Reproductive Pathology Practice Questions

Q: Which of the following statements is NOT true about Medullary breast carcinoma?

It exhibits less desmoplasia than typical breast cancer.. **Explanation:** Medullary breast carcinoma is a distinct subtype of invasive ductal carcinoma characterized by a paradox: it appears histologically high-grade (aggressive) but clinically follows a relatively favorable course. **1. Why Option D is the correct answer (The "NOT True" statement):** The question asks for the incorrect statement. Option D is actually a **true** statement, but it is often misidentified by students. Medullary carcinoma is characterized by a "soft" or "fleshy" consistency (hence the name "medullary") because it exhibits **minimal to no desmoplasia** (fibrotic stromal reaction). In contrast, typical invasive ductal carcinoma (NOS) is hard and gritty due to significant desmoplasia. Therefore, the statement that it exhibits less desmoplasia is true, making it an incorrect choice for a "NOT true" question. *Note: If the question intended for D to be the answer, it likely contained a typo in the prompt or options. In standard pathology, Medullary CA is defined by its lack of desmoplasia.* **2. Analysis of other options:** * **Option A (Good prognosis):** True. Despite having high-grade nuclear features, it has a better 10-year survival rate (>90%) than typical infiltrating ductal carcinoma. * **Option B (3rd-4th decade):** True. It tends to occur in younger women (often 75%), 2. No glandular/tubular structures, 3. Dense lymphoplasmacytic infiltrate, 4. High mitotic grade, 5. Circumscribed margins. * **Triple Negative:** Most medullary carcinomas are ER, PR, and HER2/neu negative. * **Imaging:** Often mimics a benign lesion (like a fibroadenoma) on mammography due to its well-circumscribed borders.

Q: Regarding the phyllodes tumor, all of the following statements are true, except:

Most of these tumors are high grade. **Explanation:** Phyllodes tumors are fibroepithelial neoplasms of the breast that arise from the **intralobular stroma** [1]. Understanding their grading and behavior is crucial for NEET-PG. **Why Option C is the correct answer (False statement):** The majority of phyllodes tumors (approximately 60–75%) are **low-grade (benign)** [1]. Only a small percentage are classified as borderline or high-grade (malignant). Grading is based on stromal cellularity, mitotic rate, nuclear pleomorphism, and the nature of the tumor borders. **Analysis of other options:** * **Option A (True):** Unlike common fibroadenomas which can be interlobular, phyllodes tumors specifically arise from the **intralobular stroma** [1]. * **Option B (True):** Recent molecular studies have identified that the **overexpression of HOXB13** (a homeobox gene) is a significant biomarker for increased stromal proliferation and is associated with higher grades and more aggressive clinical behavior. * **Option D (True):** Phyllodes tumors are biphasic (epithelial and stromal). However, the malignant potential resides solely in the **stromal component** [1]. Consequently, when these tumors metastasize (most commonly to the lungs via hematogenous spread), the deposits consist only of the sarcomatous stromal elements, not the epithelium [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Morphology:** Characterized by "leaf-like" (phyllodes) projections of stroma covered by epithelium [1]. * **Age:** Typically occurs in the 6th decade (older than fibroadenoma patients). * **Treatment:** Wide local excision with 1cm margins is preferred over simple enucleation to prevent local recurrence [1]. * **Distinction:** Unlike fibroadenomas, phyllodes tumors show increased stromal cellularity and "stromal overgrowth" [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1072-1074.

Q: Which of the following tumours commonly metastasizes to the ovary, except?

Oesophagus. **Explanation:** Metastatic (secondary) tumors of the ovary account for approximately 10–25% of all ovarian malignancies. The ovary is a frequent site for metastasis due to its rich vascularity and the phenomenon of "fertile soil." **Why Oesophagus is the Correct Answer:** While the gastrointestinal tract is the most common source of ovarian metastasis, the primary sites are typically the **stomach, colon, and appendix**. Oesophageal cancer rarely metastasizes to the ovary. In clinical practice and pathology series, the esophagus is not considered a "common" primary site for Krukenberg tumors or other secondary ovarian deposits compared to the other options listed. **Analysis of Incorrect Options:** * **Stomach (Option B):** This is the most common source of the classic **Krukenberg tumor** (signet-ring cell carcinoma). It spreads via retrograde lymphatic dissemination or transcoelomic shedding. * **Malignant Melanoma (Option A):** Melanoma is known for its unpredictable hematogenous spread. It is the most common non-epithelial, non-GI solid tumor to metastasize to the ovary. * **Lymphoma (Option D):** Ovarian involvement is common in systemic lymphomas (especially Non-Hodgkin Lymphoma). Burkitt lymphoma, in particular, frequently involves the ovaries in pediatric and young adult populations. **High-Yield Clinical Pearls for NEET-PG:** * **Krukenberg Tumor:** Defined pathologically by the presence of **signet-ring cells** and a sarcomatoid stroma. The most common primary is the **Stomach**, followed by the Colon. * **Laterality:** Metastatic ovarian tumors are typically **bilateral** (80% of cases) and solid, whereas primary epithelial ovarian tumors are more often unilateral (especially in early stages). * **Common Primaries:** In order of frequency: Stomach > Colon > Breast > Appendix > Pancreas. * **Pseudomyxoma Peritonei:** Often associated with mucinous tumors of the **Appendix** metastasizing to the ovary.

