Reproductive Pathology Practice Questions

Q: All of the following are germ cell tumors EXCEPT:

Clear cell tumor. **Explanation:** The classification of ovarian tumors is based on the cell of origin. Ovarian tumors are broadly divided into three categories: **Surface Epithelial-Stromal tumors**, **Germ Cell tumors**, and **Sex Cord-Stromal tumors**. **Why Clear Cell Tumor is the correct answer:** **Clear cell tumor** belongs to the **Surface Epithelial** category (along with serous, mucinous, and endometrioid tumors). It is derived from the ovarian surface epithelium or associated endometriosis. It is notably associated with endometriosis and hypercalcemia. **Why the other options are Germ Cell Tumors (GCTs):** Germ cell tumors arise from the primordial germ cells of the ovary. * **Dysgerminoma:** The most common malignant GCT; it is the female counterpart of the testicular seminoma. * **Choriocarcinoma:** A non-gestational GCT that secretes high levels of hCG. * **Teratoma:** The most common GCT overall, categorized into mature (benign/dermoid cyst), immature (malignant), and monodermal (e.g., Struma ovarii). **NEET-PG High-Yield Pearls:** * **Most common ovarian tumor overall:** Serous cystadenoma (Epithelial). * **Most common ovarian tumor in young girls/adolescents:** Germ cell tumors (specifically Dermoid cyst). * **Tumor Markers:** * Dysgerminoma: **LDH**, placental alkaline phosphatase (PLAP). * Yolk Sac Tumor: **Alpha-fetoprotein (AFP)** (Schiller-Duval bodies are pathognomonic). * Choriocarcinoma: **beta-hCG**. * **Clear Cell Carcinoma:** Associated with **Endometriosis** and carries the worst prognosis among epithelial ovarian cancers if diagnosed at advanced stages.

Q: A 45-year-old female underwent hysterectomy for dysfunctional uterine bleeding. Following are the gross and histological findings. Which of the following is the most likely diagnosis?

Leiomyoma. ***Leiomyoma*** - The **well-circumscribed whorled white-gray mass** with **interlacing bland smooth muscle bundles** and **cigar-shaped nuclei** are classic features of leiomyoma. - **Absence of atypia** and **low mitotic rate** (<10 mitoses/10 HPF) distinguish it from malignant smooth muscle tumors. *Leiomyosarcoma* - Would show **significant nuclear atypia**, **coagulative necrosis**, and **high mitotic rate** (≥10 mitoses/10 HPF). - Often presents as a **poorly circumscribed mass** with irregular borders, unlike the well-demarcated nature described. *Mixed Mullerian tumor* - Contains **biphasic components** with both **epithelial** and **mesenchymal** elements, not pure smooth muscle. - Shows **high-grade malignant features** with significant pleomorphism and mitotic activity. *Vaginal carcinoma* - Represents **squamous** or **glandular malignancy** arising from the **vaginal wall**, not uterine myometrium. - Would not present as a **myometrial mass** removed during hysterectomy for dysfunctional uterine bleeding.

Q: Which of the following ovarian neoplasms shows Rokitansky's protuberance?

