Reproductive Pathology Practice Questions

Q: Which type of breast carcinoma exhibits the least desmoplastic reaction?

Lobular. ***Lobular*** - **Lobular carcinoma** tends to be less desmoplastic than other types, characterized by **small, non-cohesive cells** that invade the stroma with minimal reaction [1]. - It is frequently bilateral and can have a subtle histological presentation, making it less likely to elicit a strong desmoplastic response. *Medullary* - **Medullary carcinoma** is associated with a prominent **lymphocytic infiltrate** and notable desmoplastic stromal reaction [1]. - It presents with a large, well-circumscribed mass and often has a more aggressive nature, which contradicts the characteristics of desmoplastic carcinoma. *Tubular* - **Tubular carcinoma** shows abundant desmoplastic stroma, resulting in a firm consistency [2], contrary to the nature of least desmoplastic carcinoma. - It features distinctive tubular structures and is generally considered a subtype with a more significant desmoplastic reaction. *Ductal* - **Ductal carcinoma**, particularly infiltrating ductal carcinoma, often has a strong desmoplastic reaction, leading to significant stromal fibrosis. - This type frequently presents as a hard mass due to the involved desmoplastic response, differing from the lobular type's characteristics. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 454-456. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 453-454.

Q: In which condition is the 'Swiss cheese pattern' typically observed in pathology?

Endometrial hyperplasia. ***Metropathica hemorrhagica*** - Characterized by a **Swiss cheese pattern** due to multiple cystic changes in the endometrium [1], often associated with chronic endometrial irritation. - The pattern arises from **irregular endometrial proliferation** and is indicative of disturbances in menstrual function. *Mucinous cystadenoma* - Typically presents as a **smooth, multilocular cyst** with mucin production, but does not exhibit a Swiss cheese morphology. - Often associated with **abdominal masses** rather than the specific endometrial patterns seen in metropathica hemorrhagica. *Dermoid* - Consists of **teratoma-like tissues** and may show cystic areas, but lacks the Swiss cheese appearance associated with endometrial pathology. - Commonly found in **ovarian masses**, characterized by a variety of tissue types instead of the specific cystic changes related to metropathica hemorrhagica. *Serous cystadenoma* - Features a **serous fluid-filled cyst**, often uniform in appearance, without the Swiss cheese pattern. - Primarily occurs in the ovaries and is noted for its **smooth surface** rather than the cystic irregularities typical of metropathica hemorrhagica. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 473-475.

Q: Inhibin is a tumor marker associated with which of the following tumors?

Granulosa cell tumor. ***Granulosa cell tumor (a type of ovarian tumor)*** - **Inhibin** is a polypeptide hormone primarily produced by the **granulosa cells** of the ovary and Sertoli cells of the testis [1]. - Granulosa cell tumors, being composed of granulosa cells, often **overproduce inhibin**, making it a valuable tumor marker for diagnosis, monitoring recurrence, and treatment response [1]. *Serous cystadenoma (a type of ovarian epithelial tumor)* - While serous cystadenomas are common ovarian tumors, they are of **epithelial origin** and typically do not produce inhibin. - Markers like **CA-125** are more commonly associated with epithelial ovarian cancers, though not typically with benign serous cystadenomas. *Krukenberg tumor (a metastatic ovarian tumor)* - Krukenberg tumors are **metastatic neoplasms to the ovary**, most commonly originating from the gastrointestinal tract (especially the stomach). - Their marker profile reflects the primary tumor, and **inhibin is not a typical marker** for these metastatic lesions. *Dysgerminoma (a type of ovarian germ cell tumor)* - Dysgerminomas are **germ cell tumors** of the ovary, analogous to seminomas in males. - Tumor markers associated with dysgerminomas include **lactate dehydrogenase (LDH)**, and sometimes **beta-hCG**, but not inhibin. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1036-1037.

Q: Most common malignant ovarian tumor is?

