Gynecologic Oncology and Pathology - Test 2

Question 1

What is the DDx for a post-menopausal woman who presents with vaginal bleeding?

Answer 1

Menorrhagia (can still happen post-menopausally)

Endometrial hyperplasia

Endometrial cancer

Fibroids

Adenomyosis (endometrial tissue that invaded the myometrium)

Clotting disorder

Question 2

What finding on ultrasound is consistent with endometrial cancer? Is this finding specific?

Answer 2

Endometrial thickening (>4mm) or a thickened stripe

Note that endometrial hyperplasia will look like this as well; biopsy will differentiate hyperplasia from cancer

Question 3

What are the risk factors for developing endometrial cancer?

Answer 3

• Excess estrogen
  
  • Obesity because it results in increased aromatization of androgens -> estradiol and also androstenedione -> estrone; estrogen stimulates the endometrium!
  • PCOS
  • Estrogen replacement therapy
  • Hx of Tamoxifen use (antagonist at breast tissue - treats breast cancer, agonist at endometrial tissue)
• Nulliparity
• Diabetes mellitus
• Lynch syndrome

Question 4

What is the treatment for endometrial cancer?

Answer 4

Hysterectomy (+/- post-op radiation and chemo)

Question 5

You see a 44 year old woman who presents with vaginal bleeding. She has an extensive family history colon cancer so you order genetic testing. What is your suspicion?

Answer 5

Lynch syndrome

Question 6

29 yo female presents with pelvic pain, pressure, excessive menstrual bleeding. On exam you feel a smooth, round mass in the uterus. What is at the top of your DDx?

Answer 6

Leiomyoma

Question 7

What is the precursor lesion to enometrial cancer?

Answer 7

Endometrial hyperplasia is in-situ neoplasia (shitty term)

Question 8

How do you treat a pre-menopausal woman who hopes to have children for endometrial hyperplasia? What if she is post-menopausal or does not want kids?

Answer 8

Tx for pre-menopausal and wants kids: progesterone

Hysterectomy otherwise

Question 9

50 year-old female presents with abdominal bloating, constipation, and increased urinary frequency.

What is one diagnosis that you should rule out? How do you do this?

Answer 9

Always consider ovarian cancer in women over 40 with new onset of vague abdominal, pelvic, GI, or urinary complaints

Rule out with serum CA-125 - a glycoprotein marker made by most epithelial ovarian cancers (it it NOT specific at all, though!) as well as ultrasound or CT to look for masses or ascites

Question 10

What is omental “cake” as seen on a CT scan and what disease is it associated with?

Answer 10

It is when epithelial ovarian cancer spreads to the omentum and makes it stick together and grow big

Question 11

What types of ovarian tumors are most common in women under 30? From what cells do these arise?

Answer 11

Germ cell tumors arise from oocytes

Question 12

What is the treatment for eipthelial ovarian cancer?

Answer 12

Surgery (cytoreduction - remove all visible cancer) followed by 6-8 cycles of chemotherapy (cisplatin or carboplatin + paclitaxel)

Question 13

Most hereditary cases of breast and ovarian cancer are caused by mutations in…?

Answer 13

BRCA 1 and 2

Question 14

A 5 year-old girl presents with pelvic pain and a pelvic mass is found on ultrasound. What is your DDx?

Answer 14

Germ cell neoplasm (there are a shitload of subtypes but fuck it)

Question 15

A 35 year old female presents with anxiety, palpitations, tremor, history of weight loss, and pelvic pressure. She has an ovarian mass on ultrasound. What type of tumor is this likely to be?

Answer 15

This is probably a struma ovaii, a type of germ cell ovarian tumor that contains thyroid tissue (functional thyroid tissue in this case)

Question 16

What is this and how does it present (what symptoms)?

Answer 16

This is an endometrioma (from endometriosis)

Symptoms:

May be asymptomatic

Dysmenorrhea (pain w/ menses)

Dyspareunia

Chronic pelvic pain

Question 17

Post-coital bleeding is classic for what type of gynecologic cancer? What else should be on the differential for this symptom?

Answer 17

Cervical cancer

Other possibilities:

Pregnancy

Molar pregnancy

Endometrial cancer

Question 18

What are the risk factors for getting HPV?

Answer 18

Early age at onset of sexual activity

Multiple lifetime partners (>5)

Smoking

Immunosuppression

Question 19

A 74 year old woman presents with genital itching. On exam, you see the following. What is this called and what cancer does this predispose a person to?

Answer 19

This is lichen sclerosus, it predisposes to vulvar cancer

Question 20

What virus predisposes people to developing vulvar cancer? What is the precursor lesion?

Answer 20

HPV

Precursor lesion is vulvar intraepithelial neoplasia (see photo)

Question 21

A 22 year old patient presents with heavy vaginal bleeding. She is sexually active. Beta-hCG is very high and pelvic ultrasound shows a uterine mass with no fetus. What is the diagnosis and expected appearance of the pathology specimen?

How is this treated?

Answer 21

Molar pregnancy - looks like a grape vine or some shit

Treatment: D&C, followed by weekly b-hCG monitoring until it reaches 0

Question 22

Do all types of ovarian cancers predispose the patient to ovarian torsion?

Answer 22

Yeah

Question 23

What type of hydatiform mole increases future risk of choriocarcinoma?

Answer 23

Complete mole (diploid)

Question 24

Name the tumor markers that show up in the following ovarian cancer subtypes:

embryonal carcinoma

seminoma

yolk sac tumor

choriocarcinoma

teratoma

Answer 24