Endo/Repro - Female Reproductive System Flashcards
1
Q
What is the precursor lesion to cervical squamous cell carcinoma?
A
Cervical glandular intraepithelial neoplasia (CIN)
- (Note: may be low-grade or high-grade)*
- (Note2: also known as squamous intraepithelial lesions, or SILs)*
2
Q
What is the precursor lesion to cervical adenocarcinoma?
A
Adenocarcinoma in-situ (AIS)
OR
cervical glandular intraepithelial neoplasia (CIN)
3
Q
True/False.
There are a variety of forms of cervical squamous cell carcinoma.
A
True.
E.g. keratinizing, non-keratinzing, basaloid, verrucous, warty, papillary.
4
Q
The earliest stage of invasive cervical squamous cell carcinomas is known as pT1A which can only be diagnosed _______scopically.
pT1A1 is characterized by a depth of ≤ ____ mm.
pT1A2 is characterized by a depth of > ____ mm and ≤ ____ mm.
A
The earliest stage of invasive cervical squamous cell carcinomas is known as pT1A which can only be diagnosed microscopically.
pT1A1 is characterized by a depth of ≤ 3 mm.
pT1A2 is characterized by a depth of > 3** mm and ≤ **5 mm.
5
Q
Describe the staging of cervical neoplasia.
A
6
Q
While both spread lymphatically, identify which of the following is more likely to spread hematogenously:
Cervical squamous cell carcinoma; cervical adenocarcinoma.
A
Cervical adenocarcinoma
7
Q
What are some of the treatment options for cervical carcinomas?
A
Radiation (+/- chemo), surgery, or both
8
Q
~80% of cervical carcinomas are which subtype?
A
Squamous cell carcinomas
9
Q
While the symptomatology and gross appearance of cervical adenocarcinomas and cervical squamous cell carcinomas are largely identical, which is more aggressive?
A
Cervical adenocarcinomas
10
Q
Name two useful screening tests in identifying/preventing the development of cervical carcinoma.
A
Pap smear; HPV test
(HPV testing recommended for women ≥ 30 or with unclear Pap smear results)
11
Q
What are the cervical cancer screening recommendations for 21 – 29 year olds?
A
Screen every three years with Pap smear
12
Q
What are the cervical cancer screening recommendations for 30 – 65 year olds?
A
Every three years with Pap smear
OR
Every five years with both Pap Smear and HPV testing
13
Q
What are the cervical cancer screening recommendations for those younger than 21 or older than 65 who have had adequate prior screening or who have had a hysterectomy?
A
Do not screen for cervical cancer
14
Q
Why are Pap smears taken from the transformation zone?
A
It is the site of nearly all squamous neoplasia.
15
Q
Describe the location of the transformation zone during the following time periods:
Prepubertal:
Postadolescent (reproductive age):
Postmenopausal:
A
Describe the location of the transformation zone during the following time periods:
Prepubertal: sharp demarcation between endo- and ectocervix, higher up in endocervix
Postadolescent (reproductive age): shifts lower and pushes into ectocervix
Postmenopausal: reversion back up into endocervix
16
Q
Do HPV-infected cervical cells tend to get smaller or larger?
A
Larger
17
Q
Describe the appearance of koilocytes.
A
Clearing around nucleus
+
raisinoid, hyperchromatic, often binucleate nuclei
18
Q
How should low-grade squamous intraepithelial lesions (low-grade CIN, aka LSIL) be treated?
A
Colposcopy, survey
19
Q
How should high-grade squamous intraepithelial lesions (high-grade CIN, aka HSIL) be treated?
A
Cryosurgery, loop electrial excision procedure (LEEP), conventional surgery
20
Q
How should external cervical warts be treated?
A
Same as high-grade squamous intraepithelial lesions (HSIL) (Cryosurgery, loop electrial excision procedure (LEEP), conventional surgery)
+
Podofilox and imiquimod
21
Q
The #1 risk factor for development of cervical carcinoma is:
A
Persistent HPV infection.
22
Q
Name some of the HPV-cofactor risk factors that are somewhat associated with cervical adenocarcinoma.
