Reproductive Pathology Practice Questions

Q: A 50-year-old lady developed ascites. CT abdomen showed bilateral ovarian masses which were resected. The histopathological slide from the mass is shown below. What is the diagnosis?

Krukenberg tumour. ***Krukenberg tumour*** - The presence of **bilateral ovarian masses** and **ascites** in a 50-year-old lady, along with the typical histopathological appearance of **signet ring cells** (which would be implied by the image), is highly characteristic of a Krukenberg tumour. - Krukenberg tumours are **metastatic adenocarcinomas** to the ovary, most commonly originating from the stomach, colon, or breast, and are known for their bilateral presentation and mucin-filled signet ring cells. *Dysgerminoma* - Dysgerminomas are **germ cell tumours** that typically affect younger women and are often unilateral [1]. - Histologically, they are characterized by large, polygonal cells with clear cytoplasm and prominent nucleoli, arranged in nests or cords separated by fibrous septa infiltrated by lymphocytes, which is different from signet ring cells. *Serous cystadenoma* - Serous cystadenomas are **benign epithelial ovarian tumours** that are typically unilateral and cystic, filled with clear, watery fluid. - Histologically, they show a single layer of cuboidal or columnar epithelial cells lining the cyst, lacking the solid appearance and signet ring cells seen in Krukenberg tumours. *Granulosa cell tumour* - Granulosa cell tumours are **sex cord-stromal tumours** that are often unilateral and can produce estrogen, leading to symptoms like abnormal uterine bleeding [2]. - Histologically, they are characterized by Call-Exner bodies (small, fluid-filled spaces between granulosa cells) and coffee-bean nuclei, which are distinct from the signet ring cells of a Krukenberg tumour. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1034-1035. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 481-482.

Q: A 6-year-old girl with precocious puberty was found to have an ovarian tumour, which was resected laparoscopically. Histopathological slides were prepared. What is the diagnosis?

Granulosa cell tumour. ***Granulosa cell tumour*** - Granulosa cell tumours are the most common **estrogen-producing ovarian tumours** in children, leading to **precocious puberty** [2]. - Histologically, they often show **Call-Exner bodies** and a coffee-bean nuclear groove. - These tumors can occur at any age and all cases are potentially malignant [2]. *Arrhenoblastoma* - Arrhenoblastomas are **androgen-producing tumours** that cause **virilization** (e.g., hirsutism, clitoromegaly), not precocious puberty [3]. - They are typically composed of Sertoli and Leydig cells. *Endodermal sinus tumour* - Endodermal sinus tumours (yolk sac tumours) are **germ cell tumours** that produce **alpha-fetoprotein (AFP)**. - They are highly malignant and do not typically cause precocious puberty. *Thecoma* - Thecomas are benign ovarian tumours that can produce **estrogen**, but they are **less common** than granulosa cell tumours as a cause of precocious puberty in this age group [2]. - They are composed primarily of lipid-laden spindle cells [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1036-1037. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 481-482. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1037-1038.

Q: This appearance of mammary skin is due to:

Lymphatic penetration. ***Lymphatic penetration*** - The image illustrates **peau d'orange**, a classic sign of **inflammatory breast cancer**, caused by tumor cells blocking lymphatic drainage in the skin of the breast [1]. - This blockage leads to **edema** and accentuation of hair follicles, creating an orange peel-like appearance [1]. *Intra-epithelial cancer* - **Intra-epithelial cancer** (e.g., Paget disease of the nipple) primarily affects the epidermis and presents as a scaly, eczematous rash, not the diffuse skin thickening and pitting seen here [2]. - While it can be associated with an underlying invasive cancer, the visual presentation in the image is not typical for a purely intra-epithelial process [2]. *Sub-epidermal cancer* - **Sub-epidermal cancer** refers to malignancies located beneath the epidermis, often presenting as a palpable mass or nodule [1]. - It would not typically cause the widespread **skin edema** and **lymphatic obstruction** characteristic of peau d'orange, which affects a broader area of the skin due to involvement of dermal lymphatics [1]. *Vascular embolization* - **Vascular embolization** involves the blockage of blood vessels, which can lead to ischemia, necrosis, or localized discoloration. - It does not explain the characteristic **lymphatic obstruction** and **edema** that causes the peau d'orange appearance in the mammary skin [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 453-454. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1061-1062.

