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T2 - Phase 2 - Systems Modules (III) > Endo/Repro - Female Reproductive System > Flashcards

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)*
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2
Q

What is the precursor lesion to cervical adenocarcinoma?

A

Adenocarcinoma in-situ (AIS)

OR

cervical glandular intraepithelial neoplasia (CIN)

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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.

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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.

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5
Q

Describe the staging of cervical neoplasia.

A
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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

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7
Q

What are some of the treatment options for cervical carcinomas?

A

Radiation (+/- chemo), surgery, or both

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8
Q

~80% of cervical carcinomas are which subtype?

A

Squamous cell carcinomas

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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

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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)

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11
Q

What are the cervical cancer screening recommendations for 21 – 29 year olds?

A

Screen every three years with Pap smear

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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

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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

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14
Q

Why are Pap smears taken from the transformation zone?

A

It is the site of nearly all squamous neoplasia.

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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

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16
Q

Do HPV-infected cervical cells tend to get smaller or larger?

A

Larger

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17
Q

Describe the appearance of koilocytes.

A

Clearing around nucleus

+

raisinoid, hyperchromatic, often binucleate nuclei

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18
Q

How should low-grade squamous intraepithelial lesions (low-grade CIN, aka LSIL) be treated?

A

Colposcopy, survey

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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

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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

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21
Q

The #1 risk factor for development of cervical carcinoma is:

A

Persistent HPV infection.

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22
Q

Name some of the HPV-cofactor risk factors that are somewhat associated with cervical adenocarcinoma.

A

Obesity, OCPs

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23
Q

Name some of the HPV-cofactor risk factors strongly associated with cervical squamous cell carcinoma.

A

Parity, smoking, OCPs

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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)

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25
Q

Do most HPV infections resolve spontaneously?

A

Yes.

Many under age 30 test positive but most don’t show progression/persistence of the infection.

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26
Q

What are the most important HPV protein products (and which substances do they inhibit, respectively)?

A

E6 (p53);

E7 (Rb)

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27
Q

HPV random viral integration occurs at ____/____ open reading frames.

A

HPV random viral integration occurs at E1/E2 open reading frames.

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28
Q

Disruption of HPV ____ removes the repression of E6 and E7 genes (with resultant overexpression).

A

Disruption of HPV E2 removes the repression of E6 and E7 genes (with resultant overexpression).

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29
Q

Cervarix is a ______valent vaccine that targets the following HPV subtypes:

A

Cervarix is a bivalent vaccine that targets the following HPV subtypes:

16, 18

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30
Q

Gardasil is a ______valent vaccine that targets the following HPV subtypes:

A

Gardasil is a quadrivalent vaccine that targets the following HPV subtypes:

6, 11, 16, 18

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31
Q

Gardasil 9 is a ______valent vaccine that targets the following HPV subtypes:

A

Gardasil 9 is a nonovalent vaccine that targets the following HPV subtypes:

6, 11, 16, 18, 31, 33, 45, 52, 58

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32
Q

Which gardasil vaccine(s) is(are) available in the U.S.?

A

Gardasil 9 only

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33
Q

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

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

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34
Q

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

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

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35
Q

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

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

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36
Q

How common is endometriosis?

A

Affects 10 - 15% of women of reproductive age

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37
Q

What are the two most common sites of endometrial implantation?

A

Ovaries;

uterine ligaments

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38
Q

Ovarian endometrial implants are typically described as having what appearance?

What other term is used to describe yellow-brown endometrial tissues outside the uterus?

A

‘Chocolate cysts;’

‘gunpowder lesions’

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39
Q

The tissues seen in endometriosis typically present as normal endometrial tissue with what addition(s)?

A

Hemosiderin-laden macrophages

+

red blood cells

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40
Q

Name some of the S/Sy of endometriosis.

A

Dysmenorrhea (painful menstruation);

pain in the back, pelvis, and/or lower abdomen;

dyspareunia (painful intercourse);

irregular bleeding;

infertility

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41
Q

What is the most common malignancy of the female genital tract?

