Reproductive Pathology Practice Questions

Q: Placental alkaline phosphatase (ALP) is used as a tumor marker for which of the following neoplasms?

Seminoma. **Explanation:** **1. Why Seminoma is the Correct Answer:** Placental Alkaline Phosphatase (PLAP) is a heat-stable fetal isoenzyme normally expressed by the syncytiotrophoblast. In oncopathology, PLAP serves as a highly sensitive, though not entirely specific, serum and immunohistochemical marker for **Seminoma** (and its ovarian counterpart, Dysgerminoma) [1]. It is elevated in approximately 50–60% of patients with advanced seminoma. It is particularly useful in distinguishing seminoma from other non-seminomatous germ cell tumors (NSGCTs). **2. Analysis of Incorrect Options:** * **B. Choriocarcinoma:** The hallmark marker for Choriocarcinoma is **beta-hCG** (human chorionic gonadotropin), produced by syncytiotrophoblasts [1]. While PLAP can be focal, it is not the diagnostic marker of choice. * **C. Teratoma:** Mature and immature teratomas typically do not produce specific serum markers like PLAP. If markers are elevated in a teratoma, it usually suggests a "mixed germ cell tumor" component. * **D. Lymphoma:** Testicular lymphoma (the most common testicular tumor in men >60) is diagnosed via markers like **CD20** or **CD45** (LCA), not PLAP. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most sensitive marker for Seminoma:** PLAP. * **Most specific marker for Yolk Sac Tumor:** Alpha-fetoprotein (AFP) (Schiller-Duval bodies are pathognomonic). * **Smoking Fact:** Serum PLAP levels can be falsely elevated in heavy smokers; this must be considered when interpreting results. * **IHC Profile:** Seminomas are typically **PLAP (+)**, **c-KIT/CD117 (+)**, and **OCT4 (+)**, but **CD30 (-)** [1]. CD30 is instead a marker for Embryonal Carcinoma. **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: Which germ cell tumor is not seen in males?

Sertoli cell tumor. **Explanation:** The classification of testicular tumors is divided into **Germ Cell Tumors (GCTs)** and **Sex Cord-Stromal Tumors**. 1. **Why Sertoli Cell Tumor is the correct answer:** The question asks which *germ cell tumor* is not seen in males. **Sertoli cell tumors** are derived from the sex cord-stromal cells (the supportive cells of the testis), not from the primordial germ cells. Therefore, while they occur in males, they are classified as **Sex Cord-Stromal Tumors**, making them the outlier in a list of Germ Cell Tumors. 2. **Analysis of Incorrect Options (Germ Cell Tumors):** * **Seminoma (Option B):** The most common pure germ cell tumor in adults (ages 30–40). It is highly radiosensitive and carries a good prognosis. * **Teratoma (Option D):** A germ cell tumor composed of all three germ layers (ectoderm, mesoderm, endoderm). In prepubertal males, they are usually benign; in post-pubertal males, they are considered malignant. * **Choriocarcinoma (Option A):** A highly aggressive non-seminomatous germ cell tumor (NSGCT) characterized by early hematogenous spread and high levels of β-hCG. **High-Yield Clinical Pearls for NEET-PG:** * **Most common testicular tumor:** Seminoma. * **Most common testicular tumor in infants/children:** Yolk Sac Tumor (Endodermal Sinus Tumor); associated with elevated **Alpha-Fetoprotein (AFP)**. * **Reinke Crystals:** Pathognomonic histological finding in **Leydig Cell Tumors** (another type of Sex Cord-Stromal tumor). * **Schiller-Duval Bodies:** Characteristic histological finding in Yolk Sac Tumors. * **AFP is NEVER elevated in pure Seminomas.** If AFP is high, a non-seminomatous component is present.

Q: In carcinoma of the breast with HER-2/neu immunohistochemistry staining, which of the following scores necessitates further FISH study?

