Reproductive Pathology Practice Questions

Q: All of the following are true about Krukenberg's tumor except?

Has a rough surface. **Explanation:** Krukenberg tumor is a metastatic signet-ring cell carcinoma of the ovary, most commonly originating from a primary site in the gastrointestinal tract. **Why Option A is the correct answer (The Exception):** Krukenberg tumors are characterized by a **smooth, bosselated (knobby) surface**. The capsule remains intact, and the tumor does not typically show surface adhesions or a "rough" texture unless there is extensive peritoneal carcinomatosis. Therefore, the statement that it has a rough surface is incorrect. **Analysis of Incorrect Options:** * **Option B (Shape maintained):** Despite significant enlargement, the tumor typically replaces the ovarian stroma while preserving the overall **kidney-shaped or ovoid contour** of the ovary. * **Option C (Usually bilateral):** In over **80% of cases**, Krukenberg tumors are bilateral. This is a hallmark feature of metastatic ovarian tumors compared to primary epithelial ovarian tumors, which are more often unilateral. * **Option D (Arises from stomach):** The most common primary site is the **stomach (pylorus)**, followed by the colon, breast, and appendix. The spread occurs via retrograde lymphatic dissemination. **High-Yield Clinical Pearls for NEET-PG:** * **Microscopy:** Characterized by **signet-ring cells** (mucin-filled cytoplasm displacing the nucleus to the periphery) and dense stromal hyperplasia. * **Primary vs. Secondary:** If a signet-ring cell tumor is found in the ovary, a gastroscopy/colonoscopy is mandatory to find the primary. * **Age:** Often affects younger women compared to primary ovarian cancer, frequently presenting during the reproductive years. * **Diagnosis:** Immunohistochemistry (IHC) typically shows **CK7 negative and CK20 positive** if the primary is colorectal, or **CK7 positive** if the primary is gastric.

Q: What is the percentage change of cystic glandular hyperplasia turning to malignancy?

1%. **Explanation:** The progression of endometrial hyperplasia to malignancy depends significantly on the presence of **cellular atypia**. **Cystic Glandular Hyperplasia (CGH)**, also known as Simple Hyperplasia without atypia, is characterized by an increase in the number of glands which may be dilated (cystic), but the cells lining them do not show nuclear abnormalities. 1. **Why 1% is correct:** According to the classic **Kurman’s classification**, simple hyperplasia without atypia (CGH) has a very low malignant potential, with only about **1%** of cases progressing to endometrial carcinoma over a period of 10–20 years. 2. **Why other options are incorrect:** * **0.1% and 0.2%:** These values are too low; while the risk is minimal, it is clinically documented at approximately 1%. * **10%:** This value is more characteristic of **Complex Hyperplasia without atypia** (approximately 3–5%) or is an underestimate for cases with atypia. **High-Yield Clinical Pearls for NEET-PG:** * **The Kurman Classification Risk Profile:** * Simple Hyperplasia (CGH): **1%** * Complex Hyperplasia: **3%** * Simple Atypical Hyperplasia: **8%** * Complex Atypical Hyperplasia: **29% (approx. 30%)** * **Key Concept:** The presence of **atypia** is the single most important prognostic factor for progression to cancer. * **Management:** CGH is usually treated with progestogens (to oppose estrogen) and periodic follow-up biopsies, rather than immediate hysterectomy.

Q: What is the most common extragonadal site for germ cell tumors?

