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Pathology MCQ > Female Genital > Flashcards

Female Genital Flashcards

1
Q

Which of the following is LEAST accepted as a gonococcal complication?

  1. Urethral stricture in a male
  2. Acute suppurative salpingitis
  3. Myometrial abscess
  4. Pyosalpinx and / or hydrosalpinx
  5. Tubo-ovarian abscess
A
  1. *Myometrial abscess
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2
Q

A clinical request states “?Paget’s disease of the Vulva” . Which of the following is most correct?

  1. The request is in error and likely means Paget’s disease of “breast” or “bone”
  2. This is a condition in which most have an underlying invasive SCC of the vulva
  3. This is a condition in which most have an underlying invasive adenocarcinoma of the vulva
  4. This is a condition in which most have an underlying invasive adenocarcinoma of the the lower vagina
  5. This is not usually associated with underlying carcinoma and, while wide local excision is preferred, may persist for decades without invasion/metastasis
A
  1. *This is not usually associated with underlying carcinoma and, while wide local excision is preferred, may persist for decades without invasion/metastasis
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3
Q

An MRI shows an incidental 1.5cm fluid filled structure in the vaginal wall closely related to the lumen in a 40 year old, separate from the cervix. Which of the following is most correct?

  1. It most likely represents a Bartholin’s cyst
  2. It most likely represents a Gartner duct cyst
  3. It most likely represents an epidermoid cyst
  4. It most likely represents a Nabothian cyst
  5. It most likely represents a focus of vaginal adenosis
A
  1. *It most likely represents a Gartner duct cyst
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4
Q

Concerning patient with carcinoma of the cervix, which of the following statements is most correct?

  1. If a patient with high grade squamous intraepithelial lesion is “lost to followup” they would have a 10% risk of invasive cancer at 2 years
  2. The average age of diagnosis is 60 – 65 years
  3. Squamous cell carcinomas account for over 97+% of cervical neoplasia
  4. Benign polyps are not recognised as forming in the cervical canal – all are considered at least low-grade malignancies
  5. Neuroendocrine tumor is not a recognised form of cervical carcinoma
A
  1. *If a patient with high grade squamous intraepithelial lesion is “lost to followup” they would have a 10% risk of invasive cancer at 2 years
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5
Q

Concerning the staging of cervical carcinoma which of the following is most correct?

  1. Stage 0 is used for carcinomas less than or equal to 7mm width and no deep (<3mm) invasion
  2. Stage 1 refers to carcinoma confined to the superficial epithelial layer of the cervix
  3. Stage II refers to extension confined to the deep cervix but not beyond
  4. Stage III should be considered when the tumors extends to the pelvic side wall or lower third of the vagina
  5. Stage IV indicates there is distant visceral metastasis
A
  1. *Stage III should be considered when the tumors extends to the pelvic side wall or lower third of the vagina
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6
Q

Which of the following is LEAST recognised as a cause of anovulatory cycles?

  1. Thyroid disease
  2. Granulosa cell tumor
  3. Polycystic ovarian syndrome
  4. Obesity
  5. MEN II syndrome
A
  1. *MEN II syndrome
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7
Q

Concerning endometriosis which of the following is LEAST correct?

  1. 6-10 % of women have foci of endometriosis
  2. Endometriosis may be seen in patients with amenorrhea due to gonadal dysgenesis
  3. Endometriosis can seen in lung, brain and bone sites
  4. Endometriosis can be seen in the urogenital tract of males treated with high dose estrogens
  5. Endometriosis is not associated with malignancies, increased risk of malignancy
A
  1. *6-10 % of women have foci of endometriosis
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8
Q

Concerning carcinoma of the endometrium which of the following is LEAST correct?

  1. Recognised common presenting complaints include post menopausal bleeding and perimenopausal menorrhagia
  2. Type I (accounting for 80%) has associations with diabetes, obesity, prolonged estrogen stimulation and hypertension
  3. It can occur in a setting of endometrial atrophy – particularly in older patients
  4. Pelvic peritoneal deposits indicate direct spread through the myometrium
  5. Invasion of the cervix represents Stage II disease
A
  1. *Pelvic peritoneal deposits indicate direct spread through the myometrium
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9
Q

A patient has a CT staging request stating “Mixed Mullerian Tumor: heterogenous mesenchymal component”, which of the following statements is most correct?

  1. This is a tumor of primitive embryonal remnants with its origin in the adenexa, between ovary and fimbria
  2. It is a tumor most commonly seen in adolescent females
  3. The heterogenous mesenchymal component suggests a poorer prognosis
  4. 5 Year survival, is good and in the order of 80 -90% even for high stage disease due to chemosensitivity
  5. The presence of bone / fat / muscle or cartilaginous elements should suggest a mature teratoma instead
A
  1. *The heterogenous mesenchymal component suggests a poorer prognosis
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10
Q

Concerning uterine leiomyomas, which of the following statements is most correct?

  1. A leiomyoma may spread unto uterine veins and even to lungs and still be considered benign
  2. The neoplasms are strongly EBV associated
  3. Rapid increase in size with pain in pregnancy should suggest malignant transformation
  4. Multiple small peritoneal nodules secondary to leiomyomas indicates malignant transformation
  5. They do not involve the uterine ligaments
A
  1. *A leiomyoma may spread unto uterine veins and even to lungs and still be considered benign
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11
Q

Concerning polycystic ovarian syndrome (PCOS), which of the following is most correct?

  1. It is associated with premature atherosclerosis
  2. It affects 0.5 -1 % of women of reproductive age
  3. Polycystic ovaries are seen in 50 - 70% of women and are not specific to PCOS
  4. It is associated with infertility but not proven to have associations with malignancy
  5. There is associated markedly elevated progesterone causing associated infertility
A
  1. *It is associated with premature atherosclerosis
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12
Q

Concerning ovarian neoplasms which of the following statements is LEAST correct?

  1. 80% of ovarian neoplasms are benign
  2. 10-15% of ovarian neoplasms are benign teratomas
  3. Serous surface epithelial tumors account for 30% of ovarian neoplasms (and ~50% of malignancies)
  4. Mucinous surface epithelial tumors account for only 2-5% of ovarian neoplasms
  5. Only 30% of serous surface epithelial tumors are malignant
A
  1. *Mucinous surface epithelial tumors account for only 2-5% of ovarian neoplasms
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13
Q

Concerning ovarian malignancy which of the following statements is LEAST correct?

