Gyn

Front 1

Ovarian mass. What should you be concerned about?

Back 1

endometrial hyperplasia or carcinoma due to unopposed estrogen production
Fibrothecoma

Front 2

Ovarian lesion

Back 2

Struma ovarii in a teratoma

Front 3

What distinguishes benign from malignant smooth muscle tumor of the uterus?

Back 3

Coagulative necrosis

Front 4

Melanoma is measured how?

Back 4

From the surface of the epithelium (discounting acellular keratin layer) to the deepest portion of the tumor.

Front 5

SCC depth of invasion is measured how?

Back 5

Measured from adjacent basement membrane of the closest dermal papillae.

Front 6

The uterine lesion illustrated is:

Back 6

Malignant mixed mullerian tumor, heterologous
sarcomatous component heterologous: muscle, cartilage, osteoid, fat
homologous: endometrial stromal sarcoma, leiomyosarcoma

Front 7

Hydatidiform mole is txed by?

Back 7

Evacuation of uterus and serial beta-hCG titers

Front 8

Ovarian lesion

Back 8

Mucinous cystadenoma

Front 9

Ovarian lesion

Back 9

Serous cystadenoma

Front 10

Vulvar lesion showed the following IHC profile: CK7+, CK20-, CEA+, GCDFP-15+, HMB-45-, Uroplakin III-,
Most likely dx?

Back 10

Paget's disease

Front 11

This endometrial lesion is ?

Back 11

Simple hyperplasia w/out atypia
PTEN strong and diffuse staining

Front 12

This endometrial lesion is?

Back 12

Complex hyperplasia w/out atypia

Front 13

This ovarian lesion was excised. The patient can be best followed up with which of the following serum markers?

Back 13

AFP
yolk sac carcinoma/endodermal sinus tumor

Front 14

Most common malignancy arising out of a benign teratoma?

Back 14

Squamous cell carcinoma

Front 15

FIGO grade 1
FIGO grade 2
FIGO grade 3

Back 15

FIGO grade 1 Well-differentiated: 0-5% solid tumor
FIGO grade 2 Moderately differentiated: 6%-50% of nonsquamous tumor is solid
FIGO grade 3 Poorly differentiated: >50% of nonsquamous tumor is solid

Front 16

What is this lesion in the ovary?
What other tumor may develop?
What chromosome do patients carry?

Back 16

gonadoblastoma
dysgerminoma (seminoma)
Y chromosome
Does not metastasize

Front 17

What are the distinctive structures shown?
Dx?
Associated w/?
Tumor cells + for what stains?

Back 17

Call-Exner bodies
granulosa cell tumor
75% associated w/ hyperestrinism which may cause endometrial hyperplasia.
Calretinin+, EMA-
Usually presents Stage 1

Front 18

What is the most reliable diagnostic feature distinguishing this lesion from the more aggressive neoplasm arising from this tissue type?

Back 18

Serous borderline tumor
Lack of stromal invasion

Front 19

Vaginal bx

Back 19

Adenosis
•Adenosis present in 35% to 90% after in utero exposure to DES, taken by pregnant women until 1971 in USA.

Front 20

Endometrial curettage from a 26-yo woman. What is this?

Back 20

Arias-Stella reaction

Front 21

Vulvar cyst at 4 o'clock position at the introitus. Most likely dx?

Back 21

Bartholin duct cyst
Located at 4 and 8 o'clock position at introitus

Front 22

Ovarian lesion

Back 22

Brenner tumor
urothelial markers +

Front 23

Endometrial bx shows ?

Back 23

Day 16-17 secretory endometrium

Front 24

Most common origin of ovarian lesion w/ these features?

Back 24

GI tract
Metastatic signet ring cell adenocarcinoma of ovary

Front 25

Differentiated VIN

Back 25

Occurs in older patients.
Not HPV related.
Greater risk of progression to invasion than common basaloid/warty HPV-related VIN lesion.

Front 26

Paget's disease of the vulva frequently recurs after excision. Why?

Back 26

Microscopic lesion often extends beyond grossly visible lesion.

Front 27

Sarcoma botyroides of the vagina occurs in predominantly what age group?
Sarcoma boytroides of the cervix occurs in what age group?

Back 27

Children <5 yrs
teens - young adults

Front 28

Most CIN lesions arise from ?

Back 28

Transformation zone of cervix

Front 29

FIGO definition of microinvasive SCC of cervix

Back 29

Stage IA1: tumor <3 mm deep and <7 mm wide.
Stage IA2: tumor 3-5 mm deep and <7 mm wide

Front 30

Histologically benign glands in malignant stroma.

