Reproductive Pathology — MCQs

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?

Q46Medium

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

Q47Medium

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

Q48Easy

Which marker is associated with granulosa cell tumor?

Q49Medium

Hobnail cells are seen in which of the following conditions?

Q50Medium

Histological features of hydatidiform mole include:

Reproductive Pathology Indian Medical PG Practice Questions and MCQs

Question 41: Which of the following germ cell tumors is malignant?

A. Leydig cell tumor
B. Sertoli cell tumor
C. Seminoma (Correct Answer)
D. Dermoid cyst

Explanation: **Explanation:** The classification of testicular and ovarian tumors is a high-yield topic for NEET-PG. To answer this correctly, one must distinguish between **Germ Cell Tumors (GCTs)** and **Sex Cord-Stromal Tumors**. **1. Why Seminoma is correct:** Seminomas are the most common type of germ cell tumor in the testis. By definition, **all testicular germ cell tumors in adults are considered malignant** [1] (except for the rare prepubertal yolk sac tumor or dermoid cyst). Seminomas are characterized by large, uniform cells with clear cytoplasm (rich in glycogen) and distinct cell borders, separated by fibrous septa containing a lymphocytic infiltrate [1]. They are highly radiosensitive and have an excellent prognosis. **2. Why the other options are incorrect:** * **Leydig and Sertoli cell tumors (Options A & B):** These are **Sex Cord-Stromal Tumors**, not germ cell tumors. While they can occasionally be malignant (approx. 10%), the majority are benign. * **Dermoid cyst (Option D):** This is a specialized form of a mature cystic teratoma. In the **ovary**, dermoid cysts are common and almost always **benign** [3]. While teratomas in post-pubertal males are usually malignant, the term "Dermoid cyst" specifically refers to the benign cystic variant. **High-Yield Clinical Pearls for NEET-PG:** * **Tumor Marker:** Seminomas may show elevated **hCG** (if syncytiotrophoblasts are present) [2] but **never** elevated AFP. Elevated AFP always indicates a non-seminomatous component (like Yolk Sac Tumor). * **Microscopy:** Look for the "fried egg appearance" and "lymphocytic infiltration." * **Ovarian Counterpart:** The histological equivalent of a seminoma in the ovary is the **Dysgerminoma** [3]. **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 Diseases Of The Urinary And Male Genital Tracts, pp. 512-513. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1035-1036.

Question 42: An 80-year-old male presents with a testicular tumor. What is the most probable diagnosis?

A. Lymphoma (Correct Answer)
B. Seminoma
C. Teratoma
D. Lipoma

Explanation: **Explanation:** The correct answer is **Lymphoma**. In the context of testicular tumors, age is the most critical diagnostic clue for the NEET-PG exam. **1. Why Lymphoma is correct:** Testicular lymphoma (specifically **Diffuse Large B-Cell Lymphoma**) is the most common testicular neoplasm in men **older than 60 years** [3]. While germ cell tumors dominate younger age groups, any testicular mass in an elderly patient should be considered lymphoma until proven otherwise. It often presents as a painless enlargement and has a high propensity for bilateral involvement (synchronous or metachronous). **2. Why the other options are incorrect:** * **Seminoma:** This is the most common overall germ cell tumor, but its peak incidence is between **30–50 years**. It is rare in men over 60. * **Teratoma:** In adults, these are usually malignant components of mixed germ cell tumors and typically occur in the **20–30 year** age bracket. In infants, they are benign. * **Lipoma:** While a lipoma of the spermatic cord is a common paratesticular finding, it is not a primary testicular tumor and does not fit the clinical presentation of a "testicular tumor" in this demographic. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common testicular tumor overall:** Seminoma [1]. * **Most common testicular tumor in children (<3 years):** Yolk Sac Tumor (associated with high Alpha-Fetoprotein). * **Most common bilateral testicular tumor:** Lymphoma. * **Reinke Crystals:** Pathognomonic for Leydig Cell Tumors [2]. * **Schiller-Duval Bodies:** Pathognomonic for Yolk Sac Tumors. * **Rule of Thumb:** If the patient is >60, think Lymphoma; if 15–35, think Germ Cell Tumors (Seminoma/Non-seminomatous). **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. 510-512. [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. 983-984. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 513-514.

