Reproductive Pathology Practice Questions

Q: Most common benign breast tumour:

Fibroadenoma. ***Fibroadenoma*** - **Fibroadenomas** are the **most common benign breast tumors**, typically presenting as mobile, firm, and non-tender masses [1]. - They are composed of both **glandular and stromal tissue** and are more prevalent in younger women [1]. *Phyllodes tumour* - **Phyllodes tumors** are much **rarer** than fibroadenomas and can be benign, borderline, or malignant [3]. - They tend to grow **rapidly** and are characterized by a leaf-like stromal pattern [3]. *Fibroadenosis* - **Fibroadenosis** (or fibrocystic changes) refers to a collection of **benign changes** in the breast tissue, including cysts, fibrosis, and epithelial hyperplasia, rather than a single tumor [2]. - It is a common condition causing lumpy and painful breasts, especially before menstruation [4]. *DCIS* - **Ductal Carcinoma In Situ (DCIS)** is a **non-invasive form of breast cancer** where abnormal cells are confined to the milk ducts. - It is not a benign tumor and carries a risk of progression to invasive breast cancer. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 448-449. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 445-446. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1074. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1052.

Q: Germ cell tumour not seen in males:

Sertoli cell tumour. ***Correct: Sertoli cell tumour*** - Sertoli cell tumours are **sex cord-stromal tumours**, NOT germ cell tumours - They arise from specialized supporting cells in the testes (Sertoli cells) that normally nurture developing germ cells - These tumours produce hormones (estrogen, inhibin) and are distinct from germ cell neoplasias - Account for <1% of testicular tumours *Incorrect: Seminoma* - Seminoma IS a germ cell tumour - the **most common type** in males (40-50% of testicular germ cell tumours) [1] - Originates from malignant germ cells in the testes [1] - Characterized by uniform cells, lymphocytic infiltrate, and excellent prognosis with radiation sensitivity [3] *Incorrect: Choriocarcinoma* - Choriocarcinoma IS a highly aggressive **germ cell tumour** that occurs in males (testicular origin) [1] - Produces **human chorionic gonadotropin (hCG)** - important tumor marker [2] - Can occur as pure choriocarcinoma or as part of mixed germ cell tumour [2] - Characterized by syncytiotrophoblast and cytotrophoblast cells [2] *Incorrect: Teratoma* - Teratoma IS a germ cell tumour composed of tissues from all three embryonic germ layers (ectoderm, mesoderm, endoderm) [1] - Common in males (testicular teratoma) - can be mature or immature [1] - In adult males, even mature teratomas have malignant potential unlike in children [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. [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 Lower Urinary Tract and Male Genital System, pp. 980-982.

Q: An 18-year-old woman presents for follow-up of an abnormal Pap smear that revealed an abnormality suggestive of HPV infection. Which of the following was the likely cytopathologic finding?

Koilocytes. ***Koilocytes*** - **Koilocytes** are **pathognomonic cellular changes** indicative of **HPV infection** on a Pap smear [1], [2] - These cells are characterized by an **enlarged nucleus**, often **hyperchromatic**, with a **perinuclear halo** (a clear zone around the nucleus) and cytoplasmic changes [1], [2] - This is the classic cytopathologic finding that confirms HPV infection in cervical cytology [2] *Fibroids* - **Uterine fibroids** are **benign smooth muscle tumors** of the uterus and are not detected by a Pap smear, which screens for cervical cellular abnormalities - They typically present with heavy menstrual bleeding, pelvic pressure, or pain, and are diagnosed via imaging like ultrasound - Fibroids are structural lesions, not cytopathologic findings *Donovan bodies* - **Donovan bodies** are intracellular inclusions found in macrophages and are diagnostic of **granuloma inguinale** (also known as donovanosis) - This is a bacterial sexually transmitted infection caused by *Klebsiella granulomatis* - Associated with genital ulcers and are not related to HPV infection or Pap smear findings *Clear cells* - **Clear cells** are a type of cell seen in specific **adenocarcinomas**, such as **clear cell carcinoma of the vagina or cervix**, which are rare - While these are malignant cells, their presence is not suggestive of HPV infection but rather a specific type of cancer - Clear cell carcinoma has historically been associated with in utero DES (diethylstilbestrol) exposure **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, p. 1010. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 466-467.

Q: A 60-year-old woman presents with a 2-week history of uterine bleeding. Gynecologic examination reveals an enlarged uterus. The hysterectomy specimen shows a large polypoid mass involving the endometrium and myometrium. Histologic examination reveals malignant glands and malignant stromal elements, including striated muscle and cartilage. What is the appropriate diagnosis?

