PROLOG: Gynecologic Oncology Flashcards Preview

PROLOG (Personal Review of Learning in Obstetrics and Gynecology) > PROLOG: Gynecologic Oncology > Flashcards

Flashcards in PROLOG: Gynecologic Oncology Deck (84)
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1
Q

FIGO Staging: Vaginal Cancer

A
2
Q

What are the two main types of endometrial cancer?

A
  1. Estrogen driven
    1. Generally occurs in younger women
    2. Result of atypia 2/2 estrogen hyperstimulation in anovulatory women
    3. Tumor is identified in a lower stage and grade
  2. p53
    1. Independent of estrogen exposure
    2. Generally occurs in older females regardless of BMI
    3. More aggressive such as papillary serous or clear cell
    4. Tumor is identified in a higher grade and stage
3
Q

Stage 1 Ovarian Cancer

A

Divided into 3 subsets

  • Stage IA: involves tumor limited to one ovary or fallopian tube and no involvement of the ovarian capsule or malignant cells in the peritoneal washings or ascites
  • Stage IB: involves tumor spread to both ovaries or fallopian tubes with no involvement of “ “
  • Stage IC: involves tumor to one or both ovaries and is further divided into three sections
    • IC1: surgical spill
    • IC2: tumor ruptured before surgery or tumor on the surface of the ovary
    • IC3: tumor cells in the ascites or peritoneal washings
4
Q

What percentage of mature teratomas will subsequently develop into squamous cell cancers?

A

1%

5
Q

A 70 yo pt found to have SCC of the vagina. The tumor is located in the anterior/proximal two-thirds of the vagina along the anterior wall. What is the first site of LNM?

A

Internal iliac lymphatic chain

6
Q

45 yo pt presents for follow up for Stage IIA SCC of the cervix, s/p radical hysterectomy followed by vaginal brachytherapy. Physical exam with a 2 cm mass palpable at the top of the vaginal cuff without sidewall fixation. PET CT confirms 2 cm mass located in the midline pelvis that was not previously present. No evidence of metastasis to lymph nodes or more distant sites. Biopsy of mass confirms recurrence. MOST appropriate treatment?

A

Pelvic exenteration: en bloc resection of uterus, tubes, ovaries, parametrium (if present), bladder, rectum, vagina, urethra, portion of levator muscles > resection with a clear margin is achieved in 75-97% of cases

Women who develop central recurrence (vaginal apex or pelvis without side wall involvement) after primary RT or after surgery followed by RT, pelvic exent represents the only potentially curative option for local recurrence or persistent disease

Those who successfully undergo exent (negative margins and no metastatic disease) have ~50% chance of being cured; the remainder die of recurrent cancer

7
Q

What option exists for patients who are not candidates for surgical resection via exent for recurrent cervical cancer?

A

Chemotherapy (palliative) with cisplatin (50 mg/m2, given IV every 3 weeks)

Studies show response rate of 38%

8
Q

Staging of GTN

A
  1. Confined to uterus
  2. Extends outside uterus but limited to genital structures (adnexa, vagina, broad ligament)
  3. Extends to lungs, with or without genital tract involvement
  4. Extends to distant sites, including brain and liver

Women diagnosed with FIGO stage I, II, or III GTN have a survival rate approaching 100%.

9
Q

Patient is coming in to office for follow up after a suction curettage for a complete molar pregnancy. She is doing well but wants to know the risk of another molar pregnancy after having this one. What is the recurrence risk of a complete molar pregnancy?

A

10-fold increased risk

The risk of repeat molar pregnancy after 1 prior mole is ~1%, which is about 10-20 times the baseline risk for the general population.

10
Q

What is the MOST common cell type of epithelial ovarian cancer?

A

Serous histology is, by far, the most common type, occurring in up to 80% of cases of advanced ovarian cancer.

Advanced stage (III/IV) is the most common stage at diagnosis, unfortunately, and is best treated with optimal cytoreduction (<1 cm of visible tumor after surgery) and postop platinum-based chemotherapy for 6 cycles

11
Q

Most patients receiving external beam therapy for cervical cancer will experience what complication?

