Neoplasia: soft tissue tumours of the uterus: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Neoplasia: soft tissue tumours of the uterus

Sample item

A 48-year-old woman has a rapidly enlarging uterine mass. Histology shows a spindle cell tumour with marked nuclear atypia, 15 mitoses per 10 high-power fields and geographic areas of coagulative tumour cell necrosis. What is the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Leiomyosarcoma

Smooth muscle tumours are separated by atypia, mitotic count and the type of necrosis. Marked atypia, high mitotic activity and coagulative tumour cell necrosis establish leiomyosarcoma, which is aggressive and spreads haematogenously, often to the lungs.

Option by option

  • A. Cellular leiomyoma

    A cellular leiomyoma is benign, with minimal atypia and a low mitotic count.

  • B. Endometrial stromal nodule

    An endometrial stromal nodule is a circumscribed benign stromal tumour without marked atypia or high mitotic counts.

  • C. Leiomyosarcoma (correct)

    The triad of atypia, brisk mitoses and tumour cell necrosis is diagnostic of leiomyosarcoma.

  • D. Leiomyoma with hyaline degeneration

    Hyaline degeneration is a benign change of fibroids and lacks atypia and tumour cell necrosis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is C, Leiomyosarcoma. Smooth muscle tumours are separated by atypia, mitotic count and the type of necrosis.

Why is "Cellular leiomyoma" not the answer?

A cellular leiomyoma is benign, with minimal atypia and a low mitotic count.

Why is "Endometrial stromal nodule" not the answer?

An endometrial stromal nodule is a circumscribed benign stromal tumour without marked atypia or high mitotic counts.

Why is "Leiomyoma with hyaline degeneration" not the answer?

Hyaline degeneration is a benign change of fibroids and lacks atypia and tumour cell necrosis.

What concept does this question test?

It tests Neoplasia: soft tissue tumours of the uterus in Pathology. Marked atypia, high mitotic activity and coagulative tumour cell necrosis establish leiomyosarcoma, which is aggressive and spreads haematogenously, often to the lungs.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neoplasia: soft tissue tumours of the uterus?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.