2+. **Explanation:** The assessment of **HER-2/neu** status is a critical step in breast cancer management as it determines eligibility for targeted therapies like Trastuzumab. The standard initial screening method is **Immunohistochemistry (IHC)**, which measures protein expression on the cell surface. * **Why 2+ is the correct answer:** An IHC score of **2+** is considered **equivocal (borderline)**. It indicates weak to moderate complete membrane staining in >10% of tumor cells. Because this result is ambiguous, it necessitates reflex testing with **Fluorescence In Situ Hybridization (FISH)** to detect gene amplification. Only if the FISH study is positive is the patient considered HER-2 positive. **Analysis of Incorrect Options:** * **0 and 1+ (Negative):** A score of 0 (no staining) or 1+ (faint/incomplete staining) is considered **HER-2 negative**. No further molecular testing is required, and the patient is not a candidate for HER-2 targeted therapy. * **3+ (Positive):** A score of 3+ (strong, uniform, circumferential membrane staining in >10% of cells) is considered **strongly positive**. This is diagnostic on its own, and FISH is generally not required to initiate treatment. **High-Yield Clinical Pearls for NEET-PG:** * **HER-2/neu** is a proto-oncogene located on **Chromosome 17q**. * **Gold Standard:** While IHC is the initial screen, FISH is the gold standard for accuracy. * **Triple Negative Breast Cancer (TNBC):** Defined as being ER negative, PR negative, and HER-2 negative (IHC 0 or 1+). * **New Category:** "HER2-low" (IHC 1+ or 2+/FISH negative) is a recently recognized category that may respond to newer antibody-drug conjugates (e.g., Trastuzumab deruxtecan).

Question 1

What is the pathogenetic mechanism of HPV in causing cervical carcinoma?

Accepted Answer

Genomic instability mediated by E6 and E7 proteins

Answer

Downregulation of p16INK4 protein

Answer

Degradation of cyclin D1

Answer

Upregulation of BCL2

Question 2

A 25-year-old man presents with bilateral gynecomastia and multiple metastatic tumor nodules in both lung fields. What is the most likely primary site of the cancer?

Accepted Answer

Testicle

Answer

Bone marrow

Answer

Kidney

Answer

Islets cells of the pancreas

Question 3

A 22-year-old man complains about his inability to conceive a child. On physical examination, the patient is noted to be tall (6 ft, 5 in) and exhibits gynecomastia and testicular atrophy. Laboratory studies demonstrate increased serum levels of follicle-stimulating hormone. Cytogenetic studies reveal a chromosomal abnormality. What is the most common cause of this patient's chromosomal abnormality?

Accepted Answer

Meiotic nondisjunction

Answer

Expansion of a trinucleotide repeat

Answer

Isochromosome formation

Answer

Nonreciprocal translocation

Question 4

Placental alkaline phosphatase (ALP) is used as a tumor marker for which of the following neoplasms?

Accepted Answer

Seminoma

Answer

Choriocarcinoma

Answer

Teratoma

Answer

Lymphoma

Question 5

A 29-year-old female presents with severe pain during menstruation (dysmenorrhea). During workup, an endometrial biopsy is obtained. The pathology report from this specimen makes the diagnosis of chronic endometritis. Based on this pathology report, which one of the following was present in the biopsy sample of the endometrium?

Accepted Answer

Plasma cells

Answer

Neutrophils

Answer

Lymphocytes

Answer

Lymphoid follicles

Question 6

Benign condyloma is associated with which condition?

Accepted Answer

Infection by human papillomavirus (HPV) type 11

Answer

Infection by HPV type 16

Answer

Infection by HPV type 18

Answer

Lichen sclerosus

Question 7

A study of women with breast carcinoma is done to determine the presence and amount of estrogen receptor (ER) and progesterone receptor (PR) in the carcinoma cells. Large amounts of ER and PR are found in the carcinoma cells of some patients, while these receptors are not present in the cells of other patients. Patients with positivity for ER and PR are likely to exhibit which of the following traits?

Accepted Answer

Higher response to therapy

Answer

Greater immunogenicity

Answer

Greater likelihood of metastases

Answer

Greater risk of familial breast cancer

Question 8

Which germ cell tumor is not seen in males?

Accepted Answer

Sertoli cell tumor

Answer

Choriocarcinoma

Answer

Seminoma

Answer

Teratoma

Question 9

"Basal-like" carcinoma of breast can be identified as:

Accepted Answer

Estrogen Receptor (ER) -ve; HER2 -ve

Answer

Estrogen Receptor (ER) +ve; HER2 -ve

Answer

HER2 +ve

Answer

Estrogen Receptor (ER) +ve; HER2 +ve

Question 10

In carcinoma of the breast with HER-2/neu immunohistochemistry staining, which of the following scores necessitates further FISH study?

Accepted Answer

2+

Answer

0

Answer

1+

Answer

3+

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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