Q: Which of the following is the most common type of ovarian tumors?

Serous epithelial tumor. **Explanation:** Ovarian tumors are classified based on their cell of origin into three main categories: Surface Epithelial Tumors, Germ Cell Tumors, and Sex Cord-Stromal Tumors. **1. Why Serous Epithelial Tumor is correct:** Surface epithelial tumors are the most common type of ovarian neoplasms, accounting for approximately **60–70% of all ovarian tumors** and up to 90% of malignant ones. Among these, **Serous tumors** (both benign serous cystadenoma and malignant serous cystadenocarcinoma) are the most frequent subtype. Serous cystadenomas are the most common benign epithelial tumors, while High-Grade Serous Carcinoma (HGSC) is the most common primary ovarian malignancy. **2. Why other options are incorrect:** * **Granulosa cell tumor:** These are Sex Cord-Stromal tumors. They are rare (approx. 2–5% of ovarian tumors) and are known for producing estrogen, often presenting with postmenopausal bleeding or precocious puberty. * **Mature teratoma (Dermoid cyst):** This is a Germ Cell Tumor. While it is the **most common ovarian tumor in women under 30**, it is less frequent than epithelial tumors in the overall population. * **Dysgerminoma:** This is the most common **malignant** germ cell tumor, typically seen in young women/adolescents, but it represents only about 1% of all ovarian cancers. **High-Yield Clinical Pearls for NEET-PG:** * **Most common overall:** Serous Epithelial Tumor. * **Most common benign tumor in young females (<30 yrs):** Mature Cystic Teratoma. * **Most common malignant tumor in young females:** Dysgerminoma. * **Psammoma bodies:** Classically seen in Serous Papillary tumors. * **Tumor Marker:** CA-125 is the primary marker for epithelial ovarian tumors.

Question 1

What is the most common site of metastasis for prostate cancer?

Accepted Answer

Lumbar spine

Answer

Skull

Answer

Femur

Answer

Sacrum

Question 2

A histopathological examination of an excision specimen from a lesion on the dorsal surface of the penis reveals a papillary lesion with clear vacuolization of epithelial cells on the surface and extension of the hyperplastic epithelium into the underlying tissue. What is the possible diagnosis?

Accepted Answer

Verrucous carcinoma

Answer

Bowen's disease

Answer

Erythroplasia of Queyrat

Answer

Condyloma acuminatum

Question 3

A 66-year-old man presents with urinary frequency, hesitancy, and dysuria. Digital rectal examination shows an enlarged, rubbery, and nodular prostate. Serum PSA is modestly elevated. Which of the following is most closely related to the pathogenesis of this patient's likely condition?

Accepted Answer

Dihydrotestosterone (DHT)

Answer

Estrogen

Answer

Alpha-fetoprotein (AFP)

Answer

Testosterone

Question 4

Which of the following statements is NOT true about Medullary breast carcinoma?

Accepted Answer

It exhibits less desmoplasia than typical breast cancer.

Answer

It has a good prognosis.

Answer

It typically presents in the 3rd-4th decade of life.

Answer

It is associated with BRCA1 mutations.

Question 5

Regarding the phyllodes tumor, all of the following statements are true, except:

Accepted Answer

Most of these tumors are high grade

Answer

Intralobular stromal tumor

Answer

Overexpression of HOXB13 is associated with more aggressive clinical behavior

Answer

Metastasis of only the non-epithelial/stromal component

Question 6

Which of the following tumours commonly metastasizes to the ovary, except?

Accepted Answer

Oesophagus

Answer

Malignant melanoma

Answer

Stomach

Answer

Lymphoma

Question 7

A 30-year-old female presents with a palpable mass in her left breast that has been steadily increasing in size over the past year. On examination, the mass is well-circumscribed, freely mobile, and measures approximately 5.7 cm in its greatest dimension. A core needle biopsy is performed. What is the most probable diagnosis?

Accepted Answer

Giant fibroadenoma

Answer

Fibroadenoma

Answer

Ductal Carcinoma In Situ (DCIS)

Answer

Intraductal papilloma

Question 8

A patient presents with complaints of sciatica. Radiological examination reveals sclerotic lesions on his skull. Which of the following is most likely to be elevated in this patient?

Accepted Answer

Prostate specific antigen (PSA)

Answer

Carcinogenic embryonic antigen (CEA)

Answer

Alkaline phosphatase

Answer

Alpha 1 antitrypsin

Question 9

Which of the following is NOT a tumor marker for testicular tumors?

Accepted Answer

CEA

Answer

HCG

Answer

AFP

Answer

Alpha 1 antitrypsin

Question 10

Which of the following is the most common type of ovarian tumors?

Accepted Answer

Serous epithelial tumor

Answer

Granulosa cell tumor

Answer

Mature teratoma

Answer

Dysgerminoma

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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