Female genital tract quiz answers. Uterine pathology questions with answers – Useful for NEET-SS Oncopathology, DM Histopathology, NIMHANS- Neuropathology fellowships and FRCPath-Histopathology.

Question 1: A 55-year-old woman has a hysterectomy for persistent bleeding. On gross examination you see a 2-cm polypoid mass with a villous surface. The cut surface is white, spongy and cystic. Microscopically the surface of the lesion has broad, dub-shaped papillae of stroma covered by proliferative phase endometrial cells. The stroma consists of bland cells that resemble fibroblasts and benign endometrial stromal cells. What is the diagnosis?

A.  Adenomyoma
B.  Atypical
C.  Adenofibroma
D.  Benign polyp
E.  Adenomatoid tumor

Answer:  C

The correct answer is adenofibroma

Question 2:  Which of the following can be seen in atypical hyperplasia?
A.  Architectural pattern may be simple or complex.
B.  Metaplastic changes may be present in any type of hyperplasia (particularly the morular variant of squamous metaplasia).
C.  True nuclear stratification (2-4 cells thick) with loss of polarity usually present and ofi:en more marked than in complex hyperplasia without atypia.
D.  Atypical cells tend to be enlarged; nuclear-cytoplasmic ratio is increased; nuclei large, hyperchromatic, and pleomorphic (tend to be more rounded than oval); nuclear membranes usually irregular·and thick; nucleoli prominent
E. All of the above

Answer: E
All of these findings can be seen in the spectrum of atypical endometrial hyperplasia. While they can demonstrate papillary in folding, a cribriform or confluent pattern is never seen. There are no characteristic stromal findings for atypical hyperplasia.

Question 3. According to the latest WHO classification of female genital tract tumors (2020), which of the following variants of leiomyoma is an addition?

A.  Symplastic
B.  Fumarate hydratase deficient
C.  Anaplastic
D.  Bizzare
E.  Pleomorphic

Answer:  B

Answer is Fumarate hydratase deficient

Question 4. A 51 year old woman presented with vaginal bleeding and workup revealed a large uterine mass. Hysterectomy and bilateral salpingo-oophorectomy is performed. Pathology is consistent with a low grade endometrial sarcoma. Which of the following statements is false?
A.  CD10 is negative in tumor cells
B.  ER and PR positive in tumor cells
C.  h-Caldesmon is negative in tumor cells
D. JAZF1-SUZ12 mutation is most commonly seen

Answer:  A

CD10 is positive in low grade stromal sarcomas.

Question 5. True statement about the recently proposed molecular classification of endometrial carcinomas is? WHO 2020
A.  Copy number high group, lack p53 mutations
B.  Copy number low group, have p53 mutations
C.  Tumors with CTNNB1 mutations have a good prognosis
D.  POLE ultramutated tumors have a good prognosis

Answer:  D

It proposed a classification that separates endometrial carcinomas in 4 groups:

Copy number – high (frequently involving mutations of TP53); this group includes the vast majority of serous carcinomas and 25% of high grade endometrioid tumors

Copy number – low (frequently involving mutations of PTEN, PIK3CA, ARID1A and KRAS); this group is mostly composed of low grade endometrioid carcinomas

Microsatellite instability hypermutated (frequently involving alterations of mismatch repair protein genes)

Molecular classification of endometrial carcinomas- female genital tract mcqs[/caption] this group is mostly composed of endometrioid cancers, which despite having a dramatically increased transversion mutation frequency and newly identified hotspot mutations in the POLE gene (which encodes the central catalytic subunit of DNA polymerase epsilon), appear to have a better prognosis than other groups.

CTNNB1 mutations have been found to be an adverse prognostic feature in patients with low grade, low risk endometrial carcinoma.

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