Reproductive Pathology Practice Questions

Q: What is the primary reason for infertility in Sertoli cell only syndrome?

The absence of germ cells in this condition.. ***The absence of germ cells in this condition.*** - **Sertoli cell only syndrome** is characterized by the complete or near-complete absence of germ cells in the seminiferous tubules [2]. - Since germ cells are the precursors to spermatozoa, their absence directly results in the inability to produce sperm, leading to **infertility** [1]. *Too many Sertoli cells inhibit spermatogenesis via inhibin* - While Sertoli cells produce **inhibin B**, which negatively regulates FSH, the primary issue in Sertoli cell only syndrome is the lack of germ cells, not an overabundance of Sertoli cells or excessive inhibin production causing inhibition [1]. - The syndrome is defined by the *absence of germ cells*, not by a functional alteration of Sertoli cells due to their quantity. *Proper blood-testis barrier is not established* - The **blood-testis barrier (BTB)** is formed by tight junctions between Sertoli cells and is crucial for creating an immunological barrier for developing germ cells [2]. - While disruptions in BTB integrity can impair spermatogenesis, the primary cause of infertility in Sertoli cell only syndrome is the *absence of the cells that the barrier is meant to protect* (germ cells), rather than a failure of the barrier itself. *Sufficient numbers of spermatozoa are not produced* - This statement is true as a *result* of infertility, but it does not explain the *primary reason* for it. - The lack of spermatozoa is a direct consequence of the **absence of germ cells**, which are necessary precursors for sperm production [1].

Q: Which of the following is the strongest predisposing factor for testicular germ cell tumors?

Previous testicular germ cell tumor. ***Previous testicular germ cell tumor*** - A previous diagnosis of a **testicular germ cell tumor** is the strongest risk factor for developing a new, contralateral tumor. - This risk is significantly higher than that associated with other predisposing factors. *Testicular feminization syndrome* - While **gonadal dysgenesis** conditions like **androgen insensitivity syndrome** (sometimes referred to as testicular feminization syndrome) can increase the risk of gonadal tumors, it is not the strongest factor compared to a prior cancer history. - The risk is related to the presence of **undescended testes** or dysgenetic gonads within these syndromes. *Family history of testicular cancer* - A **family history** of testicular cancer does increase the risk, suggesting a genetic predisposition. - However, this risk is generally lower than the risk associated with having already had one testicular germ cell tumor. *Cryptorchidism* - **Cryptorchidism** (undescended testis) is a well-established risk factor for testicular germ cell tumors, with the risk increasing the higher the position of the testis [1], [2]. - Despite this, the risk associated with a history of cryptorchidism is still less potent than having a prior testicular cancer [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. 508-509. [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. 976-977.

Q: Signet ring cells are characteristically seen in which ovarian tumor?

Krukenberg tumor. ***Krukenberg tumor*** - The **signet ring appearance** is classically associated with Krukenberg tumors, which are metastatic tumors of the ovary often arising from gastric cancer [1]. - These tumors contain **mucin-filled cells** that resemble signet rings when viewed histologically [1]. *Teratoma* - Teratomas contain **multiple cell types** and may have various appearances, but they do not typically exhibit a signet ring configuration [3]. - More characteristic findings include **dermoid cysts** or tissue types from all three embryonic layers [3]. *Granulosa cell tumor* - Granulosa cell tumors are primarily characterized by **hormonal activity**, producing estrogen, and do not display signet ring cells. - Histologically, they are defined by **Call-Exner bodies** and small follicles rather than signet ring morphology. *Dysgerminoma* - Dysgerminomas, a type of germ cell tumor, typically show **solid sheets of uniform cells** without the signet ring feature [2]. - They are more associated with **lymphocytic infiltration** and often elevate serum levels of **LDH** [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 779. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1034-1035. [3] 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 germ cell tumor overall?

Teratoma. ***Teratoma*** - Teratomas are the **most common germ cell tumors** [1][2][5], often arising in the **gonads** but can also occur in extragonadal sites. - These tumors are characterized by their ability to differentiate into various tissue types, including **hair, muscle, and bone** [1][3]. *Mixed germ cell tumor* - While they can occur, mixed germ cell tumors comprise various types and are not as common as **teratomas** [2][5]. - They usually consist of different germ cell components leading to a more complex histology [2]. *Choriocarcinoma* - Choriocarcinoma is a rare and aggressive **germ cell tumor** that arises from trophoblastic tissue and is less common than **teratomas** [4]. - It is typically associated with elevated **beta-hCG** levels and has a characteristic **placental pattern** [4]. *Endodermal sinus tumor* - Endodermal sinus tumors, also known as **yolk sac tumors**, are a type of germ cell tumor but are notably less common than **teratomas** [2]. - They are distinguished by the presence of **Schiller-Duval bodies** on histological examination. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 480-481. [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] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 982-983. [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. [5] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1035-1036.