A

Acute cystitis

12
Q

Treatment Options of Cervical Cancer by Stage

Stage I

A
13
Q

Treatment for Stage IB2, IIA, IIB, stage III, and stage IVA cervical cancer

A

If no surgical lymph node evaluation, then whole pelvic exent + radiation therapy with brachytherapy and concurrent weekly cisplatin chemotherapy

14
Q

Preferred initial effective regimen to treat high-risk GTN

A

Etoposide, MTX, dactinomycin (actinomycin D), alternating with cyclophosphamide and vincristine (Oncovin)

EMA-CO

Secondary treatment usually involves bleomycin, etoposide, and cisplatin (BEP)

15
Q

The HPV E6 oncoprotein directly binds cell cycle regulatory proteins, especially ___.

A

p53

16
Q

Karyotype of partial mole and sonographic features

A

One maternal haploid set and two paternal haploid sets of chromosomes

Presence of a fetus and a thickened placenta

17
Q

Causes of postop fever

A
18
Q

Histological hallmark of serous endometrial carcinoma

A

Psammoma bodies: concentric rings of calcifications

Present in serous cystadenocarcinoma of the ovary, serous carcinoma of endometrium, other tumors of lungs, thyroid, and kidney

19
Q

GTN is defined by the FIGO in a specific manner following a molar pregnancy. One of the following criteria must be met.

A
20
Q

Definition of optimal debulking in ovarian cancer

A

Disease smaller than 1 cm left in the abdomen

21
Q

What is the most common side effect of radiation therapy for cervical cancer?

A

GI: N/V in acute phase and diarrhea in late phase (2-3 weeks after radiation)

These conditions are generally management with supportive treatment.

22
Q

Cervical Cancer Stage: I and II

A
23
Q

Cervical Cancer Staging: III and IV

A
24
Q

Radical hysterectomies are reserved for which stage cervical cancers?

A

Stage IB1 and nonbulky stage IIA tumors

The surgery can shorten the vagina, but it maintains its pliability and lubrication; this may be desirable for younger patients.

25
Q

What is gestational trophoblastic disease?

A

Group of tumors that arise from trophoblastic cells > usually the result of an abnormal fertilization event

Molar pregnancy

Choriocarcinoma

Placental site trophoblastic tumor (PSTT)

Epithelioid trophoblastic tumor (ETT)

26
Q

A 36 yo P2 patietn has a known BRCA2 mutation. She recently underwent a prophylactic BSO. By how much is her risk of epithelial ovarian cancer reduced?

A

80%

27
Q

In patients with HNPCC, a risk-reducing BSO may reduce the incidence of epithelial cancer by to ___%?

A

100%

28
Q

What is the risk of choriocarcinoma after a normal pregnancy?

A

1 in 30,000

Specifically, it occurs 2/3 of the time after a term pregnancy and 1/3 of the time following a SAB or termination.

29
Q

When does routine screening for colon cancer cease?

A
30
Q

What is the MOST common gynecologic cancer worldwide?

A

Cervical cancer

31
Q

70 yo P3 postmenopausal, no bleeding, EMB 6 mm. Next step?

A

Routine care.

Work-up for thickened endometrial stripe in an asymptomatic postmenopausal woman is not well-defined.

32
Q

Pathology and appropriate plan of treatment for placental site trophoblastic tumor

A

Pathology: Intermediate trophoblasts with few syncytial elements

Management: hysterectomy (resistent to chemo)

** slight elevation of HCG and human placental lactogen relative to the tumor mass **

33
Q

Which HPV strain has the highest risk of carcinogenic potential?

A

16 (accounts for 60% of all cases worldwide)

18 (accounts for 15% of cases)

34
Q

A 48 yo woman is diagnosed with an intraductal papilloma, and core biopsy reveals atypical cells. What is the MOST appropriate next step in management?

A

Surgical excision due to invasive carcinoma or carcinoma in situ being present in 15%-20% of women who undergo excisional procedures

35
Q

Vaginal cancer is unique in that it can spread by direct extension, lymphatically, and hematogenously. The location of the cancer in relation to the upper or distal portion of the vagina determines which lymphatics will drain the site.

A
36
Q

Breast Cancer Screening

A
37
Q

Tamoxifen

A

SERM

Has agonist, as well as antagonist properties

The relative risks of PE and DVT are increased 2-3 fold in patients who take tamoxifen. Its estrogen-like effect on the endometrium has been associated with endometrial hyperplasia, leiomyomas, polyps, and uterine cancer.

