which type of uterine cancer?

Q40Easy

Endodermal sinus tumour is associated with which of the following?

Reproductive Pathology Indian Medical PG Practice Questions and MCQs

Question 31: 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?

A. Desmin
B. E-cadherin (Correct Answer)
C. Lysyl hydroxylase
D. P selectin

Explanation: **Explanation:** The hallmark of **Lobular Carcinoma In Situ (LCIS)** and invasive lobular carcinoma is the **loss of cellular adhesion** due to the absence of **E-cadherin**. [1] 1. **Why E-cadherin is correct:** E-cadherin is a transmembrane glycoprotein responsible for calcium-dependent cell-to-cell adhesion in epithelial tissues. It is linked to the cytoskeleton via catenins. In lobular neoplasia (both LCIS and Invasive Lobular Carcinoma), a mutation in the *CDH1* gene leads to a complete loss of E-cadherin expression. This results in the characteristic "dyscohesive" appearance of cells, which appear rounded and detached from one another, often forming a "single-file" pattern in invasive cases. [1] 2. **Why other options are incorrect:** * **Desmin:** This is an intermediate filament found in muscle cells (smooth, skeletal, and cardiac). It is not expressed in breast epithelial cells. * **Lysyl hydroxylase:** This enzyme is involved in the post-translational modification (cross-linking) of collagen. While important for the extracellular matrix, its expression is not a diagnostic marker for differentiating lobular from ductal carcinoma. * **P-selectin:** This is an adhesion molecule found on activated platelets and endothelial cells, primarily involved in leukocyte rolling during inflammation, not in the structural integrity of breast epithelium. **NEET-PG High-Yield Pearls:** * **E-cadherin Negative:** Lobular Carcinoma (In situ and Invasive). [1] * **E-cadherin Positive:** Ductal Carcinoma (In situ and Invasive). * **LCIS Clinical Fact:** It is often an incidental finding, frequently bilateral and multicentric, and serves as a risk factor for developing invasive carcinoma in *either* breast. * **Morphology:** LCIS cells are small, uniform, and lack pleomorphism; they fill and distend the acini of the lobule. [2] **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 454-455. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1054-1056.

Question 32: Schiller-Duval bodies are seen in which of the following tumors?

A. Teratoma
B. Seminoma
C. Yolk sac tumor (Correct Answer)
D. Choriocarcinoma

Explanation: **Explanation:** **Schiller-Duval bodies** are the pathognomonic histological hallmark of **Yolk Sac Tumors** (also known as Endodermal Sinus Tumors). These structures consist of a central capillary surrounded by a layer of visceral and parietal neoplastic cells, mimicking a primitive glomerulus. * **Why Yolk Sac Tumor is correct:** These tumors are the most common germ cell tumor in children [1]. Apart from Schiller-Duval bodies, they are characterized by the production of **Alpha-fetoprotein (AFP)**, which serves as a crucial serum marker for diagnosis and monitoring. * **Why other options are incorrect:** * **Teratoma:** Characterized by tissues derived from all three germ layers (ectoderm, mesoderm, endoderm), such as hair, teeth, or cartilage [2]. * **Seminoma:** Histology shows nests of large, uniform cells with clear cytoplasm ("fried-egg appearance") separated by fibrous septa containing lymphocytes [1]. * **Choriocarcinoma:** Composed of a dimorphic population of cytotrophoblasts and syncytiotrophoblasts [3], typically associated with very high levels of **beta-hCG** and early hematogenous spread. **High-Yield Clinical Pearls for NEET-PG:** * **Schiller-Duval bodies** are present in only about 50% of Yolk Sac Tumors; their absence does not rule out the diagnosis. * **Hyaline globules** (PAS-positive) are another common histological finding in Yolk Sac Tumors. * In the ovary, Yolk Sac Tumors are highly aggressive and usually unilateral. * **Reinke crystals** are the classic finding for Leydig cell tumors (not a germ cell tumor). **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] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 480-481. [3] 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.

Question 33: What is the unique histological feature of a Leydig cell tumor of the testis?

A. Reinke's crystals (Correct Answer)
B. Psammoma bodies
C. Michaelis-Guttman bodies
D. None of the above

Explanation: **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.

Question 34: 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?

