Ovarian Cyst Tumors Disord Endo N Myometrium
.JPG "Ovarian Cyst Tumors Disord Endo N Myometrium - Quiz")
"CTL: Ovarian cysts and tumors"
"CTL: Disorders of endo,myometrium"
Questions and Answers
- 1.
A 33-year-old woman presents with dull lower abdominal pain and abdominal distention. Surgical exploration finds viscous fluid in the peritoneal cavity, multiple small irregular peritoneal implants, and significantly enlarged ovaries. A biopsy of one of these peritoneal masses is examined by a pathologist and the diagnosis of “metastatic mucin-secreting neoplasm” is reported. Which of the following is the most likely primary tumor?
- A.
Mucinous ovarian cystadenoma
- B.
Mucinous borderline ovarian tumor
- C.
Mucinous ovarian cystadenocarcinoma
- D.
Krukenberg tumor
- E.
Mucinous adenoma of the appendix
Correct Answer
E. Mucinous adenoma of the appendixExplanation
The most likely primary tumor in this case is a mucinous adenoma of the appendix. This is suggested by the presence of mucin-secreting peritoneal implants and significantly enlarged ovaries, which are characteristic of pseudomyxoma peritonei, a condition caused by the rupture of a mucinous adenoma of the appendix. The other options, including mucinous ovarian cystadenoma, mucinous borderline ovarian tumor, mucinous ovarian cystadenocarcinoma, and Krukenberg tumor, are less likely to be the primary tumor in this case.Rate this question:
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- 2.
A 47-year-old woman presents with abdominal distention. The patient reports an appendectomy two years ago. Surgical exploration finds viscous fluid in the peritoneal cavity, multiple small irregular peritoneal implants, and significantly enlarged left ovary. A biopsy of one of these peritoneal masses is examined by be a pathologist and the diagnosis of “metastatic mucin-secreting neoplasm” is reported. Which of the following is the most likely primary tumor?
- A.
Mucinous ovarian cystadenoma
- B.
Krukenberg metastases
- C.
Mucinous ovarian tumor of borderline malignancy
- D.
Adenoma of the appendix
- E.
Well differentiated adenocarcinoma of the appendix
Correct Answer
C. Mucinous ovarian tumor of borderline malignancyExplanation
The most likely primary tumor in this case is a mucinous ovarian tumor of borderline malignancy. This is suggested by the presence of mucin-secreting neoplastic cells in the peritoneal implants, as well as the significantly enlarged left ovary. Mucinous ovarian tumors of borderline malignancy have the potential to spread to the peritoneum and cause peritoneal implants. The other options, such as mucinous ovarian cystadenoma, Krukenberg metastases, adenoma of the appendix, and well-differentiated adenocarcinoma of the appendix, are less likely based on the given information.Rate this question:
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- 3.
Histologic examination of the ovaries removed from a 43-year-old woman reveals the tissue shown for you evaluation. Which of the following is the most likely diagnosis?
- A.
Thecoma
- B.
Immature teratoma
- C.
Granulosa cell tumor
- D.
Sertoli-Leydig cell tumor
- E.
Dysgerminoma
Correct Answer
C. Granulosa cell tumorExplanation
The histologic examination of the ovaries revealed tissue consistent with a granulosa cell tumor. Granulosa cell tumors are a type of ovarian cancer that arise from the granulosa cells, which are responsible for producing estrogen. These tumors are more common in women in their 40s and 50s and often present with symptoms related to hormonal imbalances, such as abnormal vaginal bleeding. Histologically, granulosa cell tumors are characterized by the presence of small, uniform cells arranged in a characteristic pattern known as Call-Exner bodies. These tumors are typically low-grade malignancies and have a good prognosis with early detection and treatment.Rate this question:
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- 4.
A 38-year-old Caucasian woman presents to her gynecologist because her menstrual periods have become irregular. The patient also reports that she has hair growing on her face and has developed mild acne, which she has not had since she was a teenager. Physical examination reveals distended abdomen and a palpable mass on the right adnexa. Laparotomy with subsequent adnexectomy is performed and the gross and microscopic appearance of the ovarian mass is shown for your evaluation below. Which of the following is the most likely diagnosis?
- A.
Sertoli-Leydig ovarian tumor
- B.
Fibroma (Meigs syndrome)
- C.
Thecoma
- D.
Granulosa cell tumor
Correct Answer
A. Sertoli-Leydig ovarian tumorExplanation
Sertoli-Leydig cell tumour is a group of tumours composed of variable proportions of Sertoli cells, Leydig cells, and in the case of intermediate and poorly differentiated neoplasms, primitive gonadal stroma and sometimes heterologous elements.