  1. The presence and extent of papillary projections correlates with an increased risk of malignancy
  2. The presence and extent of solid components correlates with an increased risk of malignancy
  3. The presence of bilateral lesions strongly suggests malignancy (>60% risk of malignancy)
  4. The presence of fine calcifications / psammoma bodies is a feature of serous tumors but not necessarily carcinoma
  5. The presence of associated ascites suggests an increased risk of malignancy
A
  1. *The presence of bilateral lesions strongly suggests malignancy (>60% risk of malignancy)
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14
Q

Concerning endometroid carcinomas, which of the following is most correct?

  1. They account for less than 1% of ovarian carcinomas
  2. They have associations with both adenocarcinoma of the endometrium and endometriosis
  3. Peritoneal haemorrhagic nodules strongly suggest late stage disease
  4. Bilateral disease is rare (<1%)
  5. They are uniformly solid masses
A
  1. *They have associations with both adenocarcinoma of the endometrium and endometriosis
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15
Q

A PET study for carcinoid syndrome shows abnormal activity in an 8 cm heterogenous left ovarian mass but no other abnormal uptake. Which of the following is most correct?

  1. The appearances suggest a hypermetabolic focus, but likely incidental in the clinical setting
  2. The appearances may represent a carcinoid but carcinoid syndrome would not be expected given the apparent absence of metastasis
  3. Dysgerminomas are a common cause of 5 -HT production/ carcinoid syndrome
  4. The appearances suggest a special form of ovarian teratoma
  5. The appearances suggest choriocarcinoma
A
  1. *The appearances suggest a special form of ovarian teratoma
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16
Q

A 25 year old patient has PV bleeding and heterogenous non-cystic mass intrauterine mass expanding the uterus but states she has not had intercourse since her recent normal delivery 9 weeks ago. Beta hCG is positive. Which of the following is most correct?

  1. Choriocarcinoma or Placental Site trophoblastic tumor can present after a normal pregnancy
  2. An ovarian hormonally active neoplasm with endometrial hyperplasia is most likely
  3. A partial molar pregnancy was associated with the previous pregnancy
  4. A hydatiform mole associated with the previous pregnancy is most likely
  5. It may represent a retained infected cotyledon
A
  1. *Choriocarcinoma or Placental Site trophoblastic tumor can present after a normal pregnancy
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17
Q

The enlargement of the uterus in pregnancy is largely due to / best described as :

  1. Uterine hyperplasia
  2. Uterine hypertrophy
  3. Either uterine hypertrophy or hyperplasia are acceptable: the terms are interchangeable
  4. “Uterine enlargement” (the myometrium thins but overall cell numbers change by less than 10%)
  5. Endocrine-induced paraplasia
A
  1. *Uterine hypertrophy
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18
Q

Which is true? (March 2015)

a. Vulval melanoma is usually invasive at presentation

A

Vulval melanoma
o Second most common vulval cancer, typically affecting post-menopausal women
o Classified as mucosal melanomas
o Very rare – ten cases in Australia per year
o Usually diagnosed late and invasive or metastasized at presentation

ANSWER: Vulval melanoma is usually invasive at presentation

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19
Q

Which of these associations is true? (August 2014, March 2015)

a. Condylomata acuminatum is a precursor for SCC

A

Condylomata accuminatum (genital warts) are benign sexually transmitted warts
o Assoc w HPV 6 & 11; low malignant potential
o Occurs on moist mucocutaneous surfaces in either gender
o Tend to recur but only rarely progress to in situ or invasive SCC
• HPV 16 and 18 are considered to have high malignant potential and are assoc w increased risk of cervical cancer

ANSWER: Condylomata accuminatum is rarely a precursor lesion for SCC

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20
Q

Which of these is true? (March 2015)

a. Adenocarcinoma of the cervix has the same implicated HPV as SCC

A

Adenocarcinoma of the cervix arises at the squamocolumnar junction (as SCC)
• May arise from cervical adenoCa in situ

Risk factors:
o Almost always associated w HPV 16 (80%) (less commonly HPV 18 - 10%) - Subtypes clear cell carcinoma and mesonephric carcinoma are not associated
o Sexual history: Multiple previous or current partners; Young age at first intercourse
o High parity
o Immunosuppression
o Oral contraceptives
o HLA subtypes
o Not assoc w smoking (although SCC is)

ANSWER: Adenocarcinoma of the cervix has the same implicated HPV as SCC (HPV 16>18)

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21
Q

Which is true of cervical adenocarcinoma? (March 2015)

a. More likely to be detected by pap smear than SCC
b. Spreads to the endometrium preferentially
c. Adenocarcinoma has the same HPV risk factors as SCC

A

AdenoCa of the cervix
o Less common histological subtype, accounting for 12.5% of cervical cancers
- (Proportion increasing, as it is less likely to be detected by pap smear)

Pathology:

- Arise from the squamocolumnar junction
- Thought to arise from cervical adenoCa in situ, which is almost always assoc w HPV 16

Risk factors:

- HPV 16>18
- Multiple sexual partners, early age of first intercourse
- High parity
- Immunosuppression
- HLA subtypes
- Oral contraceptives
- Cigarette smoking is not a risk factor (but is for SCC)

Pattern of spread:
Local: vagina, laterally to the bladder
Metastases: more likely to spread to the lung & adrenal glands than other cervical cancers

Subtypes:

- Clear cell – associated w DES, not assoc w HPV
- Endometroid
- Mucinous
- Serous
- Mesonephric

ANSWER: Cervical adenocarcinoma has the same HPV risk factors as SCC

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22
Q

Which is false regarding cervical carcinoma? (March 2017)

a. Adenocarcinoma has a worse prognosis than SCC
b. Neuroendocrine tumour has a poor prognosis
c. Upper vaginal involvement has a poor prognosis
d. Rectal involvement poor prognosis
e. Ureter involvement has a poor prognosis

A

ANSWER: Upper vaginal involvement does not have a poor prognosis – there is 29% mortality at 5 years (stage IIA disease)

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23
Q

Which are associated? (August 2014)

a. Adenocarcinoma of the cervix and HPV
b. SCC of the cervix and HIV

A

ANSWER: Adenocarcinoma of the cervix is associated with HPV

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24
Q

Regarding adenomyosis, which of the following is true? (September 2013)

a. Adenomyosis tends to cause more diffuse uterine enlargement than leiomyomas
b. Found in 1% of resected hysterectomy sections
c. Early loss of response to the cyclical hormone influence
d. Each rest of cells represents a polyclonal population
e. Rare but characteristic venous/villous infiltration

