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Question 1
Correct
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Which of the following is the most common germ cell tumour of the testis affecting an adult male?
Your Answer: Seminoma
Explanation:Germ cell tumours represent 90% of primary tumours arising in the testis. They are broadly divided into seminomas and non-seminomas. Seminomas are the most common testicular germ cell tumour seen in 40% cases. The other non-seminomatous histological subtypes include embryonal (25%), teratocarcinoma (25%), teratoma (5%) and pure choriocarcinoma (1%).
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This question is part of the following fields:
- Pathology
- Urology
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Question 2
Correct
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Out of the given options, which of the following is the most likely diagnosis in a 25-year old gentleman presenting with a testicular germ cell tumour?
Your Answer: Embryonal carcinoma
Explanation:Embryonal carcinoma is a non-seminomatous germ cell tumour of the testis, accounting for 25% testicular tumours. Other germ cell tumours include seminoma, teratoma and choriocarcinoma. Embryonal carcinomas are known to occur in men aged 25-35 years, and occasionally in teens. They are rarely seen in ovaries of females. It can spread to the vas deferens and also to the aortic lymph nodes. Embryonal carcinomas are known to have elements of fetal origin such as cartilage. Usually, the main tumour is about 2.5cm long, with an extension of 8-9cm along the testicular cord. Contiguous spread to the testicle is seen in less than 1% cases.
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This question is part of the following fields:
- Pathology
- Urology
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Question 3
Correct
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A 7-year-old boys undergoes a testicular biopsy after a tumour is found in his right testis. Elements similar to hair and teeth are found in it. What kind of tumour is this?
Your Answer: Teratoma
Explanation:A teratoma is a tumour containing tissue elements that are similar to normal derivatives of more than one germ layer. They usually contain skin, hair, teeth and bone tissue and are more common in children, behaving as a benign tumour. After puberty, they are regarded as malignant and can metastasise.
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This question is part of the following fields:
- Pathology
- Urology
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Question 4
Correct
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A 42 year old women presents with end stage renal failure and is prepared to receive a kidney from her husband. HLA testing showed that they are not a 100% match and she is given immunosuppressant therapy for this. Three months later when her renal function tests were performed she showed signs of deteriorating renal function, with decreased renal output, proteinuria of +++ and RBCs in the urine. She was given antilymphocyte globulins and her condition reversed. What type of graft did this patient receive?
Your Answer: Allograft
Explanation:Allograft describes a graft between two of the same species. As the donor and the recipients are history-incompatible, rejection of the graft is common and is controlled by immunosuppressive drug therapy. Isograft and syngraft are synonymous and referred to a graft transferred between genetically identical individuals e.g. identical twins. In this case rejection is rare as they are history-compatible.
Autograft refers to transfer of one part of the body to another location.
Xenograft is transfer of tissue from another species e.g. pig to human in valve replacement surgeries and rejection is very high.
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This question is part of the following fields:
- Inflammation & Immunology; Renal
- Pathology
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Question 5
Correct
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A biopsy is performed on a 67-year-old-man with testicular seminoma; it reveals that the tumour affects the tunica vaginalis. The tumour stage in this case is:
Your Answer: T2
Explanation:The primary tumour staging for testicular seminoma is as follows, according to AJCC guidelines:
Tis: intratubular germ cell neoplasia (carcinoma in situ)
T1: tumour limited to testis/epididymis without vascular or lymphatic invasion; the tumour can invade into the tunica albuginea but not the tunica vaginalis
T2: tumour limited to testis/epididymis with vascular or lymphatic invasion or tumour extending through the tunica albuginea with involvement of the tunica vaginalis
T3: tumour invading the spermatic cord, with or without vascular/lymphatic invasion
T4: tumour invading the scrotum, with or without vascular/lymphatic invasion.
According to these guidelines, the tumour in this case has a T2 stage.
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This question is part of the following fields:
- Pathology
- Urology
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Question 6
Correct
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A sexually active 21 year old man presents with the history of dysuria for the past 3 days. Urine culture confirmed Neisseria gonorrhoeae and smear showed abundant neutrophils. Which of the following mediators is responsible for causing diapedesis of the neutrophils to reach the site of infection?