Serous cystadenocarcinoma. ***Serous cystadenocarcinoma*** - This is the **most common type of malignant ovarian tumor**, accounting for approximately 40-50% of all ovarian cancers. - It is typically characterized by **cystic and solid components** and is often bilateral. *Mucinous cystadenocarcinoma* - This is the **second most common type** of epithelial ovarian cancer, less frequent than serous types. - Mucinous tumors are often **larger** and more commonly unilateral than serous tumors. *Malignant teratoma* - This is a rare type of ovarian germ cell tumor, which is distinct from the more common epithelial ovarian cancers. - Malignant teratomas include immature teratomas and are far less common than epithelial tumors like serous cystadenocarcinomas. *Sarcoma* - **Ovarian sarcomas** are exceedingly rare primary ovarian malignancies, forming a very small percentage of all ovarian cancers. - Most ovarian malignancies originate from the **surface epithelium** of the ovary, not stromal tissue.

Q: In which condition are Call-Exner bodies seen?

Granulosa cell tumors. ***Granulosa cell tumors*** - **Call Exner bodies** are characteristic of granulosa cell tumors, usually appearing as small, round structures resembling immature Graafian follicles [1]. - These tumors produce **estrogens**, leading to symptoms like abnormal uterine bleeding due to endometrial hyperplasia [1]. *Dysgerminoma* - Dysgerminoma typically features **solid, homogeneous tissue** and does not form Call Exner bodies. - It is more common in **younger women** and usually associated with elevated **LDH levels**. *Serous cystadenomas* - These tumors are generally **cystic** and do not exhibit Call Exner bodies, focusing instead on serous fluid production. - They are one of the most common types of ovarian tumors but lack the characteristic features of granulosa cell tumors. *Krukenberg tumor* - Krukenberg tumors are metastatic lesions of the ovaries, often resulting from **gastric carcinoma** and do not produce Call Exner bodies. - They typically present with **bilateral ovarian masses** and may be associated with **mucin-secreting histology**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1036-1037.

Q: What is the risk of malignancy associated with duct ectasia?

No risk of malignancy. ***No risk of malignancy*** - **Duct ectasia** is characterized by the dilation of subareolar ducts and is a **benign condition** with no direct association with an increased risk of developing breast cancer [1]. - While it can present with clinical symptoms that *mimic* breast cancer, such as nipple discharge or a palpable mass, it is not considered a **premalignant lesion** [1]. *1.5% risk of malignancy* - This value is not recognized as a typical risk for malignancy associated with duct ectasia; it may be applicable to other benign breast conditions. - Many benign conditions have varying degrees of malignancy risk, but duct ectasia itself is **not one of them** [1]. *7% risk of malignancy* - This percentage is significantly higher than any established risk for malignancy in benign duct ectasia. - This value is not appropriate for a condition that is considered entirely **benign**. *10% risk of malignancy* - A 10% risk would indicate a substantial predisposition to cancer, which is not characteristic of duct ectasia. - This figure might be more relevant to **atypical hyperplasias** or other high-risk breast lesions. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1052.

Q: Which type of breast cancer is most commonly associated with bilateral breast carcinoma?

Invasive lobular carcinoma. ***Invasive lobular carcinoma*** - **Invasive lobular carcinoma (ILC)** is the type of breast cancer most frequently associated with **bilateral disease**. [1], [2] This is due to its growth pattern, which often involves the widespread infiltration of cells that can occur in both breasts. [2] - ILC cells tend to grow in single-file strands, making them less likely to form a palpable mass or be detected by mammography, leading to a higher chance of multifocal or bilateral involvement. [1] *Ductal carcinoma in situ* - **Ductal carcinoma in situ (DCIS)** is a non-invasive lesion, meaning the cancerous cells are confined to the breast ducts and have not spread into surrounding breast tissue. - While DCIS can be multifocal within the same breast, it is less commonly associated with bilateral synchronous or metachronous disease compared to invasive lobular carcinoma. *Invasive ductal carcinoma* - **Invasive ductal carcinoma (IDC)** is the most common type of invasive breast cancer overall, accounting for 70-80% of all invasive breast cancers. - While IDC can be bilateral, it is less frequently associated with bilateral presentation than invasive lobular carcinoma. Its growth pattern typically forms a distinct mass that is more readily detected. *None of the options* - This option is incorrect because **invasive lobular carcinoma** is indeed a type of breast cancer with a well-established association with bilateral disease. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 454-455. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1068-1069.

