Reproductive Pathology Practice Questions

Q: Infertility is a common feature in Sertoli cell-only syndrome because:

There are no germ cells in this condition. **Explanation:** **Sertoli cell-only syndrome (SCOS)**, also known as Del Castillo syndrome, is a condition characterized by the complete absence of germ cells in the seminiferous tubules. **1. Why Option C is Correct:** The fundamental pathology of SCOS is the **absence of the germinal epithelium**. While the seminiferous tubules are lined by functional Sertoli cells, the precursor cells (spermatogonia) that eventually undergo meiosis to become spermatozoa are missing. Without these germ cells, spermatogenesis cannot initiate, leading to absolute infertility and **non-obstructive azoospermia**. **2. Analysis of Incorrect Options:** * **Option A:** In SCOS, the number of Sertoli cells is not "too many"; rather, they are the *only* cells present. Infertility is due to the lack of germ cells, not an inhibitory effect of Sertoli cells. * **Option B:** While Sertoli cells form the blood-testis barrier, the primary cause of infertility in this specific syndrome is the lack of "raw material" (germ cells), not a structural failure of the barrier. * **Option D:** This is technically true but imprecise. "Sufficient numbers" implies some sperm are produced; in SCOS, there is a **total absence** of sperm production. **Clinical Pearls for NEET-PG:** * **Hormonal Profile:** Characterized by **elevated FSH** (due to decreased Inhibin B from dysfunctional/stressed Sertoli cells) but usually **normal LH and Testosterone** levels (as Leydig cells are typically unaffected). * **Diagnosis:** The definitive diagnosis is made via **Testicular Biopsy**, which shows "empty" tubules containing only Sertoli cells. * **Physical Exam:** Patients usually have normal secondary sexual characteristics but may have slightly smaller-than-average testes. * **Genetics:** Often associated with microdeletions in the **AZF (Azoospermia Factor) region** of the Y chromosome.

Q: Call Exner bodies are seen in which of the following conditions?

Granulosa cell tumor. **Explanation:** **Call-Exner bodies** are the pathognomonic histological hallmark of **Granulosa Cell Tumors (GCT)**, specifically the adult type. These are small, fluid-filled spaces surrounded by granulosa cells arranged in a rosette-like pattern. The spaces contain eosinophilic material (secreted basement membrane components) and often resemble primitive follicles. * **Granulosa Cell Tumor (Correct):** These are sex cord-stromal tumors. Histologically, they show "coffee-bean" nuclei (due to longitudinal grooves) and Call-Exner bodies. Clinically, they are known for producing **estrogen**, leading to precocious puberty in children or endometrial hyperplasia/carcinoma in postmenopausal women. **Inhibin** is the specific serum marker used for diagnosis and monitoring recurrence [1]. **Why other options are incorrect:** * **Mature Teratoma:** A germ cell tumor containing tissues from all three germ layers (ectoderm, mesoderm, endoderm). Characteristic findings include hair, sebum, and teeth, but not Call-Exner bodies. * **Endodermal Sinus Tumor (Yolk Sac Tumor):** Characterized by **Schiller-Duval bodies** (glomeruloid-like structures) and elevated **Alpha-Fetoprotein (AFP)** levels. * **Sertoli-Leydig Cell Tumor:** These typically show tubules lined by Sertoli cells and clusters of Leydig cells containing **Reinke crystals**. They usually present with virilization due to androgen production. **High-Yield Clinical Pearls for NEET-PG:** * **Schiller-Duval bodies:** Yolk Sac Tumor. * **Reinke Crystals:** Leydig cell tumor. * **Psammoma bodies:** Serous cystadenocarcinoma. * **Hobnail cells:** Clear cell carcinoma of the ovary. * **Coffee-bean nuclei:** Granulosa cell tumor and Brenner tumor. **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: A 36-year-old primigravida develops peripheral edema late in the second trimester. On physical examination, her blood pressure is 155/95 mm Hg. Urinalysis shows 2+ proteinuria, but no blood, glucose, or ketones. At 36 weeks, she gives birth to a normal viable but low-birth-weight infant. Her blood pressure returns to normal, and she no longer has proteinuria. Which of the following pathologic findings is most likely to be found on examination of the placenta?