Question 43: Enlarged and pale placenta is typically due to infection by which of the following?

A. Parvovirus
B. Measles
C. Syphilis (Correct Answer)
D. Toxoplasmosis

Explanation: **Explanation:** The correct answer is **Syphilis (Option C)**. Congenital syphilis, caused by *Treponema pallidum*, is a classic cause of a disproportionately large, heavy, and pale placenta (placentomegaly) [1]. **Why Syphilis is correct:** The characteristic "enlarged and pale" appearance is due to a combination of **villous edema**, chronic villitis, and a specific vascular pathology known as **obliterative endarteritis** [1] (concentric "onion-skin" thickening of the vessel walls). These changes lead to decreased perfusion, compensatory hypertrophy of the placenta, and a pale, fleshy texture. Histologically, the presence of Hofbauer cells (fetal macrophages) and perivascular cuffing are hallmark findings. **Why other options are incorrect:** * **Parvovirus B19 (Option A):** While it can cause placental edema (hydrops fetalis), the primary pathology is severe fetal anemia due to the destruction of erythroblasts [2]. It does not typically present with the specific "pale and fleshy" placentomegaly associated with syphilis. * **Measles (Option B):** Measles is not a common cause of congenital placental infection or significant morphological changes like placentomegaly. * **Toxoplasmosis (Option D):** While part of the TORCH infections, Toxoplasmosis usually results in focal calcifications and inflammation rather than the diffuse, massive enlargement seen in syphilis [3]. **High-Yield Pearls for NEET-PG:** * **Placentomegaly:** Defined as a placental weight >90th percentile for gestational age. * **Differential for Large Placenta:** Diabetes mellitus, Rh incompatibility (Eryblastosis fetalis), Syphilis, and α-thalassemia (Hydrops fetalis). * **Syphilis Triad (Hutchinson’s):** Interstitial keratitis, sensorineural deafness, and notched incisors. * **Microscopy Tip:** Look for "villous immaturity" and "obliterative endarteritis" in syphilis-related placental questions [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 386-388. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 470-472. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1041-1042.

Question 44: Histological features of leiomyoma are all except?

A. Well-circumscribed tumor
B. Less cellular than surrounding normal myometrium (Correct Answer)
C. Cells arranged in interlacing fascicles at right angles
D. Spindle-shaped smooth muscle cells with eosinophilic cytoplasm

Explanation: **Explanation:** **Leiomyoma** (uterine fibroids) is the most common benign tumor of the female genital tract, derived from smooth muscle cells of the myometrium. **Why Option B is the correct answer:** Leiomyomas are characterized by **increased cellularity** compared to the surrounding normal myometrium. They consist of a dense proliferation of smooth muscle cells; therefore, the statement that they are "less cellular" is histologically incorrect. **Analysis of Incorrect Options:** * **Option A (Well-circumscribed):** Grossly, leiomyomas are sharply demarcated, firm, grey-white, and possess a characteristic **whorled appearance** [1][3]. Although they lack a true capsule, they are clearly separated from the normal myometrium by a "pseudocapsule" of compressed muscle fibers. * **Option C (Interlacing fascicles):** This is a classic histological hallmark. The smooth muscle cells are organized into bundles or fascicles that intersect at various angles (often described as **interlacing or whorled**) [1]. * **Option D (Spindle-shaped cells):** Microscopically, the cells are uniform, spindle-shaped, and possess elongated "cigar-shaped" nuclei with blunt ends and abundant eosinophilic (pink) cytoplasm [1][2]. **High-Yield NEET-PG Pearls:** 1. **Estrogen Dependency:** Leiomyomas are sensitive to estrogen; they enlarge during pregnancy and shrink after menopause. 2. **Degenerations:** The most common type is **Hyaline degeneration** [2]. **Red degeneration** (carneous) is specific to pregnancy due to venous thrombosis and infarction. 3. **Malignant Transformation:** Transformation into Leiomyosarcoma is extremely rare (<0.1%) and typically arises *de novo*, not from a pre-existing leiomyoma. 4. **Genetic Association:** Mutations in the **MED12** gene are found in approximately 70% of cases [3]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 276-278. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1024-1025. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, p. 1024.