Rate of endometrial cancer in women who take tamoxifen is 1.6 per 1,000 patient-years, compared to 0.62 per 1,000 patient-years in women who do not take tamoxifen.

38
Q

Management of invasive cervical cancer in pregnancy

A
39
Q

For women older than 30 years with a palpable breast mass, what is the most appropriate test to order?

Same for women younger than 30 years?

A

Diagnostic mammography

U/S

40
Q

What is the major difference between LBO and SBO?

A

Concept of “closed loop”

In most patients, the ileocecal valve does not allow reflux of air or GI contents from the large bowel into the ileum. Any process, such as a tumor, scarring, or radiation therapy, that closes off access of GI contents to the anus will lead to a closed loop > result in large-bowel perforation if not treated

41
Q

What does a complete staging procedure entail?

A

Pelvic washings, BSO, hysterectomy, peritoneal biopsies, pelvic and para-aortic LND, omentectomy

When metastatic disease is found, cytoreductive surgery, including bowel resection, to remove as much of the tumor as possible is indicated, not staging.

42
Q

Recommended surgical staging for ovarian/fallopian tube malignancy

A

TAH, BSO, pelvic washing, peritoneal biopsies, para-aortic and pelvic LND, and partial or total omentectomy

43
Q

23 yo G2P1001 has U/S to assess anatomy at 18 weeks. An 8-cm multiloculated tumor is noted on the L adnexa and appears to be out of the pelvis. The patient has no pain, remainder of exam is normal. What is the MOST common ovarian malignancy diagnosed in pregnancy?

A

Dysgerminoma

If a lesion is found to be cancerous during pregnancy, the most likely is this. 30% of all malignant tumors in pregnancy = dysgerminoma. They have good prognosis. Removed using unilateral adnexectomy and generally staging is performed as metastatic dz occurs in lymphatics.

44
Q

What should persistent vaginal bleeding 6 weeks post delivery signify to you?

A

Another pregnancy OR evaluate for GTD

45
Q

How is stage iii/IV ovarian cancer best treated?

A

Cytoreductive surgery. (<1 cm visible tumor after surgery) and then 6 cycles of platinum-based chemo

46
Q

Neuronal injuries associated with pelvic surgery

  • Ilioinguinal/iliohypogastic (L1–2)
  • Genitofemoral (L1–2)
  • Lateral cutaneous femoral (L2–3)
  • Pudendal (S2–4)
  • Obturator (L2–4)
  • Femoral (L2–4)
  • Peroneal (L4–5/S1–2)
A
47
Q

Best screening option for a 45 yo woman with dense breasts?

A

Digital mammography (not film)

48
Q

the strongest scientific evidence for the benefit of acupuncture in cancer patients is for

A

Emesis

49
Q

What is the standard of treatment for advanced ovarian cancer?

A

Cytoreductive surgery followed by chemo

but if patients are medically compromised, can do neoadjuvant chemo instead

50
Q

A 37-year-old woman is a known BRCA1 gene mutation carrier. She has undergone prophylactic bilateral mastectomy and recently received a risk-reducing salpingo-oophorectomy. She has no other medical or surgical history. She comes to your clinic with severe vaginal dryness and reports debilitating vasomotor symptoms. She is interested in therapy. You inform her that the best therapy for her is

(A) vaginal moisturizers
(B) hormone therapy (HT)

(C) gabapentin
(D) selective serotonin reuptake inhibitors

A

(B) hormone therapy (HT)

If the uterus is still in place, progestin therapy is required to decrease the risk of developing endometrial cancer; otherwise, estrogen alone may be used. In this case, the patient has not undergone a hysterectomy, and thus the combination of estrogen and progestin would be required.

51
Q

A 31-year-old woman comes to your office with vaginal bleeding. On examination, she is found to have a friable cervical mass, extension to the pelvic sidewalls, and a palpable supraclavicular lymph node. Biopsies of the cervix and lymph node confirm the presence of squamous cell car- cinoma. A positron emission tomography (PET)–computed tomography (CT) scan is performed and reveals extensive hypermetabolic pelvic disease, para-aortic lymphadenopathy, multiple lung lesions, and a supraclavicular node. She wishes to pursue treatment. You advise her that her best management option is

(A) radiation therapy
(B) chemoradiotherapy
(C) supraclavicular node resection

(D) chemotherapy

A

(D) chemotherapy

stage IVB cervical cancer is not amenable to surgery or radiation therapy, is associ- ated with a poor prognosis, and is rarely curable.

