Reproductive Pathology Practice Questions

Q: Which of the following is true about a complete mole?

Marked trophoblast atypia. **Explanation:** Hydatidiform moles are part of a spectrum of Gestational Trophoblastic Diseases. Understanding the distinction between Complete and Partial moles is a high-yield topic for NEET-PG. **Why Option C is Correct:** In a **Complete Mole**, there is a total lack of fetal tissue and generalized hydropic swelling of villi. Microscopically, it is characterized by **marked, circumferential trophoblastic proliferation** (both syncytiotrophoblast and cytotrophoblast) and significant **trophoblastic atypia** [1]. This exuberant growth is the reason for the significantly higher risk of progression to choriocarcinoma compared to partial moles [1]. **Why Other Options are Incorrect:** * **Option A:** A karyotype of **69,XXY** (triploidy) is characteristic of a **Partial Mole**. Complete moles are diploid (**46,XX** in 90% of cases), resulting from the fertilization of an "empty" egg by one or two sperm (androgenetic) [1]. * **Option B:** In complete moles, **hCG levels are typically > 100,000 mIU/mL**, often much higher than in normal pregnancy or partial moles, leading to clinical features like hyperemesis gravidarum and theca lutein cysts [1]. * **Option D:** **p57KIP2** is a paternally silenced, maternally expressed gene. Since a complete mole lacks a maternal genome, it is **p57 negative** (absent staining). Partial moles, which contain maternal DNA, are p57 positive. **NEET-PG High-Yield Pearls:** * **Snowstorm appearance** on ultrasound is the classic sign of a complete mole [1]. * **Risk of Choriocarcinoma:** 2-3% for complete moles; rare for partial moles [1]. * **Management:** Suction curettage followed by serial hCG monitoring to ensure levels return to zero [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1044-1046.

Q: In the provided cut section of the ovary shown below, which of the following represents a common germ cell tumor?

Dermoid cyst. ***Dermoid cyst*** - **Mature cystic teratoma** (dermoid cyst) is the **most common ovarian germ cell tumor**, accounting for 95% of all ovarian teratomas. - Cut section typically shows **hair, teeth, sebaceous material**, and other **mature tissues** from all three germ cell layers (ectoderm, mesoderm, endoderm). *Serous cystadenoma* - This is a **surface epithelial tumor**, not a germ cell tumor, arising from the **ovarian surface epithelium**. - Cut section shows **thin-walled cysts** filled with **serous fluid**, lacking the characteristic mature tissues seen in teratomas. *Dysgerminoma* - Although this is a **germ cell tumor**, it represents only **1-2%** of ovarian germ cell tumors, making it much less common than dermoid cyst. - Cut section appears as a **solid, lobulated mass** with **uniform cells** and **lymphocytic infiltration**, not the mixed tissue appearance of teratomas. *Mucinous cystadenoma* - This is also a **surface epithelial tumor**, not a germ cell tumor, arising from **ovarian surface epithelium**. - Cut section shows **multilocular cysts** filled with **thick, mucoid material**, without the hair, teeth, or sebaceous components of dermoid cysts.

Q: In which of the following infectious diseases is the testis involved but the epididymis spared?

Syphilis. In the context of male reproductive tract infections, the anatomical site of involvement is a high-yield distinction for NEET-PG. **Explanation of the Correct Answer:** **Syphilis (Option A)** is unique because it characteristically involves the **testis first**, often sparing the epididymis. In tertiary syphilis, the testis may be affected by a diffuse interstitial inflammation or a localized **gumma**. This leads to a painless, smooth, and heavy enlargement of the testis (often called a "billiard ball" testis). The underlying medical concept is that *Treponema pallidum* has a predilection for the testicular parenchyma rather than the ductal system. **Explanation of Incorrect Options:** * **Gonorrhea (Option B) and Chlamydia (Option D):** These are the most common causes of acute epididymitis in men under 35. The infection typically ascends from the urethra through the vas deferens, affecting the **epididymis first**. If the infection spreads to the testis, it is termed epididymo-orchitis. * **Chancroid (Option C):** Caused by *Haemophilus ducreyi*, this condition primarily presents with painful genital ulcers and painful inguinal lymphadenopathy (buboes). It does not typically involve the internal structures like the testis or epididymis. **High-Yield Clinical Pearls for NEET-PG:** * **Rule of Thumb:** Bacterial infections (Gonorrhea, Chlamydia, *E. coli*) usually affect the **epididymis** first. Viral (Mumps) and Granulomatous (Syphilis) infections usually affect the **testis** first. * **Tuberculosis (TB):** Unlike syphilis, TB of the genital tract characteristically starts in the **epididymis** (forming a "cold abscess") and may later spread to the testis. * **Mumps:** The most common cause of isolated orchitis in post-pubertal males; it spares the epididymis.

