Reproductive Pathology Practice Questions

Q: Which of the following histological features characterizes a hydatidiform mole?

Hydropic degeneration of the villous stroma. **Explanation:** The hallmark of a **Hydatidiform Mole** (Gestational Trophoblastic Disease) is the abnormal proliferation of trophoblastic tissue combined with fluid accumulation within the chorionic villi. **1. Why Option B is Correct:** The core pathology involves **hydropic degeneration**, where the villous stroma becomes edematous and swollen due to the accumulation of fluid. This leads to the formation of characteristic "grape-like" vesicles. Microscopically, this is accompanied by a lack of fetal blood vessels (avascular villi) and varying degrees of trophoblastic proliferation. **2. Why the Other Options are Incorrect:** * **Option A:** Hyaline membrane degeneration is typically associated with Respiratory Distress Syndrome (RDS) in neonates or certain chronic inflammatory processes, not molar pregnancies. * **Options C & D:** These are incorrect because **trophoblastic proliferation** (both cytotrophoblasts and syncytiotrophoblasts) is a defining feature of a mole. In a Complete Mole, there is circumferential proliferation of both layers; in a Partial Mole, the proliferation is usually focal and involves mainly the syncytiotrophoblast. **High-Yield NEET-PG Pearls:** * **Complete Mole:** 46 XX (most common), "Snowstorm appearance" on USG, markedly high hCG, no fetal parts, 15-20% risk of malignancy. * **Partial Mole:** 69 XXY (Triploidy), fetal parts present, focal hydropic changes, lower risk of malignancy (<5%). * **Karyotype:** Complete mole is entirely paternal in origin (androgenetic), whereas a partial mole involves one maternal and two paternal sets of chromosomes. * **Diagnosis:** Histopathology remains the gold standard, showing "cistern formation" (central fluid collection in villi).

Q: A 50 year old female presented with a breast mass that was operated and the microscopic examination in given. What is the diagnosis?

Mucinous carcinoma breast. ***Mucinous carcinoma breast*** - The micrograph shows clusters and nests of relatively uniform tumor cells floating in abundant extracellular **mucin**, which is the hallmark of this diagnosis. - This subtype of invasive ductal carcinoma is typically well-differentiated, hormone receptor-positive (**ER/PR positive**), and carries a more favorable prognosis than conventional invasive ductal carcinoma. *Lobular carcinoma breast* - This carcinoma is characterized by small, discohesive tumor cells infiltrating the stroma individually or in a **single-file** or **“Indian file”** pattern, which is not seen here [1]. - A key feature is the loss of **E-cadherin** expression, leading to the discohesive nature of the cells [3]. *Medullary carcinoma* - Histologically, this tumor presents as poorly differentiated cells arranged in solid, **syncytial sheets** with a prominent **lymphoplasmacytic infiltrate** [2]. - The image lacks both the syncytial growth pattern and the dense inflammatory background characteristic of medullary carcinoma [2]. *Phyllodes tumour* - This is a biphasic **fibroepithelial tumor**, characterized by a hypercellular stromal component and an epithelial component arranged in a **leaf-like** (phyllodes) architecture. - The defining feature is the proliferating stroma, whereas the image shows a carcinoma defined by its epithelial cells and extracellular mucin. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 454-455. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 455-456. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1068-1069.

Q: Edematous villi with chromosome XY were found. What will be the diagnosis?

Complete mole. ***Correct: Complete mole*** The finding of **edematous/hydropic villi** with a diploid karyotype (**46,XY**) is characteristic of a **Complete hydatidiform mole**. - A complete mole results from the fertilization of an 'empty' ovum by a single sperm (which duplicates, 46,XX) or two sperm (**46,XY**), leading to no fetal parts and diffuse **trophoblastic proliferation**. *Incorrect: Partial mole* A **Partial mole** is almost always triploid (e.g., **69,XXY** or 69,XXX), resulting from fertilization of a normal ovum by two sperm. - Histologically, it presents with a mixture of **normal and abnormal** (hydropic) villi, focal trophoblastic changes, and often identifiable **fetal parts**. *Incorrect: Cyst* This is a nonspecific term referring to a fluid-filled sac and does not account for the specific histological findings of abnormal **placental tissue** (edematous villi). - The presence of an abnormal **diploid karyotype (XY)** points towards a specific gestational trophoblastic disease rather than a generalized cystic structure. *Incorrect: Ectopic pregnancy* Ectopic pregnancy involves implantation outside the uterine cavity and, if villi are present, they are usually **normal chorionic villi** and not diffusely edematous. - The histological finding of **diffuse edematous villi** accompanied by the specific complete mole karyotype (**46,XY**) excludes a typical ectopic pregnancy.