Carcinosarcoma. ***Carcinosarcoma*** - Carcinosarcomas (also known as **Malignant Mixed Mullerian Tumors**) are characterized by a biphasic histology, containing both **malignant epithelial (carcinomatous)** and **malignant mesenchymal (sarcomatous)** components [1], [2]. - The presence of **malignant glands** (epithelial component) and **malignant stromal elements**, including **striated muscle** and **cartilage** (both heterologous mesenchymal components), is pathognomonic for carcinosarcoma [1]. *Endometrioid adenocarcinoma* - This is a **pure epithelial malignancy** composed of malignant glandular structures resembling normal endometrial glands [2]. - It **lacks the malignant mesenchymal (stromal) elements** that are a key feature in the patient's presentation. *Pleomorphic adenoma* - This tumor is typically found in **salivary glands** not the uterus, and is a **benign mixed tumor** with both epithelial and stromal components, usually without malignant transformation in the initial presentation. - The uterine bleeding, enlarged uterus, and malignant histologic findings are **inconsistent with a pleomorphic adenoma**, which is also a type of salivary gland tumor. *Leiomyosarcoma* - This is a **pure mesenchymal malignancy** composed of smooth muscle cells with evidence of malignancy, such as increased mitotic activity, nuclear atypia, and coagulative necrosis. - It **lacks the malignant glandular (epithelial) component** found in this patient's tumor. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 475-476. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1022-1024.

Q: Gleason's grading system is for -

Carcinoma prostate. ***Carcinoma prostate*** - The **Gleason grading system** is a widely used and crucial method for assessing the **aggressiveness** and **prognosis** of **prostate cancer** [1]. - It evaluates the **architectural patterns** of glandular differentiation in prostate cancer tissue, assigning primary and secondary grades that are summed to create a **Gleason score** [1]. *Carcinoma colon* - The grading of **colorectal carcinoma** typically involves assessing factors such as gland formation, nuclear pleomorphism, and mitotic activity, but does not use the **Gleason system**. - Instead, colon cancer is often graded as **well, moderately, or poorly differentiated** adenocarcinoma. *Carcinoma thyroid* - **Thyroid carcinomas** are graded based on their specific histological subtype (e.g., papillary, follicular, medullary, anaplastic) and features such as **nuclear characteristics**, **invasion**, and **mitotic activity**. - The **Gleason system** is not applicable to thyroid cancer. *Carcinoma testis* - **Testicular cancers** are primarily classified and staged based on their specific **histological type** (e.g., seminoma, embryonal carcinoma, teratoma). - While grading occurs within some subtypes (e.g., germ cell tumors), the **Gleason system** is not used for testicular malignancies. **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. 993-994.

Q: Struma ovarii is

Teratoma of ovary. ***Teratoma of ovary*** - **Struma ovarii** is a rare form of **monodermal teratoma** that is composed predominantly of **thyroid tissue** (more than 50%) [1]. - As a teratoma, it originates from **germ cells** and can contain various mature or immature tissues, in this case, primarily thyroid [2]. *May present as hypothyroidism* - While composed of thyroid tissue, **struma ovarii** typically causes **hyperthyroidism** due to the autonomous production of thyroid hormones [1]. - Hypothyroidism would be an atypical presentation, as the ectopic thyroid tissue usually functions independently of pituitary control, leading to excess hormone production [1]. *Thyroid gland tumor in pregnancy* - Struma ovarii is a tumor of the **ovary**, not the thyroid gland itself, and it can occur independently of pregnancy, although it might be diagnosed during pregnancy due to increased screening. - While thyroid tumors can occur during pregnancy, this option describes the wrong anatomical location for struma ovarii. *Ovarian stromal hyperplasia* - **Ovarian stromal hyperplasia** involves an increase in the number of stromal cells within the ovary, often associated with androgen excess. - Struma ovarii, in contrast, is a **germ cell tumor** characterized by the presence of thyroid tissue, not hyperplasia of ovarian stromal cells [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, p. 1034. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 480-481.

Q: Germ cell tumor(s) of paediatric includes all except

Leydig cell tumor. Leydig cell tumor - Leydig cell tumors are sex cord-stromal tumors, not germ cell tumors, and are less common in the pediatric population compared to adulthood. - While they can occur in children, they originate from the interstitial cells of the testes and produce steroids, differentiating them from germ cell lines. Embryonal cell carcinoma - This is a highly malignant germ cell tumor that can occur in pediatric patients, particularly in the testes or ovaries [1], [2]. - It is characterized by primitive, undifferentiated cells with significant pleomorphism and frequent mitoses [1]. Choriocarcinoma - Although rare, choriocarcinoma is a highly aggressive germ cell tumor that can affect children, particularly in the gonads or mediastinum [2], [3]. - It is characterized by the presence of syncytiotrophoblastic and cytotrophoblastic cells and elevated human chorionic gonadotropin (hCG) [2]. Pure yolk sac tumor - The yolk sac tumor, also known as an endodermal sinus tumor, is the most common malignant germ cell tumor in infants and young children [1]. - It is often associated with elevated alpha-fetoprotein (AFP) levels and can be found in the gonads or sacrococcygeal region. **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. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1035-1036. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1140-1141.

Q: Which of the following is the ovarian counterpart of testicular seminoma?