Mediastinum. **Explanation:** Germ cell tumors (GCTs) typically arise in the gonads (testes and ovaries). However, during embryogenesis, primordial germ cells migrate from the yolk sac endoderm to the gonadal ridges. If these cells fail to reach the gonads or stray from the migratory path, they can give rise to **Extragonadal Germ Cell Tumors (EGGCTs)**, which always occur in midline structures. **Why Mediastinum is correct:** In the **adult population**, the **mediastinum** (specifically the anterior mediastinum) is the most common site for extragonadal germ cell tumors. They represent about 50-70% of all adult EGGCTs. **Analysis of Incorrect Options:** * **Sacrococcygeal region:** This is the most common site for extragonadal GCTs (specifically Teratomas) in **infants and children**, but it is less common than the mediastinum when considering the overall population or adult-specific data often tested in PG exams. * **Retroperitoneum:** This is the second most common site in adults. However, a primary retroperitoneal GCT must be distinguished from a metastatic deposit from an occult testicular primary (Burned-out tumor). * **Pineal gland:** This is a common site for intracranial GCTs (Germinomas) [1], but it is less frequent overall compared to the mediastinum. **High-Yield Clinical Pearls for NEET-PG:** 1. **Most common mediastinal GCT:** Teratoma (usually benign in females, potentially malignant in males). 2. **Klinefelter Syndrome (47, XXY):** Strongly associated with the development of mediastinal germ cell tumors. 3. **Tumor Markers:** Always check AFP (Yolk sac component) and ̢-hCG (Choriocarcinoma component) for diagnosis and monitoring. 4. **Rule of Thumb:** Any midline mass in a young adult should raise suspicion for a Germ Cell Tumor. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1140-1141.

Q: Brenner tumor is a type of which of the following?

Epithelial tumors. **Explanation:** **Brenner tumor** is a surface epithelial-stromal tumor of the ovary. The correct answer is **A (Epithelial tumors)** because these tumors are composed of nests of transitional cells (urothelium-like) embedded within a dense fibromatous stroma. This is a classic example of "transitional cell metaplasia" of the surface epithelium. **Why other options are incorrect:** * **Sex cord-stromal tumors:** These arise from the ovarian stroma or primitive sex cords (e.g., Granulosa cell tumor, Sertoli-Leydig tumor, Fibroma). While Brenner tumors have a prominent fibrous component, the defining neoplastic element is epithelial. * **Germ cell tumors:** These originate from primordial germ cells (e.g., Teratoma, Dysgerminoma, Yolk sac tumor). Brenner tumors do not share this embryological origin. **High-Yield Clinical Pearls for NEET-PG:** 1. **Histology (Most Common Question):** Characterized by **"Walthard cell rests"** and cells with a longitudinal nuclear groove, famously described as **"Coffee bean nuclei."** 2. **Nature:** Most Brenner tumors (95%) are **benign**, unilateral, and often discovered incidentally. 3. **Gross Appearance:** They are solid, firm, and pale yellow-tan, often resembling an ovarian fibroma. 4. **Association:** They are sometimes associated with mucinous cystadenomas in the same or contralateral ovary. 5. **Epithelial Subtypes:** Remember the mnemonic **"MS. BEB"** for Surface Epithelial Tumors: **M**ucinous, **S**erous, **B**renner, **E**ndometrioid, and **B**lear (Clear) cell tumors.

Q: Male pseudohermaphroditism is seen in which of the following conditions?

All the above. **Explanation:** **Male Pseudohermaphroditism** (now termed 46,XY Disorder of Sex Development) is a condition where an individual has a **46,XY genotype** and testes are present, but the external genitalia are either ambiguous or completely female. This occurs due to defects in androgen synthesis or action during fetal development. **Why "All the above" is correct:** 1. **5-α Reductase Deficiency:** This enzyme converts Testosterone to the more potent **Dihydrotestosterone (DHT)**. DHT is essential for the virilization of external genitalia. In its absence, individuals have a 46,XY karyotype and internal testes but female or ambiguous external genitalia at birth. 2. **17-α Hydroxylase Deficiency:** This enzyme is crucial for the synthesis of both cortisol and sex steroids (androgens/estrogens). A deficiency leads to a total lack of androgen production in the testes, resulting in a failure of male external genital development (female phenotype). 3. **Gonadal Dysgenesis (Partial/Mixed):** In 46,XY individuals with dysgenetic gonads, there is inadequate production of Testosterone and Anti-Müllerian Hormone (AMH). This leads to incomplete masculinization of the external genitalia, fitting the definition of male pseudohermaphroditism. **Clinical Pearls for NEET-PG:** * **Androgen Insensitivity Syndrome (AIS):** The most common cause of male pseudohermaphroditism; caused by a defect in the androgen receptor. * **5-α Reductase Deficiency Hallmark:** "Penis-at-twelve." At puberty, high testosterone levels can cause partial virilization/clitoral enlargement. * **True Hermaphroditism:** Defined by the presence of **both** ovarian and testicular tissue (ovotestis). * **Female Pseudohermaphroditism:** 46,XX karyotype with ovaries, but virilized external genitalia (most common cause: **Congenital Adrenal Hyperplasia** due to 21-hydroxylase deficiency).