A

Endometrial carcinoma

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42
Q

Name a few risk factors for endometrial carcinoma.

A

Think excess estrogen exposure:

Obesity;

infertility (nulliparity);

anovulatory cycles;

PCOS

(also, diabetes and hypertension)

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43
Q

Which type of endometrial carcinoma is driven by estrogens and maybe some microsatellite instability?

A

Type 1

(hyperplastic)

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44
Q

Which type of endometrial carcinoma is more common in thin women and is associated with mutated p53?

A

Type 2

(sporadic)

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45
Q

Type 2 endometrial carcinoma (sporadic type) is associated with endometrial atrophy, mutated p53, and the following subtypes:

A

Serous (with Psammoma bodies);

clear cell;

mixed

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46
Q

Endometrial hyperplasia without atypia is characterized by a ratio of glands:stroma > ___%.

How is it treated?

A

Endometrial hyperplasia without atypia is characterized by a ratio of glands:stroma ≥ 50%.

Progesterone only

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47
Q

True/False.

Atypical endometrial hyperplasia is associated with enlarged nuclei, multiple mitoses, and a 33% risk of progression to endometrial malignancy.

A

True.

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48
Q

Name a common cause of endometrial bleeding that results due to focal hyperplasia of the basalis layer.

A

Endometrial polyps

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49
Q

Endometrial polyp development is associated with what drug use?

A

Tamoxifen

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50
Q

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 ____ - ____.

A

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.

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51
Q

Which type of squamous carcinoma of the vulva is seen in women around 55 and is an HPV- and cigarette-driven process?

A

Group 1 (basaloid or warty; 30% of cases)

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52
Q

Which type of squamous carcinoma of the vulva is seen in women around 77 and is not an HPV- and cigarette-driven process?

A

Group 2 (keratinizing; 70% of cases)

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53
Q

Keratinizing squamous carcinomas of the vulva (group 2) are associated with what disease?

A

Lichen sclerosus

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54
Q

What is the equivalent of cervical intraepithelial neoplasia in the external genitalia?

A

Vulvar intraepithelial neoplasia

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55
Q

Lichen sclerosus is characterized by what changes in the vulvar epidermis and/or dermis?

A

Epidermal thinning;

dermal fibrosis

56
Q

Describe the S/Sy of lichen sclerosus.

A

Lighter vulvar pigmentation,

atrophy of labia minora,

leukoplakia with ‘parchment paper’ surface,

itching and subsequent hyperkeratosis

57
Q

Paget’s disease of the vulva is what?

A

A carcinoma in-situ

58
Q

Paget’s disease of the vulva is most common in what age and race?

A

Postmenopausal, white women

59
Q

True/False.

Paget’s disease of the vulva is a slowly progressive, indolent carcinoma in-situ.

A

True.

60
Q

Paget’s disease of the vulva can present similarly (and must be differentiated from) what other condition?

A

Melanoma

(which will stain positive for S-100)

61
Q

Describe the histology of the cells seen in Paget’s disease of the vulva.

A

Proliferation of neoplastic large cells with clear cytoplasm (glandular differentiation)

62
Q

Describe the immunohistochemistry of Paget’s disease of the vulva.

A

CA-125, PAS, HER2, keratin

63
Q

True/False.

Leiomyomas usually present asymptomatically but can present with pain and/or abnormal bleeding.

A

True.

64
Q

Leiomyosarcomas tend to spread along __________ (lymphatics/hematogenous routes/seeding routes).

A

Leiomyosarcomas tend to spread along lymphatics.

65
Q

Leiomyosarcomas tend to arise de novo in women around ____ years of age and have a ____ prognosis.

A

Leiomyosarcomas tend to arise de novo in women around 50** years of age and have a **poor prognosis.

66
Q

What neoplasia of the uterus requires coagulative tumor cell necrosis?