A

Adenomyosis:
o Benign lesion of the uterus
- Considered on the spectrum of endometriosis
- Ectopic endometrial tissue in the myometrium
- Smooth muscle hyperplasia
- Dysfunctional myometrium does not contract properly and leads to menorrhagia

o Clinical:

  • Menorrhagic
  • Dysmenorrhoea
  • Chronic pelvic pain

o Epidemiology:

  • Multiparous women
  • Women with a history of instrumentation
  • 20% of women affected

o Four types:

  • Diffuse adenomyosis (most common)
  • Focal adenomyosis
  • +/- Adenomyoma (controversial as a separate entity)
  • Cystic adenomyosis and adenomyotic cyst (rare)

o Globular enlargement of the uterus - Contour usually preserved

ANSWER: Adenomyosis tends to cause more diffuse uterine enlargement than leiomyomas

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25
Q

Association of cervical cancer with smoking (March 2014)

A

Risk factors for cervical cancer:
o HPV 16 and 18 - Except for clear cell carcinoma of the cervix & mesonephric carcinoma of the cervix
o Multiple sexual partners or a male partner w multiple previous partners
o Young age at first intercourse
o High parity
o Immunosuppression
o Certain HLA subtypes
o Oral contraceptives
o Smoking - Except for cervical adenocarcinoma

Different types of cervical carcinoma:
o	Squamous cell carcinoma:
- Large cell keratinizing squamous cell carcinoma
- Large cell nonkeratinizing SCC
- Small cell nonkeratinizing (poorly differentiated)
- Morphologic variants:
•	Spindled
•	Lymphoepithelial-like carcinoma
•	Varrucous carcinoma
•	Condylomatous (warty) carcinoma
•	Papillary squamous and squamotransitional carcinoma
•	Basaloid squamous carcinoma

o Adenocarcinoma

o Villoglandular adenocarcinoma

o Endometroid adenocarcinoma

o Clear cell adenocarcinoma

o Adenoid basal carcinoma

o Adenoid cystic carcinoma

o Neuroendocrine tumours:

- Carcinoid
- Atypical carcinoma
- Small cell neuroendocrine neoplasia
- Large cell neuroendocrine carcinoma
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26
Q

Which is false regarding adenomyosis? (March 2017)

a. Involved uteruses have a coarsely nodular external contour
b. Uterine enlargement/wall thickening is predominantly due to muscle hyperplasia/hypertrophy

A

ANSWER: Involved uteruses typically have an enlarged, smooth globular contour (not coarse or nodular)

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27
Q

Regarding endometrial hypertrophy:

a. If complex with atypia, 1/3 progress to carcinoma
b. If simple with atypia, 1/3 progress to carcinoma

A

As per statdx
o Complex with atypia – 25% progress to carcinoma
o Simple with atypia – 2% progress to carcinoma

ANSWER: If complex with atypia, 1/3 (25%) progress to endometrial carcinoma

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28
Q

Regarding endometrial cancer: (March 2015)

a. Tamoxifen is associated with type 2
b. Type 1 is associated with atrophy
c. Type 2 is associated with oestrogen secretion

A 
Type 1 endometrial cancer (80%):
o Arises in the setting of unopposed hyper-oestrogenism and endometrial hyperplasia
o Epidemiology: women 55-65 years
o Well differentiated, slow progression, good prognosis
o PTEN gene mutation in 30-80%
o Risk factors:
	Oestrogen replacement therapy
	PCOS and anovulatory cycles
	Tamoxifen
	Obesity
	Early menarche and late menopause
	Nulliparity
	Oestrogen producing ovarian tumours e.g. granulosa cell cancer
	Diabetes
Type 2 endometrial cancer (20%):
o Arises in the setting of endometrial atrophy
o Epidemiology: women 65-75 years
o P53 mutation in up to 50%
o Less well differentiated
	- Lymphatic spread early
	- Peritoneal seeding via fallopian tubes
	- Poorer prognosis

Associated cancer syndromes:
o HNPCC – 30-50x increased risk
o Precursor lesions of complex hyperplasia with atypia are associated in ~40%

ANSWER: All options are incorrect

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29
Q

Which is true? (September 2013)

a. Imaging can differentiate between endometrial hyperplasia and carcinoma
b. Tamoxifen causes endometrial thickening
c. Polyps develop malignancy in 75%
d. Endometrial atrophy is not a cause of post-menopausal bleeding

A

ANSWER: Tamoxifen causes endometrial thickening

30
Q

Which is true? (March 2015)

a. Pregnancy is associated with disseminated peritoneal leiomyomatosis
b. Leiomyoma is a precursor lesion for leiomyosarcoma
c. Leiomycosarcoma typically presents with metastases
d. Leiomyosarcoma typically spreads to the brain

A

Leiomyosarcoma accounts for 1/3 of uterine sarcomas and 8% of uterine tumours
o Arise de novo or from a prexisting leiomyoma
(Sarcomatous transformation of leiomyoma occurs in 0.1-0.8%)

Pattern of tumour spread:

  • Myometrium, pelvic blood vessels and lymphatics, adjacent pelvic structures, abdominal cavity
  • Metastases later, most commonly to lungs (liver and brain)

Presentation:

  • Abnormal PV bleeding
  • Pelvic mass (massive uterine enlargement)
  • Pelvic pain
  • Symptoms from metastases is an uncommon presentation

ANSWER: Leiomyoma is a precursor lesion for leiomyosarcoma (0.1-0.8% sarcomatous degeneration)

31
Q

Regarding leiomyosarcoma, which is true? (March 2017)

a. Haematogenous spread commonly occurs
b. Development from a leiomyoma is rare
c. Distinguishing benign from malignant is most difficult in young patients

A

ANSWER: Development from leiomyoma is rare (0.1-0.5%)

32
Q

Regarding leiomyoma, which is false? (March 2017)

a. Most commonly presents in women in their 20s and 30s
b. Vascular invasion is possible
c. Enlarge with pregnancy and infarction

A

ANSWER: Leiomyomas more commonly present in women in their 30s and 40s (not 20s)

33
Q

Which is associated with diffuse uterine enlargement with an irregular contour? (March 2016)

a. Adenomyosis
b. Leiomyomas
c. Endometrial carcinoma

A

ANSWER: Leiomyomas

34
Q

Which association is true? (August 2014)

a. Leiomyosarcoma and DES
b. Rhabdomyosarcoma and retinoblastoma

A

DES associated abnormalities:
- synthetic oestrogen prescribed to women in 1948-1971

o First generation:
- Increased risk of breast cancer and breast cancer mortality

o Second generation (daughters):

  • Vaginal clear cell adenocarcinoma
  • Cervical squamous cell dysplasia
  • Breast cancer
  • T shaped uterus (Increased risk of poor pregnancy outcomes)
  • Vaginal adenosis

o Second generation (sons):

  • Cryptorchidism
  • Hypospadias
  • Hypogonadism
Retinoblastoma germline mutations:
o	Retinoblastoma
o	Retinocytoma
o	Pineoblastoma
o	Osteosarcoma

ANSWER: DES is not associated with leiomyosarcoma, but it is strongly associated with vaginal clear cell adenocarcinoma. Retinoblastoma is associated with osteosarcoma, not rhabdomyosarcoma.

