Reproductive Pathology Practice Questions

Q: What is the unique histological feature of a Leydig cell tumor of the testis?

Reinke's crystals. **Explanation:** **Leydig cell tumors** are the most common type of sex cord-stromal tumors of the testis. The pathognomonic histological feature is the presence of **Reinke’s crystals**. These are elongated, eosinophilic, rod-shaped or rectangular cytoplasmic inclusions. While they are highly specific for Leydig cell tumors, they are only identified in approximately 25–40% of cases. Microscopically, these tumors also show large, polygonal cells with abundant granular eosinophilic cytoplasm [1] and distinct cell borders. **Analysis of Incorrect Options:** * **Psammoma bodies:** These are concentric lamellated calcifications. They are characteristic of papillary thyroid carcinoma, serous cystadenocarcinoma of the ovary, and meningiomas, but are not associated with Leydig cell tumors. * **Michaelis-Guttman bodies:** These are laminated mineralized inclusions (iron and calcium) found within macrophages (von Hansemann cells) in **Malakoplakia**, typically occurring in the urinary bladder due to chronic *E. coli* infections. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Leydig cell tumors are often hormonally active [1]. In children, they cause **precocious puberty** due to androgen production [1]. In adults, they may cause **gynecomastia** due to increased estrogen or aromatization of androgens [1]. * **Biological Behavior:** Most are benign (90%) [1]; malignancy is rare and usually suggested by large size (>5cm), increased mitotic activity, and vascular invasion. * **Tumor Markers:** Unlike germ cell tumors (GCTs), Leydig cell tumors do **not** show elevations in LDH, AFP, or beta-hCG [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 510-514.

Q: Which of the following is not a germ cell tumor of the ovary?

Brenner tumor. To answer this question correctly, one must understand the histological classification of ovarian tumors, which are categorized based on their tissue of origin: **Surface Epithelial**, **Germ Cell**, and **Sex Cord-Stromal** tumors. ### **Why Brenner Tumor is the Correct Answer** The **Brenner tumor** is a **Surface Epithelial-Stromal tumor**, not a germ cell tumor. It is characterized histologically by "Walthard cell nests"—islands of transitional epithelium (resembling bladder epithelium) within a dense fibromatous stroma. On microscopy, the nuclei often show a longitudinal groove, famously described as **"Coffee-bean nuclei."** Most Brenner tumors are benign and are often incidental findings. ### **Analysis of Incorrect Options (Germ Cell Tumors)** Germ cell tumors (GCTs) arise from the primordial germ cells of the ovary and typically occur in young women (ages 10–30). * **Dysgerminoma (Option C):** The most common malignant GCT. It is the female counterpart of the testicular seminoma. It is highly radiosensitive and associated with elevated **LDH**. * **Endodermal Sinus Tumor (Option A):** Also known as Yolk Sac Tumor. It is highly aggressive and characterized by **Schiller-Duval bodies** on histology and elevated **Alpha-fetoprotein (AFP)**. * **Polyembryoma (Option B):** An extremely rare and highly malignant GCT composed of "embryoid bodies" that resemble early embryos. ### **High-Yield Clinical Pearls for NEET-PG** * **Most common ovarian tumor overall:** Serous Cystadenoma (Epithelial). * **Most common germ cell tumor:** Benign Cystic Teratoma (Dermoid cyst). * **Tumor Markers:** * Dysgerminoma → LDH, hCG. * Yolk Sac Tumor → AFP. * Choriocarcinoma → β-hCG. * **Brenner Tumor Association:** Often associated with mucinous cystadenomas; look for the "Coffee-bean nuclei" keyword in clinical vignettes.

Q: In what age group is seminoma most common?