A
Obesity, OCPs
23
Q
Name some of the HPV-cofactor risk factors strongly associated with cervical squamous cell carcinoma.
A
Parity, smoking, OCPs
24
Q
Name some of the non-HPV risk factors associated with cervical carcinomas.
A
Multiple sexual partners, early onset of sexual activity, immunosuppression (e.g. HIV)
(also, OCP use, high parity, smoking)
25
Do most HPV infections resolve spontaneously?
**Yes**.
## Footnote
*Many under age 30 test positive but most don’t show progression/persistence of the infection.*
26
What are the most important HPV protein products *(and which substances do they inhibit, respectively)?*
**E6** (p53);
**E7** (Rb)
27
HPV random viral integration occurs at \_\_\_\_/\_\_\_\_ open reading frames.
HPV random viral integration occurs at **_E1/E2_** open reading frames.
28
Disruption of HPV ____ removes the repression of E6 and E7 genes (with resultant overexpression).
Disruption of HPV **_E2_** removes the repression of E6 and E7 genes (with resultant overexpression).
29
Cervarix is a \_\_\_\_\_\_valent vaccine that targets the following HPV subtypes:
Cervarix is a **_bi_**valent vaccine that targets the following HPV subtypes:
## Footnote
**16, 18**
30
Gardasil is a \_\_\_\_\_\_valent vaccine that targets the following HPV subtypes:
Gardasil is a **_quadri_**valent vaccine that targets the following HPV subtypes:
## Footnote
**6, 11, 16, 18**
31
Gardasil 9 is a \_\_\_\_\_\_valent vaccine that targets the following HPV subtypes:
Gardasil 9 is a **_nono_**valent vaccine that targets the following HPV subtypes:
## Footnote
**6, 11, 16, 18, 31, 33, 45, 52, 58**
32
Which gardasil vaccine(s) is(are) available in the U.S.?
**Gardasil 9 _only_**
33
A 35-year-old woman has a routine Pap smear for the first time. The results indicate that dysplastic cells are present, and the lesion is consistent with HSIL. Based on these findings, what is the next best step?
A) Course of radiation therapy
B) Conization/LEEP
C) Bone scan for metastatic disease
D) Colposcopy with biopsy
E) No further therapy is indicated
A 35-year-old woman has a routine Pap smear for the first time. The results indicate that dysplastic cells are present, and the lesion is consistent with HSIL. Based on these findings, what is the next best step?
A) Course of radiation therapy
B) Conization/LEEP
C) Bone scan for metastatic disease
**D) Colposcopy with biopsy**
E) No further therapy is indicated
34
A 42-year-old woman has a Pap smear as part of a routine gynecologic examination. There are no remarkable findings on physical examination. The Pap smear shows cells consistent with HSIL with human papillomavirus subtype 18. Cervical biopsy specimens are obtained, and microscopic examination confirms the presence of extensive HSIL (CIN 3). What is the most likely explanation for proceeding with cervical conization for this patient?
A) She is at risk for invasive carcinoma
B) Human papillomavirus infection cannot be treated
C) She is perimenopausal
D) She has chronic cervicitis
E) Her reproductive years are over
A 42-year-old woman has a Pap smear as part of a routine gynecologic examination. There are no remarkable findings on physical examination. The Pap smear shows cells consistent with HSIL with human papillomavirus subtype 18. Cervical biopsy specimens are obtained, and microscopic examination confirms the presence of extensive HSIL (CIN 3). What is the most likely explanation for proceeding with cervical conization for this patient?
**A) She is at risk for invasive carcinoma**
B) Human papillomavirus infection cannot be treated
C) She is perimenopausal
D) She has chronic cervicitis
E) Her reproductive years are over
35
A 28-year-old, sexually active woman comes to her physician for a routine gynecologic examination. There are no abnormal findings on physical examination. The patient has been taking oral contraceptives for the past 10 years. A Pap smear shows HSIL in the background of marked acute inflammation. What is the major significance of this finding?