Primary treatment of stage IVB cervical cancer consists of systemic chemotherapy with the goal to prolong survival and improve quality of life.

Systemic combination chemotherapy with cisplatin (eg, cisplatin with paclitaxel, topotecan, or gemcitabine) has been shown to result in a superior survival rate compared with cisplatin alone.

Chemotherapy often results in a short duration of response, and median overall survival in patients with stage IVB cervical cancer is only 13–15 months.

52
Q

Treatment for low risk GTD

A

MTX

53
Q

A 34-year-old woman, gravida 0, para 0, comes to your office with a left pelvic mass that is highly suspicious for ovarian cancer on ultrasonographic imaging. She states that she desires fertility preservation. During her surgery, pelvic washings and a LSO are performed. She has no evidence of extraovarian disease, although a frozen section reveals a grade 1 endometrioid ovarian cancer. The best next step in management is

(A) no further surgical intervention

(B) hysterectomy, right salpingo-oophorectomy, lymphadenectomy, omentectomy, and

peritoneal biopsies
(C) right salpingo-oophorectomy, lymphadenectomy, omentectomy, and peritoneal biopsies

(D) lymphadenectomy, omentectomy, and peritoneal biopsies
(E) biopsy of the other ovary

A

(D) lymphadenectomy, omentectomy, and peritoneal biopsies

In a subgroup of women, fertility-sparing surgery with preservation of the contralateral ovary and uterus, may be appropriate.

54
Q

A 9-year-old girl has a complex adnexal mass and precocious puberty. The tumor marker most likely to assist in your preoperative evaluation is

(A) CA 125 level
(B) carcinoembryonic antigen level
(C) multivariate index assay for ovarian cancer

(D) human epididymis protein 4 level

(E) inhibin B level

A

(E) inhibin B level

For the described patient with signs of precocious puberty, the sources of estrogen should be evaluated. This is a common presentation for a juvenile-type granulosa cell tumor. The tumor marker most likely to assist in your evaluation is inhibin B level.

55
Q

What is the risk of a persistent complete mole after D&C?

A

20%

56
Q

surveillance recommendations for those with lynch syndrome

A

The most effective method to prevent gynecologic can- cer is risk-reducing hysterectomy and bilateral salpingo- oophorectomy. Lynch syndrome-associated endometrial cancer is more likely to develop in the lower uterine segment. Therefore, a total hysterectomy with removal of the cervix should be performed. Because cases are likely to occur before menopause, surgery is most effec- tive when performed at premenopausal ages or in women who have completed childbearing.

57
Q

A 73-year-old woman comes to your office with a prolonged history of vulvar pruritus and burning. On examination, the vulva and perineum have a red, velvety, inflamed appearance (Fig. 92-1; see color plate). An office biopsy is performed, revealing large cells with prominent nuclei and coarse chromatin (Fig. 92-2; see color plate). The most appropriate next step in management is

(A) cervical cancer screening, colonoscopy, and mammography

(B) positron emission tomography scan
(C) topical corticosteroid cream
(D) topical imiquimod cream

A

A. cervical cancer screening, colonoscopy, and mammography

The vulva is the most common site of extramammary Paget disease, accounting for up to 65% of cases.

The median age at diagnosis of patients with Paget disease of the vulva is late 60s to early 70s. Paget disease usually presents as a red, scaly lesion and is associated with pruritus, burning, dysuria, and discharge.

The primary treatment of noninvasive Paget disease of the vulva is wide excision of the full thickness of the involved skin.

58
Q

A 36-year-old woman comes to your office with postcoital bleeding. She has not had any medi- cal care for the past 10 years. On speculum examination, you observe a 5-cm friable mass with extension to the upper third of the vagina. A biopsy reveals an invasive squamous cell carcinoma. Rectovaginal examination is negative for parametrial involvement or invasion into the rectum. Office cystoscopy shows no invasion into the bladder, and chest X-ray is negative for meta- static disease. Positron emission tomography (PET)–computerized tomography (CT) scan shows enlarged and hypermetabolic right pelvic and para-aortic lymph nodes. The patient’s cancer stage is

(A) IB2

(B) IIA2

(C) IIIA

(D) IVB

A

The described patient has a 5-cm cervical lesion but the involvement of the vagina increases her stage from IB2 (tumor limited to the cervix, greater than 4 cm) to IIA2.

