Female Reproductive Pathology — MCQ Quiz

Question 1

Which HPV subtypes are most strongly associated with condylomata acuminata of the vulva?

Accepted Answer

HPV 6 and 11 — HPV 6 and 11 are low-risk subtypes causing condylomata acuminata with low malignant transformation risk. ---

Question 2

A postmenopausal woman has white parchment-like vulvar plaques with vaginal orifice constriction. What is the most likely diagnosis?

Accepted Answer

Lichen sclerosus — Lichen sclerosus causes epidermal thinning, white plaques, and vaginal constriction. It carries a 1–5% risk of progressing to SCC. ---

Question 3

The hallmark histologic feature of HPV infection seen in condylomata acuminata is

Accepted Answer

Koilocytosis with perinuclear vacuolization — Koilocytosis — perinuclear cytoplasmic vacuolization with wrinkled nuclear contours — is the hallmark cytopathic effect of HPV infection. ---

Question 4

A vulvar lesion shows large pale intraepidermal cells with mucin confirmed by PAS staining. What is the diagnosis?

Accepted Answer

Extramammary Paget disease — Paget disease shows large pale epithelioid cells with PAS-positive mucin. Mucin positivity distinguishes it from melanoma, which lacks mucin. ---

Question 5

Which best distinguishes vulvar Paget disease from Paget disease of the breast?

Accepted Answer

Vulvar Paget disease usually has no underlying tumour — Unlike breast Paget disease, which is almost always associated with underlying carcinoma, vulvar Paget disease usually has no demonstrable underlying tumour. ---

Question 6

A middle-aged smoker develops a multifocal warty poorly differentiated vulvar carcinoma. Which precursor lesion is most likely involved?

Accepted Answer

Vulvar intraepithelial neoplasia — HPV-related vulvar carcinoma in younger women is preceded by VIN. Cigarette smoking and immunodeficiency increase the risk of progression. ---

Question 7

Which organism is responsible for the greatest proportion of cervicitis cases in STD clinics?

Accepted Answer

Chlamydia trachomatis — C. trachomatis accounts for up to 40% of cervicitis in STD clinics and causes prominent lymphoid follicles on histology. ---

Question 8

HPV oncoprotein E7 drives cervical carcinogenesis primarily by

Accepted Answer

Inactivating the Rb tumour suppressor protein — E7 binds and inactivates Rb, promoting uncontrolled cell cycle progression. E6 targets p53. ---

Question 9

CIN III differs from CIN I histologically primarily by showing

Accepted Answer

Full thickness epithelial atypia with absent koilocytosis — CIN III shows near-complete loss of maturation affecting virtually all layers. Koilocytosis, prominent in CIN I, is typically absent in CIN III. ---

Question 10

Which statement about the quadrivalent HPV vaccine is correct?

Accepted Answer

It protects against HPV types 6, 11, 16, and 18 — The quadrivalent vaccine covers types 6, 11, 16, and 18. It does not replace screening because other oncogenic types exist and many women are already infected. ---

Question 11

A cervical tumour encircles the cervix and penetrates the underlying stroma deeply. This morphologic appearance is called

Accepted Answer

Barrel cervix — When tumour encircles the cervix and invades the stroma, it produces a barrel cervix identifiable on direct palpation. ---

Question 12

The most common cause of death in advanced invasive cervical carcinoma is

Accepted Answer

Renal failure from ureteral obstruction — Most patients with advanced cervical cancer die from local invasion. Ureteral and bladder obstruction leading to renal failure is the most common cause of death. ---

Question 13

The diagnosis of chronic endometritis specifically requires the presence of

Accepted Answer

Plasma cells in the endometrial stroma — Lymphocytes are normally present in the endometrium and are not diagnostic. Plasma cells are the key diagnostic requirement for chronic endometritis. ---

Question 14

Adenomyosis differs from endometriosis in that adenomyosis

Accepted Answer

Derives from the basalis layer and does not bleed cyclically — Adenomyosis derives from the stratum basalis which does not respond to hormonal cycling. Endometriosis contains functioning endometrium that undergoes cyclic bleeding. ---

Question 15

Which theory of endometriosis best explains its occurrence in the lungs and skeletal muscle?

