GYN Chapter 29: Malignant Diseases of the Cervix

Question 1

SCCA vs AdenoCa: 80-85% of cervical tumors

Answer 1

SCCA (80-85%) > Adenocarcinoma (15-20%)

Question 2

Degree oil differentiation of cervical tumors

Answer 2

Grade 1: well-differentiated
Grade 2: intermediate
Grade 3: undiffferentiated

Question 3

These tumors are morphologically similar to those found in vulva, warty, appearing as large bulbous masses.

Answer 3

Verrucous carcinoma of the cervix

Question 4

True or False: Verrucous carcinoma frequently metastasizes to the lungs and breasts.

Answer 4

They rarely metastasize but they may be admixed with the more virulent SCCA.

Question 5

Histologic variants of cervical adenocarcinoma (2).

Answer 5

Endocervical

• typical
• contains instracytoplasmic mucin, related to the mucinous cells of the endocervix

Endometrioid
-little to no mucin, resembles EM carcinoma

Question 6

Immunohistochemistry stains that differentiate and endocervical from endometrioid carcinoma

Answer 6

1. estrogen receptor
2. vimentin
3. p16
4. CEA

Endocervical if:
(+) p16, CEA
(-) ER, vimentin

Question 7

this is a rare but virulent variety of adenocarcinoma which appears as microscopically innocuous, with well-differentiated mucinous glands, bland histologic appearance which tend to be invasive and metastasize early.

Answer 7

adenoma malignum/minimal deviation adenocarcinoma

Question 8

Associated with DES exposure, histologically indentical to the ovarian counterpart.

Answer 8

clear cell adenocarcinoma of the cervix

Question 9

Primary path for distant spread

Answer 9

Lymphatics

Primary pelvic nodes:
Pericervical
Presacral
Hypogastric (internal iliac)
External iliac
Nodes in the obturator fossa

Secondary pelvic nodes:
Common iliac
Paraaortic

The inguinal nodes are considered primary when the lower third of vagina is involved.

Question 10

Sentinel node for cervical ca

Answer 10

Obturator nodes (most frequently involved)

Question 11

A biopsy of this node may be performed in assessment of advanced cervical ca that has spread outside the abdomen. It become involved after the paraqortic nodes.

Answer 11

Left scalene/supraclavicular node

Question 12

The most important determinant of prognosis of cervical ca

Answer 12

FIGO Stage

Question 13

5-yr survival rate of patient with positive para aortic LN who underwent extended-field radiation therapy

Answer 13

40-50%

Question 14

SCCA vs Adenocarcinoma: poorer prognosis

Answer 14

adenocarcinoma has poorer prognosis