35
Q

Regarding leiomyoma, which is true? (September 2013)

a. The presence of PV bleeding is assoc with an increased risk of malignant transformation
b. There is not even moderate mitotic activity
c. Size greater than 10cm is associated with increased risk of malignancy
d. Cords of cells in the venous system is consistent with malignancy
e. Benign leiomyomas are polyclonal

A

• 30% of patients with benign leiomyoma have abnormal PV bleeding
• Leiomyomas have a very low mitotic rate (<5 figures/10 high power fields)
• Atypical growth patterns for leiomyomas (not necessarily malignant):
o Disseminated intraperitoneal leiomyomatosis
o Benign metastasizing leiomyoma (to lungs)
o Intravenous leiomyomatosis
o Lymphangioleiomyomatisis

ANSWER: There is not even moderate mitotic activity associated with leiomyoma

36
Q

Which of these is true? (March 2015)

a. Carcinosarcoma of the cervix
b. Adenosarcoma of the endometrium

A
  • Adenosarcoma of the uterus is an uncommon cancer of the mesenchymal tissues of the uterus
  • Carcinosarcoma of the cervix is extremely rare

Classification of uterine sarcomas:
o Mixed:
- Malignant mixed mullerian tumour of the uterus (~50-70%)
- Adenosarcoma of the uterus
- Mixed uterine leiomyosarcoma and endometrial stromal sarcoma

o Pure:

- Uterine leiomyosarcoma (35-50%)
- Endometrial stromal sarcoma (10%)
- Other rare sarcomas of the uterus (Fibrosarcoma, Rhabdosarcoma, Liposarcoma, Angiosarcoma)

Main histological types of cervical cancer:
o Squamous cell carcinoma (80-90%)
o Adenocarcinoma of the cervix (5-20%)
- Clear cell carcinoma of the cervix
- Endometroid carcinoma of the cervix (7%)
- Mucinous carcinoma of the cervix - Adenoma malignum (3%)
- Serous carcinoma of the cervix
- Mesonephric carcinoma of the cervix (3%)
o Neuroendocrine tumours of the cervix - Small cell carcinoma (0.5-6%)
o Adenosquamous carcinoma of the cervix (rare)

ANSWER: Adenosarcomas of the uterus are a subtype of mixed uterine sarcomas. Carcinosarcoma of the cervix is extremely rare.

37
Q

Which is true of endometrial cancer? (August 2016)

a. Type 1 is usually low grade
b. In endometrial sarcoma, the most common epithelial component is clear cell
c. Malignant mixed mullerian tumour often has the morphology of a polyp
d. Type 1 is associated with atrophy
e. Type 2 is associated with ovarian endometroid cancer

A

Type 1 endometrial cancer:
o 80%; Arises in the setting of unopposed hyperoestrogenism and endometrial hyperplasia
o Women 55-65 years

Pathology:

- Well differentiated tumours, favourable outcomes
- PTEN gene mutation in 30-80%
- Histological subtypes: Endometroid carcinoma of the endometrium (85%)

Risk factors:

- Oestrogen replacement therapy
- PCOS and anovulatory cycles
- Tamoxifen
- Obesity
- Early menarche or late menopause
- Nulliparity
- Oestrogen producing ovarian tumours e.g. granulosa cell cancer
- Diabetes mellitus

Type 2 endometrial cancer:
o 20%; Arises in the setting of endometrial atrophy
o Women 65-75 years

Pathology:
- p53 mutation in 50%
- Poorly differentiated, early spread via lymphatics and fallopian tubes into the peritoneum
- Poorer prognosis
- Histological subtypes:
• Papillary serous carcinoma of the endometrium
• Clear cell carcinoma of the endometrium
• Adenosquamous carcinoma of the endometrium
• Adenocarcinoma of the endometrium with squamous differentiation
• Undifferentiated of the endometrium e.g. small cell undifferentiated carcinoma of the endometrium

Associations: Hereditary non-polyposis colon cancer: 30-50x increased lifetime risk
• Precurser lesions (complete hyperplasia with atypia) associated in >40% of cases

Endometrial sarcoma (endometrial stromal sarcoma):
o Malignant subtype of endometrial stroma tumours
- Low grade endometrial stromal sarcoma
- Undifferentiated uterine sarcoma
o <2% of uterine malignancies; 10% of uterine sarcomas
o Pre-menopausal women – 5th decade

Malignant mixed mullerian tumour of the uterus (uterine carcinosarcoma):
o 50% of uterine sarcomas
o Epithelial and mesodermal components

Epithelial component subtypes:
•	Endometroid adenocarcinoma
•	Clear cell carcinoma
•	Mucinous carcinoma
•	Papillary-serous carcinoma

Sarcomatoid component subtypes:
• Undifferentiated sarcoma
• Rhabdomyosarcoma

o Present as an intracavity mass with dilatation of the endometrial canal

ANSWER: Endometrial carcinoma is usually low grade (80% - type I)

38
Q

What is the most common cause of diffuse uterine enlargement with an irregular contour? (August 2016)

a. Multiple leiomyomas
b. Adenomyosis

A

ANSWER: Multiple leiomyomas

39
Q

Regarding PCOS: (March 2015)

a. It is a risk factor for ovarian cancer
b. Unilateral ovarian enlargement is seen in stromal hyperthecosis

A

• PCOS is a risk factor for endometrial cancer

Ovarian hyperthecosis:
o Presence of luteinised thecal cells w/in a hyperplastic ovarian stroma

Clinical manifestations:

- Hyperandrogenism
- Obesity
- Hypertension
- Impaired glucose tolerance
- Virilisation more common in pre-menopausal women and hyper-oestrogenism in post-menopausal women

Pathology:

  • Moderately hyperplastic ovarian stroma with luteinised thecal cells (single cells, nests or nodules)
  • Luteinised cells located centrally in ovarian hyperthecosis, and located peripherally in PCOS

Associations:

- Endometrial hyperplasia
- Endometrial carcinoma
- Ovarian fibrothecoma

Features:

- Increased ovarian size bilaterally
- May appear normal or nodular

ANSWER: Both options are incorrect, PCOS is a risk factor for endometrial cancer and ovarian hyperthecosis typically causes bilateral ovarian enlargement

40
Q

Which association is false? (March 2016)

a. Turner syndrome and gonadoblastoma
b. Fibroma and Meig syndrome
c. Thecoma and endometrial thickening
d. Sertoli-Leydig cell and hyperandrogenism

A

Gonadoblastoma:
o Associated w disorders of sexual development:
- Newborn with ambiguous genitalia
- Precocious puberty or virulisation

Epidemiology:

  • Usually discovered before age 30, most commonly in the neonatal period
  • May occur in phenotypic males or females

Pathology:

  • Benign tumour, can develop into a germ cell tumour if not resected
  • If the patient has a contralateral undescended testis, this is often removed as well due to the risk of bilateral gonadoblastoma
  • Bilateral in 50% of cases
  • Assoc w chromosomal abnormalities & gonadal dysgenesis
  • Only assoc w Turner syndrome if there is XY mosaicism

ANSWER: Turner syndrome is not typically associated with gonadoblastoma unless there is XY mosaicism

41
Q

Which ovarian tumour is most likely to occur in post-menopausal women? (March 2015)

a. Mucinous cystadenoma
b. Granulosa
c. Serous cystadenoma
d. Serous cystadenocarcinoma
e. MMMT

A

Serous cystadenoma:
o Peak incidence in 4th and 5th decades
o 25% of all benign ovarian neoplasms (50-70% of serous tumours are benign)
o 10-20% bilateral
o 84% of simple cysts in post menopausal women are serous cystadenomas at surgery

ANSWER: Serous cystadenoma

42
Q

Which is true regarding BRCA2 mutation? (March 2017)

a. Associated with serous ovarian carcinoma
b. Associated with mucinous ovarian carcinoma

A

ANSWER: BRCA2 is associated with a 15-25% lifetime risk of ovarian serous carcinoma

43
Q

Regarding ovarian cystadenocarcinoma, what is most true? (August 2016)

a. Ovarian serous adenocarcinoma arises from the fallopian fimbria

A

Ovarian cystadenocarcinoma
o Malignant ovarian epithelial tumour (serous tumour)
o Largest proportion of malignant epithelial tumours (50-80%) - 25% of serous tumours
o 6th – 7th decades

Pathology:

  • Multilocular cystic ovarian tumour with papillary projections
  • Psammomatous bodies in ~30%
  • Elevated CA-125 in >90%
  • Arise from the epithelium at the fimbriated end of the fallopian tube

ANSWER: Ovarian cystadenocarcinoma arises from the fallopian fimbria

44
Q

Regarding mucinous cystadenocarcinoma, which is true? (August 2016)

a. Usually unilateral
b. Usually bilateral
c. Is the most common cause of peritoneal carcinomatosis

A 
Bilaterality of surface epithelial stromal tumours
o Serous
	- Serous cystadenoma (benign): 20%
	- Serous cystadenoma (borderline): 30%
	- Serous cystadenocarcinoma: 66%
o Mucinous cystadenoma and carcinoma: 5%
o Endometroid carcinoma: 40%
o Brenner (transitional cell): 10%

Mucinous cystadenoma:
o 30-50 years
o 20-25% of benign ovarian tumours, 80% of mucinous tumours

Pathology: lined by columnar epithelium, multiloculated filled with thick, gelatinous mucin
- Mural calcification more common than in serous tumours

Mucinous cystadenocarcinoma
o 5-10% of ovarian mucinous tumours
o Very rarely arises from degeneration of an ovarian teratoma

ANSWER: Mucinous cystadenocarcinoma is usually unilateral

45
Q

Which of the following ovarian lesions is most commonly bilateral? (September 2013)

a. Endometroid
b. Mucinous
c. Fibroma
d. Brenner

A

ANSWER: Endometriod tumours are the most likely to be bilateral out of these options

Serous (65%)> Metastatic (>50%) > Endometrioid and clear cell (40%) > Teratoma (15%) > Mucinous (5-10%) > Granulosa cell tumour (5%)

46
Q

A patient has a lesion in the right ovary. Which of the following would most favour serous cystadenocarcinoma? (September 2013)

a. A similar lesion on the left
b. Extensive calcification
c. Solid enhancing components
d. Increased AFP

A
  • 65% of malignant ovarian cystadenocarcinomas are bilateral, whereas 25% of benign ovarian cystadenomas are unilateral
  • Solid enhancing components and papillary projections are markers of malignancy (But not specific for cystadenocarcinoma)
  • Cystadenocarcinoma is associated w elevated serum Ca-125

ANSWER: Bilaterality would favour serous cystadenocarcinoma over other diagnoses

47
Q

The first lymph nodes involved in ovarian cancer are: (August 2016)

a. Retroperitoneal
b. Inguinal

A

ANSWER: Retroperitoneal (pelvic also common)

48
Q

What is the most likely non-cystic ovarian tumour? (August 2016, March 2017)

a. Brenner tumour

A 
Predominantly solid ovarian neoplasms:
o	Brenner tumour
o	Thecoma
o	Fibroma
o	Endometroid granulosa cell tumours
o	Dysgerminoma
o	Endodermal sinus tumour (yolk sac tumour)
o	Metastatic

ANSWER: Brenner tumour

49
Q

Which association is true? (March 2014)

a. Carcinosarcoma and post-menopausal females
b. Vulval sarcoma and …

A

Carcinosarcoma of the ovary
o Rare type of malignant mixed mullerian tumour (MMMT) of the ovary
o Less than 1% of ovarian cancers

Epidemiology: Post menopausal females; 6th – 8th decades

Pathology:

  • Biphasic carcinomas w epithelial & stromal elements
  • High incidence of haemorrhagic ascites

o Aggressive neoplasms with a poor prognosis

ANSWER: Carcinosarcoma occurs in post-menopausal females

50
Q

Regarding ovarian tumours (?cancer): (September 2013)

a. Struma ovarii is a recognized pattern

A

Struva ovarii
o Subtype of ovarian teratoma composed entirely (or predominantly) of thyroid tissue & containing variable-sized follicles w colloid material
- >50% of the tumour should be thyroid tissue for diagnosis
o 5-8% of patients show evidence of clinical thyrotoxicosis
o 90-95% of struma ovarii are benign

