Reproductive Pathology Practice Questions

Q: A glomerulus-like structure composed of a central blood vessel enveloped by germ cells within a space lined by germ cells, is seen in which of the following?

Endodermal sinus tumor. **Explanation:** The structure described in the question is a **Schiller-Duval body**, which is the pathognomonic histological hallmark of an **Endodermal Sinus Tumor (Yolk Sac Tumor)**. **1. Why the Correct Answer is Right:** A Schiller-Duval body consists of a central capillary (blood vessel) surrounded by a layer of neoplastic germ cells, all situated within a space lined by a single layer of flattened or cuboidal cells [1]. This "glomerulus-like" appearance mimics the primitive gut or yolk sac structures. These tumors also characteristically show **alpha-fetoprotein (AFP)** positivity and the presence of eosinophilic, PAS-positive hyaline droplets [1]. **2. Why the Other Options are Wrong:** * **Sertoli-Leydig cell tumor:** Characterized by tubules lined by Sertoli cells and clusters of interstitial Leydig cells (Reinke crystals may be present). * **Granulosa cell tumor:** Known for **Call-Exner bodies**, which are small, follicle-like spaces filled with eosinophilic material and surrounded by granulosa cells with "coffee-bean" nuclei. * **Sex cord tumor with annular tubules (SCTAT):** Features ring-shaped tubules surrounding hyaline bodies; it is strongly associated with Peutz-Jeghers syndrome. **3. High-Yield Clinical Pearls for NEET-PG:** * **Yolk Sac Tumor:** Most common germ cell tumor in children; highly malignant but chemo-sensitive [1]. * **Tumor Marker:** Elevated **Serum AFP** is essential for diagnosis and monitoring recurrence [1]. * **Histology Keyword:** "Schiller-Duval bodies" = Yolk Sac Tumor. * **Age Group:** Typically affects young women (ovary) or young children (testis) [1]. **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: Krukenberg adenocarcinoma of the ovary can occur as a result of metastases from all the following primary sites except:

Liver. **Explanation:** A **Krukenberg tumor** is a metastatic signet-ring cell adenocarcinoma of the ovary. The hallmark of this condition is the presence of mucin-secreting "signet-ring cells" within a cellular stroma derived from the ovarian medulla. **Why Liver is the Correct Answer:** The liver is not a primary site for Krukenberg tumors. While the liver is a common site for metastasis *from* GI cancers, it does not typically metastasize *to* the ovary in the form of a Krukenberg tumor. Metastatic spread to the ovaries usually occurs via retrograde lymphatic spread or transcoelomic seeding from organs with mucosal surfaces. **Analysis of Incorrect Options:** * **Stomach (Option A):** This is the **most common** primary site (approx. 70%). Gastric adenocarcinoma (diffuse type) frequently spreads to the ovaries [1]. * **Breast (Option B):** Lobular carcinoma of the breast is a well-documented primary source for Krukenberg tumors, often presenting bilaterally. * **Pancreas (Option D):** Along with the colon, gallbladder, and appendix, the pancreas is a recognized primary site for these metastatic lesions. **NEET-PG High-Yield Pearls:** 1. **Bilateralism:** 80% of Krukenberg tumors are bilateral, whereas primary ovarian surface epithelial tumors are more often unilateral. 2. **Microscopy:** Look for the **Signet-ring cell**—the nucleus is pushed to the periphery by a large cytoplasmic mucin vacuole (PAS positive) [1]. 3. **Primary vs. Secondary:** If a tumor is bilateral and composed of signet-ring cells, always look for a primary in the stomach (via endoscopy). 4. **Spread:** The most accepted mechanism of spread is **retrograde lymphatic drainage**, not just transcoelomic seeding. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 779.

Question 1

A 35-year-old woman who underwent a modified radical mastectomy of her right breast 2 years ago for infiltrating ductal carcinoma presents with enlargement of her right breast. The breast has a swollen, red-discolored appearance, is diffusely indurated and tender on palpation, and has multiple palpable axillary lymph nodes in the lower axilla. The working clinical diagnosis is inflammatory carcinoma. Microscopic sections from this red, indurated area are most likely to reveal?

Accepted Answer

Extensive invasion of dermal lymphatics

Answer

Duct ectasia with numerous plasma cells

Answer

Infiltrating malignant ducts surrounded by numerous neutrophils

Answer

Malignant vascular tumor forming slitlike spaces

Question 2

A 13-year-old male presents with bilateral enlargement of his breasts. Physical exam is otherwise unremarkable, and the breast enlargement is thought to be a normal variation at puberty. What would histologic sections of breast tissue most likely reveal?

Accepted Answer

Proliferation of ducts in hyalinized fibrous tissue with periductal edema

Answer

Atrophic ductal structures with increased numbers of lipocytes

Answer

Dilated ducts filled with granular, necrotic, acidophilic debris

Answer

Granulomatous inflammation surrounding ducts with numerous plasma cells

Question 3

Which type of uterine cancer has a histological appearance that resembles epithelial ovarian cancer?

Accepted Answer

Uterine papillary serous carcinoma

Answer

Clear cell carcinoma

Answer

Endometroid adenocarcinoma

Answer

Mucinous carcinoma

Question 4

What is the normal range for Prostate-Specific Antigen (PSA)?

Accepted Answer

< 4 ng/mL

Answer

4-10 ng/mL

Answer

10-20 ng/mL

Answer

> 20 ng/mL

Question 5

Which of the following statements is true about seminoma of the testis?

Accepted Answer

It commonly occurs in the 6th decade.

Answer

An undescended testis is more liable to develop this tumor.

Answer

Histologically, it resembles dysgerminoma of the ovary.

Answer

It is radioresistant.

Question 6

A glomerulus-like structure composed of a central blood vessel enveloped by germ cells within a space lined by germ cells, is seen in which of the following?

Accepted Answer

Endodermal sinus tumor

Answer

Sertoli-Leydig cell tumor

Answer

Granulosa cell tumor

Answer

Sex cord tumor with annular tubules

Question 7

Krukenberg adenocarcinoma of the ovary can occur as a result of metastases from all the following primary sites except:

Accepted Answer

Liver

Answer

Stomach

Answer

Breast

Answer

Pancreas

Question 8

All of the following clinicopathologic features are seen more often in seminomas as compared to non-seminomatous germ cell tumors of the testis except?

Accepted Answer

They are often associated with raised levels of serum AFP and HCG

Answer

Tumors remain localized to testis for a long time

Answer

They are radiosensitive

Answer

They metastasize predominantly by lymphatics

Question 9

Which of the following statements about the Gleason score is NOT true?

Accepted Answer

It is the most important prognostic factor.

Answer

It is used for grading prostatic carcinoma.

Answer

The maximum score is 10.

Answer

The minimum score is 2.

Question 10

Which of the following statements is not true regarding gene mutations associated with breast carcinoma?

Accepted Answer

BRCA1 mutations are present in the majority of breast carcinoma cases.

Answer

The most common mutation in inherited breast carcinoma is BRCA1.

Answer

Inherited breast carcinomas account for approximately 3% of all breast cancer cases.

Answer

Mutations in the p53 gene are also associated with an increased risk of colon and brain cancers.

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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