Reproductive Pathology Practice Questions

Q: What is the most common germ cell tumor overall?

Teratoma. ***Teratoma*** - Teratomas are the **most common germ cell tumors** [1][2][5], often arising in the **gonads** but can also occur in extragonadal sites. - These tumors are characterized by their ability to differentiate into various tissue types, including **hair, muscle, and bone** [1][3]. *Mixed germ cell tumor* - While they can occur, mixed germ cell tumors comprise various types and are not as common as **teratomas** [2][5]. - They usually consist of different germ cell components leading to a more complex histology [2]. *Choriocarcinoma* - Choriocarcinoma is a rare and aggressive **germ cell tumor** that arises from trophoblastic tissue and is less common than **teratomas** [4]. - It is typically associated with elevated **beta-hCG** levels and has a characteristic **placental pattern** [4]. *Endodermal sinus tumor* - Endodermal sinus tumors, also known as **yolk sac tumors**, are a type of germ cell tumor but are notably less common than **teratomas** [2]. - They are distinguished by the presence of **Schiller-Duval bodies** on histological examination. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 480-481. [2] 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. [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. 982-983. [4] 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. [5] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1035-1036.

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

Lobular. ***Lobular*** - **Invasive lobular carcinoma (ILC)** is the breast cancer type most frequently associated with **bilateral disease**, occurring in about 5-28% of cases. - This tendency is attributed to its infiltrative growth pattern and potential for multifocal involvement, making bilateral involvement more likely. *Paget's disease* - **Paget's disease of the breast** is a rare form of breast cancer that primarily affects the skin of the **nipple and areola**. - It is almost exclusively **unilateral**, and its presentation with eczematous changes is distinct from bilateral parenchymal involvement. *Medullary* - **Medullary carcinoma** is a rare subtype of invasive ductal carcinoma known for its often **well-circumscribed appearance** and better prognosis. - While it can be multifocal, it does not have a strong propensity for **bilateral occurrence** like lobular carcinoma. *None of the options* - This option is incorrect because **lobular carcinoma** is well-established in medical literature as having the highest incidence of bilateral presentation among breast cancer types.

Q: A testicular tumor in a man aged 60 years is most likely to be:

Lymphoma. ***Lymphoma*** - **Testicular lymphoma** is the most common testicular tumor in men over **60 years of age**, originating from lymphoid tissue. - It often presents as a rapidly enlarging, painless testicular mass and can be bilateral [1]. *Germ cell tumor* - **Germ cell tumors** are the most common testicular tumors overall but predominantly affect younger men, typically between **15 and 40 years of age**. - While they can occur at any age, they are much rarer in men over **60**. *Sertoli cell tumor* - **Sertoli cell tumors** are rare tumors that can occur at any age, but they do not show a predisposition for men over **60** specifically. - They tend to be benign and may be associated with **hormonal imbalances** in some cases. *Teratocarcinoma* - **Teratocarcinoma** is a mixed germ cell tumor composing elements of both **teratoma** and **embryonal carcinoma**. - Like other germ cell tumors, it typically affects younger men and is less common in the elderly population.

Q: Commonest primary site of Krukenberg tumour is:

Stomach. ***Stomach*** - The **stomach** is the most frequent primary site for the metastatic adenocarcinoma that gives rise to a **Krukenberg tumor** in the ovary [1]. - Gastric adenocarcinomas, particularly **diffuse-type gastric cancer** (including signet ring cell carcinoma), often spread to the ovaries via the peritoneal cavity or lymphatic routes [1]. *Breast* - While breast cancer can metastasize to the ovaries, it is a **less common primary source** for Krukenberg tumors compared to gastric cancer. - Breast carcinoma metastases to the ovary generally do not have the classic **signet-ring cell morphology** characteristic of Krukenberg tumors. *Colon* - **Colorectal cancer** is another potential primary source, but it accounts for a **smaller percentage** of Krukenberg tumors than gastric cancer. - Ovarian metastases from colonic carcinoma might have different histological features than the typical signet ring cells. *Small intestine* - Metastatic tumors to the ovary from the **small intestine** are **rare**, making it an unlikely primary site for a Krukenberg tumor. - Primary adenocarcinomas of the small intestine are themselves uncommon compared to those of the colon or stomach. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 779.