Q: Histopathological features of granulosa cell tumor include all except:

CA-125 positivity. ***CA-125 positivity*** - **CA-125** is a **serum marker** predominantly associated with **epithelial ovarian cancer** (especially serous carcinoma), not a histopathological feature visible on microscopy. - It is not typically expressed by granulosa cell tumors (GCTs), which are sex cord-stromal tumors that produce **Inhibin** as their characteristic serum marker [1]. - **This is NOT a histopathological feature** but rather a laboratory/serological test, making it the correct answer to this "EXCEPT" question. *Incorrect: Microfollicular pattern* - Granulosa cells arrange themselves in **microfollicular or macrofollicular patterns**, creating small cystic spaces that are a key architectural feature [1]. - This pattern of growth is one of the characteristic **histopathological findings** seen on routine microscopy of adult GCTs. *Incorrect: Coffee bean nuclei* - This describes the characteristic appearance of tumor cell nuclei with **longitudinal grooves or infoldings**, giving them a distinct **'coffee bean'** appearance [1]. - This unique **nuclear morphology** is a classic and essential **histopathological feature** observed on H&E staining for diagnosis of GCT [1]. *Incorrect: Call-Exner bodies* - These are **small rosette-like structures** with central cystic spaces filled with eosinophilic material, formed by granulosa cells arranged in a circular pattern [1]. - Their presence is a **pathognomonic microscopic feature** of adult GCTs and represents follicular differentiation seen in these sex cord-stromal tumors [1]. **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 30-year-old man presents with a painless testicular mass. An ultrasound shows a well-circumscribed, homogeneous, non-hemorrhagic testicular tumor. Which of the following is the most likely diagnosis?

Seminoma. Seminoma - The clinical presentation (painless mass in a 30-year-old) combined with ultrasound findings (well-circumscribed, homogeneous, non-hemorrhagic tumor) strongly favors seminoma, the most common testicular germ cell tumor [1]. - Histologically, seminomas consist of large, clear cells separated by delicate fibrovascular septa infiltrated with lymphocytes, confirming this diagnosis [1]. Yolk sac tumor - This tumor is primarily the most common germ cell malignancy in infants and young children (under 3 years old) [1]. - It is classically associated with significantly elevated serum marker Alpha-fetoprotein (AFP). Choriocarcinoma - This highly aggressive tumor is characterized by significant hemorrhage, necrosis, and cavitation due to vascular invasion, which contradicts the 'non-hemorrhagic' description [2]. - It produces high levels of Human Chorionic Gonadotropin (hCG) due to the presence of syncytiotrophoblasts [1]. Teratoma - Teratomas are typically seen as heterogeneous or complex cystic masses on ultrasound due to the presence of various differentiated tissue elements (e.g., cartilage, bone, fat) [3]. - Pure teratomas are rare in adults; they usually form part of a mixed germ cell tumor [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. 979-982. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 512-513. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 982-983.

Q: 15-year-old girl presents with a big pelvic mass. CT abdomen shows omental thickening and large ovarian mass. For surgical staging, biopsy of the ovarian mass was done. The specimen findings are diagnostic of?