Q: A 24 -year-old male patient with undescended testis has a lump in the groin since birth which was increasing since last 6 months. The resected specimen is shown below. All are correct about the condition except:

Does not invade the tunica. ***Does not invade the tunica*** - This statement is incorrect. **Seminomas**, which are common in undescended testes, often **invade the tunica albuginea** and rete testis. - Invasion of the tunica is a common feature of testicular germ cell tumors, including seminoma, and is an important prognostic factor. *Tumor maintains the testis contour* - **Seminomas** typically grow as a large, homogeneous mass that can **replace the testicular parenchyma** but often maintains the overall contour of the testis. - The tumor expands within the tunica albuginea, leading to an enlarged but often still ovoid shape of the testis. *Necrosis commonly starts from center of tumor* - **Necrosis** is a common feature in larger **seminomas**, and it typically starts in the **center of the tumor** due to inadequate blood supply as the tumor outgrows its vascularization. - This central necrosis can lead to cystic degeneration within the tumor. *PAS positive tumor cells in sheets* - **Seminoma cells** are typically rich in **glycogen**, which stains **PAS (Periodic Acid-Schiff) positive** [1]. - These cells are characteristically arranged in **sheets or lobules** separated by delicate fibrovascular septa, often with a prominent lymphocytic infiltrate [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. 980-982.

Q: Name the cell shown in the Pap smear image.

Koilocyte. ***Koilocyte*** - A **koilocyte** is a squamous epithelial cell that has undergone a series of structural changes, indicative of **human papillomavirus (HPV) infection** [1][2]. - Key features include a **perinuclear halo** (a clear zone around the nucleus), a **hyperchromatic nucleus** (darkly stained nucleus), and often a slightly irregular nuclear membrane [1][2]. *Superficial cells* - These are mature squamous cells with a **small, pyknotic nucleus** (dense and dark) and abundant, transparent cytoplasm [1]. - They are typically seen in the later stages of the menstrual cycle and do not show the characteristic perinuclear halo of koilocytes. *Intermediate cells* - These are polygonal or oval-shaped squamous cells with a **larger, vesicular nucleus** (less dense) than superficial cells and a moderate amount of cytoplasm. - They are common throughout the menstrual cycle but lack the specific nuclear and cytoplasmic changes associated with HPV infection. *Trichomonas infection* - While **Trichomonas vaginalis** can be identified in a Pap smear, it appears as pear-shaped flagellated protozoa, often associated with a "dirty" background due to inflammatory cells and cellular debris. - It does not present as a specific cell type like a koilocyte, but rather as an infectious agent. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, p. 1010. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1008-1010.

Q: The following is the picture of the pap smear of a 45-year-old female with left ovarian tumor in her late menstrual phase showing squamous cells. What is the likely histology of the tumor?

Granulosa cell tumor. ***Granulosa cell tumor*** - The Pap smear shows **mature squamous cells with abundant cytoplasm and small nuclei**, indicating a significant **estrogenic effect**. This is consistent with an ovarian tumor that produces estrogen, such as a granulosa cell tumor. - Granulosa cell tumors are **sex cord-stromal tumors** known for their **estrogen production**, leading to endometrial hyperplasia, irregular bleeding, and cytologic changes reflecting hyperestrogenism. *Dysgerminoma* - Dysgerminomas are **germ cell tumors** of the ovary that typically do **not produce hormones** (estrogen or progesterone) in quantities sufficient to cause significant squamous cell maturation or hyperplasia on a Pap smear. - These tumors are often associated with elevated tumor markers like **lactate dehydrogenase (LDH)**, but do not directly influence squamous cell morphology in this manner. *Serous papillary carcinoma* - Serous papillary carcinomas are **epithelial ovarian tumors**, which are common, but primarily present with non-specific symptoms or symptoms related to mass effect or ascites. - These tumors are not typically associated with **estrogen production** that would lead to the widespread maturation of squamous cells seen in the Pap smear. *Mucinous adenocarcinoma* - Mucinous adenocarcinomas are another type of **epithelial ovarian tumor** known for producing mucus. - They also do **not typically produce hormones** in a way that would lead to the hyperestrogenic effect observed in the Pap smear, characterized by mature squamous cells with abundant cytoplasm.

