Lifecycles - Specific Findings

Question 1

alpha-fetoprotein

Answer 1

Tumor marker - Yolk sac (endodermal sinus) tumor of infants/young children

Question 2

Schiller-Duval bodies

Answer 2

Seen in 50% of yolk sac (endodermal sinus) tumors of infants/young children

Question 3

17-hydroxyprogesterone

Answer 3

Intermediate metabolic product in the conversion of pregnenolone to mineralocorticoids and cortisol

Elevated levels seen in 21-hydroxylase deficiency

Question 4

“Coffee bean” nucleus

Answer 4

Classical finding associated with Brenner ovarian tumor

Question 5

Honeycomb uterus

Answer 5

Ultrasound finding classic for molar pregnancy

Question 6

“Cluster of grapes” structure

Answer 6

Ultrasound finding classic for molar pregnancy

Question 7

Specific treatment for HER2+ breast cancers

Answer 7

Trastuzumab (Herceptin)

Question 8

Paget Cells

Answer 8

Large cells seen in the epidermis surrounded by a clear halo

If seen in the breast, suggestive of underlying malignancy

If seen in the vulva, NOT associated with underlying malignancy

Question 9

Maternal serum screening findings - Edwards Disease

Answer 9

Decreased AFP, bHCG, and Estriol

Normal Inhibin A

Question 10

Koilocytes

Answer 10

Cells with wrinkled, “raisin-like” nuclei and a zone of perinuclear clearing (“halo”)

Pathognomonic for HPV-associated lesions:

Condyloma (HPV 6, 11)
Cervical dysplasia/carcinoma (HPV 16, 18)

Question 11

What pathological condition of a fetus is associated with elevated AFP in the amniotic fluid / maternal serum?

Answer 11

Neural tube defect

Question 12

Signet ring cells

Answer 12

Mucin-secreting cells

Key finding in Krukenberg Tumor - metastatic adenocarcinoma of the stomach to the ovaries bilaterally

Question 13

Trichomonas - PE & Lab Findings

Answer 13

Vaginitis with foul-smelling, greenish, froshy discharge
Friable (“Strawberry”) Cervix

Motile cells on wet prep

Question 14

Lab findings in PCOS

Answer 14

LH : FSH ratio > 2.1 : 1 in the first 5 days of the cycle

Elevated androgens, both testosterone (ovarian) and DHEA-S (adrenal)

Question 15

Klinefelter Syndrome - Karyotype finding

Answer 15

Genotype 47 XXY

Inactivated X chromosome (Barr body) seen on karyotype

Question 16

Klinefelter Syndrome - Lab findings

Answer 16

Slightly low testosterone with elevated LH

Indicates primary hypogonadism

Question 17

“String of Pearls” appearance of ovaries on US

Answer 17

This is a finding seen in PCOS

The “string of pearls” are actually peripherally located follicular cysts

Question 18

Reinke’s Crystals

Answer 18

Commonly seen with Leydig cell tumors of the testicle

Question 19

Pre-natal screening findings consistent with Down Syndrome

Answer 19

First trimester ultrasound shows increased nuchal translucency and hypoplastic nasal bone

Second trimester Quad screen shows:

Decreased AFP
Increased B-hCG
Decreased Estriol
Increased Inhibin A

Question 20

Prenatal screening findings consistent with Edwards syndrome

Answer 20

Second trimester Quad screen shows:

Decreased AFP, B-hCG, estriol, and decreased/normal inhibin A

Question 21

Prenatal screening findings consistent with Patau syndrome

Answer 21

First trimester pregnancy screen shows:

Decreased B-hCG
Decreased PAPP-A
Increased nuchal translucency

Question 22

Call-Exner Bodies

Answer 22

Histological structures resembling primordial ovarian follicles

Classic histological finding in Granulosa cell ovarian cancer

Question 23

What is the “Discriminatory threshold” for b-HCG?

Answer 23

1,500-2,000 IU/uL

Above this level, and intrauterine gestational sac can usually be visualized by trans-vaginal ultrasound; its absence is highly suggestive of ectopic pregnancy

Question 24

At what rate does b-HCG increase?

Answer 24

b-hCG usually doubles every 1.5 to 2 days up to 7 weeks of pregnancy; increases at a slower rate may indicate non-viable pregnancy

Question 25

Endometrial stripe

Answer 25

A region of thickened endometrial tissue visualized by altered echogenicity on US

Often seen in the setting of post-menopausal exposure to unopposed estrogen; concerning for Granulosa cell tumor