Reproductive Pathology Practice Questions

Q: Which of the following tumors is associated with increased serum placental alkaline phosphatase and positive immunohistochemical staining for placental alkaline phosphatase?

Seminoma. **Explanation:** **Seminoma** is the most common germ cell tumor of the testis. The hallmark biochemical and immunohistochemical (IHC) marker for Seminoma is **Placental Alkaline Phosphatase (PLAP)** [1]. PLAP is an enzyme normally produced by the placenta, but it is expressed by neoplastic germ cells that have not yet differentiated into specific lineages. In addition to PLAP, Seminomas are typically positive for **OCT3/4, NANOG, and CD117 (c-KIT)**, which are markers of pluripotency [1]. **Analysis of Incorrect Options:** * **Hepatoblastoma:** This is a primary liver tumor of childhood. Its characteristic marker is a significantly elevated **Alpha-fetoprotein (AFP)**. * **Hepatocellular Carcinoma (HCC):** While HCC also shows elevated **AFP**, its IHC markers typically include **Glypican-3, HepPar-1, and Arginase-1**. * **Peripheral Neuroectodermal Tumor (PNET):** Now considered part of the Ewing Sarcoma family, these tumors are characterized by the **t(11;22)** translocation and express **CD99 (MIC2)** on IHC. **High-Yield Clinical Pearls for NEET-PG:** * **Seminoma vs. Non-Seminoma:** Seminomas never produce AFP. If AFP is elevated in a suspected seminoma, it indicates a mixed germ cell tumor (usually an Yolk Sac component). * **hCG in Seminoma:** About 10-15% of seminomas contain syncytiotrophoblastic giant cells, which can cause a mild elevation in serum **hCG** [1]. * **Microscopy:** Look for "clear cells" with distinct cell borders, large nuclei, and prominent nucleoli, separated by fibrous septa containing a **lymphocytic infiltrate**. * **Radiosensitivity:** Seminomas are exquisitely radiosensitive and have an excellent 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. 980-982.

Q: Which marker is associated with granulosa cell tumor?

Inhibin. **Explanation:** **1. Why Inhibin is the Correct Answer:** Granulosa cell tumors (GCTs) are sex cord-stromal tumors that arise from the granulosa cells of the ovary. These cells naturally produce **Inhibin** [1] (specifically Inhibin B) as part of the feedback loop for Follicle-Stimulating Hormone (FSH). In GCTs, Inhibin is secreted in excess, making it a highly specific and sensitive **serum tumor marker** for diagnosis and monitoring disease recurrence [1]. Additionally, these tumors often secrete **Estrogen**, leading to clinical presentations like precocious puberty (in juveniles) or postmenopausal bleeding (in adults). **2. Why the Other Options are Incorrect:** * **CA 19-9:** This is a carbohydrate antigen primarily used as a marker for **pancreatic adenocarcinoma**, cholangiocarcinoma, and sometimes gastric or colorectal cancers. * **Ca 50:** This is a non-specific tumor-associated antigen often elevated in gastrointestinal and pancreatic malignancies; it is not used for ovarian sex cord tumors. * **Teratoma:** This is a type of germ cell tumor, not a marker. While some germ cell tumors have markers (e.g., AFP for Yolk Sac Tumor or hCG for Choriocarcinoma), mature teratomas typically do not have specific serum markers. **3. High-Yield Clinical Pearls for NEET-PG:** * **Histology:** Look for **Call-Exner bodies** (small follicles filled with eosinophilic material) and "coffee-bean" nuclei (longitudinal nuclear grooves). * **Classification:** Adult GCT (most common) vs. Juvenile GCT. * **Associated Pathology:** Due to high estrogen levels, GCT is strongly associated with **Endometrial Hyperplasia** and **Endometrial Carcinoma**. * **Immunohistochemistry (IHC):** Besides Inhibin, these tumors are often positive for **Calretinin** and **FOXL2** mutations [1]. **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: Histological features of hydatidiform mole include:

Hydropic degeneration of the villous stroma. **Explanation:** Hydatidiform mole (HM) is a part of the spectrum of Gestational Trophoblastic Diseases (GTD). The hallmark histological features of a molar pregnancy involve abnormalities of the chorionic villi [1]. **Why Option B is correct:** The characteristic microscopic finding in hydatidiform moles is **hydropic degeneration of the villous stroma**. This occurs due to the accumulation of fluid within the mesenchymal core of the chorionic villi, leading to the formation of enlarged, "grape-like" vesicles (cisterns) [1]. This is accompanied by varying degrees of **trophoblastic proliferation** (both cytotrophoblast and syncytiotrophoblast) [1]. **Why other options are incorrect:** * **Option A:** Hyaline membrane degeneration is typically associated with Diffuse Alveolar Damage (DAD) in the lungs (e.g., ARDS), not molar pregnancies. * **Options C & D:** These are incorrect because **trophoblastic proliferation** is a defining feature of hydatidiform moles. In a Complete Mole, there is circumferential and exuberant proliferation of both cytotrophoblasts and syncytiotrophoblasts [1]. In a Partial Mole, the proliferation is usually focal and less marked, but it is still present [1]. **NEET-PG High-Yield Pearls:** * **Complete Mole:** 46,XX (most common) or 46,XY; entirely paternal origin (androgenetic) [1]; diffuse villous edema; no fetal parts; high risk of choriocarcinoma (2-3%) [1]. * **Partial Mole:** Triploid (69,XXX or 69,XXY); maternal and paternal DNA; focal villous edema; fetal parts/RBCs may be present; low risk of malignancy [1]. * **Snowstorm Appearance:** The classic ultrasound finding for a complete mole. * **hCG Levels:** Markedly elevated in complete moles compared to partial moles. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1043-1044.

Question 1

Which of the following germ cell tumors is malignant?

Accepted Answer

Seminoma

Answer

Leydig cell tumor

Answer

Sertoli cell tumor

Answer

Dermoid cyst

Question 2

An 80-year-old male presents with a testicular tumor. What is the most probable diagnosis?

Accepted Answer

Lymphoma

Answer

Seminoma

Answer

Teratoma

Answer

Lipoma

Question 3

Enlarged and pale placenta is typically due to infection by which of the following?

Accepted Answer

Syphilis

Answer

Parvovirus

Answer

Measles

Answer

Toxoplasmosis

Question 4

Histological features of leiomyoma are all except?

Accepted Answer

Less cellular than surrounding normal myometrium

Answer

Well-circumscribed tumor

Answer

Cells arranged in interlacing fascicles at right angles

Answer

Spindle-shaped smooth muscle cells with eosinophilic cytoplasm

Question 5

A 42-year-old woman presents with a 8-month history of abdominal discomfort. An abdominal CT scan reveals a 6 cm cystic mass involving the right ovary with small areas of calcification. Post-removal, the mass is found to be filled with abundant hair and sebum. Microscopically, the mass exhibits glandular spaces lined by columnar epithelium, squamous epithelium with hair follicles, sebaceous glands, and dense connective tissue. What type of tumor is it?

Accepted Answer

Teratoma

Answer

Sarcoma of the ovary

Answer

Metastasis of cervical carcinoma

Answer

Squamous cell carcinoma of the ovary

Question 6

Which of the following tumors is associated with increased serum placental alkaline phosphatase and positive immunohistochemical staining for placental alkaline phosphatase?

Accepted Answer

Seminoma

Answer

Hepatoblastoma

Answer

Hepatocellular carcinoma

Answer

Peripheral neuroectodermal tumor

Question 7

What is the point of distinction between a partial mole and a complete mole?

Accepted Answer

A partial mole is triploid or tetraploid

Answer

A partial mole is more prone to turn malignant

Answer

Typical of a partial mole is cellular atypia

Answer

A partial mole shows trophoblastic proliferation with absent villi

Question 8

Which marker is associated with granulosa cell tumor?

Accepted Answer

Inhibin

Answer

CA 19-9

Answer

Ca 50

Answer

Teratoma

Question 9

Hobnail cells are seen in which of the following conditions?

Accepted Answer

Clear cell carcinoma

Answer

Hilus cell tumor

Answer

Dysgerminoma

Answer

Arrhenoblastoma

Question 10

Histological features of hydatidiform mole include:

Accepted Answer

Hydropic degeneration of the villous stroma

Answer

Hyaline membrane degeneration

Answer

Non-proliferation of cytotrophoblast

Answer

Non-proliferation of syncytiotrophoblast

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?