Q: The following is a post-orchidectomy histopathological specimen. Diagnosis is:

Seminoma. ***Seminoma*** - The image shows a **monotonous population of large, clear cells** with prominent nucleoli and distinct cell borders, arranged in lobules separated by fibrous septa with **lymphocytic infiltration** [1]. - This classic histological appearance, along with the presence of **syncytiotrophoblasts** (though not explicitly mentioned as a key feature for diagnosis from this image alone, it can be seen in some seminomas), is characteristic of **seminoma**, the most common germ cell tumor of the testis [1]. *Teratoma* - Teratomas are characterized by the presence of **multiple germ layers** (ectoderm, mesoderm, endoderm) with various differentiated tissues like cartilage, bone, neural tissue, or glandular structures [1]. - The image does not show the **heterogeneous tissue differentiation** typical of a teratoma. *Lymphoma* - Testicular lymphoma typically presents with a **diffuse infiltrate of atypical lymphoid cells**, often with a high mitotic rate, and lacks the clear cell appearance and fibrous septa seen in the image. - It is more common in **older men** and can be bilateral, unlike the typical presentation of seminoma. *Yolk sac tumor* - Yolk sac tumors (endodermal sinus tumors) are characterized by various architectural patterns, including **reticular, microcystic, solid, and papillary**, often with **Schiller-Duval bodies** (glomeruloid structures) [1]. - The image does not display these specific patterns or the characteristic Schiller-Duval bodies. **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.

Q: Hysterectomy specimen from a 40-year-old lady is shown along with histology slide. The diagnosis is:

Leiomyoma. ***Leiomyoma*** - Leiomyomas are **benign smooth muscle tumors** of the uterus, characterized by well-demarcated, whorled, and firm cut surfaces [1]. - Histologically, they show bundles of **smooth muscle cells** arranged in fascicles, with minimal atypia and low mitotic activity [1]. *Carcinoma endometrium* - Endometrial carcinoma typically presents as an **irregular, friable mass** originating from the endometrial lining, often with areas of necrosis or hemorrhage. - Histologically, it shows **glandular proliferation** with architectural complexity, nuclear atypia, and often invasion into the myometrium [2]. *Leiomyosarcoma* - Leiomyosarcomas are **malignant smooth muscle tumors** that are often poorly circumscribed, with areas of hemorrhage and necrosis [1]. - Histologically, they exhibit significant **nuclear atypia**, high mitotic activity (often >10 mitoses/10 HPF), and atypical mitoses [1]. *Endometriosis* - Endometriosis involves the presence of **endometrial glands and stroma outside the uterus**, often forming "chocolate cysts" in the ovaries or implants on peritoneal surfaces. - Histology would reveal **endometrial glands and stroma** surrounded by hemosiderin-laden macrophages, not a smooth muscle tumor. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1024-1025. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1020-1021.

Q: Which of the following are poor prognostic factors in endometrial adenocarcinoma? I. Estrogen and progesterone receptor positivity II. HER-2/neu gene expression III. Histologic types papillary serous or clear cell carcinoma IV. Aneuploid tumours Select the correct answer using the code given below :

II, III and IV. ***II, III and IV*** - **HER-2/neu gene expression**, **papillary serous or clear cell histologic types**, and **aneuploid tumors** are all associated with a more aggressive disease course and worse outcomes in endometrial adenocarcinoma [1]. - These factors indicate less differentiated and often more resistant cancer, leading to higher recurrence rates and lower survival [1]. *I, III and IV* - This option incorrectly includes **estrogen and progesterone receptor positivity** as a poor prognostic factor, which is actually a favorable prognostic indicator. - **HER-2/neu gene expression** is a significant poor prognostic factor but is excluded from this option. *I, II and IV* - This option incorrectly includes **estrogen and progesterone receptor positivity** as a poor prognostic factor. - It also incorrectly excludes **histologic types papillary serous or clear cell carcinoma**, which are well-established poor prognostic factors [1]. *I, II and III* - This option incorrectly lists **estrogen and progesterone receptor positivity** as a poor prognostic factor. - It also incorrectly excludes **aneuploid tumors**, which are recognized indicators of poor prognosis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1017-1024.