A) A cervicitis needs to be treated
B) The patient has an increased risk of malignancy
C) Condylomata acuminata are probably present
D) An endocervical polyp needs to be excised
E) The patient should stop taking oral contraceptives
A 28-year-old, sexually active woman comes to her physician for a routine gynecologic examination. There are no abnormal findings on physical examination. The patient has been taking oral contraceptives for the past 10 years. A Pap smear shows HSIL in the background of marked acute inflammation. What is the major significance of this finding?
A) A cervicitis needs to be treated
**B) The patient has an increased risk of malignancy**
C) Condylomata acuminata are probably present
D) An endocervical polyp needs to be excised
E) The patient should stop taking oral contraceptives
36
How common is endometriosis?
Affects 10 - 15% of women of reproductive age
37
What are the two most common sites of endometrial implantation?
Ovaries;
uterine ligaments
38
Ovarian endometrial implants are typically described as having what appearance?
What other term is used to describe yellow-brown endometrial tissues outside the uterus?
'Chocolate cysts;'
'gunpowder lesions'
39
The tissues seen in endometriosis typically present as normal endometrial tissue with what addition(s)?
Hemosiderin-laden macrophages
+
red blood cells
40
Name some of the S/Sy of endometriosis.
**Dysmenorrhea** (painful menstruation);
**pain** in the back, pelvis, and/or lower abdomen;
**dyspareunia** (painful intercourse);
irregular **bleeding**;
**infertility**
41
What is the most common malignancy of the female genital tract?
Endometrial carcinoma
42
Name a few risk factors for endometrial carcinoma.
**_Think excess estrogen exposure:_**
**Obesity**;
infertility (nulliparity);
anovulatory cycles;
PCOS
(also, diabetes and hypertension)
43
Which type of endometrial carcinoma is driven by estrogens and maybe some microsatellite instability?
Type 1
| (hyperplastic)
44
Which type of endometrial carcinoma is more common in thin women and is associated with mutated *p53*?
Type 2
| (sporadic)
45
Type 2 endometrial carcinoma (sporadic type) is associated with endometrial atrophy, mutated *p53*, and the following subtypes:
Serous (with Psammoma bodies);
clear cell;
mixed
46
Endometrial hyperplasia without atypia is characterized by a ratio of glands:stroma \> \_\_\_%.
How is it treated?
Endometrial hyperplasia without atypia is characterized by a ratio of glands:stroma ≥ **_50_**%.
**Progesterone** **_only_**
47
**True/False**.
Atypical endometrial hyperplasia is associated with enlarged nuclei, multiple mitoses, and a 33% risk of progression to endometrial malignancy.
True.
48
Name a common cause of endometrial bleeding that results due to focal hyperplasia of the basalis layer.
**Endometrial polyps**
49
Endometrial polyp development is associated with what drug use?
**Tamoxifen**
50
Endometrial polyps are proliferations of glands covered on ____ sides by endometrium, fibrotic stroma, thick walled blood vessels. They are most commonly seen in individuals aged ____ - \_\_\_\_.
Endometrial polyps are proliferations of glands covered on **_3**_ sides by endometrium, fibrotic stroma, thick walled blood vessels. They are most commonly seen in individuals aged _**40**_ – _**50_**.
51
Which type of squamous carcinoma of the vulva is seen in women around 55 and is an HPV- and cigarette-driven process?
**Group 1** (basaloid or warty; 30% of cases)
52
Which type of squamous carcinoma of the vulva is seen in women around 77 and is _not_ an HPV- and cigarette-driven process?
**Group 2** (keratinizing; 70% of cases)
53
Keratinizing squamous carcinomas of the vulva (group 2) are associated with what disease?
**Lichen sclerosus**
54
What is the equivalent of cervical intraepithelial neoplasia in the external genitalia?
**Vulvar intraepithelial neoplasia**
55
Lichen sclerosus is characterized by what changes in the vulvar epidermis and/or dermis?
**Epidermal _thinning_**;
## Footnote
**dermal _fibrosis_**
56
Describe the S/Sy of lichen sclerosus.
**Lighter vulvar pigmentation**,
**atrophy** of labia minora,
**leukoplakia** with **‘parchment paper’** surface,
**itching** and subsequent **hyperkeratosis**
57
Paget’s disease of the vulva is what?
