Reproductive Pathology Practice Questions

Q: Which of the following is NOT true about serous cystadenoma of the ovary?

Multiloculated, sticky, gelatinous fluid. **Explanation:** The correct answer is **D (Multiloculated, sticky, gelatinous fluid)** because this description is characteristic of **Mucinous cystadenoma**, not Serous cystadenoma. 1. **Why Option D is the correct choice (The "False" statement):** Serous cystadenomas are typically filled with thin, straw-colored, watery (serous) fluid. In contrast, mucinous tumors are characterized by thick, viscid, gelatinous material (mucin) and are more frequently multiloculated with multiple small cysts. 2. **Why Options A and B are wrong:** Serous cystadenomas are the most common benign epithelial ovarian tumors. While they are often **unilateral** (approx. 80%), they have a higher propensity for **bilaterality** (approx. 20%) compared to mucinous tumors (only 5% bilateral). Therefore, both unilateral and bilateral presentations are clinically true. 3. **Why Option C is wrong:** Serous tumors (both benign and malignant) are associated with **Psammoma bodies**, which are microscopic, laminated, **concentric calcifications**. These are a classic histopathological hallmark of serous neoplasia. **High-Yield Clinical Pearls for NEET-PG:** * **Most Common:** Serous cystadenoma is the most common benign epithelial tumor of the ovary. * **Psammoma Bodies:** Always associate these with Serous Ovarian Cancer, Papillary Thyroid Cancer, and Meningioma. * **Size:** Mucinous tumors are known for reaching massive sizes, often filling the entire abdominal cavity. * **Risk of Rupture:** Rupture of a mucinous tumor can lead to **Pseudomyxoma Peritonei** (jelly belly). * **Lining:** Serous tumors are lined by ciliated columnar epithelium (resembling the fallopian tube), while mucinous tumors are lined by endocervical-like cells.

Q: Serum alpha-fetoprotein level is elevated in which of the following conditions?

Endodermal sinus tumor. **Explanation:** The correct answer is **Endodermal sinus tumor (Yolk Sac Tumor)**. **1. Why Endodermal Sinus Tumor is correct:** Endodermal sinus tumors are highly aggressive germ cell tumors that histologically recapitulate the extra-embryonic yolk sac. Since the fetal yolk sac is the primary site of **Alpha-Fetoprotein (AFP)** synthesis, these tumors characteristically produce high levels of AFP. This marker is highly specific and sensitive for this condition, making it essential for diagnosis and monitoring treatment response. A classic histological finding is the **Schiller-Duval body**. **2. Analysis of Incorrect Options:** * **A. Dysgerminoma:** This is the most common malignant germ cell tumor. Its characteristic markers are **LDH (Lactate Dehydrogenase)** and sometimes hCG (if syncytiotrophoblast giant cells are present), but never AFP. * **C. Immature Teratoma:** These tumors are composed of tissues from all three germ layers. While they may occasionally show mild elevations of AFP if they contain yolk sac elements, the primary marker associated with neural elements in these tumors is **AFP is usually normal** unless mixed components exist. * **D. Choriocarcinoma:** This tumor arises from trophoblastic tissue and is characterized by extremely high levels of **beta-hCG**. It does not produce AFP. **3. High-Yield Clinical Pearls for NEET-PG:** * **Yolk Sac Tumor:** Most common germ cell tumor in children; AFP is the hallmark marker. * **Mixed Germ Cell Tumors:** If a patient has elevations in both AFP and hCG, suspect a mixed germ cell tumor. * **Summary Table of Markers:** * **Dysgerminoma:** LDH, placental alkaline phosphatase (PLAP). * **Yolk Sac Tumor:** AFP. * **Choriocarcinoma:** beta-hCG. * **Granulosa Cell Tumor:** Inhibin (Sex cord-stromal tumor).

Q: What is the most common germ cell tumor of the ovary?