Q: Which of the following is included in the Modified Bloom Richardson criteria for Carcinoma Breast?

Mitotic rate. ***Mitotic rate*** - The **Modified Bloom-Richardson (Nottingham) criteria** for breast carcinoma grading includes three components: **tubular/glandular formation**, **nuclear pleomorphism**, and **mitotic rate**. - **Mitotic rate** assesses the frequency of cell division and is scored based on the number of mitoses per 10 high-power fields. - A higher mitotic rate indicates more aggressive tumor growth and contributes to a higher histological grade. *Desmoplasia* - **Desmoplasia** refers to the fibrous stromal reaction surrounding a tumor and is a common feature of invasive carcinomas. - While it is associated with tumor invasion, it is **not one of the three specific criteria** used in the Modified Bloom-Richardson grading system. - The MBR system focuses on cellular morphology and proliferative activity, not stromal response. *Lymphovascular invasion* - **Lymphovascular invasion** (LVI) indicates the presence of tumor cells within lymphatic or blood vessels, signifying higher metastatic potential. - While LVI is an important **prognostic factor** in breast cancer staging and treatment planning, it is **not part of the MBR histological grading criteria**. - The MBR system evaluates only tubular formation, nuclear features, and mitotic activity. *Nuclear pleomorphism* - **Nuclear pleomorphism** (nuclear grade/nuclear atypia) is actually **one of the three components** of the Modified Bloom-Richardson criteria. - It assesses variation in nuclear size, shape, and chromatin pattern within tumor cells. - Both mitotic rate and nuclear pleomorphism are correct components of the MBR system; however, if forced to choose one answer, mitotic rate is more distinctly quantifiable and is often emphasized in teaching contexts.

Q: A 30-year-old woman presents with complaints of dysmenorrhea and dyspareunia, accompanied by chronic pelvic pain. She undergoes a hysterectomy. Based on the cut section of the hysterectomy specimen provided, identify the condition.

Adenomyosis. ***Adenomyosis*** - The image depicts a **thickened uterine wall** with poorly demarcated, **whorled or trabeculated areas** within the myometrium, often containing small blood or fluid-filled cysts, which are characteristic macroscopic findings in adenomyosis. - The clinical presentation of **dysmenorrhea**, **dyspareunia**, and **chronic pelvic pain** is highly consistent with adenomyosis, where endometrial tissue invades the muscular wall of the uterus. - The diffuse involvement of the myometrium without discrete masses is pathognomonic for adenomyosis. *Endometrial hyperplasia* - Endometrial hyperplasia involves **excessive proliferation of endometrial glands** and stroma within the endometrial cavity, not invasion into the myometrium. - It typically presents with **abnormal uterine bleeding** rather than the dysmenorrhea and pelvic pain seen here. - The cut section would show a **thickened endometrium** rather than myometrial involvement. *Uterine leiomyoma* - Uterine leiomyomas (fibroids) are benign smooth muscle tumors that present as **discrete, well-demarcated, firm, rubbery masses** within or protruding from the myometrium. - The macroscopic appearance in the image, characterized by a diffuse, poorly circumscribed involvement of the myometrial wall, is inconsistent with leiomyoma. - Leiomyomas have a **whorled, white-tan cut surface** that is sharply demarcated from surrounding tissue. *Endometriosis* - Endometriosis involves the presence of **endometrial tissue outside the uterus**, such as on the ovaries, peritoneum, or other pelvic organs. - While it can cause similar symptoms (dysmenorrhea, dyspareunia, chronic pelvic pain), the image provided shows the **cut section of a hysterectomy specimen**, indicating a condition *within* the uterine wall, not external implants. - Endometriosis would not show the characteristic myometrial thickening and trabeculation seen in adenomyosis.