Dermoid cyst. ### Explanation **Correct Answer: C. Dermoid cyst** **Why it is correct:** A **Dermoid cyst** (Mature Cystic Teratoma) is a germ cell tumor containing tissues from all three germ layers (ectoderm, mesoderm, and endoderm). The **Rokitansky protuberance** (also known as the *dermoid plug*) is a focal solid projection arising from the inner wall of the cyst. This protuberance is a high-yield diagnostic feature as it typically contains the most diverse tissues, such as hair follicles, sebaceous glands, bone, or even rudimentary teeth. On imaging (USG/CT), it appears as a solid nodule within the fluid-filled cyst. **Why the other options are incorrect:** * **A. Androblastoma (Sertoli-Leydig Cell Tumor):** This is a sex cord-stromal tumor that produces androgens. It is typically solid and does not feature the cystic architecture or the specific protuberance seen in teratomas. * **B. Mucinous cystadenoma:** These are large, multiloculated cysts filled with thick, gelatinous mucoid material. They lack the solid, tissue-rich "plug" characteristic of dermoids. * **D. Papillary serous cystadenoma:** While these may show "papillary projections," these are distinct from Rokitansky’s protuberance. Serous tumors are characterized by Psammoma bodies and thin, watery fluid. **NEET-PG High-Yield Pearls:** * **Most common ovarian tumor in young women:** Dermoid cyst. * **Most common complication:** Torsion (due to high fat content making it buoyant). * **Malignant transformation:** Occurs in <2% of cases, most commonly into **Squamous Cell Carcinoma** (usually arising from the Rokitansky protuberance). * **Radiological Sign:** "Tip of the iceberg" sign on ultrasound (due to acoustic shadowing from hair/sebum).

Question 1

Which among the following are testicular tumor markers?

Accepted Answer

b-hCG, AFP, and LDH are true markers, while CA-125 and CEA are false.

Answer

b-hCG, AFP, and LDH are false markers, while CA-125 and CEA are true.

Answer

b-hCG, AFP, and CEA are false markers, while LDH and CA-125 are true.

Answer

b-hCG, AFP, and CEA are true markers, while LDH and CA-125 are false.

Question 2

Which of the following is associated with Paget's disease of the mammary gland?

Accepted Answer

CEA

Answer

S-100

Answer

HMB 45

Answer

Neuron specific enolase

Question 3

A 20-year-old female was diagnosed with granulosa cell tumor of the ovary. Which of the following biomarkers would be most useful for diagnosis and follow-up of the patient?

Accepted Answer

Inhibin

Answer

Neuron-specific enolase

Answer

CA 19-9

Answer

CA 50

Question 4

All of the following are germ cell tumors EXCEPT:

Accepted Answer

Clear cell tumor

Answer

Dysgerminoma

Answer

Choriocarcinoma

Answer

Teratoma

Question 5

A 45-year-old female underwent hysterectomy for dysfunctional uterine bleeding. Following are the gross and histological findings. Which of the following is the most likely diagnosis?

Accepted Answer

Leiomyoma

Answer

Leiomyosarcoma

Answer

Mixed Mullerian tumor

Answer

Vaginal carcinoma

Question 6

Which of the following ovarian neoplasms shows Rokitansky's protuberance?

Accepted Answer

Dermoid cyst

Answer

Androblastoma

Answer

Mucinous cystadenoma

Answer

Papillary serous cystadenoma

Question 7

Corpora amylacea are microscopic structures found in which of the following glands?

Accepted Answer

Prostate gland

Answer

Parotid gland

Answer

Pineal gland

Answer

Pituitary gland

Question 8

A patient with a long-standing intrauterine contraceptive device (IUCD) develops chronic pelvic pain. The device is removed, and a biopsy of the endometrium is performed. The biopsy specimen shows a prominent infiltrate composed of lymphocytes, plasma cells, and histiocytes. Which of the following is the most likely diagnosis?

Accepted Answer

Chronic endometritis

Answer

Acute endometritis

Answer

Adenomyosis

Answer

Endometriosis

Question 9

What is the most important prognostic factor in breast carcinoma?

Accepted Answer

Stage of the tumour at the time of diagnosis

Answer

Histological grade of the tumour

Answer

Status of estrogen and progesterone receptors

Answer

Overexpression of p53 tumor suppressor gene

Question 10

A 49-year-old female presented with postmenopausal bleeding and a uterine cavity growth on sonography. During surgery, the growth is large, multicystic, and exceeds 10 cm in diameter. Granulosa cell tumor is suspected. What characteristic histological finding helps distinguish granulosa cell tumor from other uterine tumors?

Accepted Answer

Call-Exner bodies

Answer

Asbestos bodies

Answer

Amyloid bodies

Answer

None of the above

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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