A

Leiomyosarcomas

67
Q

Which rare, deadly gynecological tumor is seen in women around 65 and is characterized by a combo of epithelial and stromal tumor cells?

A

Malignant mixed mullierian tumor

68
Q

True/False.

Women with malignant mixed mullierian tumors typically have a history of hysterectomy. These tumors are a mix of two separate carcinomas.

A

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
Q

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

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
Q

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

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
Q

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

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
Q

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

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
Q

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

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
Q

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

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
Q

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

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
Q

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

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
Q

Any enlargement in the female pelvic area is going to cause physical exam and ultrasound abnormalities and is called an ________ mass.

A

Any enlargement in the female pelvic area is going to cause physical exam and ultrasound abnormalities and is called an adnexal mass.

78
Q

Define ‘adnexal mass.’

A

Any enlargement in the female pelvic area that causes (or has the potential to cause) physical exam and ultrasound abnormalities

79
Q

___% of ovarian neoplasms are benign.

A

80 % of ovarian neoplasms are benign.

80
Q

Most ovarian malignancies are __________.

A

Most ovarian malignancies are carcinomas.

81
Q

(1) Which is more common, ovarian or endometrial carcinomas?
(2) Which is typically more concerning?

A

(1) Endometrial;
(2) Ovarian (later presentation due to lack of bleeding and relatively hidden location)

82
Q

Ovarian tumors ______ (are/are not) normally treated surgically.

A

Ovarian tumors are normally treated surgically.

83
Q

Name three genetic predispositions to ovarian neoplasia.

A

BRCA1,

BRCA2,

Lynch syndrome

84
Q

Many who test positive for BRCA1/2 get prophylactic ______ectomies and ______ectomies.

A

Many who test positive for BRCA1/2 get prophylactic _mast_ectomies and _salping_ectomies.

85
Q

What gene is overexpressed in 30% of ovarian malignancies?

A

HER-2

86
Q

What gene is overexpressed in 50% of high-grade ovarian malignancies?

A

p53

87
Q

In order of descending frequency, what are the four categories of ovarian neoplasia based on starting tissue and/or location?

A

Surface–derived (~70%)

Germ-cell–derived (~20%)

Sex-cord-stroma–derived (~10%)

Metastases (~5%)

88
Q

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 –

A

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
Q

What makes high-risk HPV strains high-risk?

A

Increased ability to incoporate into the host genome

90
Q

What is the most common ovarian mass in a young women?

A

Follicular cysts

91
Q

How do corpus luteum cysts present?

A

As a diffusely large ovary

92
Q

What procedure refers to the removal of the ovaries and fallopian tubes?

A

Salpingo-oophorectomy

93
Q

What percentage of women under 70 have BRCA1 and/or BRCA2 mutations?

A

5%

94
Q

True/False.

Ovarian HER-2 overexpression indcates a poor prognosis and p53 mutations are typically associated with high-grade tumors.

A

True.

95
Q

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

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
Q

What serum biomarker is associated with ovarian malignancies?

A

CA-125

97
Q

What semi-unique histopathology is seen in serous carcinomas of the ovaries?

A

Psammoma bodies

98
Q

Malignant mucinous tumors of the ovaries are associated with _____ mutations.

A

Malignant mucinous tumors of the ovaries are associated with KRAS mutations.

99
Q

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?

A

Pseudomyxoma peritonei

100
Q

Endometriod ovarian tumors (20% associated with endometriosis) are typically _________ (benign/malignant).

A

Endometriod ovarian tumors (20% associated with endometriosis) are typically malignant.

101
Q

Which is associated with KRAS mutations, serous ovarian cystadenocarcinomas, mucinous ovarian cystadenocarcinomas, or both?

A

Both

102
Q

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.

A

True.

(No stromal invasion in these tumors)

103
Q

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?

A

Clear cell carcinoma of the ovary

104
Q

________ tumors of the ovaries are usually benign and have characterstic ‘coffee-bean’ nuclei.

A

Brenner tumors of the ovaries are usually benign and have characterstic ‘coffee-bean’ nuclei.

