Reproductive Pathology Practice Questions

Q: What is the most common histological variety of uterine carcinoma?

Adenocarcinoma. ***Adenocarcinoma*** - **Endometrial adenocarcinoma** is by far the most common type of uterine carcinoma, accounting for about 80% of all cases [1]. - It arises from the **glandular epithelial cells** lining the endometrium and is typically associated with **estrogen exposure** [1]. *Squamous cell carcinoma* - **Squamous cell carcinoma** of the uterus is extremely rare and usually occurs in the cervix, not the uterine body. - While it can occur in the endometrium in specific circumstances (e.g., in association with pyometra), it is not the most common type. *Serous carcinoma* - **Uterine serous carcinoma** is a more aggressive, high-grade subtype that accounts for a smaller percentage (5-10%) of uterine cancers. - It is typically seen in older women and often presents at an advanced stage, but it is not the most common overall. *Mixed carcinoma* - **Mixed carcinoma** of the uterus contains elements of more than one histological type, typically adenocarcinoma and another more aggressive component. - These are uncommon and represent a smaller fraction of uterine cancers compared to pure adenocarcinoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1016-1018.

Q: Which one of the following is an important tumor marker in the diagnosis of endodermal sinus tumor?

Alpha-fetoprotein. ***Alpha-fetoprotein*** - **Alpha-fetoprotein (AFP)** is consistently elevated in patients with **endodermal sinus tumor (yolk sac tumor)**, making it a crucial diagnostic marker. - The tumor cells produce AFP, reflecting their differentiation towards embryonic yolk sac structures. *HCG* - **Human chorionic gonadotropin (HCG)** is primarily associated with **choriocarcinoma** and other germ cell tumors like mixed germ cell tumors containing choriocarcinoma components [1],[2]. - While some germ cell tumors can co-express HCG and AFP, AFP is the dominant and most specific marker for endodermal sinus tumors. *CA-125* - **CA-125** is a widely used tumor marker for **epithelial ovarian cancer**. - It is not typically elevated in germ cell tumors such as endodermal sinus tumors. *LDH* - **Lactate dehydrogenase (LDH)** can be elevated in various cancers, including some germ cell tumors, reflecting high tumor burden and rapid cell turnover. - However, LDH is a **non-specific marker** and not as specific for endodermal sinus tumor as AFP. **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. 512-513. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1035-1036.

Q: The most important prognostic factor for carcinoma of the breast is:

Stage. ***Stage*** - **Tumor stage** (TNM staging system) is the most critical prognostic factor for breast carcinoma because it directly reflects the extent of disease spread at diagnosis, including tumor size, nodal involvement, and distant metastases [1]. - Patients with **early-stage disease** (localized) generally have a much better prognosis than those with **late-stage disease** (regional or metastatic) [1]. *Tumor DNA content* - **Tumor DNA content**, specifically **aneuploidy**, can be an indicator of a more aggressive tumor phenotype. - While it has prognostic value, it is less important than pathological stage in clinical decision-making. *Histological subtype* - The **histological subtype** (e.g., invasive ductal carcinoma, invasive lobular carcinoma) affects prognosis, with some subtypes having more aggressive behavior [2]. - However, the overall stage, particularly lymph node involvement, overrides the prognostic impact of the specific subtype [1]. *Tumor grade* - **Tumor grade**, based on the degree of cellular differentiation, nuclear pleomorphism, and mitotic activity, is an important prognostic factor [2]. - Higher-grade tumors are generally more aggressive, but its prognostic significance is secondary to that of tumor stage, especially when considering the complete clinical picture [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1070-1072. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 457-458.

Q: Call-Exner bodies are seen in:

Granulosa cell tumor. ***Granulosa cell tumor*** - **Call-Exner bodies** are characteristic histological features of **granulosa cell tumors**, appearing as small, fluid-filled spaces resembling immature ovarian follicles [1]. - They are formed by granulosa cells arranged around an eosinophilic, fluid-filled space containing hyaluronic acid [1]. *Dysgerminoma* - Dysgerminomas are characterized by large, uniform cells with clear cytoplasm and prominent nuclei, often separated by fibrous septa infiltrated by lymphocytes [1]. - They do not typically exhibit Call-Exner bodies; instead, they are the ovarian counterpart of testicular seminomas [1]. *Polyembryoma* - Polyembryoma is a rare and highly malignant germ cell tumor characterized by the formation of **embryoid bodies** that mimic early embryonic development [1]. - These tumors do not contain Call-Exner bodies and are distinct in their histological appearance [1]. *Theca cell tumor* - Theca cell tumors (thecomas) are benign ovarian tumors composed of spindle-shaped cells resembling normal ovarian stromal cells, often arranged in fascicles [1]. - They are known for their hormonal activity, particularly estrogen production, but lack Call-Exner bodies in their histological structure [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1026-1037.

Q: Which of the following statements about borderline tumors is false?