Sertoli-Leydig cell tumour is a member of the sex cord-stromal tumour group of ovarian and testicular cancers. The tumour is rare, comprising less than 1% of testicular tumours. While the tumour can occur at any age, it occurs most often in young adults. Recent studies have shown that many cases of Sertoli Leydig cell tumor of the ovary are caused by germline mutations in the DICER1 gene. These hereditary cases tend to be younger, often have a multinodular thyroid goiter and there may be a personal or family history of other rare tumors such as pleuropulmonary blastoma, Wilms tumor and cervical rhabdomyosarcoma
ClassificationThe tumour is subdivided into many different subtypes. The most typical is composed of tubules lined by Sertoli cells and interstitial clusters of Leydig cells.
PresentationDue to excess testosterone secreted by the tumour, one-third of female patients present with a recent history of progressive masculinization. Masculinization is preceded by anovulation, oligomenorrhoea, amenorrhoea and defeminization. Additional signs include acne and hirsutism, voice deepening, clitoromegaly, temporal hair recession, and an increase in musculature. Serum testosterone level is high.
DiagnosisPresence of an ovarian tumour plus hormonal disturbances suggests a Sertoli-Leydig cell tumour. However, hormonal disturbance is present in only 2/3 of cases. A conclusive diagnosis is made via histology, as part of a pathology report made during or after surgery. See also Sex cord-stromal tumour.Rate this question:
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- 5.
A 22-year-old woman has purulent vaginal discharge, fever, lower abdominal pain and extreme tenderness of the cervix. If this process is not treated, what is a possible complication?
- A.
Cystadenoma of the ovary
- B.
Ectopic pregnancy
- C.
Fistula
- D.
Leiomyoma
- E.
Squamous cell carcinoma
Correct Answer
B. Ectopic pregnancyExplanation
If left untreated, the possible complication for a 22-year-old woman with purulent vaginal discharge, fever, lower abdominal pain, and extreme tenderness of the cervix is an ectopic pregnancy. Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, typically in the fallopian tube. This can lead to severe abdominal pain, bleeding, and potentially life-threatening complications if the pregnancy continues to develop in the fallopian tube. Prompt medical intervention is necessary to prevent further complications and preserve the woman's health.Rate this question:
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- 6.
A 23-year-old student presents to the campus health clinic with lower abdominal pain and a painful swollen right knee. She denies any trauma to the knee. Pelvic examination reveals an ill-defined thickening in the right and left adnexae. A vaginal discharge is noted. The patient is febrile. The WBC count is 18,500/μL. If untreated, which of the following would be the most likely complication in this patient?
- A.
Bronchopneumonia
- B.
Lung abscess
- C.
Meningitis
- D.
Tubo-ovarian abscess
- E.
Vaginal ulceration
Correct Answer
D. Tubo-ovarian abscessExplanation
A tuboovarian abscess is an inflammatory mass involving the fallopian tube, ovary, and, occasionally, other adjacent pelvic organs (eg, bowel, bladder) . This may manifest as a tuboovarian complex (an agglutination of those structures) or a collection of pus (tuboovarian abscess). These abscesses are found most commonly in reproductive age women and typically result from upper genital tract infection. Tuboovarian abscess is usually a complication of ****PELVIC INFLAMMATORY DISEASE.******
Tuboovarian abscess is a serious and potentially life-threatening condition. Aggressive medical and/or surgical therapy is required and rupture of an abscess may result in sepsis. The mortality rate associated with tuboovarian abscess was approximately 50 percent or higher prior to the advent of broad-spectrum antibiotics and modern surgical practice.
In current practice, the mortality rate approaches zero for abscesses that have not ruptured. Current mortality rates for patients with ruptured abscesses are not reported in the literature; data from the 1960s suggested a mortality rate ranging from 1.7 to 3.7 percent.
Treatment modalities include broad spectrum antibiotic therapy, minimally-invasive drainage procedures, invasive surgery, or combinations of these interventions. For the large majority of small to medium sized tuboovarian abscesses, antibiotic therapy alone can affect cure.Rate this question:
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- 7.
A 37-year-old woman with two children complains of infertility. She and her new husband desire a child, but they have been unable to conceive in three years of marriage. Her most recent menses were 5 days ago. For several months following her divorce, she had nagging lower abdominal pain and low-grade recurrent fevers. The patient was promiscuous during the last two years of her previous marriage, having several male sex partners. On physical examination, the vital signs are normal. The physical examination is essentially normal. The external genitalia and pelvic examination are also normal. Which of the following is the most likely explanation for her infertility?