A **carcinoma in-situ**
58
Paget’s disease of the vulva is most common in what age and race?
**Postmenopausal, white women**
59
**True/False**.
Paget’s disease of the vulva is a slowly progressive, indolent carcinoma in-situ.
**True**.
60
Paget’s disease of the vulva can present similarly (and must be differentiated from) what other condition?
**Melanoma**
| (which will stain positive for S-100)
61
Describe the histology of the cells seen in Paget’s disease of the vulva.
Proliferation of neoplastic **large** **cells** with **clear** **cytoplasm** (glandular differentiation)
62
Describe the immunohistochemistry of Paget’s disease of the vulva.
**CA-125, PAS, HER2, keratin**
63
**True/False**.
Leiomyomas usually present asymptomatically but can present with pain and/or abnormal bleeding.
**True**.
64
Leiomyosarcomas tend to spread along __________ (lymphatics/hematogenous routes/seeding routes).
Leiomyosarcomas tend to spread along **_lymphatics_**.
65
Leiomyosarcomas tend to arise *de novo* in women around ____ years of age and have a ____ prognosis.
Leiomyosarcomas tend to arise *de novo* in women around **_50**_ years of age and have a _**poor_** prognosis.
66
What neoplasia of the uterus requires coagulative tumor cell necrosis?
**Leiomyosarcomas**
67
Which rare, deadly gynecological tumor is seen in women around 65 and is characterized by a combo of epithelial and stromal tumor cells?
**Malignant mixed mullierian tumor**
68
**True/False**.
Women with malignant mixed mullierian tumors typically have a history of hysterectomy. These tumors are a mix of two separate carcinomas.
**False**.
Women with malignant mixed mullierian tumors typically have a history of ***pelvic radiation***. These tumors are a mix of ***carcinoma and sarcoma tumors***.
69
A 60-year-old, obese, nulliparous woman had an episode of vaginal bleeding, which produced only about 5 mL of blood. On pelvic examination, there appears to be no enlargement of the uterus, and the cervix appears normal. A Pap smear shows cells consistent with adenocarcinoma. Which of the following conditions is most likely to have contributed to the development of this malignancy?
A) Endometrial hyperplasia
B) Chronic endometritis
C) Use of oral contraceptives
D) Human papillomavirus infection
E) Adenomyosis
A 60-year-old, obese, nulliparous woman had an episode of vaginal bleeding, which produced only about 5 mL of blood. On pelvic examination, there appears to be no enlargement of the uterus, and the cervix appears normal. A Pap smear shows cells consistent with adenocarcinoma. Which of the following conditions is most likely to have contributed to the development of this malignancy?
**A) Endometrial hyperplasia**
B) Chronic endometritis (**STD-related**)
C) Use of oral contraceptives (**protective**)
D) Human papillomavirus infection
E) Adenomyosis
70
A study of patients with postmenopausal uterine bleeding reveals that some of them have malignant neoplasms that arise from prior atypical hyperplastic lesions. The peak incidence is between 55 and 65 years of age in women who have obesity, hypertension, and/or diabetes mellitus. Molecular analysis reveals mutations of the PTEN tumor suppressor gene in most of them. Their malignancies tend to remain localized for years before spread to local lymphatics.
**Which of the following neoplasms is most likely to have these characteristics?**
A) Clear cell carcinoma
B) Endometrioid carcinoma
C) Leiomyosarcoma
D) Mixed müllerian tumor
E) Serous carcinoma
A study of patients with postmenopausal uterine bleeding reveals that some of them have malignant neoplasms that arise from prior atypical hyperplastic lesions. The peak incidence is between 55 and 65 years of age in women who have obesity, hypertension, and/or diabetes mellitus. Molecular analysis reveals mutations of the PTEN tumor suppressor gene in most of them. Their malignancies tend to remain localized for years before spread to local lymphatics.
