Reproductive Pathology Practice Questions

Q: Serum alpha-fetoprotein level is elevated in which of the following conditions?

Endodermal sinus tumor. **Explanation:** The correct answer is **Endodermal Sinus Tumor (Yolk Sac Tumor)**. This is because the tumor is derived from the extraembryonic yolk sac, which is the physiological site of **Alpha-Fetoprotein (AFP)** synthesis during fetal development [1]. Consequently, AFP serves as a highly specific and sensitive serum biomarker for the diagnosis and monitoring of this malignancy. **Analysis of Options:** * **Endodermal Sinus Tumor (A):** Characterized histologically by **Schiller-Duval bodies** (glomeruloid structures). It is the most common germ cell tumor in children and consistently presents with markedly elevated AFP levels [1]. * **Immature Teratoma (B):** These tumors are composed of tissues from all three germ layers (ectoderm, endoderm, mesoderm) in varying stages of immaturity (typically neuroepithelium). While they may occasionally show mild AFP elevation if yolk sac elements are present, it is not their primary diagnostic marker. * **Choriocarcinoma (C):** This is a highly malignant tumor of trophoblastic cells. The characteristic marker is **beta-hCG**, not AFP. * **Dysgerminoma (D):** This is the female counterpart of the male seminoma. It is typically associated with elevated **LDH** (Lactic Dehydrogenase) and sometimes placental alkaline phosphatase (PLAP), but AFP remains normal. **High-Yield NEET-PG Pearls:** 1. **Schiller-Duval bodies** are pathognomonic for Yolk Sac Tumors [1]. 2. **Reinke crystals** are characteristic of Leydig cell tumors. 3. **Call-Exner bodies** are seen in Granulosa cell tumors (Marker: **Inhibin**). 4. **Psammoma bodies** are found in Serous cystadenocarcinoma. 5. **Summary of Markers:** * Yolk Sac Tumor: AFP * Choriocarcinoma: beta-hCG * Dysgerminoma: LDH * Granulosa Cell Tumor: Inhibin **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: What is the tumor marker for choriocarcinoma?

HCG. **Explanation:** **Choriocarcinoma** is a highly malignant germ cell tumor or gestational trophoblastic neoplasm characterized by the proliferation of **cytotrophoblasts** and **syncytiotrophoblasts** without the formation of chorionic villi [1]. 1. **Why HCG is correct:** Syncytiotrophoblasts are responsible for the synthesis and secretion of **Human Chorionic Gonadotropin (HCG)**. In choriocarcinoma, HCG levels are characteristically markedly elevated [1]. It serves as a definitive marker for diagnosis, monitoring treatment response, and detecting recurrence [1]. 2. **Why the other options are incorrect:** * **AFP (Alpha-Fetoprotein):** This is the marker for **Yolk Sac Tumors** (Endodermal Sinus Tumors) and Hepatocellular Carcinoma. * **CEA (Carcinoembryonic Antigen):** A non-specific marker primarily used for monitoring **colorectal carcinoma** and other adenocarcinomas (pancreas, lung, breast). * **Desmin:** An intermediate filament used as an immunohistochemical marker for **muscle-derived tumors** (e.g., Rhabdomyosarcoma or Leiomyosarcoma), not germ cell tumors. **High-Yield Clinical Pearls for NEET-PG:** * **Hematogenous Spread:** Choriocarcinoma is notorious for early hematogenous spread, most commonly to the **lungs** (presenting as "cannonball metastases" on X-ray). * **Histology:** Look for a "dimorphic" population of cells (syncytiotrophoblasts and cytotrophoblasts) with extensive **hemorrhage and necrosis**, but an absolute **absence of villi** [1]. * **Response to Therapy:** Gestational choriocarcinoma (following pregnancy) has an excellent prognosis with chemotherapy (Methotrexate), whereas non-gestational (ovarian/testicular) choriocarcinoma is more resistant [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1035-1036.

Q: Struma ovarii is composed entirely of what tissue?