Accepted Answer

Vascular or lymphatic dissemination of endometrial cells — Vascular and lymphatic dissemination explains how endometrial tissue reaches distant sites like the lungs, heart, and skeletal muscle where retrograde flow cannot reach. ---

Question 16

Why are COX-2 inhibitors and aromatase inhibitors useful in treating endometriosis?

Accepted Answer

They reduce prostaglandin E2 and local oestrogen production — Endometriotic tissue has high aromatase activity and elevated PGE2, promoting local oestrogen and survival of ectopic tissue. Both drug classes target these mechanisms. ---

Question 17

Histologic diagnosis of endometriosis requires at least two of which three features?

Accepted Answer

Endometrial glands, endometrial stroma, and haemosiderin pigment — The three diagnostic features are endometrial glands, endometrial stroma, and haemosiderin pigment. At least two must be present to confirm the diagnosis histologically. ---

Question 18

Anovulatory cycles cause abnormal uterine bleeding because

Accepted Answer

Oestrogen excess without progesterone leads to unstable endometrium — Without ovulation, there is no progesterone from the corpus luteum. Unopposed oestrogen keeps the endometrium in a proliferative phase that is prone to irregular breakdown. ---

Question 19

Complex endometrial hyperplasia with cellular atypia carries what approximate risk of progression to carcinoma?

Accepted Answer

Between 20 and 50% — Complex hyperplasia with atypia carries a 20–50% risk of progression to endometrial carcinoma, the highest risk category. Without atypia the risk is less than 5%. ---

Question 20

Which tumour suppressor gene is most commonly mutated as an early event in endometrioid endometrial carcinoma?

Accepted Answer

PTEN — PTEN inactivating mutations are early events in endometrioid carcinoma, dysregulating the PI-3-kinase/AKT pathway. TP53 mutations are characteristic of serous type carcinoma. ---

Question 21

Serous endometrial carcinoma differs from endometrioid carcinoma in that serous carcinoma

Accepted Answer

Arises on a background of atrophy and has TP53 mutations — Serous carcinoma arises in older postmenopausal women on a background of atrophy. Nearly all cases harbour TP53 mutations and are high-grade by definition. ---

Question 22

A woman with Cowden syndrome has a germline mutation that increases her risk of endometrial carcinoma. Which gene is mutated?

Accepted Answer

PTEN — Cowden syndrome is caused by germline PTEN mutations. PTEN loss dysregulates PI-3-kinase/AKT signalling, significantly increasing the risk of endometrioid endometrial carcinoma. ---

Question 23

Which histologic feature is most characteristic of leiomyosarcoma but not leiomyoma?

Accepted Answer

Tumour necrosis with cytologic atypia and mitoses — Leiomyosarcoma requires all three features for diagnosis: tumour necrosis, cytologic atypia, and mitotic activity. Leiomyomas may show mitoses alone without fulfilling malignancy criteria. ---

Question 24

Leiomyomas are most correctly described as arising from

Accepted Answer

Smooth muscle cells of the myometrium — Leiomyomas are benign tumours arising from smooth muscle cells of the myometrium. They are monoclonal and oestrogen-sensitive, shrinking after menopause. ---

Question 25

A leiomyosarcoma is discovered in a postmenopausal woman. Which statement about its origin is correct?

Accepted Answer

It arises de novo from myometrial mesenchymal cells — Leiomyosarcomas arise de novo from myometrial mesenchymal cells, not from pre-existing leiomyomas. They are almost always solitary and occur in postmenopausal women. ---

Question 26

Which complication of salpingitis directly results from adhesions of the tubal plicae?