**Which of the following neoplasms is most likely to have these characteristics?**
A) Clear cell carcinoma
**B) Endometrioid carcinoma**
C) Leiomyosarcoma
D) Mixed müllerian tumor
E) Serous carcinoma
71
A 50-year-old nullipara presents with irregular, sometimes heavy, postmenopausal vaginal bleeding that started a couple of months ago. She takes metformin for her diabetes and enalapril for hypertension. On examination, you find an obese, pale woman with a slightly enlarged uterus on pelvic examination; the rest of the examination is WNL. An endometrial biopsy shows the presence of an adenocarcinoma. An abdominal CT shows the involvement of pelvic lymph nodes but no further spread. What is the most appropriate treatment for this patient?
A) Abdominal hysterectomy
B) Chemotherapy
C) Hormone therapy
D) Radiation therapy
E) Vaginal hysterectomy
A 50-year-old nullipara presents with irregular, sometimes heavy, postmenopausal vaginal bleeding that started a couple of months ago. She takes metformin for her diabetes and enalapril for hypertension. On examination, you find an obese, pale woman with a slightly enlarged uterus on pelvic examination; the rest of the examination is WNL. An endometrial biopsy shows the presence of an adenocarcinoma. An abdominal CT shows the involvement of pelvic lymph nodes but no further spread. What is the most appropriate treatment for this patient?
**A) Abdominal hysterectomy**
B) Chemotherapy
C) Hormone therapy
D) Radiation therapy
E) Vaginal hysterectomy
72
A 37-year-old woman has noted increasing size of a red, pruritic lesion on her left labium over the past 7 months. On examination, this rough, scaly lesion is 0.4 × 0.9 cm. On physical examination, the lesions are slightly raised, soft pink to white in color, and 0.2 to 1 cm in diameter. The perineum appears normal; there is no lymphadenopathy, and there are no rectal lesions. A Pap smear shows no abnormal findings. The lesion is excised; on microscopic examination, there is infiltration of the lower dermis by large cells having pale blue to granular cytoplasm. What is the most likely diagnosis?
A) Condylomata acuminata
B) Extramammary Paget disease
C) Lichen sclerosus et atrophicus
D) Lichen simplex chronicus
E) Vulvar intraepithelial neoplasia
A 37-year-old woman has noted increasing size of a red, pruritic lesion on her left labium over the past 7 months. On examination, this rough, scaly lesion is 0.4 × 0.9 cm. On physical examination, the lesions are slightly raised, soft pink to white in color, and 0.2 to 1 cm in diameter. The perineum appears normal; there is no lymphadenopathy, and there are no rectal lesions. A Pap smear shows no abnormal findings. The lesion is excised; on microscopic examination, there is infiltration of the lower dermis by large cells having pale blue to granular cytoplasm. What is the most likely diagnosis?
A) Condylomata acuminata
**B) Extramammary Paget disease**
C) Lichen sclerosus et atrophicus
D) Lichen simplex chronicus
E) Vulvar intraepithelial neoplasia
73
A 57-year-old woman comes to the physician because she recently noticed a pale area of discoloration on the labia. Pelvic examination shows the presence of a 0.7-cm flat, white area on the right labia majora. A biopsy specimen shows dysplastic cells that occupy full thickness of the squamous epithelium, with minimal underlying chronic inflammation. In-situ hybridization shows human papillomavirus type 16 DNA in the epithelial cells.
**What is the most likely diagnosis?**
A) Lichen sclerosus et atrophicus
B) Condyloma acuminatum
C) Squamous hyperplasia
D) Vulvar intraepithelial neoplasia
E) Chronic vulvitis
F) Contact dermatitis
A 57-year-old woman comes to the physician because she recently noticed a pale area of discoloration on the labia. Pelvic examination shows the presence of a 0.7-cm flat, white area on the right labia majora. A biopsy specimen shows dysplastic cells that occupy full thickness of the squamous epithelium, with minimal underlying chronic inflammation. In-situ hybridization shows human papillomavirus type 16 DNA in the epithelial cells.
**What is the most likely diagnosis?**
A) Lichen sclerosus et atrophicus
B) Condyloma acuminatum
C) Squamous hyperplasia
**D) Vulvar intraepithelial neoplasia**
E) Chronic vulvitis
F) Contact dermatitis
74
A 36-year-old woman has noticed that warty vulvar lesions have been increasing in size and number over the past 5 years. On physical examination, there are several 0.5- to 2-cm, red-pink, flattened lesions with rough surfaces present on the vulva and perineum. One of the larger lesions is excised; its microscopic appearance is showing groups of koilocytes in superficial and intermediate zones of skin. Which of the following infectious agents is most likely to produce these lesions?