3rd-4th decade of life. **Explanation:** Seminoma is the most common type of germ cell tumor (GCT) of the testis, accounting for approximately 50% of all cases [1]. **1. Why the Correct Answer is Right:** The peak incidence of seminoma occurs in the **3rd to 4th decade of life** (ages 30–40). While germ cell tumors as a group are the most common malignancy in young men, seminomas tend to occur slightly later than non-seminomatous germ cell tumors (NSGCTs), which peak in the 2nd to 3rd decade. **2. Why Incorrect Options are Wrong:** * **Option A & B (4th-6th decade):** While seminomas can occur in older men, they are significantly less common after age 50. The classic "pure" seminoma is a disease of young adulthood. * **Option D (6th-7th decade):** This age group is more characteristic of **Spermatocytic Tumor** (formerly Spermatocytic Seminoma) [1]. Unlike classic seminoma, spermatocytic tumors occur in men over age 65, are slow-growing, and do not metastasize. **3. NEET-PG High-Yield Clinical Pearls:** * **Morphology:** Characterized by large, uniform cells with distinct cell borders, clear cytoplasm (rich in glycogen), and large nucleoli [1]. A classic feature is the presence of **lymphocytic infiltrates** in the fibrous stroma. * **Tumor Markers:** Seminomas are typically negative for AFP. **hCG** may be mildly elevated in 10-15% of cases (due to syncytiotrophoblastic giant cells), and **LDH** is used to monitor tumor burden. * **Prognosis:** Highly radiosensitive and has an excellent prognosis. * **Risk Factor:** Cryptorchidism is the most significant risk factor. * **Ovarian Counterpart:** The histological equivalent in females is the **Dysgerminoma**. **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.

Question 1

Syncitiotrophoblast is seen in which of the following conditions?

Accepted Answer

Choriocarcinoma

Answer

Partial mole

Answer

Complete mole

Answer

Placental site of trophoblastic tumor

Question 2

A 62-year-old woman presents with a breast lump that she discovered 6 days ago. A breast biopsy shows lobular carcinoma in situ. Compared to normal epithelial cells of the breast lobule, these malignant cells would most likely show decreased expression of which of the following proteins?

Accepted Answer

E-cadherin

Answer

Desmin

Answer

Lysyl hydroxylase

Answer

P selectin

Question 3

Schiller-Duval bodies are seen in which of the following tumors?

Accepted Answer

Yolk sac tumor

Answer

Teratoma

Answer

Seminoma

Answer

Choriocarcinoma

Question 4

What is the unique histological feature of a Leydig cell tumor of the testis?

Accepted Answer

Reinke's crystals

Answer

Psammoma bodies

Answer

Michaelis-Guttman bodies

Answer

None of the above

Question 5

A 31-year-old, sexually active woman has had a mucopurulent vaginal discharge for 1 week. On pelvic examination, the cervix appears reddened around the os, but no erosions or mass lesions are present. A Pap smear shows numerous neutrophils, but no dysplastic cells. A cervical biopsy specimen shows marked follicular cervicitis. Which of the following infectious agents is most likely to produce these findings?

Accepted Answer

Chlamydia trachomatis

Answer

Candida albicans

Answer

Gardnerella vaginalis

Answer

Herpes simplex virus

Question 6

A baby is born with a testicular mass. Histologic sections of the mass demonstrate epithelial-lined spaces with flattened-to-cuboidal epithelial cells containing vacuolated cytoplasm with eosinophilic, hyaline-like globules. Scattered structures resembling primitive glomeruli (endodermal sinuses) are also seen. If appropriate immunohistochemical stains are performed, the eosinophilic cytoplasmic globules would most likely contain which of the following?

Accepted Answer

Alpha-fetoprotein

Answer

Estrogen receptors

Answer

Human chorionic gonadotropin

Answer

Human papilloma virus

Question 7

Bilateral, multicentric carcinoma of the breast is usually associated with which histological type?

Accepted Answer

Invasive lobular carcinoma

Answer

Mucoid carcinoma

Answer

Infiltrating ductal carcinoma

Answer

Non-infiltrating ductal carcinoma

Question 8

Which of the following is not a germ cell tumor of the ovary?

Accepted Answer

Brenner tumor

Answer

Endodermal sinus tumor

Answer

Polyembryoma

Answer

Dysgerminoma

Question 9

In what age group is seminoma most common?

Accepted Answer

3rd-4th decade of life

Answer

5th-6th decade of life

Answer

4th-5th decade of life

Answer

6th-7th decade of life

Question 10

Adenoacanthoma is which type of uterine cancer?

Accepted Answer

Well-differentiated adenocarcinoma

Answer

Poorly differentiated adenocarcinoma

Answer

Mucinous carcinoma

Answer

Papillary serous carcinoma

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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