Accepted Answer

Increased risk of tubal ectopic pregnancy — Adhesions of the tubal plicae narrow the tubal lumen, impeding passage of the fertilised ovum and significantly increasing the risk of tubal ectopic pregnancy. ---

Question 27

In which group of women is fallopian tube carcinoma particularly increased?

Accepted Answer

Women with BRCA gene mutations — BRCA mutation carriers have significantly increased risk of fallopian tube carcinoma. In prophylactic oophorectomy specimens, 10% had occult malignancy equally split between ovary and fallopian tube. ---

Question 28

Polycystic ovarian disease is characterised by which combination of biochemical abnormalities?

Accepted Answer

High LH, low FSH, and excess androgens — PCOS is characterised by excess androgen production, elevated LH, and low FSH. The absence of corpora lutea on histology reflects the failure of ovulation. ---

Question 29

A 35-year-old woman is found to have a large ovarian cyst filled with clear serous fluid and papillary projections. Psammoma bodies are noted histologically. What is the most likely diagnosis?

Accepted Answer

Serous cystadenoma — Psammoma bodies — concentrically laminated calcified concretions — are characteristic of serous tumours. They are found at the tips of papillary projections. ---

Question 30

High-grade serous ovarian carcinoma is most strongly associated with mutations in which gene?

Accepted Answer

TP53 — 96% of high-grade serous ovarian carcinomas harbour TP53 mutations. Low-grade serous tumours are associated with KRAS, BRAF, or ERBB2 mutations instead. ---

Question 31

Which feature best distinguishes a primary ovarian mucinous tumour from a Krukenberg tumour?

Accepted Answer

Primary mucinous tumours tend to be unilateral and large — Primary ovarian mucinous tumours are typically unilateral and large. Krukenberg tumours are metastatic mucinous adenocarcinomas from the GI tract and are characteristically bilateral. ---

Question 32

Pseudomyxoma peritonei is most commonly caused by

Accepted Answer

Metastasis from a gastrointestinal primary, usually the appendix — Although ovarian mucinous tumours can seed the peritoneum, pseudomyxoma peritonei is most commonly caused by metastasis from the GI tract, primarily the appendix. ---

Question 33

Ovarian endometrioid carcinoma is notable because 15–30% of cases are associated with

Accepted Answer

Concomitant endometrial carcinoma — 15–30% of women with ovarian endometrioid carcinoma have a concomitant endometrial carcinoma. Both share PTEN mutations reflecting similar pathogenetic mechanisms. ---

Question 34

The Brenner tumour of the ovary is characterised histologically by nests of

Accepted Answer

Transitional-type epithelium resembling urinary tract in abundant stroma — Brenner tumour contains nests of transitional-type epithelium resembling the urinary tract within abundant fibrous stroma. Most are benign and unilateral. ---

Question 35

A 16-year-old girl presents with a large solid ovarian mass containing immature neural tissue and areas of necrosis. What is the most likely diagnosis?

Accepted Answer

Immature malignant teratoma — Immature malignant teratomas occur in young women with a mean age of 18 years. They contain immature elements including neuroepithelium, which is particularly ominous. ---

Question 36

Which rare complication can occur in women with mature cystic teratomas containing neural tissue?

Accepted Answer

Limbic encephalitis as a paraneoplastic phenomenon — Limbic encephalitis is a rare paraneoplastic complication of mature teratomas containing neural tissue. It typically remits after tumour resection. ---

Question 37

CA-125 is most useful clinically in ovarian cancer for which purpose?

Accepted Answer

Monitoring response to treatment in diagnosed cases — CA-125 is elevated in 75–90% of epithelial ovarian cancers but is also elevated in benign conditions, limiting its screening value. Its greatest utility is monitoring treatment response. ---

Question 38

Ascending placental infection most commonly presents histologically as

Accepted Answer

Acute chorioamnionitis with neutrophilic infiltration — Ascending bacterial infections cause acute chorioamnionitis — neutrophilic infiltration of the chorioamnion with oedema and congestion. Extension to the cord causes funisitis. ---

Question 39

Which group of organisms is associated with haematogenous placental infection causing villitis?