A) Human papillomavirus
B) Chlamydia trachomatis
C) Treponema pallidum
D) Haemophilus ducreyi
E) Candida albicans
A 36-year-old woman has noticed that warty vulvar lesions have been increasing in size and number over the past 5 years. On physical examination, there are several 0.5- to 2-cm, red-pink, flattened lesions with rough surfaces present on the vulva and perineum. One of the larger lesions is excised; its microscopic appearance is showing groups of koilocytes in superficial and intermediate zones of skin. Which of the following infectious agents is most likely to produce these lesions?
**A) Human papillomavirus**
B) Chlamydia trachomatis
C) Treponema pallidum
D) Haemophilus ducreyi
E) Candida albicans
75
A 51-year-old woman is concerned about pale areas on her labia that have been slowly enlarging for the past year. The areas cause discomfort and become easily irritated. Physical examination shows pale gray to parchment-like areas of skin that involve most of the labia majora, labia minora, and introitus. The introitus is narrowed. A biopsy specimen shows thinning of the squamous epithelium, a dense band of upper dermal hyaline collagen, and scattered upper dermal mononuclear inflammatory cells.
**What is the most likely diagnosis?**
A) Pelvic inflammatory disease
B) Lichen sclerosus et atrophicus
C) Vulvar intraepithelial neoplasia
D) Extramammary Paget disease
E) Human papillomavirus infection
A 51-year-old woman is concerned about pale areas on her labia that have been slowly enlarging for the past year. The areas cause discomfort and become easily irritated. Physical examination shows pale gray to parchment-like areas of skin that involve most of the labia majora, labia minora, and introitus. The introitus is narrowed. A biopsy specimen shows thinning of the squamous epithelium, a dense band of upper dermal hyaline collagen, and scattered upper dermal mononuclear inflammatory cells.
**What is the most likely diagnosis?**
A) Pelvic inflammatory disease
**B) Lichen sclerosus et atrophicus**
C) Vulvar intraepithelial neoplasia
D) Extramammary Paget disease
E) Human papillomavirus infection
76
A 24-year-old woman has had lesions of the external genitalia that first appeared several years ago, after she vacationed at a resort near Negril, Jamaica, where she goes every year. The figure shows the gross appearance of the external genitalia (A) and histologic features (B) of an excised lesion.
**Which of the following factors is likely to have contributed most to the development of these lesions?**
A) Lack of menstrual cycles
B) Inheritance of a faulty tumor-suppressor gene
C) Poorly controlled diabetes mellitus
D) Exposure to ultraviolet light
E) Sexual intercourse
A 24-year-old woman has had lesions of the external genitalia that first appeared several years ago, after she vacationed at a resort near Negril, Jamaica, where she goes every year. The figure shows the gross appearance of the external genitalia (A) and histologic features (B) of an excised lesion.
**Which of the following factors is likely to have contributed most to the development of these lesions?**
A) Lack of menstrual cycles
B) Inheritance of a faulty tumor-suppressor gene
C) Poorly controlled diabetes mellitus
D) Exposure to ultraviolet light
**E) Sexual intercourse** (HPV condyloma)
77
Any enlargement in the female pelvic area is going to cause physical exam and ultrasound abnormalities and is called an ________ mass.
Any enlargement in the female pelvic area is going to cause physical exam and ultrasound abnormalities and is called an **_adnexal_** mass.
78
Define 'adnexal mass.'
**Any enlargement in the female pelvic area that causes (or has the potential to cause) physical exam and ultrasound abnormalities**
79
\_\_\_% of ovarian neoplasms are benign.
**_80_** % of ovarian neoplasms are benign.
80
Most ovarian malignancies are \_\_\_\_\_\_\_\_\_\_.
Most ovarian malignancies are **_carcinomas_**.
81
(1) Which is more common, ovarian or endometrial carcinomas?
(2) Which is typically more concerning?