The tumor would need to extend to the lower third of the vagina to increase the stage to IIIA. The positive pelvic and para-aortic lymph nodes were discovered by PET–CT and are not included in staging.

59
Q

After comprehensive surgical staging, a 65-year-old woman is diagnosed with stage IB uterine papillary serous carcinoma. The next step in management is

(A) observation
(B) whole abdominal radiation therapy

(C) megestrol acetate
(D) doxorubicin
(E) carboplatin–paclitaxel

A

E

Uterine papillary serous carcinoma, however, is an aggressive histologic subtype of endometrial cancer that resembles serous ovarian carcinoma. Although the cancer represents less than 10% of all cases of endometrial cancer, it accounts for more than 50% of relapses and deaths attributed to endometrial carcinoma in the United States.

Bas- ing the decision to proceed on comprehensive surgical staging given the presence of certain uterine character- istics, such as depth of myometrial invasion and lym- phovascular space involvement, is not reliable in uterine papillary serous carcinoma because metastatic disease can be seen even in the absence of such risk factors.

Because recurrence rates in patients with stage IA uterine papil- lary serous carcinoma have been reported to be as high as 40%, adjuvant systemic therapy generally is recom- mended for patients with residual cancer in the uterine specimen after hysterectomy. Because of the significant risk of recurrence reported in a number of studies, it is appropriate to offer platinum–taxane-based chemother- apy with brachytherapy to women with stage IA uterine papillary serous carcinoma. The exception is patients with uterine papillary serous carcinoma confined to a polyp or with no residual disease in the uterine specimen at the time of hysterectomy. Recurrence rates for patients with stage IB uterine papillary serous carcinoma may be as high as 58–60%. Adjuvant treatment for women with stage IB disease should include platinum–taxane- based systemic therapy with brachytherapy. Thus, for this patient with stage IB disease, treatment after surgical resection should include carboplatin–paclitaxel.

60
Q

A 64-year-old woman underwent dilation and curettage for abnormal uterine bleeding and was diagnosed with leiomyosarcoma. She was referred to gynecology/oncology for surgical management and subsequently underwent an abdominal hysterectomy with surgical staging, which determined a diagnosis of stage I leiomyosarcoma. What is the best next step in this woman’s surveillance?

A

physical examination every three months for the first two years, followed by 6- to 12-month intervals.

61
Q

A 64-year-old woman underwent dilation and curettage for abnormal uterine bleeding and was diagnosed with leiomyosarcoma. She was referred to gynecology/oncology for surgical management and subsequently underwent an abdominal hysterectomy with surgical staging, which determined a diagnosis of stage I leiomyosarcoma. What is the best next step in this woman’s surveillance?

A

physical examination every three months for the first two years, followed by 6- to 12-month intervals.

62
Q

What can be given to a patient with epithelial ovarian cancer who is undergoing chemotherapy to reduce the degree of neutropenia?

A

Pegylated filgrastim is a long-acting granulocyte colony stimulating factor (G-CSF)

62
Q

What can be given to a patient with epithelial ovarian cancer who is undergoing chemotherapy to reduce the degree of neutropenia?

A

Pegylated filgrastim is a long-acting granulocyte colony stimulating factor (G-CSF)

63
Q

You are treating a 64-year-old woman with adjuvant chemotherapy with carboplatin and paclitaxel for stage III epithelial ovarian cancer after surgical debulking. She reports a sensation of burning and tingling in her fingers and toes. What is the MOA of the agent most likely responsible for her symptoms?

A

Paclitaxel: microtubule stabilization

Peripheral neuropathy is a common side effect of paclitaxel.

64
Q

What is the treatment for severe hemorrhagic cystitis?

A

Continuous bladder irrigation

65
Q

What is the mechanism of action of carboplatin?

A

Inhibition of DNA synthesis by creating DNA adducts.

66
Q

What histologic finding on frozen section is pathognomonic for an ovarian cystadenocarcinoma?

A

Psammoma bodies

67
Q

When targeting superficial malignances such as breast cancer with radiation therapy, use of which of the following is preferred?

A

Electrons

68
Q

You are providing genetic counseling for a patient with breast cancer. She reports that her sister had osteosarcoma, and her mother had adrenocortical carcinoma. In which gene do you suspect a mutation is responsible?