Back 30

Mullerian adenosarcoma

Front 31

Tumor of the uterus that is not related to unopposed estrogen.

Back 31

Uterine serous carcinoma

Front 32

17-yo pt w/ large ovarian mass. Origin of tumor is most likely?

Back 32

Germ cell

Front 33

Conditions associated w/ tubal ectopic pregnancy.

Back 33

Salpingitis isthmica nodosa
Chlamydial infection
Follicular salpingitis
IUD

Front 34

How are immature teratomas of the ovary graded?

Back 34

Grade 1: Immature neuroepithelium occupying <1 LPF (4x obj) on the worst slide.
Grade 2: Immature neuroepithelium occupying no more than 3 LPFs on the worst slide.
Grade 3: immature neuroepithelium occupying >3 LPFs on any slide.

Front 35

Least common type of twin placenta

Back 35

Monoamniotic monochorionic

Front 36

Partial mole vs. complete mole

Back 36

Partial triploid, complete diploid (paternal only)
Partial mole has lower risk of progression to gestational trophoblastic neoplasia.
Partial mole has less pronounced trophoblast proliferation.
Partial mole may be inadvertently dxed as missed abortion by both clinician and pathologist.

Front 37

What stain can distinguish complete from partial hydatidiform moles?

Back 37

p57^kip is expressed from maternal allele in most tissues. Therefore, it is underexpressed in complete moles. Syncytiotrophoblastic cells are nonreactive and maternal decidualized stromal cells are strongly reactive in all types of gestations.

Front 38

What stain can distinguish inflammatory atypia of the cervix from CIN?

Back 38

Ki-67 stains upper layers of epithelium in CIN and condyloma accuminatum and is confined to basal layer in normal squamous.

Front 39

What stain can distinguish differentiated VIN from squamous cell hyperplasia of vulva

Back 39

VIN is likely to show nuclear p53+ while squamous hyperplasia does not.

Front 40

What stain can distinguish smooth muscle neoplasm of uterus from endometrial stromal lesion?

Back 40

Smooth muscle neoplasms typically h-caldesmon+. Endometrial stromal lesion CD10+, h-caldesmon-.

Front 41

What stain can distinguish endometrial carcinoma from endocervical carcinoma?

Back 41

HPV+ (&/or p16) and ER-, vimentin- favors endocervical.
ER+, vimentin+ and HPV- favors endometrial.

Front 42

Mass removed from the cervix.

Back 42

Glassy cell carcinoma
younger age group, mean age 40 yrs
Associated w/ pregnancy, HPV 16 &18
Peripheral blood eosinophilia
Prominent eosinophilic inflammatory infiltrate

Front 43

exophytic mass in the endometrial cavity of a 55-year-old woman who underwent a total abdominal hysterectomy and BSO

Back 43

Endometrioid adenocarcinoma

Front 44

an incidentally found 1.3-cm myometrial nodule in a hysterectomy specimen obtained from a 47-year-old woman

Back 44

Adenomatoid tumor

Front 45

endometrial polyp fragment obtained during an endometrial curettage

Back 45

The image depicts well-spaced glands in a myomatous stroma. Squamous morular metaplasia is conspicuous. In the setting of a polyp, these findings are most consistent with an atypical polypoid adenomyoma.

Front 46

ovarian mass. The tumor cells are immunoreactive for calretinin and negative for EMA.

Back 46

The nuclei are round and nuclear grooves (a prominent feature in adult granulosa cell tumors) are not seen. The calretinin(+)/EMA(-) is consistent with a sex cord-stromal tumor, specifically, a juvenile granulosa cell tumor.

Front 47

The image provided represents a section of a cold-knife cone biopsy obtained from a 29-year-old woman with a history of glandular dysplasia on Papanicolaou smear. What HPV subtypes are associated w/ this entity?

Back 47

At least 90% of cervical adenocarcinomas contain human papillomavirus and types 16 and 18 account for approximately 80-90% of cases.

Front 48

What is the most common histologic subtype of Müllerian malignancy observed in women with known BRCA mutations?

Back 48

high-grade serous carcinomas

Front 49

The image depicts a section of an infiltrative uterine mass resected from a 74-year-old woman who initially presented with postmenopausal bleeding. Molecular analysis revealed evidence for the presence of a t(11;22)(q24;q12) translocation. What is the usual presentation of this tumor?

Back 49

Extrauterine involvement by the tumor at presentation is common.
Post menopausal women, poor prx

Front 50

What is this disease and how is it transmitted?