ANSWER: Unclear – struva ovarii is a recognized pattern in ovarian teratoma

51
Q

Which is true regarding ovarian teratomas? (March 2016)

a. Ovarian teratomas are associated with limbic encephalitis
b. Immature teratomas are associated with carcinoid syndrome

A 
Causes of limbic encephalitis:
o	Small cell lung cancer
o	Testicular germ cell tumours
o	Thymic neoplasms
o	Breast cancer
o	Ovarian tumours e.g. ovarian carcinoma or teratoma
o	Haematological malignancies e.g. Hodgkin lymphoma
o	Gastrointestinal malignancy
o	Neuroblastoma

Syndromes rarely associated with mature teratomas:
o Hyperthyroidism/thyrotoxicosis – struma ovarii
o Carcinoid syndrome

ANSWER: Ovarian teratomas are associated with limbic encephalitis

52
Q

Which is false of ovarian cancer? (September 2013)

a. Gestation and non-gestational choriocarcinoma have the same prognosis
b. Prognosis of fibroma is not affected by ascites
c. Brenner tumours are usually solid

A

ANSWER: Non-gestational choriocarcinomas have a much worse prognosis than gestational choriocarcinoma

53
Q

Which is false regarding choriocarcinoma? (March 2017)

a. Gestational and non-gestational choriocarcinoma have the same prognosis
b. Choriocarcinomas metastasise early and often have metastases at diagnosis

A

ANSWER: Non-gestational choriocarcinoma has a much worse prognosis than gestational choriocarcinoma

54
Q

Regarding Meigs syndrome, what is most correct? (March 2015)

a. Right sided chylothorax
b. Right sided hydrothorax
c. Left sided haemothorax
d. Left sided chylothorax
e. Bilateral haemorrhagic pleural effusions

A

Features of Meigs syndrome:
o Ascites and pleural effusion assoc w a benign, usually solid ovarian tumour
- Usually a fibroma (80-90%), but less commonly fibrothecoma, thecoma, granulosa cell tumour or Brenner tumour
o Pleural effusion is right sided in 60-70%

ANSWER: Right sided hydrothorax

55
Q

Which neoplasm does not cause Meigs syndrome? (August 2014)

a. Brenner
b. Dysgerminoma
c. Granulosa cell tumour
d. Fibroma
e. Thecoma

A

Meigs syndrome
Clinical:
- ascites & pleural effusion assoc w a benign (usually solid) ovarian tumour
- Pleural effusion and ascites usually resolve post resection of the tumour

Associated ovarian tumours:
	Fibroma (90%)
	Fibrothecoma
	Thecoma
	Granulosa cell tumour
	Brenner tumour (rare)

ANSWER: Meigs syndrome is not associated with dysgerminoma

56
Q

What is most likely to be hormonally active in a young patient? (March 2015)

a. Juvenile granulosa cell
b. Choriocarcinoma
c. Yolk sac tumour
d. Serous cystadenoma
e. Immature teratoma

A

Juvenile granulosa cell tumour:

  • Ovarian sex cord/stromal tumour
  • accounts for 5% of granulosa cell tumours

Epidemiology:

- Premenarche girls and young women
- Mean age at presentation 13

Endocrine:

- Precocious puberty as a result of oestrogen secretion (May cause resultant uterine enlargement and endometrial thickening) 
- Rarely produce androgens

Associations:

- Mafucci syndrome
- Ollier disease

o 90% low grade – surgery is curative in these patients. Higher grade may require chemoTx

Summary of other options:
o Choriocarcinoma: secretes bHCG
o Yolk sac tumour: secretes AFP
o Serous cystadenoma: non-secretory
o Immature teratoma: elevated AFP in 50%, usually does not secrete bHCG
- 3% of mature cystic teratomas will contain struma ovarii (mature thyroid tissue) and secrete thyroid hormone (8% present with thyrotoxicosis)

ANSWER: Juvenile granulosa cell tumour

57
Q

What neoplasm is associated with pseudohermaphrodism? (March 2014)

a. Leydig cell tumour
b. Sertoli-Leydig cell tumour
c. Graulosa cell tumour
d. Serous malignancy
e. Mucinous tumour

A

Sertoli-Leydig tumour

  • Rare tumours of the ovary
  • Assoc w mutations of the DICER1 gene
  • 25% malignant

Pathology:

- Variable proportions of Sertoli and Leydig cells
- Tubules lined with Sertoli cells and intervening clusters of Leydig cells in well differentiated tumours

Clinical:
- Excess testosterone excreted by the tumour
• High serum testosterone in 2/3
• No specific tumour markers
- 1/3 of female patients present with progressive masculinization, Anovulation, Oligomenorrhoea/amenorrhoea, Defeminisation: acne, hirsuitism, clitoromegaly, temporal hair recession, increased musculature

ANSWER: Sertoli-Leydig cell tumours are associated with pseudohermaphrodism

58
Q

Which tumour is most likely to result in hyperandrogenism? (March 2014)

a. Granulosa cell tumour
b. Leydig cell tumour
c. Sertoli-leydig cell tumour
d. Serous cystadenoma

A
  • Granulosa cell: oestrogen
  • Leydig cell: virulisation +/- hyperoestrogenism
  • Sertoli-leydig cell: virulisation +/- masculinisation. Can be a cause of pseudohermaphrodism in women

ANSWER: Sertoli-leydig cell tumours are most associated

59
Q

What is least likely to cause foetal hydrops? (March 2015)

a. Paroxysmal SVT
b. Parvovirus
c. Thoracic mass

A

Hydrops fetalis is excessive loss of fluid into the 3rd space in a foetus (at least two fetal compartments)

Causes of foetal hydrops:
o IMMUNE (10%)
- Fetomaternal blood group incompatibility – erythroblastosis foetalis (Less common due to management of Rhesus incompatibility)

o NON-IMMUNE
- Chromosomal abnormalies: Turner’s syndrome; Trisomies: T13, T18, 21