A
69
Q

Radical vaginal trachelectomy

A

Removal of the cervix, the upper part of the vagina, and pelvic lymph nodes. If no pelvic nodal metastasis is observed, the trachelectomy is performed and the uterus and vagina are reunited and a cerclage is put in place.

It is reserved for younger women with tumors ≤ 2 cm in size and who desire to preserve their fertility.

70
Q

What stage of cervical cancer benefits from palliative radiation therapy?

A

Stage IVB

71
Q

Risk-reducing bilateral mastectomy decreases breast cancer incidence in BRCA carriers by approximately what percentage?

A

90% or more

72
Q

A 64-year-old woman presents to your office for vaginal pruritus. Her history is significant for breast cancer that was treated, and she is currently in remission. On physical examination, you note that the vulva and perineum have a velvety red, eczematoid appearance. You perform a wide local excision of the lesion, and the histology is illustrated above. Margins are negative. Which of the following is the best next step in management?

A

Expectant management is recommended after WLE of the lesion.

It is important to note that 20% of patients with Paget’s disease will also have a nongenital tract malignancy, therefore, thorough evaluation and screening of other possible malignancies is recommended preoperatively, including pap smear, colonoscopy, and mammogram.

72
Q

A 64-year-old woman presents to your office for vaginal pruritus. Her history is significant for breast cancer that was treated, and she is currently in remission. On physical examination, you note that the vulva and perineum have a velvety red, eczematoid appearance. You perform a wide local excision of the lesion, and the histology is illustrated above. Margins are negative. Which of the following is the best next step in management?

A

Expectant management is recommended after WLE of the lesion.

It is important to note that 20% of patients with Paget’s disease will also have a nongenital tract malignancy, therefore, thorough evaluation and screening of other possible malignancies is recommended preoperatively, including pap smear, colonoscopy, and mammogram.

73
Q

A 43-year-old G0 woman presents to the office with the complaint of a lump in her right breast. On exam, you note some dimpling and nipple retraction, and a 3 cm mass is noted at the 11 o’clock position. The best next step in diagnosis would be which one of the following?

A

Diagnostic mammogram

74
Q

What type of breast cancer typically presents with a scaly, raw, vesicular, or ulcerated lesion on the nipple?

A

Paget Disease of Breast

75
Q

At which cervical cancer stage is chemoradiation therapy equivalent to cytoreductive surgery?

A

1B2

76
Q

Difference between usual and differentiated VIN?

A

Usual VIN is typically caused by the HPV and associated risk factors.

Differentiated VIN is typically associated with lichen sclerosus and squamous cell carcinoma. It corresponds to a higher-grade lesion and must be treated with wide local excision, with margins between 0.5 and 1 cm.

76
Q

Difference between usual and differentiated VIN?

A

Usual VIN is typically caused by the HPV and associated risk factors.

Differentiated VIN is typically associated with lichen sclerosus and squamous cell carcinoma. It corresponds to a higher-grade lesion and must be treated with wide local excision, with margins between 0.5 and 1 cm.

77
Q

Chemotherapy-associated hemorrhagic cystitis is a complex inflammatory response induced by a toxic metabolite (***) produced as a byproduct of the hepatic metabolism of ifosfamide and cyclophosphamide.

A

Acrolein

77
Q

Chemotherapy-associated hemorrhagic cystitis is a complex inflammatory response induced by a toxic metabolite (***) produced as a byproduct of the hepatic metabolism of ifosfamide and cyclophosphamide.

A

Acrolein

78
Q

A 26-year-old female presents for a screening Pap smear. The results demonstrate atypical squamous cells of undetermined significance. What is the best next step in evaluation?

A

HPV testing

Immediate colposcopy (C) is not the best next course of action for a woman less than 30 years of age with an unknown HPV status. It is acceptable to perform HPV testing, and if HPV is positive, colposcopy is then recommended.

78
Q

A 26-year-old female presents for a screening Pap smear. The results demonstrate atypical squamous cells of undetermined significance. What is the best next step in evaluation?

A

HPV testing

79
Q

A 79 yo Black women undergoes EMB for PMB. Pathology shows high-grade serous uterine papillary serous carcinoma.

Most common lesion seen on histology?

A

Psammoma bodies