Multiple infarcts. ### Explanation **Diagnosis: Preeclampsia** The patient presents with the classic triad of **Preeclampsia**: hypertension (≥140/90 mm Hg) and proteinuria (2+) developing after 20 weeks of gestation in a primigravida, which resolves postpartum. **Why "Multiple Infarcts" is correct:** The underlying pathology of preeclampsia is **abnormal cytotrophoblast invasion** of the spiral arteries. Instead of transforming into high-capacitance, low-resistance vessels, the spiral arteries remain narrow and muscular. This leads to **placental hypoperfusion and ischemia**. Grossly and microscopically, this manifests as **multiple placental infarcts**, retroplacental hemorrhages, and "villous agglutination." Chronic ischemia results in uteroplacental insufficiency, explaining the **low-birth-weight (IUGR)** infant seen in this case. **Why other options are incorrect:** * **A. Chorioamnionitis:** This is an ascending bacterial infection (usually following prolonged rupture of membranes) characterized by fever, maternal tachycardia, and fetal tachycardia. It shows neutrophil infiltration of the fetal membranes, not infarcts. * **B. Chronic villitis:** Often associated with TORCH infections (e.g., CMV, Syphilis). It involves lymphocytic infiltration of the villi rather than ischemic changes related to maternal hypertension. * **C. Hydropic villi:** This is a hallmark of **Gestational Trophoblastic Disease** (Molar pregnancy). While partial moles can present with hypertension, they occur earlier in pregnancy and involve fetal parts with "Swiss-cheese" cystic villi. **Clinical Pearls for NEET-PG:** * **Definitive Treatment:** Delivery of the fetus and placenta. * **Microscopic hallmark:** **Acute Atherosis** (fibrinoid necrosis of the vessel wall with lipid-laden macrophages) in the spiral arteries. * **Placental weight:** In preeclampsia, the placenta is often small for gestational age due to chronic ischemia.

Question 1

Risk of breast cancer is highest in which of the following conditions?

Accepted Answer

Lobular carcinoma in situ

Answer

Proliferative disease without atypia

Answer

Proliferative disease with atypia

Answer

Atypical ductal hyperplasia

Question 2

Infertility is a common feature in Sertoli cell-only syndrome because:

Accepted Answer

There are no germ cells in this condition

Answer

Too many Sertoli cells inhibit spermatogenesis

Answer

Proper blood-testis barrier is not established

Answer

Sufficient numbers of spermatozoa are not produced

Question 3

Call Exner bodies are seen in which of the following conditions?

Accepted Answer

Granulosa cell tumor

Answer

Mature teratoma

Answer

Endodermal sinus tumor

Answer

Sertoli-Leydig cell tumor

Question 4

A 15-year-old girl undergoes Pap smear analysis. The smear demonstrates koilocytes, which are approximately the same size as intermediate cells, with enlarged hyperchromatic nuclei and perinuclear halos. These abnormal cells are infected by which of the following viruses?

Accepted Answer

Human papillomavirus

Answer

Human Immunodeficiency Virus

Answer

Cytomegalovirus

Answer

Herpes simplex virus 1

Question 5

What is the most specific immunohistochemical marker to rule out invasive ductal carcinoma?

Accepted Answer

p63

Answer

Ki-67

Answer

Desmin

Answer

HER2/neu

Question 6

All of the following are features of borderline tumors except?

Accepted Answer

Stromal invasion seen

Answer

Occurs in younger age

Answer

Mitotic figures < 9/10 per high power field

Answer

Very good prognosis

Question 7

Which of the following substances is secreted by non-seminomatous germ cell tumors of the testis?

Accepted Answer

Alpha-fetoprotein (AFP)

Answer

Carcinoembryonic antigen (CEA)

Answer

Acid phosphatase

Answer

Cytokeratin

Question 8

Paget's disease of the nipple is classified as which of the following?

Accepted Answer

Neoplasia

Answer

Infection

Answer

Dermatitis

Answer

Hypopigmentation

Question 9

A 36-year-old primigravida develops peripheral edema late in the second trimester. On physical examination, her blood pressure is 155/95 mm Hg. Urinalysis shows 2+ proteinuria, but no blood, glucose, or ketones. At 36 weeks, she gives birth to a normal viable but low-birth-weight infant. Her blood pressure returns to normal, and she no longer has proteinuria. Which of the following pathologic findings is most likely to be found on examination of the placenta?

Accepted Answer

Multiple infarcts

Answer

Chorioamnionitis

Answer

Chronic villitis

Answer

Hydropic villi

Question 10

Which of the following is not a marker of seminoma?

Accepted Answer

Alpha fetoprotein

Answer

PLAP

Answer

Beta HCG

Answer

LDH

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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