Breast, female and male genital pathology

19 NEET-PG practice questions on Breast, female and male genital pathology, part of Pathology. The first 19 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Hard
A 17-year-old girl is brought to the gynaecology OPD because she has never menstruated. She is 165 cm tall with normal female external genitalia but poor breast development. FSH is 95 IU/L and LH is raised. Ultrasound shows a small uterus but no recognisable ovaries; the karyotype is 46,XY. Laparoscopy shows bilateral streak gonads. What is the most important step to protect her from cancer?
1. AYearly pelvic ultrasound
2. BOestrogen replacement alone
3. CBilateral gonadectomy
4. DSix-monthly serum AFP
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Answer: C · Bilateral gonadectomy
This is 46,XY complete gonadal dysgenesis (Swyer syndrome): the gonads never become testes, so no AMH or testosterone is made, and a uterus and female genitalia develop. Dysgenetic gonads that contain Y-chromosome material carry a high risk of gonadoblastoma, which can progress to dysgerminoma or other germ cell tumours, so the streak gonads are removed once the diagnosis is made. Hormone replacement then induces puberty, and pregnancy is possible with a donor oocyte because the uterus is present. The diagnosis should be explained with privacy and sensitivity.
- A: Ultrasound surveillance cannot reliably detect early tumours in streak gonads.
- B: Oestrogen induces puberty but does nothing to remove the tumour risk.
- D: Gonadoblastoma and dysgerminoma do not reliably raise AFP, so it cannot be used for screening.
Question 2 · Medium
A 7-year-old boy is brought to the endocrine OPD with rapid growth in height, pubic hair and a deepening voice over 8 months. His left testis contains a firm 2 cm nodule, while the right testis is still of prepubertal size. Serum testosterone is raised and LH and FSH are suppressed. Histology of the nodule shows sheets of polygonal cells with abundant eosinophilic cytoplasm containing rod-shaped crystalloids. What is the diagnosis?
1. AMature teratoma
2. BLeydig cell tumour
3. CYolk sac tumour
4. DSertoli cell tumour
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Answer: B · Leydig cell tumour
Polygonal eosinophilic cells with rod-shaped Reinke crystalloids are Leydig cells, and a Leydig cell tumour secretes androgens, causing gonadotropin-independent (peripheral) precocious puberty with suppressed LH and FSH. Because gonadotropins are suppressed, the opposite testis stays prepubertal in size. In adults these tumours may secrete oestrogen and present with gynaecomastia. Most are benign, especially in children, and are treated by excision.
- A: Mature teratomas contain tissues from several germ layers and are not androgen-secreting.
- C: Yolk sac tumours raise AFP and do not cause virilisation.
- D: Sertoli cell tumours form tubules and are usually hormonally silent.
Question 3 · Medium
A 62-year-old woman has a 12 cm left ovarian cyst that was known for years but has grown recently. At surgery the cyst contains hair and greasy sebaceous material, and a firm, solid nodule in its wall shows invasive malignant cells. Which malignancy has most likely arisen in this tumour?
1. ACarcinoid tumour
2. BMalignant melanoma
3. CAdenocarcinoma
4. DSquamous cell carcinoma
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Answer: D · Squamous cell carcinoma
Hair and sebaceous material mean a mature cystic teratoma (dermoid cyst), whose wall is lined mostly by skin-type epidermis. Malignant transformation is uncommon (about 1-2%), occurs mainly in postmenopausal women, and is most often squamous cell carcinoma arising from that epidermis. Rapid growth of a long-standing dermoid in an older woman should raise this suspicion.
- A: Carcinoid tumours occur in teratomas but are rare and usually low grade.
- B: Melanoma arising in a dermoid cyst is rare.
- C: Adenocarcinoma can arise in a teratoma but is much less common than squamous cell carcinoma.
Question 4 · Medium
A 58-year-old woman undergoes hysterectomy for a fibroid at a district hospital, and a 3 cm firm, white, solid nodule is found incidentally in the left ovary. Histology shows nests of epithelial cells resembling urothelium, with oval nuclei bearing longitudinal grooves, set in a dense fibrous stroma. The most likely diagnosis is:
1. AKrukenberg tumour
2. BOvarian fibroma
3. CAdult granulosa cell tumour
4. DBrenner tumour
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Answer: D · Brenner tumour
Nests of urothelium-like (transitional) cells with grooved 'coffee-bean' nuclei in a dense fibrous stroma make a Brenner tumour, a surface epithelial tumour that is usually small, unilateral, benign and found incidentally. Grooved nuclei also occur in granulosa cell tumours, but those are sex cord-stromal tumours with Call-Exner bodies and oestrogenic effects. Rare borderline and malignant Brenner tumours exist, so the whole lesion is examined.
- A: Krukenberg tumours are usually bilateral metastases with mucin-filled signet-ring cells.
- B: A fibroma is purely spindle-cell stroma without epithelial nests.