Question 45: 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?

A. Sarcoma of the ovary
B. Metastasis of cervical carcinoma
C. Squamous cell carcinoma of the ovary
D. Teratoma (Correct Answer)

Explanation: **Explanation:** The clinical presentation and histopathological findings are classic for a **Mature Cystic Teratoma** (also known as a Dermoid Cyst) [1, 2]. **1. Why the Correct Answer is Right:** A teratoma is a germ cell tumor composed of tissues derived from more than one germ layer (ectoderm, mesoderm, and endoderm) [2]. * **Grossly:** The presence of **sebum** (sebaceous material) and **hair** is pathognomonic [1, 2]. The "calcifications" mentioned on CT often correspond to teeth or bone [1]. * **Microscopically:** The description confirms multi-lineage differentiation: **Squamous epithelium/hair follicles** (Ectoderm), **Glandular spaces** (Endoderm), and **Dense connective tissue** (Mesoderm) [2]. In women of reproductive age, these are usually benign (mature). **2. Why Incorrect Options are Wrong:** * **A. Sarcoma of the ovary:** These are rare malignant tumors of mesenchymal origin. They would present as solid, fleshy masses with high mitotic activity, not with organized hair, sebum, or multi-lineage epithelial structures. * **B. Metastasis of cervical carcinoma:** This would typically present as solid nests of malignant squamous cells. It would not contain diverse tissues like hair follicles or sebaceous glands. * **C. Squamous cell carcinoma (SCC):** While SCC can rarely arise *within* a pre-existing mature teratoma (malignant transformation), the presence of multiple germ layers and benign-appearing glandular/connective tissue points primarily to the diagnosis of a Teratoma [1]. **3. NEET-PG High-Yield Pearls:** * **Most common germ cell tumor:** Mature Cystic Teratoma [2]. * **Rokitansky Protuberance:** A solid prominence within the cyst wall where most hair/teeth are found. * **Struma Ovarii:** A specialized teratoma composed entirely of thyroid tissue (can cause hyperthyroidism) [1]. * **Malignant Transformation:** Occurs in <2% of cases, most commonly into **Squamous Cell Carcinoma** [1]. * **Imaging:** "Tip of the iceberg" sign on ultrasound due to highly echogenic sebum and hair. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1033-1034. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 480-481.

Question 46: Which of the following tumors is associated with increased serum placental alkaline phosphatase and positive immunohistochemical staining for placental alkaline phosphatase?

A. Seminoma (Correct Answer)
B. Hepatoblastoma
C. Hepatocellular carcinoma
D. Peripheral neuroectodermal tumor

Explanation: **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.

Question 47: What is the point of distinction between a partial mole and a complete mole?

A. A partial mole is triploid or tetraploid (Correct Answer)
B. A partial mole is more prone to turn malignant
C. Typical of a partial mole is cellular atypia
D. A partial mole shows trophoblastic proliferation with absent villi