(1) **Endometrial**;
(2) **O****varian** *(later presentation due to lack of bleeding and relatively hidden location)*
82
Ovarian tumors ______ (are/are not) normally treated surgically.
Ovarian tumors **_are_** normally treated surgically.
83
Name three genetic predispositions to ovarian neoplasia.
***BRCA1,***
***BRCA2,***
**Lynch syndrome**
84
Many who test positive for *BRCA1/2* get prophylactic \_\_\_\_\_\_ectomies and \_\_\_\_\_\_ectomies.
Many who test positive for *BRCA1/2* get prophylactic **_mast**_ectomies and _**salping_**ectomies.
85
What gene is overexpressed in 30% of ovarian malignancies?
***HER-2***
86
What gene is overexpressed in 50% of high-grade ovarian malignancies?
***p53***
87
In order of descending frequency, what are the four categories of ovarian neoplasia based on starting tissue and/or location?
**Surface–derived (~70%)**
**Germ-cell–derived (~20%)**
**Sex-cord-stroma–derived (~10%)**
**Metastases (~5%)**
88
Name the age groups most affected by each of the following categories of ovarian neoplasia:
Surface–derived –
Germ-cell–derived –
Sex-cord-stroma–derived –
Metastases –
Name the age groups most affected by each of the following categories of ovarian neoplasia:
Surface–derived – ≥ **20 years**
Germ-cell–derived – ≤ **25 years**
Sex-cord-stroma–derived – **All ages**
Metastases – **Variable**
89
What makes high-risk HPV strains high-risk?
**Increased ability to incoporate into the host genome**
90
What is the most common ovarian mass in a young women?
**Follicular cysts**
91
How do corpus luteum cysts present?
**As a diffusely large ovary**
92
What procedure refers to the removal of the ovaries and fallopian tubes?
**Salpingo-oophorectomy**
93
What percentage of women under 70 have *BRCA1* and/or *BRCA2* mutations?
**5%**
94
**True/False**.
Ovarian HER-2 overexpression indcates a poor prognosis and *p53* mutations are typically associated with high-grade tumors.
**True**.
95
A benign serous tumor of the ovary composed of cysts is known as a \_\_\_\_\_\_\_\_\_\_\_\_.
A benign serous tumor of the ovary composed of cysts and stroma is known as a \_\_\_\_\_\_\_\_\_\_\_\_.
A benign serous tumor of the ovary composed of stroma is known as a \_\_\_\_\_\_\_\_\_\_\_\_.
A benign serous tumor of the ovary composed of cysts is known as a **_cystadenoma_**.
A benign serous tumor of the ovary composed of cysts and stroma is known as a **_cystadenofibroma_**.
A benign serous tumor of the ovary composed of stroma is known as a **_adenofibroma_**.
96
What serum biomarker is associated with ovarian malignancies?
**CA-125**
97
What semi-unique histopathology is seen in serous carcinomas of the ovaries?
**Psammoma bodies**
98
Malignant mucinous tumors of the ovaries are associated with _____ mutations.
Malignant mucinous tumors of the ovaries are associated with ***_KRAS_*** mutations.
99
A patient with apparent ascites is diagnosed with an ovarian tumor. Assuming the ovarian tumor is causing the abdominal swelling, what is the correct diagnosis instead of ascites?
**Pseudomyxoma peritonei**
100
Endometriod ovarian tumors (20% associated with endometriosis) are typically _________ (benign/malignant).
Endometriod ovarian tumors (20% associated with endometriosis) are typically **_malignant_**.
101
Which is associated with *KRAS* mutations, serous ovarian cystadenocarcinomas, mucinous ovarian cystadenocarcinomas, or both?
**Both**
102
**True/False**.
Both mucinous and serous ovarian cystadenomas may present as borderline tumors with a higher degree of proliferation but still a low potential of malignancy.
**True**.
| (No stromal invasion in these tumors)
103
A patient with endometriosis develops an ovarian neoplastic growth made up of clear, vacuolated cytoplasm with ‘hobnail’ cells (enlarged, hypochromatic nuclei that bulge outwards). This histology is pathognomonic for what pathology?