- A.
Chronic salpingitis
- B.
Early menopause
- C.
Hypothalamic lesion
- D.
Polycystic ovary syndrome
- E.
Sperm antibodies
Correct Answer
A. Chronic salpingitisExplanation
The most likely explanation for the woman's infertility is chronic salpingitis. Chronic salpingitis is inflammation of the fallopian tubes, which can lead to scarring and blockage of the tubes. This can prevent the sperm from reaching the egg and can also interfere with the fertilized egg's ability to travel to the uterus for implantation. The patient's history of lower abdominal pain and recurrent fevers following her divorce suggest a possible infection that could have led to chronic salpingitis. The normal physical examination findings do not rule out this possibility, as the inflammation may be internal and not visible externally.Rate this question:
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- 8.
A 44-year-old African American woman undergoes an abdominal hysterectomy for a “fibroid” uterus. The surgeon requests a frozen section of the tumor, which is deferred because of the lesion’s degree of cellularity. Which of the following criteria is the best to be used by the pathologist in determining benignancy versus malignancy?
- A.
Mitotic rate
- B.
Degree of cellular pleomorphism
- C.
Presence/absence of geographic necrosis
- D.
Tumor size
Correct Answer
A. Mitotic rateExplanation
The best criterion to determine benignancy versus malignancy in this case is the mitotic rate. Mitotic rate refers to the number of cells undergoing mitosis, which is an indicator of cell division and proliferation. In general, malignant tumors have a higher mitotic rate compared to benign tumors. Therefore, the pathologist can assess the mitotic rate of the tumor cells to determine if they are rapidly dividing, suggesting malignancy, or if they are not dividing as rapidly, suggesting benignancy. Other criteria such as degree of cellular pleomorphism, presence/absence of geographic necrosis, and tumor size can also provide additional information, but the mitotic rate is the most reliable indicator in this context.Rate this question:
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- 9.
A 25-year-old Caucasian woman presents with dysmenorrhea. During workup, an endometrial biopsy is obtained. The pathology report from this biopsy makes the diagnosis of chronic endometritis. Identification of which of the following cells prompted the pathologist toward the diagnosis?
- A.
Neutrophils
- B.
Lymphocytes
- C.
Plasma cells
- D.
Eosinophils
Correct Answer
C. Plasma cellsExplanation
The presence of plasma cells in the endometrial biopsy suggests chronic endometritis. Chronic endometritis is characterized by inflammation of the endometrium, which is the lining of the uterus. Plasma cells are a type of white blood cell that are typically found in chronic inflammatory conditions. Their presence indicates a chronic immune response, supporting the diagnosis of chronic endometritis. Neutrophils are typically seen in acute inflammation, while lymphocytes and eosinophils are not typically associated with endometritis.Rate this question:
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- 10.
Which of the following best describes irregular, prolonged, and heavy menstrual bleeding?
- A.
Menorrhagia
- B.
Metrorrhagia
- C.
Polymenorrhea
- D.
Menometrorrhagia
Correct Answer
D. MenometrorrhagiaExplanation
METRORRHAGIA refers to light bleeding from the uterus at irregular intervals. MENOMETRORRHAGIA refers to heavy bleeding from the uterus at irregular intervals.
MENORRHAGIA: refers to excessive or prolonged menstrual bleeding. It is technically defined as blood loss greater than 80 mL per cycle and/or menstrual periods lasting longer than seven days. However, both patients and clinicians are unreliable in their ability to predict the amount of blood loss and measurement of actual blood loss is not practical in a clinical setting. In ovulatory women, menorrhagia is typically due to an anatomic lesion (eg, fibroid) or systemic disease (eg, hemostatic defect) in ovulatory women. Anovulation is also a common cause of menorrhagia. (See "Chronic menorrhagia or anovulatory uterine bleeding".)
AMENORRHEA: refers to absence of bleeding for at least three usual cycle lengths . (See "Etiology, diagnosis, and treatment of primary amenorrhea" and "Etiology, diagnosis, and treatment of secondary amenorrhea".)
OLIGOMENORRHEA: refers to bleeding that occurs at an interval greater than 35 days.
POLYMENORRHEA: refers to regular bleeding that occurs at an interval less than 24 days.
INTERMENSTRUAL BLEEDING BLEEDING refers to bleeding that occurs between menses or between expected hormone withdrawal bleeds in women using some forms of hormonal contraception or postmenopausal hormone therapy.