  • Cardiac causes: Foetal tachyarrhythmias; Congenital cardiac anomalies; Foetal cardiac tumours e.g. cardiac rhabdomyoma
  • Twin related complications: Twin-twin transfusion (recipient twin); Twin reversed arterial perfusion sequence (pump twin)
  • In utero infections: TORCH group; Parvovirus B19 (most common infectious cause of hydrops - causes foetal anaemia); Coxsackie virus
  • Fetal tumours: Sacrococcygeal teratoma; Hepatic haemangioendothelioma; Placenta choriocarcinoma
  • Inborn errors of metabolism: Gaucher’s disease; Niemann-Pick disease
  • Congenital foetal anaemias: Alpha thalassaemia / Haemoglobin Bart’s
- Thoracic/pulmonary anomalies (thought to be due to venous return obstruction)
•	Primary foetal hydrothorax
•	CPAM
•	Congenital diaphragmatic hernia
•	Pulmonary sequestration
Other:
•	Hypoproteinaemic states 
•	Skeletal dysplasias
•	Lymphovascular anomalies
•	High output flow states

ANSWER: All options are potential causes of foetal hydrops

60
Q

Twin-twin transfusion can occur in:

a. Monochorionic diamniotic
b. Other diamniotic options

A

Twin-twin transfusion is a complication of monochorionic twin pregnancies (MCDA)
o 10% of monochorionic pregnancies

Pathology:
o Unbalanced arterio-venous communication in the placenta - Asymmetric anastomotic patterns
o Donor twin (stuck twin): pump twin, oligohydramnios, smaller
o Recipient twin: polyhydramnios, larger
o >20% growth discordance bw the twins
o Amniotic fluid discrepancy

Staging:
o Stage I: visible bladder in donor twin with normal Dopplers
o Stage II: empty bladder in donor twin with normal Dopplers
o Stage III: empty bladder in the donor twin with abnormal Dopplers
o Stage IV: Hydrops fetalis in recipient twin
o Stage V: Demise of any twin

TAPS (twin anaemia-polycythaemia sequence)
o One twin develops anaemia and the other develops polycythaemia
o No amniotic fluid discordance

ANSWER: TTTS is seen in diamniotic monochorionic pregnancies

61
Q

Which is correct regarding twin pregnancies? (March 2016)

a. Twin-twin transfusion can occur in dizygotic twins
b. Fused twins which are dichorionic diamniotic indicate a monozygotic pregnancy
c. Dichorionic diamniotic pregnancy indicates a monozygotic gestation
d. Monochorionic pregnancy indicates a monozygotic gestation

A

ANSWER: Monochorionic pregnancies arise from a monozygotic gestation

62
Q

Most likely cause of placenta praevia? (March 2015)

a. Succenturiate lobe
b. Bilobed placenta
c. Velamentous cord insertion
d. Placenta membranacea
e. Circumvellate

A 
Risk factors for placenta praevia:
o	Previous placenta praevia
o	Previous caesarean section
o	Increased maternal age
o	Increased parity
o	Large placentas: Multiple gestations; Erythroblastosis
o	Maternal history of smoking

o Succenturiate lobe:

  • Smaller accessory placental lobe which is separate to the main disc of the placenta
  • May be multiple
  • Increased risk of vasa praevia

o Bilobed placenta:

  • Variant placental development where the placenta consists of two discs of comparable size
  • Assoc w velamentous cord insertion
  • Increased risk of vasa praevia and post-partum haemorrhage secondary to retained products
  • Incidence up to 4% of pregnancies
o	Velamentous cord insertion:
- Umbilical cord inserts into the foetal membranes outside the placental margin
- Thought to result from processes leading to remodelling of the placenta as a response to abnormal blood flow
Associations
•	Bilobed placenta
•	Twin pregnancy
•	Uterine anomalies
•	Presence of an IUD
•	Single umbilical artery
•	Placenta praevia
Complications:
•	Vasa praevia
•	Increased risk of IUGR
•	Increased risk of complications of twin pregnancies: Discordant growth; TTTS

o Placenta membranacea:
- Extremely uncommon variant (1 in 20000-40000)
- Placenta develops as a thin membranous structure occupying the entire periphery of the chorion
- Placental mass can be 1-2cm thin & deficient in some areas
Associations: abnormal placental adherence in 30%
Complications:
• Placenta praevia
• IUGR
• Recurrent antepartum haemorrhage
• Second trimester miscarriages
• Foetal demise
• Post-partum complications: PPH; RPOC

o Circumvellate placenta:
- Due to a small chorionic plate, the amnion and the membranes double back around the edge of the placenta
Pathology:
• Excessive implantation occurs, covering more than half of the foetal sac
• Placenta reduces this excessive implantation by detaching at the sides
• Membranes cover the detached placenta giving a rolled edge
• Gives the appearance of a ‘placental shelf’ on ultrasound
Associations:
• Higher incidence of placental abruption
• Increased risk of IUGR

ANSWER: Placenta membranacea is the only CAUSE of placenta previa. Velamentous cord insertion would be the most common association.

63
Q

What has the highest associated risk of uterine rupture? (March 2015)

a. Placenta praevia
b. Placenta increta
c. Placenta accreta
d. Placenta percreta
e. Abruption

A

Uterine rupture:
o >90% caused by an old Caesarian scar
- “Classic” scars tend to rupture before labour
- Lower uterine segment scars tend to rupture after labour
o Uterine dehiscence may be limited by an intact serosal layer
o Full thickness rupture is assoc w massive haemoperitoneum & high rate of mortality for both mother & foetus
o Among the spectrum of abnormal villous adherence, placenta percreta has the highest risk of uterine rupture

Spectrum of abnormal villous adherence:
o Risk factors:
Prior Caesarian section
Placenta praevia
Advanced maternal age
Uterine anomalies
Intrauterine adhesion bands
Previous surgery
o Placenta accreta:
Mildest and most common (75%)
Villi are attached to the myometrium but do not invade the muscle
o Placenta increta:
Intermediate form (20%)
Villi partially invade the myometrium
o Placenta percreta:
Most severe, but least common (5%) - Incidence increasing due to the increased rate of Caesarian delivery
Transmural extension of placental tissue w serosal breech
May involve adjacent organs such as bladder or bowel
May be complicated by uterine rupture or peripartum haemorrhage

ANSWER: Placental percreta

64
Q

Regarding molar pregnancy: (March 2015)

a. Partial mole is paternally derived
b. Partial mole is associated with choriocarcinoma
c. Invasive mole is only from a complete mole
d. Complete mole has foetal parts

A

Complete hydatiform mole:
o Most common manifestation of gestational trophoblastic disease
o Characterised by the absence of foetal parts - Non invasive, diffuse swelling of the chorionic villi
o 90% have 46XX; 10% are 46XY - All chromosomes are paternally derived