Endodermal sinus tumour. ***Endodermal sinus tumour*** - The image displays characteristic **Schiller-Duval bodies**, which are pathognomonic for endodermal sinus tumors (also known as yolk sac tumors). These structures resemble primitive glomeruli with a central vessel surrounded by tumor cells. - Endodermal sinus tumors are aggressive **germ cell tumors** and are common in adolescent girls, often presenting with a large pelvic mass and elevated **alpha-fetoprotein (AFP)**, correlating with the clinical picture. *Granulosa cell tumour* - Granulosa cell tumors are **sex cord-stromal tumors** and typically present with features of estrogen excess, such as precocious puberty or abnormal uterine bleeding. - Histologically, they are characterized by **Call-Exner bodies**, which are small, gland-like structures containing eosinophilic fluid, not seen in the provided image. *Arrhenoblastoma* - Arrhenoblastomas (Sertoli-Leydig cell tumors) are also **sex cord-stromal tumors** that typically cause virilization due to androgen production. - Histologically, they show cords and tubules composed of Sertoli and Leydig cells, which are distinct from the structures in the image. *Thecoma* - Thecomas are benign **sex cord-stromal tumors** primarily composed of lipid-rich stromal cells, often producing estrogen. - They typically appear as solid, yellow tumors and histologically consist of spindle cells with intracellular lipid droplets, without the complex architectural patterns like Schiller-Duval bodies.

Question 1

Which of the following histological features characterizes a hydatidiform mole?

Accepted Answer

Hydropic degeneration of the villous stroma

Answer

Hyaline membrane degeneration

Answer

Non-proliferation of cytotrophoblasts

Answer

Non-proliferation of syncytiotrophoblasts

Question 2

A 23-year-old woman presents with a rubbery, freely movable 2-cm mass in the upper outer quadrant of the left breast. A biopsy of this lesion would most likely histologically reveal?

Accepted Answer

A mixture of fibrous tissue and ducts

Answer

Large numbers of neutrophils

Answer

Large numbers of plasma cells

Answer

Necrotic fat surrounded by lipid-laden macrophages

Question 3

A 25-year-old woman presents with lower abdominal discomfort. The surgical image is given below. What is the most likely diagnosis?

Accepted Answer

Mature cystic teratoma

Answer

Immature teratoma

Answer

Endometrioma

Answer

Serous cystadenoma

Question 4

A 30-year-old female presents to the OPD with a 3 cm breast lump in the upper medial quadrant. The lump has an uneven, bosselated surface, and the overlying skin is mildly ulcerated. Microscopic examination reveals the given findings. What is the most likely diagnosis?

Accepted Answer

Phyllodes tumor

Answer

Fibroadenoma

Answer

Paget's disease

Answer

Galactocele

Question 5

A 50 year old female presented with a breast mass that was operated and the microscopic examination in given. What is the diagnosis?

Accepted Answer

Mucinous carcinoma breast

Answer

Medullary carcinoma

Answer

Lobular carcinoma breast

Answer

Phyllodes tumour

Question 6

Edematous villi with chromosome XY were found. What will be the diagnosis?

Accepted Answer

Complete mole

Answer

Ectopic pregnancy

Answer

Partial mole

Answer

Cyst

Question 7

A biopsy from a breast mass in a 55-year-old woman shows infiltrating ductal carcinoma. Immunohistochemistry reveals ER negative, PR negative, and HER2/neu negative. What is the classification of this tumor?

Accepted Answer

Triple-negative breast cancer

Answer

HER2-enriched subtype

Answer

Luminal B subtype

Answer

Luminal A subtype

Question 8

Histopathological features of granulosa cell tumor include all except:

Accepted Answer

CA-125 positivity

Answer

Microfollicular pattern

Answer

Coffee bean nuclei

Answer

Call-Exner bodies

Question 9

A 30-year-old man presents with a painless testicular mass. An ultrasound shows a well-circumscribed, homogeneous, non-hemorrhagic testicular tumor. Which of the following is the most likely diagnosis?

Accepted Answer

Seminoma

Answer

Yolk sac tumor

Answer

Choriocarcinoma

Answer

Teratoma

Question 10

15-year-old girl presents with a big pelvic mass. CT abdomen shows omental thickening and large ovarian mass. For surgical staging, biopsy of the ovarian mass was done. The specimen findings are diagnostic of?

Accepted Answer

Endodermal sinus tumour

Answer

Granulosa cell tumour

Answer

Arrhenoblastoma

Answer

Thecoma

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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