Q: All of the following statements are true about Gleason score, except:

Scores range from 2-10. ***Scores range from 2-10*** - The **Gleason score** is obtained by summing the two most predominant architectural patterns of tumor growth, with each pattern graded from 1 to 5. The lowest possible sum is 2 (1+1) and the highest is 10 (5+5). However, **Gleason scores are now reported from 6 to 10** for clinical purposes, as grade 1 and 2 patterns are rarely seen in biopsies, and for practical purposes, anything less than a 3+3=6 is considered benign or low-risk. [1] - While mathematically the range is 2-10, in modern clinical practice, a score of 6 is the lowest grade assigned to prostate cancer, making the statement that scores range from 2-10 clinically inaccurate. *Used for grading prostate cancer* - The **Gleason score** is a well-established and widely used histological grading system specifically for prostate adenocarcinoma. [2] - It assesses the **architectural patterns** of glandular differentiation in prostate cancer to predict its aggressiveness. *Higher the score, poorer the prognosis* - A **higher Gleason score** indicates a more poorly differentiated and aggressive tumor, which correlates with a greater likelihood of metastasis and recurrence. [2] - This directly translates to a **poorer prognosis** for the patient. *Helps in planning management* - The **Gleason score** is a critical factor, along with PSA levels and clinical staging, in determining the risk stratification of prostate cancer. - This risk stratification guides treatment decisions, such as whether to pursue active surveillance, radiation therapy, surgery, or systemic therapy. **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. 990-992. [2] 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: Which of the following is a characteristic feature of endodermal sinus tumor?

Presence of Schiller-Duval bodies. **Presence of Schiller-Duval bodies** - **Schiller-Duval bodies** are pathognomonic histological structures found in **yolk sac tumors (endodermal sinus tumors)**. - They consist of a central capillary surrounded by tumor cells within a space, resembling a glomerulus. *Presence of Call-Exner bodies* - **Call-Exner bodies** are characteristic of **granulosa cell tumors** of the ovary. - They are small, follicle-like structures with a central eosinophilic fluid and granulosa cells arranged peripherally. *Presence of Homer-Wright rosettes* - **Homer-Wright rosettes** are typically seen in **neuroblastoma** and **medulloblastoma**. - These rosettes are characterized by a central fibrous space surrounded by tumor cells with surrounding nuclei, but without a lumen. *Presence of Psammoma bodies* - **Psammoma bodies** are concentric, lamellated calcified structures found in various tumors, including **papillary thyroid carcinoma**, **meningioma**, and **serous papillary ovarian carcinoma**. - Their presence indicates a neoplastic process but is not specific to endodermal sinus tumors.

Q: Somatic mutation of PTEN is seen in:

Endometrial carcinoma. ***Endometrial carcinoma*** - Somatic mutations of the **PTEN gene** are frequently associated with endometrial carcinoma, particularly in **type I endometrial cancers** [1]. - These mutations lead to **dysregulation of cellular pathways**, contributing to the development and progression of the tumor [1]. *Carcinoma breast* - While breast cancer can exhibit various mutations, including in genes like **BRCA1/2**, PTEN mutations are **not commonly associated**. - Breast cancers typically have a different **molecular profile**, including hormone receptor status that is not linked to PTEN. *Osteosarcoma* - Osteosarcoma's genetic alterations mainly involve **RB gene** and **TP53 mutations**, rather than changes in the PTEN gene. - The typical pathology does not involve the **loss of PTEN function**, making it an unlikely association with this mutation. *Retinoblastoma* - Retinoblastoma is primarily associated with mutations in the **RB1 gene**, not PTEN, and is linked to **hereditary patterns**. - PTEN mutations do not play a significant role in the pathogenesis of retinoblastoma, differentiating its genetic basis from that of endometrial carcinoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1015-1018.

Q: This type of endometrial hyperplasia leads to an increased risk of endometrial cancer.