Explanation: The primary distinction between a partial and a complete hydatidiform mole lies in their **genetic constitution** and the presence of fetal tissue [1]. 1. **Why Option A is correct:** A **partial mole** is typically **triploid** (69,XXX or 69,XXY), resulting from the fertilization of a normal ovum by two sperm (dispermy) [1]. In contrast, a **complete mole** is **diploid** (46,XX or 46,XY), usually formed by a single sperm fertilizing an "empty" egg followed by chromosomal duplication (androgenesis) [1]. 2. **Why other options are incorrect:** * **Option B:** Complete moles are significantly **more prone to malignancy** (gestational trophoblastic neoplasia/choriocarcinoma) than partial moles [2]. The risk is ~15-20% for complete moles versus <5% for partial moles [1]. * **Option C:** While both show some degree of atypia, **marked cellular atypia** and circumferential trophoblastic proliferation are hallmark features of a **complete mole** [2]. Partial moles show focal, less severe proliferation. * **Option D:** Both partial and complete moles are characterized by **hydropic villi**. In fact, partial moles typically show a mixture of normal and enlarged (scalloped) villi, whereas complete moles show diffuse enlargement [2]. **High-Yield Clinical Pearls for NEET-PG:** * **Fetal Parts:** Present in Partial Mole; Absent in Complete Mole [1]. * **p57 Expression:** Partial moles are **p57 positive** (maternal DNA present); Complete moles are **p57 negative** (maternal DNA absent). * **hCG Levels:** Markedly elevated in Complete Mole; only mildly elevated in Partial Mole [2]. * **Gross Appearance:** Complete mole shows a "bunch of grapes" appearance; Partial mole shows scattered vesicles among placental tissue. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, p. 1044. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1044-1046.

Question 48: Which marker is associated with granulosa cell tumor?

A. CA 19-9
B. Ca 50
C. Inhibin (Correct Answer)
D. Teratoma

Explanation: **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.

Question 49: Hobnail cells are seen in which of the following conditions?

A. Hilus cell tumor
B. Clear cell carcinoma (Correct Answer)
C. Dysgerminoma
D. Arrhenoblastoma

Explanation: **Explanation:** **Hobnail cells** are a classic histopathological hallmark of **Clear Cell Carcinoma (CCC)** of the ovary. These cells are characterized by a bulbous nucleus that protrudes into the lumen of a gland or cyst, with a narrow base of cytoplasm, resembling the head of a "hobnail" used in old-fashioned boots. 1. **Clear Cell Carcinoma (Correct):** This tumor is often associated with **endometriosis** [1]. Microscopically, it displays two main features: cells with abundant clear cytoplasm (rich in glycogen) and the characteristic **hobnail cells** [1]. These cells represent an attenuated or "snaggle-toothed" appearance of the epithelial lining. 2. **Hilus Cell Tumor (Incorrect):** These are androgen-secreting tumors characterized by **Reinke crystals** (pink, rod-shaped cytoplasmic inclusions) [2]. They do not feature hobnailing. 3. **Dysgerminoma (Incorrect):** This is the female counterpart of a seminoma. It is characterized by large, uniform cells with clear cytoplasm and central nuclei, arranged in nests separated by fibrous septa containing **lymphocytic infiltrates**. 4. **Arrhenoblastoma (Sertoli-Leydig Cell Tumor) (Incorrect):** This is a sex cord-stromal tumor that produces virilization [2]. Histology shows tubules lined by Sertoli cells and clusters of Leydig cells, but not hobnail morphology. **High-Yield Pearls for NEET-PG:** * **Hobnail cells** are also seen in **Endomyometritis** and **Collecting Duct Carcinoma** of the kidney. * Clear cell carcinoma of the ovary is the most common cancer associated with **Endometriotic cysts** (Chocolate cysts) [1]. * It is generally resistant to platinum-based chemotherapy compared to serous tumors. * **Stain:** Clear cell carcinoma stains positive for **HNF-1β** (Hepatocyte Nuclear Factor-1 beta). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, p. 1032. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1037-1038.

Question 50: Histological features of hydatidiform mole include:

A. Hyaline membrane degeneration
B. Hydropic degeneration of the villous stroma (Correct Answer)
C. Non-proliferation of cytotrophoblast
D. Non-proliferation of syncytiotrophoblast

Explanation: **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.

Practice by Chapter

Diseases of Male Genital Tract

Practice Questions

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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