Your Answer: Complement C5a
Explanation:C5a is part of the complement cascade and is released frim the complement C5. It acts as a chemotactic factor for neutrophils. Other chemotactic mediators are TNF, leukotrienes and bacterial products.
Bradykinin is associated with the production of pain and vasodilation.
Hageman factor is a clotting factor.
Histamine causes vasodilation.
C3B causes opsonisation.
IL-6 and IL-12 are inflammatory mediators causing B cell maturation and mediating inflammation and prostaglandins are involved with pain, increasing cell permeability and vasodilation.
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This question is part of the following fields:
- Inflammation & Immunology; Urology
- Pathology
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Question 7
Correct
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If a tumour is found in both lobes of the prostate, without nodal involvement or metastases, a histological grade of G2 and elevated PSA, what is the overall prostatic cancer stage?
Your Answer: Stage II
Explanation:The AJCC uses the TNM, Gleason score and PSA levels to determine the overall stage of prostatic cancer. This staging is as follows:
Stage I: T1, N0, M0, Gleason score 6 or less, PSA less than 10; or T2a, N0, M0, Gleason score 6 or less, PSA less than 10
Stage IIa: T1, N0, M0, Gleason score of 7, PSA less than 20; or T1, N0, M0, Gleason score of 6 or less, PSA at least 10 but less than 20; or T2a or T2b, N0, M0, Gleason score of 7 or less, PSA less than 20
Stage IIb: T2c, N0, M0, any Gleason score, any PSA; or T1 or T2, N0, M0, any Gleason score PSA of 20 or more; or T1 or T2, N0, M0, Gleason score of 8 or higher, any PSA
Stage III: T3, N0, M0, any Gleason score, any PSA Stage IV: T4, N0, M0,any Gleason score, any PSA; or any T, N1, M0,any Gleason score, any PSA; or Any T, any N, M1, any Gleason score, any PSA.
The patient in this case has a T2 N0 M0 G2 tumour, meaning it belongs in stage II
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This question is part of the following fields:
- Pathology
- Urology
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Question 8
Correct
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A 30 year old male has a painless and transilluminant swelling at the upper pole of his left testi. There is a negative cough test. Which of the following is the likely diagnosis?
Your Answer: Spermatocoele
Explanation:Spermatocele, also known as a spermatic cyst is a cystic mass usually occurring at the upper pole of the testis. Differential diagnosis included hydrocele as both are cystic, painless and transilluminant. Ultrasound is a useful modality. If symptomatic or large, surgical excision can be done.
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This question is part of the following fields:
- Pathology
- Urology
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Question 9
Correct
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When a penile tumour invades the subepithelial connective tissue of the penis, what is its stage?
Your Answer: T1
Explanation:The TNM staging used for penile cancer is as follows:
TX: primary tumour cannot be assessed
T0: primary tumour is not evident
Tis: carcinoma in situ is present
Ta: non-invasive verrucous carcinoma is present
T1: tumour is invading subepithelial connective tissue
T2: tumour is invading the corpora spongiosum or cavernosum
T3: tumour invading the urethra or prostate
T4: tumour invading other adjacent structures.
In this case, the patient has a T1 tumour.
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This question is part of the following fields:
- Pathology
- Urology
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Question 10
Correct
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A patient with testicular seminoma has the following tumour markers: LDH 1.3 times the reference levels, β-hCG 4500 mIU/ml and AFP 875 ng/ml. What's the serum tumour marker stage in this case?
Your Answer: S1
Explanation:According to AJCC guidelines, the serum tumour marker staging is the following:
S0: marker studies within normal limits
S1: lactate dehydrogenase (LDH) less than 1.5 times the reference range, beta-human chorionic gonadotrophin (β-hCG) <5000 mIU/ml, and alpha-fetoprotein (AFP) <1000 ng/ml S2: LDH 1.5–10 times the reference range, β-hCG 5000–50,000 mIU/ml or AFP 1000–10,000 ng/ml S3: LDH greater than 10 times the reference range, β-hCG >50,000 mIU/ml or AFP >10,000 ng/ml.
According to this, the patient’s tumour belongs to the S1 stage.
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This question is part of the following fields:
- Pathology
- Urology
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