Atypical. ***Atypical*** - **Atypical endometrial hyperplasia** shows both glandular architectural abnormalities and features of cellular atypia, such as nuclear pleomorphism and prominent nucleoli [1]. - The presence of cellular atypia is the key differentiator and significantly increases the risk of progression to **endometrial adenocarcinoma**, with up to 30% progressing to cancer [2]. *Simple* - **Simple endometrial hyperplasia** involves an increase in the number of endometrial glands, which retain their normal shape and uniform distribution [1]. - While it represents abnormal proliferation, the risk of progression to **endometrial cancer** is very low (less than 1%) [2]. *Complex* - **Complex endometrial hyperplasia** shows architectural crowding and branching of glands, but without cellular atypia [2]. - The glands are no longer uniformly spaced, creating a more complex pattern, but the individual cells do not show features of malignancy; therefore, the risk of progression to **endometrial cancer** is low (around 3%) [2]. *Secretive* - **Secretory endometrium** is a normal physiological phase of the menstrual cycle, occurring after ovulation under the influence of progesterone. - This term describes the histological appearance of the endometrium, not a type of hyperplasia or a premalignant condition. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1016-1018. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 473-475.

Q: Commonest histological type of germ cell tumor of the testis is:

Seminoma. ***Seminoma*** - Seminomas are the most common type of testicular cancer, accounting for approximately **30-50%** of cases in adults [1]. - They are typically sensitive to **radiation therapy**, making treatment effective [1]. *Yolk sac tumour* - This type is more common in **children** and is less frequently seen in adults with testicular cancer [1]. - While aggressive, it represents a **distinct histological type** among germ cell tumors, but not the most common. *Teratoma* - Teratomas can be found in testicular cancers, but are less common as the **sole histological type** in adults [1]. - They often contain multiple germ layers and may present later than seminomas, which are typically diagnosed earlier. *Choriocarcinoma* - This is a rare and aggressive form of testicular cancer often associated with other germ cell tumors, making it less common overall [2]. - Characterized by **elevated beta-hCG levels**, it generally does not present as the primary histological type [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. 979-982. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 510-512.

Question 1

What is the most common germ cell tumor overall?

Accepted Answer

Teratoma

Answer

Choriocarcinoma

Answer

Endodermal sinus tumor

Answer

Seminoma

Question 2

Which type of breast cancer is most commonly bilateral?

Accepted Answer

Lobular

Answer

Medullary

Answer

None of the options

Answer

Paget's disease

Question 3

A testicular tumor in a man aged 60 years is most likely to be:

Accepted Answer

Lymphoma

Answer

Germ cell tumor

Answer

Teratocarcinoma

Answer

Sertoli cell tumor

Question 4

Commonest primary site of Krukenberg tumour is:

Accepted Answer

Stomach

Answer

Breast

Answer

Colon

Answer

Small intestine

Question 5

All of the following statements are true about Gleason score, except:

Accepted Answer

Scores range from 2-10

Answer

Used for grading prostate cancer

Answer

Higher the score, poorer the prognosis

Answer

Helps in planning management

Question 6

Which of the following is a characteristic feature of endodermal sinus tumor?

Accepted Answer

Presence of Schiller-Duval bodies

Answer

Presence of Call-Exner bodies

Answer

Presence of Homer-Wright rosettes

Answer

Presence of Psammoma bodies

Question 7

Somatic mutation of PTEN is seen in:

Accepted Answer

Endometrial carcinoma

Answer

Osteosarcoma

Answer

Carcinoma breast

Answer

Retinoblastoma

Question 8

This type of endometrial hyperplasia leads to an increased risk of endometrial cancer.

Accepted Answer

Atypical

Answer

Simple

Answer

Complex

Answer

Secretory

Question 9

Patient diagnosed with squamous cell intraepithelial lesion, which of the following has the highest risk for progression to carcinoma?

Accepted Answer

High grade squamous intraepithelial neoplasia

Answer

Low grade squamous intraepithelial neoplasia

Answer

Squamous intraepithelial neoplasia associated with HIV

Answer

Squamous intraepithelial neoplasia associated with HPV 16

Question 10

Commonest histological type of germ cell tumor of the testis is:

Accepted Answer

Seminoma

Answer

Teratoma

Answer

Yolk sac tumour

Answer

Choriocarcinoma

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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