105
Q

Mature cystic teratomas of the ovary are ________ (benign/malignant).

A

Mature cystic teratomas of the ovary are benign.

106
Q

A _________ teratoma is one in which only a single germ layer is present.

A

A monodermal teratoma is one in which only a single germ layer is present.

107
Q

_________ (mature/immature) teratomas of the ovary are very rare, making up <1% of teratomas.

A

Immature teratomas of the ovary are very rare, making up <1% of teratomas.

108
Q

What is the hallmark tissue finding indicating that a tissue belongs to an immature teratoma?

A

Neuroepithelial growths

109
Q

_________ (mature/immature) cystic teratomas of the ovary are potentially malignant.

A

Immature cystic teratomas of the ovary are potentially malignant.

110
Q

What ovarian tumor has ‘fried egg’ cells and a stroma that is infiltrated by lymphocytes and plasma cells?

A

Dysgerminoma

111
Q

Which ovarian tumors are highly radiosensitive?

A

Dysgerminomas

(remember, these are analogous to seminomas)

112
Q

Which pediatric ovarian tumor is highly malignant?

A

Endodermal sinus tumors (yolk sac tumors)

113
Q

Describe the histology of an endodermal sinus tumor.

A

Schiller-Duval (glomeruloid) bodies;

AFP-positive globules

114
Q

A seven year old girl presents with an adnexal mass, multiple lung nodules and high level of HCG.

What is the likely diagnosis?

A

Choriocarcinoma

115
Q

You identify a white ovarian tumor in a patient with ascites and pleural effusion.

What is the diagnosis?

A

Fibroma

116
Q

You identify a white ovarian tumor in a patient with ascites and pleural effusion.

What is the diagnosis?

A

Thecoma

(yellow due to presence of lipids)

117
Q

What cutaneous syndrome is associated with ovarian fibromas and thecomas?

A

Basal cell nevus syndrome

118
Q

What is the serum marker for Granulosa cell tumors?

A

Inhibin

119
Q

Describe the histology of Granulosa cell tumors.

A

Call-Exner bodies;

‘coffee-bean’ nuclei

120
Q

Describe the histology of Leydig cell tumors.

A

Reinke crystals

(characteristic of ~50% of Leydig cell tumors)

121
Q

Name three malignant germ cell tumors of the ovary.

A

Dysgerminoma,

immature teratoma,

endodermal sinus (yolk sac tumor)

122
Q

Name three benign sex-cord stromal cell tumors of the ovary.

A

Fibroma,

thecoma,

Sertoli-Leydig cell tumors

123
Q

Are Granulosa cell tumors typically benign or malignant?

A

Malignant

124
Q

Elevated serum hCG is charactersitc of what two gynecological tumors?

A

Embryonal carcinoma;

choriocarcinoma

125
Q

Elevated serum lactate dehydrogenase is characterstic of what gynecological tumors?

A

Dysgerminomas

126
Q

Elevated serum AFP is characterstic of what two gynecological tumors?

A

Embryonal carcinoma;

Endodermal sinus tumors (yolk sac tumors)

127
Q

Epithelial ovarian cancers are associated with elevated serum levels of what biomarker?

A

CA-125

128
Q

Mucinous ovarian cancers are associated with elevated serum levels of what biomarker?

A

CEA

129
Q

Describe the histology of Krukenberg metastases to the ovaries.

A

Mucin-filled signet ring cells

130
Q

True/False.

Krukenberg tumors are metastases of intestinal-type gastric adenocarcinoma that typically spread to both ovaries.

A

False.

Krukenberg tumors are metastases of diffuse-type gastric adenocarcinoma that typically spread to both ovaries.

131
Q

True/False.

Breast cancer often metastasizes to the ovaries.

A

True.

132
Q
A

E.

133
Q
A

D.

134
Q
A

B.

135
Q
A

C.

136
Q
A

B.

T2 - Phase 2 - Systems Modules (III) (14 decks)

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