Question 1

Histopathological examination of a testicular mass from a 30-year-old man shows a heterogeneous collection of differentiated cells, including neural tissue, muscle bundles, islands of cartilage, clusters of squamous epithelium, structures resembling the thyroid gland, bronchial epithelium, and bits of intestinal wall or brain substance. All of the following are true about this tumor except?

Accepted Answer

In post-pubertal males, this tumor is considered benign.

Answer

Tumor markers include AFP and beta-hCG.

Answer

The presence of immature components is not required to determine the malignant potential of this tumor.

Answer

The tumor originates from totipotent cells.

Question 2

All of the following are true about Krukenberg's tumor except?

Accepted Answer

Has a rough surface

Answer

Shape of ovary is maintained

Answer

Usually bilateral

Answer

Arises usually from stomach carcinoma

Question 3

Which of the following tumors demonstrates increased activity of C-KIT?

Accepted Answer

Seminoma

Answer

Granulosa cell tumor

Answer

Embryonal carcinoma

Answer

Choriocarcinoma

Question 4

A Pap smear of a 23-year-old woman demonstrates squamous cells with enlarged, hyperchromatic nuclei and prominent perinuclear halos. The Pap smear is graded as cervical intraepithelial neoplasia, grade II (CIN II). Which of the following viruses is most likely to be etiologically related to this neoplastic growth?

Accepted Answer

Human papillomavirus (HPV)

Answer

Epstein-Barr virus (EBV)

Answer

Hepatitis B virus (HBV)

Answer

Human herpesvirus 8 (HHV 8)

Question 5

What is the percentage change of cystic glandular hyperplasia turning to malignancy?

Accepted Answer

1%

Answer

0.10%

Answer

0.2%

Answer

10%

Question 6

What is the most common extragonadal site for germ cell tumors?

Accepted Answer

Mediastinum

Answer

Retroperitoneum

Answer

Sacrococcygeal region

Answer

Pineal gland

Question 7

A 26-year-old man has occasionally felt pain in the scrotum for the past 3 months. On physical examination, the right testis is more tender than the left but does not appear to be enlarged. An ultrasound scan shows a 1.5-cm mass within the right testis. A right orchiectomy is performed, and gross examination shows the mass to be hemorrhagic and soft. A retroperitoneal lymph node dissection is done. In sections of the lymph nodes, a neoplasm is found with extensive necrosis and hemorrhage. Microscopic examination shows that areas of viable tumors are composed of cuboidal cells intermingled with large eosinophilic syncytial cells containing multiple dark, pleomorphic nuclei. Immunohistochemical staining of syncytial cells is most likely to be positive for which of the following?

Accepted Answer

Human chorionic gonadotropin

Answer

Alpha-fetoprotein

Answer

Carcinoembryonic antigen

Answer

CD20

Question 8

What is the hallmark of Arias-Stella reaction?

Accepted Answer

Nuclear enlargement

Answer

Pinopods

Answer

Vacuoles in cytoplasm

Answer

Nuclear pyknosis

Question 9

Brenner tumor is a type of which of the following?

Accepted Answer

Epithelial tumors

Answer

Sex cord stromal tumors

Answer

Germ cell tumors

Answer

None of the above

Question 10

Male pseudohermaphroditism is seen in which of the following conditions?

Accepted Answer

All the above

Answer

5-α reductase deficiency

Answer

17 hydroxylase deficiency

Answer

Gonadal dysgenesis

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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