Metastases are common. ***Metastases are common*** - This statement is **false** because **metastases are rare** in borderline ovarian tumors [1]. - While they can have intra-abdominal implants, these are usually non-invasive and do not typically metastasize to distant sites like invasive carcinomas [2]. *10% of all epithelial tumours are borderline* - Borderline ovarian tumors, also known as **tumors of low malignant potential**, account for approximately **10-15% of all epithelial ovarian tumors**. - This percentage indicates they are a significant, but not predominant, subtype of ovarian epithelial neoplasms. *they have a good prognosis* - Patients with borderline ovarian tumors generally have an **excellent prognosis**, with a 5-year survival rate typically over 90% [1], [2]. - This is due to their non-invasive nature and low potential for aggressive spread. *Absence of stromal invasion* - A key defining characteristic of borderline ovarian tumors is the **absence of destructive stromal invasion** [2]. - They exhibit epithelial proliferation beyond that seen in benign tumors, but without invading the underlying stroma, which differentiates them from invasive carcinomas. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 478-480. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1029-1032.

Q: The gene most commonly involved in endometrial carcinoma is:

PTEN. ***PTEN*** - **PTEN** (phosphatase and tensin homolog) is a **tumor suppressor gene** frequently inactivated in **endometrial carcinoma**, particularly in cases of **endometrioid histology**. - Loss of PTEN function leads to uncontrolled cell proliferation and survival by activating the **PI3K/Akt signaling pathway**, contributing to tumor development. *BRAF* - **BRAF mutations** are most commonly associated with **melanoma** and certain types of **thyroid cancer**, specifically papillary thyroid carcinoma. - While BRAF mutations can be found in a small subset of other cancers, they are not a primary driver or common gene in endometrial carcinoma. *KRAS* - **KRAS mutations** are frequently observed in **colorectal cancer**, **pancreatic cancer**, and **non-small cell lung cancer**. - Though KRAS can be mutated in various cancers, it is not the most commonly involved gene in endometrial carcinoma. *Mismatch repair genes* - Mutations in **mismatch repair (MMR) genes** (e.g., MLH1, MSH2, MSH6, PMS2) are characteristic of **Lynch syndrome** and lead to **microsatellite instability (MSI)**. - While MSI is observed in a significant subset of endometrial cancers (especially those associated with Lynch syndrome), PTEN mutations are more broadly common across all types of endometrial carcinoma.

Q: Call-Exner bodies are identified in?

Granulosa cell tumour. ***Granulosa cell tumour*** - **Call-Exner bodies** are a characteristic histological feature of granulosa cell tumors, appearing as small, gland-like structures filled with eosinophilic fluid and surrounded by granulosa cells [2]. - They represent an abortive attempt at **follicle formation** by the neoplastic granulosa cells [2]. *Endodermal sinus cell tumour* - This tumor is characterized by **Schiller-Duval bodies**, which are glomerulus-like structures, a key diagnostic feature, not Call-Exner bodies. - It is a **germ cell tumor** that typically produces alpha-fetoprotein (AFP). *Ovarian fibroma* - An ovarian fibroma is a **benign stromal tumor** characterized histologically by bundles of spindle cells with abundant collagen, lacking Call-Exner bodies. - This tumor is often associated with **Meigs' syndrome** (ascites, pleural effusion, and ovarian fibroma). *Teratoma* - Teratomas are **germ cell tumors** composed of various mature or immature tissues derived from multiple germ layers (ectoderm, mesoderm, endoderm) [1], [3]. - They do not typically contain Call-Exner bodies; instead, they show a disorganized mixture of tissues like skin, hair, teeth, bone, and neural tissue [1], [3]. **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 Female Genital Tract, pp. 1036-1037. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1033-1034.

Q: Serum lactate dehydrogenase (LDH) increased with normal alpha-fetoprotein (AFP) is seen with:

Dysgerminoma. ***Dysgerminoma*** - Dysgerminoma is associated with **increased serum lactate dehydrogenase (LDH)** levels due to high cellular turnover [1]. - It typically presents with a **normal alpha-fetoprotein (AFP)** level, which helps distinguish it from other germ cell tumors [1]. *Mucinous cystodenocarcinoma* - This tumor typically elevates **CA-125** rather than LDH, and serum AFP is not relevant. - It primarily arises from **epithelial ovarian tissue**, which does not correlate with LDH elevation. *Yolk sac tumor* - Yolk sac tumors typically show **elevated AFP** levels, not just LDH, which is a contrasting feature. - They are germ cell tumors that are associated with **high AFP** and low LDH. *Brenner's* - Brenner tumor usually does not have significant changes in **LDH** and is associated with **normal tumor markers** like AFP. - It is classified as a **benign or low malignant potential ovarian tumor**, not typically linked with elevated LDH. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1034-1035.