- C: Granulosa cell tumours lack urothelial nests and show Call-Exner bodies and oestrogen effects.
Question 5 · Medium
A 25-year-old man had an orchidopexy for a right undescended testis at the age of 9. He asks the urology resident about his cancer risk, and she lists four statements: 1. His right testis carries a higher risk of a germ cell tumour than in the general population. 2. His normally descended left testis also carries some increase in risk. 3. Most adult testicular germ cell tumours arise from germ cell neoplasia in situ. 4. Because the orchidopexy was done, his risk is now the same as other men's. Which statements are correct?
1. A1 and 3 only
2. B2, 3 and 4 only
3. C1, 2 and 3 only
4. D1, 3 and 4 only
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Answer: C · 1, 2 and 3 only
Statements 1, 2 and 3 are correct. Cryptorchidism raises the risk of a germ cell tumour several-fold in the undescended testis, and the opposite, normally descended testis is also at some increased risk, which points to an underlying testicular dysgenesis. Most adult germ cell tumours develop from germ cell neoplasia in situ. Orchidopexy, especially when done early in childhood, lowers the risk and makes the testis easy to examine, but it does not bring the risk back to normal, so he should be taught testicular self-examination.
- A: Leaves out statement 2; the contralateral testis also has an increased risk.
- B: Includes statement 4 and leaves out statement 1, which is true.
- D: Includes statement 4; orchidopexy reduces but does not abolish the risk.
Question 6 · Medium
A pathology postgraduate reviewing cervical biopsies from a screening programme writes four statements: 1. CIN 2 means dysplastic cells occupy the full thickness of the epithelium. 2. Integration of high-risk HPV DNA into the host genome is common in high-grade lesions and invasive cancer. 3. Diffuse, strong (block-type) p16 staining supports a high-risk HPV-related high-grade lesion. 4. Koilocytes reflect productive HPV infection and are typical of low-grade lesions. Which statements are correct?
1. A3 and 4 only
2. B1, 3 and 4 only
3. C2, 3 and 4 only
4. D1, 2 and 4 only
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Question 7 · Medium
A 68-year-old retired farmer has had painless enlargement of the right testis for 2 months, and the left testis has recently begun to swell too. Serum AFP and beta-hCG are normal, and LDH is raised. The orchidectomy specimen shows sheets of large atypical lymphoid cells infiltrating between and around the seminiferous tubules; the cells are CD20-positive. What is the diagnosis?
1. ADiffuse large B-cell lymphoma
2. BSpermatocytic tumour
3. CClassic seminoma
4. DEmbryonal carcinoma
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Question 8 · Hard
A 23-year-old man had a left radical inguinal orchidectomy for a mixed germ cell tumour with yolk sac and embryonal carcinoma components. CT of the chest, abdomen and pelvis shows no metastases. Serum AFP was 2,400 ng/mL just before surgery and is 560 ng/mL 12 days later; beta-hCG, mildly raised before surgery, is now normal. Taking the serum half-life of AFP as about 5-7 days, how should the 12-day AFP result be interpreted?
1. AFall consistent with complete removal
2. BUninterpretable until 6 weeks after surgery
3. CToo slow a fall; residual disease likely
4. DA rise in AFP; relapse has occurred
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Question 9 · Easy
An 18-month-old boy is brought to the paediatric surgery OPD in Patna with a firm, painless enlargement of the left testis. Serum AFP is markedly raised for his age. Histology shows a lace-like (reticular) pattern with glomerulus-like structures, each made of a central blood vessel surrounded by a cuff of tumour cells within a space. These structures are called:
1. AHomer Wright rosettes
2. BCall-Exner bodies
3. CSchiller-Duval bodies
4. DPsammoma bodies
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Question 10 · Medium
A 36-year-old woman has a rapidly growing 4 cm breast lump. Core biopsy shows a grade 3 carcinoma with pushing borders, geographic necrosis and a heavy lymphocytic infiltrate. Immunohistochemistry: ER 0%, PR 0%, HER2 0, CK5/6 positive, EGFR positive, Ki-67 70%. Which molecular subtype does this tumour belong to?
1. ALuminal B
2. BHER2-enriched
3. CLuminal A
4. DBasal-like
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Question 11 · Medium
A 28-year-old nulliparous woman has a 9 cm right ovarian cyst with papillary projections on ultrasound; CA-125 is 64 U/mL. The cystectomy specimen shows branching papillae lined by stratified, tufted serous epithelium with mild atypia and detached cell clusters, but no destructive stromal invasion anywhere. What is the diagnosis?
1. ASerous cystadenoma
2. BEndometrioid carcinoma
3. CSerous borderline tumour
4. DLow-grade serous carcinoma
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Question 12 · Easy
A 30-year-old man has a radical orchidectomy for a mixed germ cell tumour of the testis containing embryonal carcinoma and teratoma. As part of a research protocol, the tumour is karyotyped. Which chromosomal abnormality is found in nearly all such adult testicular germ cell tumours?