Mature thyroid tissue. **Explanation:** **Struma ovarii** is a highly specialized or monodermal form of a **mature cystic teratoma** (dermoid cyst) [2]. While typical teratomas contain tissues from all three germ layers [1], struma ovarii is defined by the presence of thyroid tissue as the predominant or exclusive component (comprising >50% of the tumor) [2]. * **Why Option A is correct:** The thyroid tissue found in struma ovarii is histologically **mature**, consisting of follicles filled with colloid, identical to a normal thyroid gland [2]. It is functional tissue that can synthesize thyroid hormones. * **Why Option B is incorrect:** Immature tissue (like primitive neuroepithelium) is a hallmark of **Immature Teratomas**, which are malignant [1]. Struma ovarii consists of well-differentiated, benign mature tissue [2]. * **Why Option C is incorrect:** Primary ovarian carcinoid is another type of monodermal teratoma [2]. While it can sometimes arise within a struma ovarii (forming a "Strumal Carcinoid"), the term "Struma ovarii" specifically refers to the thyroid component [2]. **High-Yield Clinical Pearls for NEET-PG:** 1. **Hyperthyroidism:** Approximately 5–10% of patients present with clinical features of thyrotoxicosis due to ectopic hormone production [2]. 2. **Imaging:** On MRI/CT, it often appears as a multicystic mass with "high-density" areas representing thick colloid. 3. **Ascites:** Interestingly, struma ovarii can present with ascites (and rarely Meigs' syndrome), mimicking ovarian malignancy. 4. **Malignancy:** Although rare, papillary or follicular thyroid carcinoma can arise within a struma ovarii [1]. **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] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, p. 1034.

Question 1

A 27-year-old female feels a lump in her breast and schedules an appointment with her doctor for examination. A tissue biopsy is taken and examined, with multiple areas showing only benign features. Which of the following findings implies an increased risk of subsequently developing invasive carcinoma?

Accepted Answer

Sclerosing adenosis

Answer

Apocrine metaplasia

Answer

Blue-domed cysts of Bloodgood

Answer

Duct ectasia

Question 2

Serum alpha-fetoprotein level is elevated in which of the following conditions?

Accepted Answer

Endodermal sinus tumor

Answer

Immature teratoma

Answer

Choriocarcinoma

Answer

Dysgerminoma

Question 3

Which virus is associated with cancer of the cervix?

Accepted Answer

Human Papillomavirus (HPV)

Answer

Human Immunodeficiency Virus (HIV)

Answer

Epstein-Barr Virus (EBV)

Answer

Human T-lymphotropic Virus (HTLV)

Question 4

Fibrocystic disease of the breast is associated with which hormonal imbalance?

Accepted Answer

Estrogen

Answer

Progesterone

Answer

Luteinizing hormone (LH)

Answer

Testosterone

Question 5

A 22-year-old man complains about his inability to conceive a child. On physical examination, the patient is noted to be tall (6 ft, 5 in) and exhibits gynecomastia and testicular atrophy. Laboratory studies demonstrate increased serum levels of follicle-stimulating hormone. Cytogenetic studies reveal a chromosomal abnormality. What is the most common cause of this patient's chromosomal abnormality?

Accepted Answer

Meiotic nondisjunction

Answer

Expansion of a trinucleotide repeat

Answer

Isochromosome formation

Answer

Nonreciprocal translocation

Question 6

What is the tumor marker for choriocarcinoma?

Accepted Answer

HCG

Answer

AFP

Answer

CEA

Answer

Desmin

Question 7

Struma ovarii is composed entirely of what tissue?

Accepted Answer

Mature thyroid tissue

Answer

Immature thyroid tissue

Answer

Primary ovarian carcinoid tissue

Answer

None of the above

Question 8

Infertility in Kallmann syndrome is due to?

Accepted Answer

Asthenospermia

Answer

Oligospermia

Answer

Blockage of epididymis

Answer

Undescended testis

Question 9

A 29-year-old female presents with severe pain during menstruation (dysmenorrhea). During workup, an endometrial biopsy is obtained. The pathology report from this specimen makes the diagnosis of chronic endometritis. Based on this pathology report, which one of the following was present in the biopsy sample of the endometrium?

Accepted Answer

Plasma cells

Answer

Neutrophils

Answer

Lymphocytes

Answer

Lymphoid follicles

Question 10

Benign condyloma is associated with which condition?

Accepted Answer

Infection by human papillomavirus (HPV) type 11

Answer

Infection by HPV type 16

Answer

Infection by HPV type 18

Answer

Lichen sclerosus

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?