Q: A cervical Pap smear report stating that "koilocytic atypia is present" indicates the presence of:

Cytologic changes caused by human papillomavirus (HPV). ***Cytologic changes caused by human papillomavirus (HPV)*** - **Koilocytic atypia** is a characteristic cytopathic effect seen in cervical epithelial cells infected with **human papillomavirus (HPV)** [2]. - Koilocytes are squamous epithelial cells with **perinuclear halos** and nuclear changes such as enlargement, hyperchromasia, and irregular contours [2]. *High-grade cervical intraepithelial neoplasia (CIN)* - While HPV infection can lead to high-grade CIN, **koilocytic atypia** itself is typically associated with **low-grade squamous intraepithelial lesion (LSIL)**, which is often a precursor to CIN [1]. - High-grade CIN (CIN 2/3) involves more severe architectural disorganization and loss of cell maturation not solely defined by koilocytic atypia. *Cytologic changes caused by herpes simplex virus (HSV)* - HSV infection in a Pap smear would show characteristic changes like **multinucleated giant cells**, **nuclear molding**, and **intranuclear inclusions**, not koilocytic atypia [3]. - These findings are distinct from the perinuclear halo and nuclear irregularities seen in HPV infection. *Cytologic changes caused by chlamydial infection* - Chlamydial infections are bacterial and primarily cause signs of **inflammation**, such as an increased number of neutrophils and plasma cells, and reactive changes in epithelial cells. - **Chlamydia** does not induce koilocytic changes; these are specific to viral infections, particularly HPV. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1006-1008. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 466-467. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 365-366.

Q: Not a histological marker for choriocarcinoma:

Villous. ***Villous*** - The absence of **chorionic villi** is a key histological feature distinguishing choriocarcinoma from other gestational trophoblastic diseases. - Choriocarcinoma is characterized by the proliferation of **cytotrophoblasts** and **syncytiotrophoblasts** without an organized villous structure. *Cytotrophoblast* - **Cytotrophoblasts** are one of the two main cell types found in choriocarcinoma, forming solid nests or cords [1]. - These cells typically have clear cytoplasm and distinct cell borders [1]. *Syncytiotrophoblast* - **Syncytiotrophoblasts** are also a prominent component of choriocarcinoma, often forming multinucleated giant cells [1]. - These cells are responsible for producing **human chorionic gonadotropin (hCG)**, which is elevated in choriocarcinoma [1]. *Bizarre nuclei* - **Bizarre and pleomorphic nuclei** are characteristic of the highly anaplastic and aggressive nature of choriocarcinoma cells [2]. - This feature reflects the significant **cellular atypia** and rapid proliferation seen in this malignancy [2]. **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. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, p. 278.

Question 1

What is the most common histological variety of uterine carcinoma?

Accepted Answer

Adenocarcinoma

Answer

Mixed carcinoma

Answer

Squamous cell carcinoma

Answer

Serous carcinoma

Question 2

Which one of the following is an important tumor marker in the diagnosis of endodermal sinus tumor?

Accepted Answer

Alpha-fetoprotein

Answer

HCG

Answer

CA-125

Answer

LDH

Question 3

The most important prognostic factor for carcinoma of the breast is:

Accepted Answer

Stage

Answer

Tumor DNA content

Answer

Histological subtype

Answer

Tumor grade

Question 4

Call-Exner bodies are seen in:

Accepted Answer

Granulosa cell tumor

Answer

Dysgerminoma

Answer

Polyembryoma

Answer

Theca cell tumor

Question 5

Which of the following statements about borderline tumors is false?

Accepted Answer

Metastases are common

Answer

Absence of stromal invasion

Answer

10% of all epithelial tumours are borderline

Answer

They have a good prognosis

Question 6

The gene most commonly involved in endometrial carcinoma is:

Accepted Answer

PTEN

Answer

BRAF

Answer

KRAS

Answer

Mismatch repair genes

Question 7

Call-Exner bodies are identified in?

Accepted Answer

Granulosa cell tumour

Answer

Endodermal sinus cell tumour

Answer

Ovarian fibroma

Answer

Teratoma

Question 8

Serum lactate dehydrogenase (LDH) increased with normal alpha-fetoprotein (AFP) is seen with:

Accepted Answer

Dysgerminoma

Answer

Yolk sac tumor

Answer

Brenner's tumor

Answer

Mucinous cystadenocarcinoma

Question 9

A cervical Pap smear report stating that "koilocytic atypia is present" indicates the presence of:

Accepted Answer

Cytologic changes caused by human papillomavirus (HPV)

Answer

Cytologic changes caused by herpes simplex virus (HSV)

Answer

High-grade cervical intraepithelial neoplasia (CIN)

Answer

Cytologic changes caused by chlamydial infection

Question 10

Not a histological marker for choriocarcinoma:

Accepted Answer

Villous

Answer

Cytotrophoblast

Answer

Syncytiotrophoblast

Answer

Bizarre nuclei

Reproductive Pathology — MCQs

Reproductive Pathology — MCQs

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