Teratoma. **Explanation:** Ovarian germ cell tumors (OGCTs) arise from the primordial germ cells of the ovary. Among all ovarian neoplasms, germ cell tumors account for approximately 15–20%. **Why Teratoma is correct:** The **Mature Cystic Teratoma (Dermoid Cyst)** is the most common germ cell tumor of the ovary, accounting for approximately 95% of all OGCTs. It is a benign tumor containing tissues from all three germ layers (ectoderm, mesoderm, and endoderm). It is most frequently diagnosed in women of reproductive age. **Analysis of Incorrect Options:** * **A. Dysgerminoma:** While this is the most common **malignant** germ cell tumor of the ovary, it is far less common than the benign mature cystic teratoma. It is the ovarian counterpart to the testicular seminoma. * **C. Endodermal Sinus Tumor (Yolk Sac Tumor):** This is the second most common malignant germ cell tumor. It is highly aggressive and characterized by elevated **Alpha-Fetoprotein (AFP)** levels and the presence of **Schiller-Duval bodies** on histology. * **D. Clear Cell Tumor:** This is a subtype of **Epithelial Ovarian Cancer**, not a germ cell tumor. It is frequently associated with endometriosis. **NEET-PG High-Yield Pearls:** * **Most common ovarian tumor overall:** Serous cystadenoma (Epithelial). * **Most common malignant germ cell tumor:** Dysgerminoma. * **Tumor Marker for Dysgerminoma:** LDH (Lactate Dehydrogenase). * **Struma Ovarii:** A specialized teratoma composed predominantly of thyroid tissue, which can lead to hyperthyroidism. * **Rokidansky’s Protuberance:** A solid prominence within a dermoid cyst where hair and teeth are often found.

Question 1

A patient presents with breast carcinoma, and investigations reveal involvement of the contralateral breast. What is the likely histological subtype?

Accepted Answer

Lobular carcinoma

Answer

Inflammatory carcinoma

Answer

Colloid carcinoma

Answer

In situ carcinoma

Question 2

Which of the following is NOT true about serous cystadenoma of the ovary?

Accepted Answer

Multiloculated, sticky, gelatinous fluid

Answer

Bilateral

Answer

Unilateral

Answer

Concentric calcification

Question 3

A postmenopausal woman presents with pruritic white lesions on the vulva. A punch biopsy of a representative area is obtained. Which of the following histologic findings is consistent with the diagnosis of Lichen sclerosis?

Accepted Answer

Blunting or loss of rete pegs

Answer

Excessive hyalinization

Answer

Acute inflammatory infiltration

Answer

Increased number of cellular layers in the epidermis

Question 4

A 35-year-old woman presents with a 2.2-cm mass in her left breast. The mass is excised, and histologic sections reveal a tumor composed of a mixture of ducts and cells. The epithelial cells within the ducts are not atypical in appearance. There is a marked increase in the stromal cellularity, but the stromal cells are not atypical in appearance and mitoses are not found. Which of the following is the most likely diagnosis?

Accepted Answer

Benign phyllodes tumor

Answer

Atypical epithelial hyperplasia

Answer

Fibroadenoma

Answer

Malignant phyllodes tumor

Question 5

A patient presents with suspected ovarian tumors. On laparotomy, bilaterally enlarged ovaries with a smooth surface are observed. What is the most likely diagnosis?

Accepted Answer

Krukenberg tumor

Answer

Granulosa cell tumor

Answer

Dysgerminoma

Answer

Primary adenocarcinoma

Question 6

Serum alpha-fetoprotein level is elevated in which of the following conditions?

Accepted Answer

Endodermal sinus tumor

Answer

Dysgerminoma

Answer

Immature teratoma

Answer

Choriocarcinoma

Question 7

What is the most common germ cell tumor of the ovary?

Accepted Answer

Teratoma

Answer

Dysgerminoma

Answer

Endodermal sinus tumor

Answer

Clear cell tumor

Question 8

What is true about endodermal sinus tumors?

Accepted Answer

Increased HCG is seen.

Answer

Schiller-Duval bodies are seen.

Answer

It is a benign tumor.

Answer

It is seen in young individuals.

Question 9

Which of the following is a triple negative breast cancer?

Accepted Answer

Secretory cell cancer

Answer

Colloid Cancer

Answer

Acinic Cell Carcinoma

Answer

Mucinous Carcinoma

Question 10

Biopsy of a persistent exophytic area on the vulva of a 60-year-old woman demonstrates a squamous epithelial lesion. No koilocytes are seen. The lesions show papillary projections composed of disordered squamous epithelium with well-differentiated cells. The basement membrane at the dermal-epidermal junction is focally disrupted by squamous cell groups extending deep into the dermis. Which of the following diagnoses is most accurate?

Accepted Answer

Vulvar squamous cell carcinoma

Answer

Condyloma acuminatum

Answer

Extramammary Paget's disease

Answer

Vulvar intraepithelial neoplasia

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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