Q: A 24-year-old woman with a history of heavy and painful menstrual periods has been having difficulty conceiving. A bimanual pelvic examination and ultrasound demonstrate a mass in the uterus presumed to be a leiomyoma. This mass is a:

benign tumor of mesenchymal tissue. **Explanation:** **Leiomyoma** (commonly known as uterine fibroids) is the most common benign tumor of the female reproductive tract. 1. **Why Option A is correct:** Leiomyomas originate from the **smooth muscle cells** of the myometrium. In embryology and pathology, muscle, bone, and connective tissues are classified as **mesenchymal tissue**. Since fibroids are non-cancerous growths of smooth muscle (myocytes) and fibroblasts, they are defined as **benign tumors of mesenchymal origin**. 2. **Why Option B is incorrect:** Tumors of the surface epithelium in the female pelvis typically refer to ovarian epithelial tumors (e.g., serous cystadenoma). The uterine lining (endometrium) is epithelial, but a mass arising from it would be a polyp or carcinoma, not a leiomyoma. 3. **Why Option C is incorrect:** Malignant epithelial tumors are called **carcinomas** (e.g., Endometrial Adenocarcinoma). Leiomyomas are benign. 4. **Why Option D is incorrect:** A malignant tumor of mesenchymal (smooth muscle) tissue is a **Leiomyosarcoma**. These are rare, usually occur in older postmenopausal women, and typically arise *de novo* rather than from a pre-existing leiomyoma. **Clinical Pearls for NEET-PG:** * **Estrogen Dependency:** Leiomyomas are sensitive to estrogen and progesterone; they often enlarge during pregnancy and shrink after menopause. * **Degenerations:** The most common degeneration is **Hyaline** (asymptomatic). **Red degeneration** (necrobiosis) occurs during pregnancy due to rapid growth and venous thrombosis, presenting with acute pain. * **Symptoms:** Most are asymptomatic, but the most common symptom is **Heavy Menstrual Bleeding (HMB)**, specifically associated with intramural and submucosal types. * **Infertility:** Submucosal fibroids are most likely to cause infertility by distorting the uterine cavity and interfering with implantation.

Question 1

Which of the following is NOT a prognostic factor of breast carcinoma?

Accepted Answer

E-cadherin expression

Answer

Erb B2

Answer

Estrogen receptor status

Answer

Progesterone receptor status

Question 2

What is the most common type of breast carcinoma?

Accepted Answer

Infiltrative ductal carcinoma

Answer

Papillary carcinoma

Answer

Paget's disease

Answer

Fibrosarcoma

Question 3

Which of the following is true about a complete mole?

Accepted Answer

Marked trophoblast atypia

Answer

Karyotype is 69,XXY

Answer

hCG levels are < 100,000 mIU/mL

Answer

p57KIP2 immunostaining is positive

Question 4

In the provided cut section of the ovary shown below, which of the following represents a common germ cell tumor?

Accepted Answer

Dermoid cyst

Answer

Serous cystadenoma

Answer

Dysgerminoma

Answer

Mucinous cystadenoma

Question 5

A 32-year-old woman has been attempting to become pregnant for the past 2 years without success. She also has had extremely painful menstrual cramping of many years' duration. An exploratory laparoscopy demonstrated multiple red-blue nodules covering the surface of her ovaries and uterine ligaments. These findings are most likely indicative of which of the following conditions?

Accepted Answer

Endometriosis

Answer

Adenomyosis

Answer

Endometrial hyperplasia

Answer

Leiomyoma

Question 6

All of the following ovarian tumours arise from surface epithelium EXCEPT?

Accepted Answer

Benign cystic teratoma

Answer

Mucinous cystadenoma

Answer

Endometrial carcinoma

Answer

Brenner tumour

Question 7

In which of the following infectious diseases is the testis involved but the epididymis spared?

Accepted Answer

Syphilis

Answer

Gonorrhea

Answer

Chancroid

Answer

Chlamydia

Question 8

A 24-year-old woman with a history of heavy and painful menstrual periods has been having difficulty conceiving. A bimanual pelvic examination and ultrasound demonstrate a mass in the uterus presumed to be a leiomyoma. This mass is a:

Accepted Answer

benign tumor of mesenchymal tissue

Answer

benign tumor of surface epithelium

Answer

malignant tumor of epithelial tissue

Answer

malignant tumor of mesenchymal tissue

Question 9

A 27-year-old woman in the third trimester of her third pregnancy discovers a lump in her left breast. On physical examination, a 2-cm, discrete, freely movable mass beneath the nipple is palpable. After the birth of a term infant, the mass appears to decrease in size. The infant is breastfed without difficulty. What is the most likely diagnosis?

Accepted Answer

Fibroadenoma

Answer

Intraductal papilloma

Answer

Lobular carcinoma in situ

Answer

Medullary carcinoma

Question 10

Which of the following is an exception for secreting hormones?

Accepted Answer

Dysgerminoma

Answer

Choriocarcinoma

Answer

Seminoma

Answer

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Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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