Dysgerminoma. ***Dysgerminoma*** - **Dysgerminoma** is the **ovarian counterpart of testicular seminoma**, both originating from **primordial germ cells** and having a similar histological appearance [1], [3]. - These tumors are typically highly sensitive to **radiation therapy and chemotherapy**, and often present with elevated **lactate dehydrogenase (LDH)** [1]. *Endodermal sinus tumor* - An **endodermal sinus tumor** (yolk sac tumor) is another type of **germ cell tumor** but is characterized by **elevated alpha-fetoprotein (AFP)** and specific Schiller-Duval bodies histologically [3]. - It is not the ovarian equivalent of seminoma; its testicular counterpart is the **yolk sac tumor** of the testis [3]. *Dermoid* - A **dermoid cyst** (mature cystic teratoma) is a common **benign germ cell tumor** containing mature tissues from all three germ layers, such as hair, teeth, and sebaceous material. - It does not have a direct testicular counterpart that is referred to as "seminoma," as seminoma is a malignant germ cell tumor [3]. *Brenner's tumor* - **Brenner's tumor** is a type of **surface epithelial-stromal tumor** of the ovary, characterized by nests of transitional cell epithelium resembling bladder urothelium within a fibrous stroma. - It is not a germ cell tumor and therefore bears no resemblance or direct counterpart to testicular seminoma. **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] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1140-1141. [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. 979-980.

Q: When should semen analysis be done?

After liquefaction with thorough mixing. ***After liquefaction with thorough mixing*** - Semen analysis should be performed **after complete liquefaction** (typically within 20-30 minutes, maximum 60 minutes) followed by **thorough mixing**. - According to **WHO guidelines (2010, 2021)**, the sample must first liquefy completely at room temperature, then be mixed well before microscopic examination. - This ensures accurate assessment of **sperm concentration, motility, and morphology** without artifacts from viscous semen. - The standard practice is to examine within **60 minutes of collection** but only after liquefaction is complete. *After 30-60 mins irrespective of liquefaction* - The phrase "irrespective of liquefaction" is **incorrect** as analysis before complete liquefaction leads to inaccurate results. - Performing analysis on a non-liquefied sample can cause **underestimation of sperm motility** and difficulty in proper microscopic assessment. - Liquefaction status must be assessed before proceeding with analysis. *As early as possible* - Analyzing too early before **liquefaction** (which typically takes 20-30 minutes) will yield inaccurate results. - A viscous, non-liquefied sample impairs proper **sperm movement assessment** and mixing. *After 15-30 mins irrespective of liquefaction* - While 30 minutes may be sufficient for many samples to liquefy, the phrase "irrespective of liquefaction" makes this incorrect. - Some samples may require up to **60 minutes** to liquefy completely, and analysis should not proceed until liquefaction is confirmed.

Question 1

Most common benign breast tumour:

Accepted Answer

Fibroadenoma

Answer

Phyllodes tumour

Answer

Fibroadenosis

Answer

DCIS

Question 2

Germ cell tumour not seen in males:

Accepted Answer

Sertoli cell tumour

Answer

Seminoma

Answer

Choriocarcinoma

Answer

Teratoma

Question 3

An 18-year-old woman presents for follow-up of an abnormal Pap smear that revealed an abnormality suggestive of HPV infection. Which of the following was the likely cytopathologic finding?

Accepted Answer

Koilocytes

Answer

Fibroids

Answer

Donovan bodies

Answer

Clear cells

Question 4

A 60-year-old woman presents with a 2-week history of uterine bleeding. Gynecologic examination reveals an enlarged uterus. The hysterectomy specimen shows a large polypoid mass involving the endometrium and myometrium. Histologic examination reveals malignant glands and malignant stromal elements, including striated muscle and cartilage. What is the appropriate diagnosis?

Accepted Answer

Carcinosarcoma

Answer

Endometrioid adenocarcinoma

Answer

Pleomorphic adenoma

Answer

Leiomyosarcoma

Question 5

Gleason's grading system is for -

Accepted Answer

Carcinoma prostate

Answer

Carcinoma colon

Answer

Carcinoma thyroid

Answer

Carcinoma testis

Question 6

A 27-year-old man has surgery for a testicular mass. Histologic sections reveal the mass to be a testicular yolk sac tumor. Which of the substances listed below is most likely to be increased in this patient's serum?

Accepted Answer

Alpha-fetoprotein

Answer

Acid phosphatase

Answer

Human chorionic gonadotropin

Answer

Alkaline phosphatase

Question 7

Struma ovarii is

Accepted Answer

Teratoma of ovary

Answer

May present as hypothyroidism

Answer

Thyroid gland tumor in pregnancy

Answer

Ovarian stromal hyperplasia

Question 8

Germ cell tumor(s) of paediatric includes all except

Accepted Answer

Leydig cell tumor

Answer

Embryonal cell carcinoma

Answer

Choriocarcinoma

Answer

Pure yolk sac tumor

Question 9

Which of the following is the ovarian counterpart of testicular seminoma?

Accepted Answer

Dysgerminoma

Answer

Endodermal sinus tumor

Answer

Dermoid

Answer

Brenner's tumor

Question 10

When should semen analysis be done?

Accepted Answer

After liquefaction with thorough mixing

Answer

After 30-60 mins irrespective of liquefaction

Answer

As early as possible

Answer

After 15-30 mins irrespective of liquefaction

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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