1. ATranslocation t(X;18)
2. BTranslocation t(11;22)
3. CDeletion of 11p13
4. DIsochromosome 12p
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Question 13 · Easy
A 31-year-old software engineer in Bengaluru has noticed a painless, heavy swelling of the right testis for 3 months. Serum AFP is normal and beta-hCG is mildly raised. After inguinal orchidectomy, the tumour shows sheets of uniform cells with clear cytoplasm and central round nuclei, divided by thin fibrous septa containing many lymphocytes. What is the most likely diagnosis?
1. AClassic seminoma
2. BEmbryonal carcinoma
3. CSpermatocytic tumour
4. DYolk sac tumour
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Question 14 · Medium
A 72-year-old woman from Madurai has a 3 cm soft, well-circumscribed, slowly growing lump in the right breast. Mammography shows a lobulated, well-defined mass that was first thought to be benign. Core biopsy shows small clusters of tumour cells floating in large pools of extracellular mucin; the tumour is ER-positive and HER2-negative. What is the diagnosis?
1. AMalignant phyllodes tumour
2. BMucinous (colloid) carcinoma
3. CMedullary-pattern carcinoma
4. DInvasive lobular carcinoma
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Question 15 · Medium
A 23-year-old woman from Kollam has had amenorrhoea for 7 months, with deepening of the voice, temporal balding and clitoromegaly developing over the same period. Serum total testosterone is markedly raised, and DHEA-S is normal. Ultrasound shows a 7 cm solid mass in the right ovary. Which tumour is most likely?
1. AAdult granulosa cell tumour
2. BDysgerminoma
3. COvarian thecoma
4. DSertoli-Leydig cell tumour
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Question 16 · Hard
A 71-year-old woman had a modified radical mastectomy with axillary clearance for breast carcinoma 12 years ago, and her right arm has been swollen and heavy ever since. She now has several purple-red, bruise-like nodules on the inner upper arm that bleed easily, one of them ulcerated. Biopsy shows irregular, anastomosing vascular channels lined by atypical, mitotically active endothelial cells dissecting between collagen bundles; the cells are positive for CD31 and ERG and negative for cytokeratin. What is the diagnosis?
1. AKaposi sarcoma
2. BPyogenic granuloma
3. CRecurrent breast carcinoma in skin
4. DLymphoedema-associated angiosarcoma
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Question 17 · Hard
A 64-year-old postmenopausal woman had breast-conserving surgery and radiotherapy for a 2 cm invasive carcinoma: ER 90%, PR 70%, HER2 1+, Ki-67 8%, nodes negative. She was started on anastrozole. Eighteen months later she has sudden back pain; X-ray shows a wedge compression fracture of L1, and DEXA shows a lumbar T-score of -2.8. Serum calcium is normal, and bone scan and MRI show no metastases. What is the mechanism of her bone loss?
1. APTH-related protein from residual tumour
2. BAntagonism of oestrogen receptors in bone
3. CRadiation damage to the lumbar vertebrae
4. DBlocked aromatisation of androgens to oestrogen
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Question 18 · Easy
A 33-year-old woman's Pap smear at a district hospital shows koilocytes, and high-risk HPV DNA is detected. Which HPV protein promotes malignant transformation by binding p53 and targeting it for degradation?
1. AE2
2. BE7
3. CE6
4. DL1
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Question 19 · Medium
A 24-year-old man is admitted with haemoptysis and breathlessness. He has bilateral gynaecomastia, and a chest X-ray shows multiple rounded 'cannon-ball' nodules. The right testis has a small, hard nodule. Serum beta-hCG is 250,000 mIU/mL and AFP is normal. Which testicular tumour is most likely?
1. AYolk sac tumour
2. BChoriocarcinoma
3. CLeydig cell tumour
4. DClassic seminoma
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Breast, female and male genital pathology

A 62-year-old woman has a 12 cm left ovarian cyst that was known for years but has grown recently. At surgery the cyst contains hair and greasy sebaceous material, and a firm, solid nodule in its wall shows invasive malignant cells. Which malignancy has most likely arisen in this tumour?

A 30-year-old man has a radical orchidectomy for a mixed germ cell tumour of the testis containing embryonal carcinoma and teratoma. As part of a research protocol, the tumour is karyotyped. Which chromosomal abnormality is found in nearly all such adult testicular germ cell tumours?

A 33-year-old woman's Pap smear at a district hospital shows koilocytes, and high-risk HPV DNA is detected. Which HPV protein promotes malignant transformation by binding p53 and targeting it for degradation?

A 24-year-old man is admitted with haemoptysis and breathlessness. He has bilateral gynaecomastia, and a chest X-ray shows multiple rounded 'cannon-ball' nodules. The right testis has a small, hard nodule. Serum beta-hCG is 250,000 mIU/mL and AFP is normal. Which testicular tumour is most likely?