Q: 'Schiller-Duval body' is a characteristic histological feature of which one of the following cancers?

Endodermal sinus tumour. ***Endodermal sinus tumour*** - **Schiller-Duval bodies** are pathognomonic histological structures found in **endodermal sinus tumours** (also known as yolk sac tumours). - These structures mimic the primitive glomerulus, consisting of a central capillary surrounded by tumour cells within a cyst-like space. *Non-gestational ovarian choriocarcinoma* - Characterized by the presence of **syncytiotrophoblast** and **cytotrophoblast** cells, often arranged in bilaminar structures [2]. - While it can produce **human chorionic gonadotropin (hCG)**, it does not typically feature Schiller-Duval bodies [2], [3]. *Dysgerminoma* - Composed of large, rounded, uniform cells with clear cytoplasm and prominent nuclei, often arranged in cords or nests separated by fibrous septa infiltrated by **lymphocytes**. - This tumour is analogous to testicular seminoma and does not contain Schiller-Duval bodies. *Sex cord stromal tumours* - A diverse group of tumours, including **granulosa cell tumours** and **Sertoli-Leydig cell tumours**, which originate from the ovarian stroma or sex cords [1]. - Histological features vary widely but generally involve granulosa cells, theca cells, Sertoli cells, or Leydig cells, and do not include Schiller-Duval bodies [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1037-1038. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, p. 982. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1035-1036.

Question 1

A 50-year-old lady developed ascites. CT abdomen showed bilateral ovarian masses which were resected. The histopathological slide from the mass is shown below. What is the diagnosis?

Accepted Answer

Krukenberg tumour

Answer

Dysgerminoma

Answer

Serous cystadenoma

Answer

Granulosa cell tumour

Question 2

A 6-year-old girl with precocious puberty was found to have an ovarian tumour, which was resected laparoscopically. Histopathological slides were prepared. What is the diagnosis?

Accepted Answer

Granulosa cell tumour

Answer

Arrhenoblastoma

Answer

Endodermal sinus tumour

Answer

Thecoma

Question 3

This appearance of mammary skin is due to:

Accepted Answer

Lymphatic penetration

Answer

Intra-epithelial cancer

Answer

Sub-epidermal cancer

Answer

Vascular embolization

Question 4

A 24 -year-old male patient with undescended testis has a lump in the groin since birth which was increasing since last 6 months. The resected specimen is shown below. All are correct about the condition except:

Accepted Answer

Does not invade the tunica

Answer

Tumor maintains the testis contour

Answer

Necrosis commonly starts from center of tumor

Answer

PAS positive tumor cells in sheets

Question 5

Name the cell shown in the Pap smear image.

Accepted Answer

Koilocyte

Answer

Superficial cells

Answer

Intermediate cells

Answer

Trichomonas infection

Question 6

The following is the picture of the pap smear of a 45-year-old female with left ovarian tumor in her late menstrual phase showing squamous cells. What is the likely histology of the tumor?

Accepted Answer

Granulosa cell tumor

Answer

Dysgerminoma

Answer

Serous papillary carcinoma

Answer

Mucinous adenocarcinoma

Question 7

The following is a post-orchidectomy histopathological specimen. Diagnosis is:

Accepted Answer

Seminoma

Answer

Teratoma

Answer

Lymphoma

Answer

Yolk sac tumor

Question 8

Hysterectomy specimen from a 40-year-old lady is shown along with histology slide. The diagnosis is:

Accepted Answer

Leiomyoma

Answer

Carcinoma endometrium

Answer

Leiomyosarcoma

Answer

Endometriosis

Question 9

Which of the following are poor prognostic factors in endometrial adenocarcinoma?
I. Estrogen and progesterone receptor positivity
II. HER-2/neu gene expression
III. Histologic types papillary serous or clear cell carcinoma
IV. Aneuploid tumours

Select the correct answer using the code given below :

Accepted Answer

II, III and IV

Answer

I, III and IV

Answer

I, II and IV

Answer

I, II and III

Question 10

'Schiller-Duval body' is a characteristic histological feature of which one of the following cancers?

Accepted Answer

Endodermal sinus tumour

Answer

Non-gestational ovarian choriocarcinoma

Answer

Dysgerminoma

Answer

Sex cord stromal tumours

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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