Accepted Answer

Toxoplasma, rubella, CMV, herpes, and syphilis — Haematogenous infections cause villitis and include the TORCH organisms — Toxoplasma, Others (syphilis, listeria), Rubella, CMV, and Herpes simplex virus. ---

Question 40

In more than 90% of ectopic pregnancies, implantation occurs in which site?

Accepted Answer

Fallopian tube — Over 90% of ectopic pregnancies are tubal. Chronic inflammation and scarring of the oviduct account for approximately 50% of cases. The remainder have no identifiable anatomic cause. ---

Question 41

Rupture of an ectopic tubal pregnancy produces which morphologic finding within the tube?

Accepted Answer

Haematosalpinx with intraperitoneal haemorrhage — The invading placenta burrows through the oviduct wall, producing haematosalpinx — intratubal haematoma — and intraperitoneal haemorrhage, which causes shock. ---

Question 42

All gestational trophoblastic tumours share which clinically useful feature?

Accepted Answer

They all elaborate hCG detectable in blood and urine — All gestational trophoblastic tumours elaborate hCG, which aids diagnosis and allows monitoring of treatment response. Levels much higher than normal pregnancy suggest choriocarcinoma. ---

Question 43

A complete hydatidiform mole differs from a partial mole in that a complete mole

Accepted Answer

Is diploid with all genetic content of paternal origin — A complete mole is diploid (46,XX or 46,XY) with all chromosomes of paternal origin, arising when two spermatozoa or a diploid sperm fertilise an empty egg. ---

Question 44

What percentage of complete hydatidiform moles progress to give rise to choriocarcinoma?

Accepted Answer

Approximately 2 to 3% — 80–90% of moles resolve after curettage. 10% of complete moles are invasive, but only 2–3% give rise to choriocarcinoma. ---

Question 45

Gestational choriocarcinoma differs histologically from hydatidiform mole because choriocarcinoma

Accepted Answer

Contains no chorionic villi and is composed of anaplastic trophoblasts — Choriocarcinoma contains no chorionic villi. It is composed entirely of anaplastic cytotrophoblasts and syncytiotrophoblasts invading the myometrium and vessels. ---

Question 46

Why does gestational choriocarcinoma respond better to chemotherapy than gonadal choriocarcinoma?

Accepted Answer

Paternal antigens trigger a maternal immune response aiding clearance — Placental choriocarcinoma carries paternal antigens absent in gonadal tumours. A maternal immune response against these foreign antigens acts as an adjunct to chemotherapy. ---

Question 47

The placental site trophoblastic tumour is distinguished from other trophoblastic tumours by

Accepted Answer

Production of human placental lactogen with only slight hCG elevation — Intermediate trophoblasts produce little hCG but abundant hPL. This distinguishes placental site trophoblastic tumour from other gestational trophoblastic diseases. ---

Question 48

The core pathophysiologic defect in preeclampsia is

Accepted Answer

Inadequate remodelling of spiral arteries causing placental hypoxia — In preeclampsia, trophoblasts fail to adequately remodel spiral artery walls. The retained musculoelastic walls keep channels narrow, causing placental hypoxia and downstream effects. ---

Question 49

HELLP syndrome complicates approximately what percentage of severe preeclampsia cases?

Accepted Answer

Approximately 10% — HELLP syndrome — Haemolysis, Elevated Liver enzymes, Low Platelets — complicates approximately 10% of severe preeclampsia cases and reflects end-organ microangiopathy. ---

Question 50

Clear cell adenocarcinoma of the vagina in young women is most strongly associated with

Accepted Answer

In utero exposure to diethylstilbestrol — Clear cell adenocarcinoma of the vagina develops in young women whose mothers took DES during pregnancy. DES causes vaginal adenosis, which is the precursor lesion. ---

Female Reproductive Pathology — MCQ Quiz

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