REPRODUCTIVE NEOPLASMS

Question 1

ovarian tumour producing aromatase

Answer 1

granulosa cell tumour

if affectes younger - can cause precocious puberty

post menopausal women

sex cord stromal tumour
produce oestrogen / progesterone
FSH stimulates granulosa cell to convert theca cell androgens to oestrogens
increased inhibin –> inhibits FSH

markers: inhibin, AMH
oestrogen secreting

s/s:
breast tenderness, menstural irregularities
abn endometrial bleeding

Question 2

ovarian fibroma
pleural effusion
ascites

Answer 2

meigs syndrome
(ovarian fibroma)

benign sex cord stroma tumour

Question 3

name (4) ovarian germ cell tumours

Answer 3

mature and immature teratomas
dysgerminoma
yolk sac tumors
nongestational choriocarcinomas

Question 4

large adnexal mass
weight loss
oligomenorrhea
tachycardia
hyperreflexia

Answer 4

struma ovarii
(type of mature teratoma)
hyperthyroidism clincal features

produce thyroxine

germ cell tumour

Question 5

ovarian mass
hirsutism, virilization
cytoplasmic inclusions

Answer 5

** sertoli-leydig cell tumour**
(testosterone producing)

elevated testosterone levels
Reinke crystals in leydig cells

germ cell tumour

Question 6

leydig cells are homologous with what cell in females

Answer 6

theca interna

cover granulosa cell layer of follicle
produce testosterone
express

Question 7

elevated CA-125 seen in ovarian cancers derived from

Answer 7

epithelium

i.e. serous cystadenocarcinoma

Question 8

aggressive
often bilateral
raised CA-125
papillary structures, stromal cores
lined by atypical epithelial cells
hypochromatic (dark blue) stain
small cytoplasms
inclusions - psammoma bodies

Answer 8

Serous cystadenocarcinoma

epithelial ovarian cancer (CA-125)
psamomma bodies
HCG, AFP normal

Question 9

what is an increased risk factor for epithelial ovarian carcinoma

Answer 9

endometriosis

Question 10

roles of oestrogen and progesterone in endometrium

Answer 10

oestrogen -> growth of endometrium
progesterone -> preparation for implantantion
progesterone loss -> shedding

growth - proliferative
preparation - secretory

Question 11

loss of basalis causes

stem cells of endometrium

Answer 11

Asherman syndrome
unable to regenerate endometrium

overaggressive curettage and dilation, scarring

causes secondary amennorrhoea

Question 12

most common time for anovulatory cycle

Answer 12

menache (first period)
menopause

lack progesterone secretory phase
endometrium eventually breaks down

uterine bleeding

Question 13

what cells are normally found in endometrium

Answer 13

lymphocytes

plasma cells are neccessary on histology for Dx of chronic endometritis

Question 14

what drug can cause endometrial polyps

Answer 14

tamoxifen

pro-oestrogenic effects on endometrium
anti-oestrogenic effects on breas

abnormal uterine bleeding

Question 15

what cancer is at an increased risk with endometriosis

Answer 15

carcinoma at site of endometriosis, especially ovary

Question 16

fever
abnormal uterine bleeding
pelvic pain
retained products conception

Answer 16

acute endometritis

acute infection

Question 17

abnormal uterine bleeding
pain
infertility
plasma cells & lymphocytes
retainde products conception. PID / IUD / TB

Answer 17

chronic endometritis

chronic inflammation

plasma cells dx on histology

Question 18

most important predictor of progression to carcinoma

Answer 18

cellular atypia

simple vs complex
presence/absence cellular atypia

simple hyperplasia with atypia - typically progress to cancer
complex hyperplasia without atypia - rarely does

Question 19

endometrial glands > stroma

Answer 19

endometrial hyperplasia

stimulated by unopposed oestrogen
postmenopausal women

postmenopasual lack progesterone phase
oese pts - androgen to oestrogen - stimulate endometrium bleeding

Question 20

location of bartholin cyst

Answer 20

either side of vaginal canal (enterance)
drains via ducts into lower vestible

produce mucous like fluid

reproductive age
unilateral painful cystic lesions

Question 21

cyst from remants of mesonephric (wollfian) duct
anterolateral vaginal wall

Answer 21

gartner cyst

Question 22

cyst from remants of female embryonic duct
vaginal wall

Answer 22

Mullerian cyst

Question 23

gland either side of urethra
homologous to male prostate

Answer 23

skene glands

Question 24

persistance of columnar epithelium in upper vaginal canal

Answer 24

adenosis

exposure to DES - diethylsetilbestrol in uterus

can lead to clear cell adenocarcinoma

Question 25

mesenchymal proliferation of immature skeletal muscle

Answer 25

**embryonal rhabdomyosarcoma **sarcoma botryoides** | bleeding grape like mass protrude vagina/penis child <5yo ## Footnote **desmin +, myogen +** **cytoplasmic cross striations**

Question 26

what neoplasm shows cytoplasmic cross striations

Answer 26

embryonal rhabdomyosarcoma | bleeding, grape like mass ## Footnote desmin, myogenin +

Question 27

what is the characteristic cell in rhabdomyosarcoma

Answer 27

rhabdomyo**blast**

Question 28

what are desmin and mygenin

Answer 28

**desmin:** intermiediate filament in muscle cells **mygenin:** nuclear transcription factor in immature skeletal muscle | positive immunohistochemical staining for these in rhabdomyosarcoma

Question 29

vaginal carcinoma usually related to

Answer 29

high risk HPV 16, 18, 31, 33 | precurosr lesion vaginal intraepitheial neoplasia (VAIN)

Question 30

the precurosr lesion vaginal intraepitheial neoplasia (VAIN) can progress to

Answer 30

vaginal carcinoma

Question 31

vaginal cancer from upper 2/3 will spread to

Answer 31

**iliac** lymph nodes | mullerian duct

Question 32

vaginal cancer from lower 1/3 will spread to

Answer 32

**inguinal** lymph nodes | urogenital sinus

Question 33

male adenocarcinoma from prostate metastastis can be treated with -? to help prevent spread

Answer 33

**17-a-hydroxylase **enzyme inhibitor (limits extratesticular androgen production) i.e. **abiraterone** | androgens produced adrenals, testes, tumour cells ## Footnote other 17α-hydroxylase inhibitors - spironolactone, ketaconazole

Question 34

germline mutations in _\_\_\_ gene increases risk for breast and ovarian cancer due to inability to repair _\_\_\_

Answer 34

BRCA1 double strand DNA breaks ## Footnote susceptable to platinum compounds i.e. carboplatin - forms DNA crosslinks

Question 35

what type of carcinoma is Pagets of the breast

Answer 35

intraepithelial adenocarcinoma

Question 36

what is a cause of angiosarcoma

Answer 36

**radiation** vinyl chloride arsenic

Question 37

pre-menopausal bloody nipple discharge no mass no skin changes no systemic symptoms

Answer 37

intrductal papilloma ## Footnote benign Papillary fronds lined by epithelial and myoepithelial cells Central fibrovascular cores