Q: Which karyotype is associated with true hermaphroditism?

46 XX/46 XY (Mosaic). ***46 XX/46 XY (Mosaic)*** - **True hermaphroditism** (now often called **ovotesticular disorder of sex development**) is characterized by the presence of both **ovarian and testicular tissue** in the same individual. - A **mosaic karyotype** such as **46 XX/46 XY** allows for the development of both types of gonadal tissue, as different cell lines with different sex chromosomes are present [1]. *45 X0 streaked gonads* - This karyotype is characteristic of **Turner syndrome**, which presents with **gonadal dysgenesis** (streaked gonads) and lacks functional ovarian or testicular tissue [2]. - Individuals with Turner syndrome are typically female in appearance but infertile due to the absence of a second X chromosome [2]. *46 XY (Testicular tissue only)* - While a **46 XY karyotype** typically leads to the development of **testicular tissue**, the presence of testicular tissue *only* does not constitute true hermaphroditism [3]. - This karyotype is associated with male sexual development, though variations can occur in disorders of sex development affecting testosterone synthesis or androgen insensitivity. *46 XX* - A **46 XX karyotype** typically leads to **female development** with the presence of ovarian tissue. - While **46 XX males** can occur due to translocation of the SRY gene, this does not result in true hermaphroditism (presence of both ovarian and testicular tissue). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 168-169. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 175-177. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 167-168.

Question 1

Which type of breast carcinoma exhibits the least desmoplastic reaction?

Accepted Answer

Lobular

Answer

Ductal

Answer

Tubular

Answer

Medullary

Question 2

In which condition is the 'Swiss cheese pattern' typically observed in pathology?

Accepted Answer

Endometrial hyperplasia

Answer

Disseminated intravascular coagulation (DIC)

Answer

Acute myocardial infarction

Answer

Chronic gastritis

Question 3

Inhibin is a tumor marker associated with which of the following tumors?

Accepted Answer

Granulosa cell tumor

Answer

Krukenberg tumor

Answer

Dysgerminoma

Answer

Serous cystadenoma

Question 4

Most common malignant ovarian tumor is?

Accepted Answer

Serous cystadenocarcinoma

Answer

Malignant teratoma

Answer

Sarcoma

Answer

Mucinous cystadenocarcinoma

Question 5

In which condition are Call-Exner bodies seen?

Accepted Answer

Granulosa cell tumors

Answer

Serous cystadenomas

Answer

Dysgerminoma

Answer

Krukenberg tumor

Question 6

What is the risk of malignancy associated with duct ectasia?

Accepted Answer

No risk of malignancy

Answer

1.5% risk of malignancy

Answer

7% risk of malignancy

Answer

10% risk of malignancy

Question 7

Which type of breast cancer is most commonly associated with bilateral breast carcinoma?

Accepted Answer

Invasive lobular carcinoma

Answer

Ductal carcinoma in situ

Answer

Invasive ductal carcinoma

Answer

None of the options

Question 8

Which of the following is included in the Modified Bloom Richardson criteria for Carcinoma Breast?

Accepted Answer

Mitotic rate

Answer

Desmoplasia

Answer

Lymphovascular invasion

Answer

Nuclear pleomorphism

Question 9

A 30-year-old woman presents with complaints of dysmenorrhea and dyspareunia, accompanied by chronic pelvic pain. She undergoes a hysterectomy. Based on the cut section of the hysterectomy specimen provided, identify the condition.

Accepted Answer

Adenomyosis

Answer

Endometrial hyperplasia

Answer

Uterine leiomyoma

Answer

Endometriosis

Question 10

Which karyotype is associated with true hermaphroditism?

Accepted Answer

46 XX/46 XY (Mosaic)

Answer

45 X0 streaked gonads

Answer

46 XY (Testicular tissue only)

Answer

46 XX

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?