Q: Which type of breast cancer is most commonly bilateral?

Lobular. ***Lobular*** - **Invasive lobular carcinoma (ILC)** is the breast cancer type most frequently associated with **bilateral disease**, occurring in about 5-28% of cases. - This tendency is attributed to its infiltrative growth pattern and potential for multifocal involvement, making bilateral involvement more likely. *Paget's disease* - **Paget's disease of the breast** is a rare form of breast cancer that primarily affects the skin of the **nipple and areola**. - It is almost exclusively **unilateral**, and its presentation with eczematous changes is distinct from bilateral parenchymal involvement. *Medullary* - **Medullary carcinoma** is a rare subtype of invasive ductal carcinoma known for its often **well-circumscribed appearance** and better prognosis. - While it can be multifocal, it does not have a strong propensity for **bilateral occurrence** like lobular carcinoma. *None of the options* - This option is incorrect because **lobular carcinoma** is well-established in medical literature as having the highest incidence of bilateral presentation among breast cancer types.

Q: A testicular tumor in a man aged 60 years is most likely to be:

Lymphoma. ***Lymphoma*** - **Testicular lymphoma** is the most common testicular tumor in men over **60 years of age**, originating from lymphoid tissue. - It often presents as a rapidly enlarging, painless testicular mass and can be bilateral [1]. *Germ cell tumor* - **Germ cell tumors** are the most common testicular tumors overall but predominantly affect younger men, typically between **15 and 40 years of age**. - While they can occur at any age, they are much rarer in men over **60**. *Sertoli cell tumor* - **Sertoli cell tumors** are rare tumors that can occur at any age, but they do not show a predisposition for men over **60** specifically. - They tend to be benign and may be associated with **hormonal imbalances** in some cases. *Teratocarcinoma* - **Teratocarcinoma** is a mixed germ cell tumor composing elements of both **teratoma** and **embryonal carcinoma**. - Like other germ cell tumors, it typically affects younger men and is less common in the elderly population.

Q: Commonest primary site of Krukenberg tumour is:

Stomach. ***Stomach*** - The **stomach** is the most frequent primary site for the metastatic adenocarcinoma that gives rise to a **Krukenberg tumor** in the ovary [1]. - Gastric adenocarcinomas, particularly **diffuse-type gastric cancer** (including signet ring cell carcinoma), often spread to the ovaries via the peritoneal cavity or lymphatic routes [1]. *Breast* - While breast cancer can metastasize to the ovaries, it is a **less common primary source** for Krukenberg tumors compared to gastric cancer. - Breast carcinoma metastases to the ovary generally do not have the classic **signet-ring cell morphology** characteristic of Krukenberg tumors. *Colon* - **Colorectal cancer** is another potential primary source, but it accounts for a **smaller percentage** of Krukenberg tumors than gastric cancer. - Ovarian metastases from colonic carcinoma might have different histological features than the typical signet ring cells. *Small intestine* - Metastatic tumors to the ovary from the **small intestine** are **rare**, making it an unlikely primary site for a Krukenberg tumor. - Primary adenocarcinomas of the small intestine are themselves uncommon compared to those of the colon or stomach. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 779.

Q: Which of the following is a characteristic feature of endodermal sinus tumor?

Presence of Schiller-Duval bodies. **Presence of Schiller-Duval bodies** - **Schiller-Duval bodies** are pathognomonic histological structures found in **yolk sac tumors (endodermal sinus tumors)**. - They consist of a central capillary surrounded by tumor cells within a space, resembling a glomerulus. *Presence of Call-Exner bodies* - **Call-Exner bodies** are characteristic of **granulosa cell tumors** of the ovary. - They are small, follicle-like structures with a central eosinophilic fluid and granulosa cells arranged peripherally. *Presence of Homer-Wright rosettes* - **Homer-Wright rosettes** are typically seen in **neuroblastoma** and **medulloblastoma**. - These rosettes are characterized by a central fibrous space surrounded by tumor cells with surrounding nuclei, but without a lumen. *Presence of Psammoma bodies* - **Psammoma bodies** are concentric, lamellated calcified structures found in various tumors, including **papillary thyroid carcinoma**, **meningioma**, and **serous papillary ovarian carcinoma**. - Their presence indicates a neoplastic process but is not specific to endodermal sinus tumors.