Back 50

Molluscum contagiosum
Direct contact, often sexually transmitted.
DNA poxvirus (Molluscipoxvirus genus)
These lesions typically present as painless, dome-shaped papules with or without central umbilication and can present in both immunocompetent and immunocompromised individuals.

Front 51

The image depicts a representative section of a polypoid uterine mass removed from a 68-year-old woman. What histologic feature portends a poor prognosis?

Back 51

Adenosarcoma
Myometrial invasion and especially sarcomatous overgrowth in adenosarcoma is associated with a poor prognosis.

Front 52

The image depicts a representative section of a 14.2-cm ovarian mass removed from a 19-year-old woman. These tumors are bilateral in what % of cases? What serum levels are elevated?

Back 52

Dysgerminoma bilateral 15% of cases.
LDH increased

Front 53

The image depicts a representative section of a cystic right ovarian mass obtained from a 67-year-old woman. What feature is most likely to be associated with a worse clinical outcome?

Back 53

Presence of invasive implants in the peritoneum
Serous borderline tumor with micropapillary architecture

Front 54

The photomicrograph is representative of a uterine mass removed from a 55-year-old woman who presented with post-menopausal bleeding. Immunohistochemistry reveals that the tumor cells are + for SMA & HMB45 while negative for S100, desmin, and CK7. What is the most likely diagnosis?

Back 54

Perivascular epithelioid cell tumor
PEComa

Front 55

The image depicts a representative section from a hysterectomy specimen removed for uterine fibroids from a 49-year-old woman. What is this?

Back 55

This is a cytologically bland smooth muscle proliferation that extends into intravascular spaces, c/w INTRAVASCULAR LEIOMYOMATOSIS (IVL). Tumor can extend into the veins of the broad ligament and can even extend into the IVC resulting in sxs such as dyspnea & syncope. Cytogenetically, similar karyotypic abnormalities are observed in IVL as in uterine leiomyomas; specifically, der(14)t(12;14)(q15;24). Hence, IVL is considered to be related to uterine leiomyomata of the usual type.

Front 56

The image depicts an incidentally found intraplacental nodule from a term placenta associated with a normal pregnancy that resulted in the birth of a healthy baby boy. What is this entity?

Back 56

intraplacental choriocarcinoma
This is rare in placentas & when discovered grossly often described as infarcts. Beta-hCG levels should be monitored in the mother & infant to determine whether further metastatic evaluation is indicated. Maternal metastases can be encountered but metastases in the infant are rare; hence, infants fare well. Choriocarcinoma is typically managed by chemotx w/ an overall disease-free survival approaching 90%.

Front 57

The photomicrograph depicts the only finding in the right ovary of a total abdominal hysterectomy and bilateral salpingo-oophorectomy specimen obtained from a 41-year-old woman. What is this associated w/?

Back 57

Keratin granulomas seen in association with endometrioid adenocarcinomas of the uterus that exhibit squamous differentiation

Front 58

Gynandroblastomas are defined as a combination of which two tumor elements?

Back 58

Granulosa cell and Sertoli cell

Front 59

The image depicts a representative section of an ovarian tumor removed from a 41-year-old woman.
What is this tumor?

Back 59

This is a trabecular carcinoid tumor admixed with thyroid follicles, c/w a dx of strumal carcinoid. 60% of cases, there is a coexisting mature cystic teratoma and bilateral ovarian disease is seen in approx 10% of cases. These tumors are almost always benign & are associated with carcinoid sxs in rare instances.

Front 60

On Pap test screening superficial cells predominate in what setting?

Back 60

Preovulation (estrogen)

Estrogen-secreting tumors

hormone replacement

Cirrhosis (lack of estrogen metabolism)

Front 61

On Pap test screening intermediate cells predominate in what setting?

Back 61

Progesterone-rich

Pregnancy

Post-ovulation

Newborn girls

Front 62

On Pap test screening parabasal cells predominate in what setting?

Back 62

Postmenopausal

Premenarche

Postpartum especially lactation

Front 63

Cytopathologists and cytotechs can perform primary screening of how many slides in what time period?

Back 63

100 pap tests in an 8-hour period is the limit

(12.5 tests/hour)

Number of 2ndary reviews is not regulated.

Front 64

According to ClIA '88 random rescreen of what %age of all negative Pap tests is required?

What happens for all Pap tests for HSIL or worse?

Back 64

10%

Review of histologic biopsy correlation for HSIL or worse and review of all prior negative Pap tests in the 5 years prior to the 1st interpretation of HSIL or worse.