A. Alpha-fetoprotein (Correct Answer)
B. Estrogen receptors
C. Human chorionic gonadotropin
D. Human papilloma virus

Explanation: The clinical presentation of a testicular mass in an infant, combined with the classic histological findings, points directly to a **Yolk Sac Tumor** (also known as Endodermal Sinus Tumor). This is the most common testicular tumor in infants and children up to 3 years of age [1]. **1. Why Alpha-fetoprotein (AFP) is correct:** The hallmark histological feature of Yolk Sac Tumors is the presence of **Schiller-Duval bodies**, which are primitive glomerular-like structures consisting of a central vessel surrounded by germ cells within a space lined by flattened epithelium. Another characteristic finding is the presence of **eosinophilic, hyaline-like globules** within the cytoplasm of the tumor cells. These globules represent the synthesis of plasma proteins by the yolk sac cells and stain strongly positive for **Alpha-fetoprotein (AFP)** and Alpha-1-antitrypsin [1]. **2. Why the other options are incorrect:** * **Estrogen receptors:** These are typically associated with breast pathology or specific gynecological tumors (e.g., Granulosa cell tumors), not germ cell tumors of the testis. * **Human chorionic gonadotropin (hCG):** This is the characteristic marker for **Choriocarcinoma** [2]. While some mixed germ cell tumors may show elevated hCG [3], the specific histology described (Schiller-Duval bodies) is pathognomonic for Yolk Sac Tumor. * **Human papilloma virus (HPV):** HPV is associated with squamous cell carcinomas of the cervix, penis, and oropharynx, but has no role in the pathogenesis of testicular germ cell tumors. **Clinical Pearls for NEET-PG:** * **Schiller-Duval bodies** = Yolk Sac Tumor (High-yield association). * **AFP** is the essential serum marker for diagnosis and monitoring recurrence in Yolk Sac Tumors. * In adults, Yolk Sac Tumors rarely occur in pure form; they are usually components of **Mixed Germ Cell Tumors** [1]. * The prognosis for pure Yolk Sac Tumor in children is generally excellent with chemotherapy and surgery. **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 Lower Urinary Tract and Male Genital System, p. 982. [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.

Question 35: Bilateral, multicentric carcinoma of the breast is usually associated with which histological type?

A. Mucoid carcinoma
B. Invasive lobular carcinoma (Correct Answer)
C. Infiltrating ductal carcinoma
D. Non-infiltrating ductal carcinoma

Explanation: **Explanation:** **Invasive Lobular Carcinoma (ILC)** is the correct answer because it is uniquely characterized by its high frequency of **bilaterality** (occurring in both breasts) and **multicentricity** (multiple primary foci within the same breast) [1]. The underlying molecular hallmark of ILC is the **loss of E-cadherin expression** (due to mutations in the *CDH1* gene). E-cadherin is a cell-adhesion molecule; its absence leads to the characteristic "single-file" or "Indian file" pattern of small, discohesive cells [1]. This lack of cohesion allows the cells to spread diffusely through the stroma without forming a distinct mass, contributing to its multicentric and bilateral nature. **Analysis of Incorrect Options:** * **Infiltrating Ductal Carcinoma (IDC):** This is the most common type of breast cancer. While it can be bilateral, it is typically a solitary, unilateral mass and lacks the specific association with multicentricity seen in ILC [1]. * **Mucoid (Colloid) Carcinoma:** This is a rare subtype characterized by "islands of tumor cells in a sea of mucin." It usually presents as a slow-growing, circumscribed mass in older women and is rarely bilateral. * **Non-infiltrating Ductal Carcinoma (DCIS):** While DCIS can be extensive within a ductal system, it is generally considered a precursor lesion and does not exhibit the same high-yield clinical association with systemic bilaterality as ILC. **NEET-PG High-Yield Pearls:** * **Molecular Marker:** Negative staining for **E-cadherin** is the gold standard to differentiate ILC from IDC. * **Metastatic Pattern:** Unlike IDC, ILC has a peculiar spread to the **peritoneum, retroperitoneum, leptomeninges, and ovaries**. * **Imaging:** ILC is notorious for being "clinically silent" and may be missed on mammography due to its diffuse growth pattern [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 454-455.

Question 36: What is true regarding a partial hydatidiform mole?

A. It has a higher chance of developing into malignancy.
B. Cellular atypia is a characteristic feature.
C. There is trophoblastic proliferation without villi.
D. It is typically triploid or tetraploid. (Correct Answer)

Explanation: **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.

Question 37: In what age group is seminoma most common?

A. 5th-6th decade of life
B. 4th-5th decade of life
C. 3rd-4th decade of life (Correct Answer)
D. 6th-7th decade of life

Explanation: **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.

Question 38: What is the term for a female patient with adenocarcinoma of the uterus along with sarcoma of the uterus?