Q: All of the following statements are true about Gleason score, except:

Scores range from 2-10. ***Scores range from 2-10*** - The **Gleason score** is obtained by summing the two most predominant architectural patterns of tumor growth, with each pattern graded from 1 to 5. The lowest possible sum is 2 (1+1) and the highest is 10 (5+5). However, **Gleason scores are now reported from 6 to 10** for clinical purposes, as grade 1 and 2 patterns are rarely seen in biopsies, and for practical purposes, anything less than a 3+3=6 is considered benign or low-risk. [1] - While mathematically the range is 2-10, in modern clinical practice, a score of 6 is the lowest grade assigned to prostate cancer, making the statement that scores range from 2-10 clinically inaccurate. *Used for grading prostate cancer* - The **Gleason score** is a well-established and widely used histological grading system specifically for prostate adenocarcinoma. [2] - It assesses the **architectural patterns** of glandular differentiation in prostate cancer to predict its aggressiveness. *Higher the score, poorer the prognosis* - A **higher Gleason score** indicates a more poorly differentiated and aggressive tumor, which correlates with a greater likelihood of metastasis and recurrence. [2] - This directly translates to a **poorer prognosis** for the patient. *Helps in planning management* - The **Gleason score** is a critical factor, along with PSA levels and clinical staging, in determining the risk stratification of prostate cancer. - This risk stratification guides treatment decisions, such as whether to pursue active surveillance, radiation therapy, surgery, or systemic therapy. **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. 990-992. [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: Somatic mutation of PTEN is seen in:

Endometrial carcinoma. ***Endometrial carcinoma*** - Somatic mutations of the **PTEN gene** are frequently associated with endometrial carcinoma, particularly in **type I endometrial cancers** [1]. - These mutations lead to **dysregulation of cellular pathways**, contributing to the development and progression of the tumor [1]. *Carcinoma breast* - While breast cancer can exhibit various mutations, including in genes like **BRCA1/2**, PTEN mutations are **not commonly associated**. - Breast cancers typically have a different **molecular profile**, including hormone receptor status that is not linked to PTEN. *Osteosarcoma* - Osteosarcoma's genetic alterations mainly involve **RB gene** and **TP53 mutations**, rather than changes in the PTEN gene. - The typical pathology does not involve the **loss of PTEN function**, making it an unlikely association with this mutation. *Retinoblastoma* - Retinoblastoma is primarily associated with mutations in the **RB1 gene**, not PTEN, and is linked to **hereditary patterns**. - PTEN mutations do not play a significant role in the pathogenesis of retinoblastoma, differentiating its genetic basis from that of endometrial carcinoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1015-1018.

Question 1

What is the primary reason for infertility in Sertoli cell only syndrome?

Accepted Answer

The absence of germ cells in this condition.

Answer

Too many Sertoli cells inhibit spermatogenesis via inhibin

Answer

Proper blood-testis barrier is not established

Answer

Sufficient numbers of spermatozoa are not produced

Question 2

Which of the following is the strongest predisposing factor for testicular germ cell tumors?

Accepted Answer

Previous testicular germ cell tumor

Answer

Testicular feminization syndrome

Answer

Family history of testicular cancer

Answer

Cryptorchidism

Question 3

Signet ring cells are characteristically seen in which ovarian tumor?

Accepted Answer

Krukenberg tumor

Answer

Dysgerminoma

Answer

Granulosa cell tumor

Answer

Teratoma

Question 4

What is the most common germ cell tumor overall?

Accepted Answer

Teratoma

Answer

Choriocarcinoma

Answer

Endodermal sinus tumor

Answer

Seminoma

Question 5

Which type of breast cancer is most commonly bilateral?

Accepted Answer

Lobular

Answer

Medullary

Answer

None of the options

Answer

Paget's disease

Question 6

A testicular tumor in a man aged 60 years is most likely to be:

Accepted Answer

Lymphoma

Answer

Germ cell tumor

Answer

Teratocarcinoma

Answer

Sertoli cell tumor

Question 7

Commonest primary site of Krukenberg tumour is:

Accepted Answer

Stomach

Answer

Breast

Answer

Colon

Answer

Small intestine

Question 8

Which of the following is a characteristic feature of endodermal sinus tumor?

Accepted Answer

Presence of Schiller-Duval bodies

Answer

Presence of Call-Exner bodies

Answer

Presence of Homer-Wright rosettes

Answer

Presence of Psammoma bodies

Question 9

All of the following statements are true about Gleason score, except:

Accepted Answer

Scores range from 2-10

Answer

Used for grading prostate cancer

Answer

Higher the score, poorer the prognosis

Answer

Helps in planning management

Question 10

Somatic mutation of PTEN is seen in:

Accepted Answer

Endometrial carcinoma

Answer

Osteosarcoma

Answer

Carcinoma breast

Answer

Retinoblastoma

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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