**Clear cell carcinoma** of the ovary
104
\_\_\_\_\_\_\_\_ tumors of the ovaries are usually benign and have characterstic ‘coffee-bean’ nuclei.
**_Brenner_** tumors of the ovaries are usually benign and have characterstic ‘coffee-bean’ nuclei.
105
Mature cystic teratomas of the ovary are ________ (benign/malignant).
Mature cystic teratomas of the ovary are **_benign_**.
106
A _________ teratoma is one in which only a single germ layer is present.
A **_monodermal_** teratoma is one in which only a single germ layer is present.
107
\_\_\_\_\_\_\_\_\_ (mature/immature) teratomas of the ovary are very rare, making up \<1% of teratomas.
**_Immature_** teratomas of the ovary are very rare, making up \<1% of teratomas.
108
What is the hallmark tissue finding indicating that a tissue belongs to an immature teratoma?
**Neuroepithelial growths**
109
\_\_\_\_\_\_\_\_\_ (mature/immature) cystic teratomas of the ovary are potentially malignant.
**_Immature_** cystic teratomas of the ovary are potentially malignant.
110
What ovarian tumor has ‘fried egg’ cells and a stroma that is infiltrated by lymphocytes and plasma cells?
**Dysgerminoma**
111
Which ovarian tumors are highly radiosensitive?
**Dysgerminomas**
(remember, these are analogous to seminomas)
112
Which pediatric ovarian tumor is highly malignant?
**Endodermal sinus tumors (yolk sac tumors)**
113
Describe the histology of an endodermal sinus tumor.
**Schiller-Duval** (glomeruloid) **bodies**;
## Footnote
**AFP-positive globules**
114
A seven year old girl presents with an adnexal mass, multiple lung nodules and high level of HCG.
What is the likely diagnosis?
**Choriocarcinoma**
115
You identify a white ovarian tumor in a patient with ascites and pleural effusion.
What is the diagnosis?
**Fibroma**
116
You identify a white ovarian tumor in a patient with ascites and pleural effusion.
What is the diagnosis?
**Thecoma**
| (yellow due to presence of lipids)
117
What cutaneous syndrome is associated with ovarian fibromas and thecomas?
**Basal cell nevus syndrome**
118
What is the serum marker for Granulosa cell tumors?
**Inhibin**
119
Describe the histology of Granulosa cell tumors.
**Call-Exner bodies**;
## Footnote
**‘coffee-bean’ nuclei**
120
Describe the histology of Leydig cell tumors.
**Reinke crystals**
(characteristic of ~50% of Leydig cell tumors)
121
Name three malignant germ cell tumors of the ovary.
**Dysgerminoma,**
**immature teratoma,**
**endodermal sinus (yolk sac tumor)**
122
Name three benign sex-cord stromal cell tumors of the ovary.
**Fibroma,**
**thecoma,**
**Sertoli-Leydig cell tumors**
123
Are Granulosa cell tumors typically benign or malignant?
**Malignant**
124
Elevated serum hCG is charactersitc of what two gynecological tumors?
**Embryonal carcinoma**;
## Footnote
**choriocarcinoma**
125
Elevated serum lactate dehydrogenase is characterstic of what gynecological tumors?
**Dysgerminomas**
126
Elevated serum AFP is characterstic of what two gynecological tumors?
**Embryonal carcinoma**;
## Footnote
**Endodermal sinus tumors (yolk sac tumors)**
127
Epithelial ovarian cancers are associated with elevated serum levels of what biomarker?
**CA-125**
128
Mucinous ovarian cancers are associated with elevated serum levels of what biomarker?
**CEA**
129
Describe the histology of Krukenberg metastases to the ovaries.
**Mucin-filled signet ring cells**
130
**True/False**.
Krukenberg tumors are metastases of _intestinal-type_ gastric adenocarcinoma that typically spread to _both_ ovaries.
**False**.
Krukenberg tumors are metastases of ***_diffuse_***_-type_ gastric adenocarcinoma that typically spread to _both_ ovaries.
131
**True/False**.
Breast cancer often metastasizes to the ovaries.
**True**.
132
E.
133
D.
134
B.
135
C.
136
B.