A. Homologous sarcoma
B. Sarcoma uterus
C. Wedge Mullerian carcinogenesis (Correct Answer)
D. Heterologous sarcoma

Explanation: **Explanation:** The correct answer is **Wedge Mullerian carcinogenesis** (also known as Malignant Mixed Mullerian Tumor or MMMT). **1. Why the correct answer is right:** Malignant Mixed Mullerian Tumors (MMMTs), now more commonly referred to as **Carcinosarcomas**, are highly aggressive neoplasms [2]. The term "Wedge Mullerian carcinogenesis" refers to the monoclonal origin of these tumors. Current molecular evidence suggests these are essentially **metaplastic carcinomas**—where a single malignant epithelial cell (adenocarcinoma) undergoes a mesenchymal transition to form the sarcomatous component [1]. Therefore, the presence of both adenocarcinoma and sarcoma in the uterus is the hallmark of this entity. **2. Why the other options are wrong:** * **Homologous sarcoma (Option A):** This refers to a sarcoma where the malignant mesenchymal tissue is native to the uterus (e.g., leiomyosarcoma or endometrial stromal sarcoma) [1]. It does not necessarily imply the presence of a concomitant adenocarcinoma. * **Sarcoma uterus (Option B):** This is a broad category that includes leiomyosarcomas and stromal sarcomas. It is an incomplete description for a mixed tumor containing epithelial malignancy. * **Heterologous sarcoma (Option D):** This refers to a sarcoma where the malignant tissue is foreign to the uterus (e.g., rhabdomyosarcoma or chondrosarcoma) [1]. While an MMMT can have heterologous elements, the term itself does not define the combination of adenocarcinoma and user. **3. Clinical Pearls for NEET-PG:** * **Demographics:** Typically occurs in postmenopausal women; often associated with a history of pelvic radiation [2]. * **Pathology:** Look for the "biphasic" appearance on histology (epithelial + mesenchymal) [2]. * **Prognosis:** Carcinosarcomas are staged as carcinomas, not sarcomas, and carry a poor prognosis due to early lymphatic spread [2]. * **High-Yield Fact:** The epithelial component (adenocarcinoma) is usually the driver of metastasis [2]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 475-476. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1022-1024.

Question 39: Adenoacanthoma is which type of uterine cancer?

A. Poorly differentiated adenocarcinoma
B. Well-differentiated adenocarcinoma (Correct Answer)
C. Mucinous carcinoma
D. Papillary serous carcinoma

Explanation: **Explanation:** **Adenoacanthoma** is a specific histological variant of **Endometrioid Adenocarcinoma** of the uterus. The term refers to a tumor composed of malignant glandular elements (adenocarcinoma) associated with areas of **benign squamous metaplasia** [1]. 1. **Why Option B is Correct:** In pathology, the presence of well-formed squamous elements (the "acanthoma" part) is almost exclusively associated with **well-differentiated (Grade 1)** endometrioid adenocarcinomas. The squamous component itself is cytologically benign; it is the glandular component that is malignant. Because these tumors are low-grade, they generally carry a better prognosis than other variants. 2. **Why Other Options are Incorrect:** * **Option A (Poorly differentiated):** If the squamous component in an adenocarcinoma appears malignant (cytological atypia and invasive features), the tumor is termed **Adenosquamous Carcinoma**. Adenosquamous carcinomas are high-grade, poorly differentiated, and have a much worse prognosis than adenoacanthomas. * **Option C (Mucinous):** These are characterized by mucin-producing cells (>50% of the tumor) and do not typically feature the squamous metaplasia defining an adenoacanthoma. * **Option D (Papillary serous):** This is a Type II endometrial carcinoma [2]. It is highly aggressive, high-grade, and characterized by psammoma bodies and complex papillae, rather than benign squamous elements. **High-Yield NEET-PG Pearls:** * **Adenoacanthoma:** Malignant glands + Benign squamous cells (Good prognosis). * **Adenosquamous Carcinoma:** Malignant glands + Malignant squamous cells (Poor prognosis). * **Most common type of Endometrial Cancer:** Endometrioid Adenocarcinoma (Type I). * **Risk Factor:** Unopposed estrogen (obesity, PCOS, HRT). * **Precursor lesion:** Atypical Endometrial Hyperplasia (EIN). **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 470-471. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1021-1022.

Question 40: Endodermal sinus tumour is associated with which of the following?

A. Schiller-Duval body (Correct Answer)
B. Multinucleate giant cells
C. R-S cells
D. Plasma cells

Explanation: **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.

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Diseases of Male Genital Tract

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Testicular Tumors

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Prostate Pathology

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Diseases of Female Genital Tract

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Cervical Pathology and Neoplasia

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Endometrial Pathology

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Ovarian Diseases and Tumors

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Gestational Trophoblastic Disease

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Placental Pathology

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Sexually Transmitted Infections

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