Complications:
- Degeneration into invasive or malignant types of gestational trophoblastic disease occurs in ~10-20%

Partial hydatiform mole:
o Contains an embryo or foetus
o Greatly enlarged placenta relative to the uterus, commonly containing cystic spaces
o Triploid karyotype, with the extra set of chromosomes usually paternal
o Increased risk of invasive mole, no increased risk of choriocarcinoma

ANSWER: All are incorrect

65
Q

Regarding hydatiform mole, which is least likely? (March 2014)

a. Partial mole is less associated with choriocarcinoma
b. Complete mole is frequently associated with foetal parts
c. Could be associated with abortion

A

ANSWER: Complete mole is not associated with foetal parts, however partial mole is

66
Q

Regarding choriocarcinoma, which is most correct? (August 2016)

a. Severely secretes bHCG
b. 25% arise post abortion

A

Choriocarcinoma of the uterus
o One of the most common choriocarcinomas, assoc w gestational trophoblastic disease
o Usually occurs w/in one year of pregnancy
- Non-gestational choriocarcinoma of the uterus is rare
o bHCG is typically elevated above levels expected for molar pregnancies
- Can have lower bHCG, especially if there is a large necrotic component to the tumour

Pathology:

- Highly vascular neoplasm
- Tumour of trophoblastic cells
- Distinguished from other gestational trophoblastic disease by an absence of chorionic villi
- 5% of cases of complete hydatiform mole are followed by choriocarcinoma (accounts for half of the cases)
  • 25% arise after normal pregnancies
  • 25% follow spontaneous abortion (20-25%) or ectopic pregnancy (2%) - 1% of gestational trophoblastic disease

Prognosis:

  • Cases arising from complete hydatiform mole are usually completely cured by chemotherapy
  • Cure rate 90-95% due to the presence of paternal DNA
  • Non-gestational choriocarcinoma has a worse prognosis

ANSWER: Both responses are correct – choriocarcinoma secretes bHCG and 20-25% arise following abortion

67
Q

Which is most correct regarding choriocarcinoma? (August 2014)

a. Unlikely to recur
b. Associated with ectopic pregnancy

A

ANSWER: Gestational choriocarcinoma is unlikely to recur as it is exquisitely chemosensitive. 2% are associated with ectopic pregnancy.

68
Q

Regarding placental site trophoblastic tumour, which is true? (March 2017)

a. The tumour severely secretes bHCG
b. Can occur years after a normal pregnancy

A

Placental site trophoblastic tumour (PSTT):
o <2% of gestational trophoblastic neoplasms
o Neoplastic proliferation of extravillous trophoblasts (Intermediate trophoblasts)

Clinical:

- Uterine mass
- Either abnormal uterine bleeding or ammenorrheoa
- Moderately elevated bHCG
- May occur 2 weeks to 14 years following the gestation

Pathology:

- Malignant trophoblastic cells diffusely infiltrating the myometrium
- May follow a normal pregnancy (50%), spontaneous abortion or molar pregnancy

Prognosis:

  • Good for localized disease
  • 10-15% die of disseminated disease

ANSWER: Placental site trophoblastic tumour can occur greater than two years following a normal pregnancy

69
Q

Which is not associated with pre-eclampsia? (March 2017)

a. Hydatiform mole
b. Placental infarcts
c. Retroplacental haemorrhage
d. Maternal glomerulonephritis
e. HELLP syndrome

A

Pre-eclampsia:

  • Widespread endothelial dysfunction which presents w HTN, oedema & proteinuria
  • Eclampsia: severe illness with CNS involvement
Epidemiology:
	- 3-5% of pregnancies
	- More common in primigravid women
	- Increased risk with women carrying molar pregnancies
	- Usually begins in the 3rd trimester (34 weeks)
	- Earlier onset in women with:
•	Pre-existing renal disease
•	HTN
•	Coagulopathies
Maternal complications from systemic endothelial dysfunction:
	Hypercoagulability
	Acute renal failure
	Pulmonary oedema
	HELLP syndrome (10%)
	Eclampsia – convulsions

Pathophysiology:

  • VEGF; PgI2
  • Abnormal placental vasculature: failure of remodeling of the spiral arteries
  • Endothelial dysfunction & imbalance in the circulating angiogenic & anti-angiogenic factors
  • Inappropriate release of factors in response to placental hypoxia - Coagulation abnormalities: thrombi develop in capillaries and arterioles
  • Organs most commonly affected: liver, kidney, brain, pituitary

Placental pathology:
- Infarcts: larger & more numerous than normal term placentas
- Exaggerated ischaemic changes (increased syncytial knots)
- Frequent retroplacental haematomas
• Reflect the instability of the uteroplacental vessels
- Abnormal decidual vessels
• Thrombi
• Lack of physiological conversion
• Fibrinoid necrosis
• Intraintimal lipid deposition

Management:

  • Delivery – symptoms usually resolve in 1-2 weeks
  • Anti-hypertensive medications do not alter the disease outcomes

o 20% of women develop non-pregnancy related HTN w/in 7 years

ANSWER: Maternal glomerulonephritis is not assoc w pre-eclampsia. Hydatiform mole increases the risk. Placental infarcts & retroplacental haemorrhage are pathological hallmarks. HELLP syndrome is a complication.

70
Q

Complications of pre-eclampsia (March 2015)

a. Thrombocytosis
b. Pulmonary haemorrhage
c. Hypofibrinogen
d. Renal papillary necrosis

A
  • Eclampsia: hyperreflexia and convulsions
  • HELLP syndrome:
    • Haemolysis, elevated liver enzymes, low platelets
    • Where subclinical hepatic disease is the primary manifestation
Complications:
o	DIC
o	Hepatic infarction
o	Hepatic haematoma
o	Hepatic rupture
o	Placental abruption
- Haemorrhagic or ischaemic stroke
- Liver injury
- Acute kidney injury – renal cortical necrosis
  • Pregnancy related complications including placental abruption, chorioamnionitis (in the setting of foetal death) and severe eclampsia account for 50% of cases of renal cortical necrosis
  • ARDS - Lung complications related to pulmonary oedema (not typically pulmonary haemorrhage)

Foetal complications:
• Growth restriction
• Foetal or perinatal death

ANSWER: None are correct – there is thymbocytopaenia in HELLP syndrome, pulmonary oedema – not pulmonary haemorrhage, higher levels of fibrinogen in pre-eclampsia patients and renal cortical necrosis rather than papillary necrosis

Pathology MCQ (18 decks)

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