PREMENSTRUAL SPOTTING SPOTTING refers to light bleeding preceding regular menses.
POSTCOITAL BLEEDING refers to vaginal bleeding that is noted within 24 hours of vaginal intercourseRate this question:
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- 11.
A 66-year-old Indian American female presents with vaginal bleeding. Endometrial biopsy is obtained and its examination reveals a microscopic focus of crowded glands of abnormal shape lined by enlarged epithelial cells with hyperchromatic nuclei and prominent nucleoli. Which of the following genes is most likely mutated in this case?
- A.
HMSH2
- B.
HMLH1
- C.
BRCA1
- D.
PTEN
Correct Answer
D. PTENExplanation
COWDEN SYNDROME is rare autosomal dominant syndrome that derives from a mutation in the PTEN tumor suppressor gene. Women with Cowden syndrome have lifetime risk of endometrial cancer of 13 to 28 percent. There are no established guidelines for endometrial screening or prevention for Cowden syndrome. Potential strategies include endometrial sampling and risk-reducing hysterectomy, similar to Lynch syndrome.Rate this question:
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- 12.
A 45 year old African American woman complains of severe menorrhagia. Her physical exam reveals an enlarged and nodular uterus. Laboratory tests are significant for an iron deficiency anemia. Which of the following is the most likely cause of her menorrhagia?
- A.
Uterine carcinoma
- B.
Functional gonadal tumors
- C.
Uterine leiomyosarcoma
- D.
Uterine leiomyoma
Correct Answer
D. Uterine leiomyomaExplanation
The most likely cause of the woman's menorrhagia is uterine leiomyoma. Uterine leiomyomas, also known as fibroids, are benign smooth muscle tumors that commonly occur in women of reproductive age. They can cause heavy or prolonged menstrual bleeding, leading to iron deficiency anemia. The physical exam findings of an enlarged and nodular uterus are consistent with uterine leiomyoma. Uterine carcinoma and uterine leiomyosarcoma are less likely as they are associated with postmenopausal bleeding, and functional gonadal tumors are not typically associated with menorrhagia.Rate this question:
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- 13.
Laparoscopic examination of a woman with fertility problems reveals “chocolate cysts” outside of the uterus. Which of the following is the most likely diagnosis?
- A.
Endometriosis
- B.
Adenomyosis
- C.
Endometriosarcoma
- D.
Ectopic pregnancy
Correct Answer
A. EndometriosisExplanation
The presence of "chocolate cysts" outside of the uterus suggests the most likely diagnosis of endometriosis. Endometriosis is a condition where the tissue that lines the uterus (endometrium) grows outside of the uterus, causing the formation of cysts. These cysts are often filled with old blood, giving them a "chocolate" appearance. This condition can cause fertility problems in women. Adenomyosis is a condition where the endometrium grows into the muscular wall of the uterus, but it does not typically result in the formation of cysts. Endometriosarcoma is a rare form of cancer that arises from endometrial tissue and is not typically associated with the formation of cysts. Ectopic pregnancy refers to the implantation of a fertilized egg outside of the uterus and would not be associated with the presence of "chocolate cysts."Rate this question:
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- 14.
A 65 year old woman presents with dysfunctional uterine bleeding. An endometrial curettage reveals hyperplastic and dysplastic glands. The patient is anxious and wants to know what this means. You correctly respond by saying:
- A.
This is endometrial cancer
- B.
This is an endometrial adenocarinoma
- C.
This is benign and will not become cancer
- D.
This is a precancerous condition
Correct Answer
D. This is a precancerous conditionExplanation
The presence of hyperplastic and dysplastic glands in the endometrial curettage indicates an abnormal growth of cells in the lining of the uterus. This condition is known as endometrial hyperplasia, which is considered a precancerous condition. Precancerous conditions have the potential to develop into cancer if left untreated. Therefore, it is important for the patient to undergo further evaluation and treatment to prevent the progression to endometrial cancer.Rate this question:
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.JPG "A 38-year-old Caucasian woman presents to her gynecologist because her menstrual periods have become irregular. The patient also reports that she has hair growing on her face and has developed mild acne, which she has not had since she was a teenager. Physical examination reveals distended abdomen and a palpable mass on the right adnexa. Laparotomy with subsequent adnexectomy is performed and the gross and microscopic appearance of the ovarian mass is shown for your evaluation below. Which of the following is the most likely diagnosis?")
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Mar 22, 2023Quiz Edited by
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Oct 31, 2012Quiz Created by
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