The Female Genital Tract

Question 1

Cystic dilation of the Bartholin gland due to duct obstruction; may be infected and may lead to abscess formation; occurrence in women >40 years old requires biopsy to rule out carcinoma.

Answer 1

Bartholin cyst

Question 2

Lesion characterized by thinning of the epidermis, basal cell degeneration, hyperkeratosis, sclerotic changes of superficial dermis, dermal lymphocytic infiltrate; not premalignant, but symptomatic form has increased risk of vulvar cancer.

Answer 2

Lichen sclerosus

Question 3

Lesion characterized by acanthosis, hyperkeratosis, dermal lymphocytic infiltrate with evident mitosis; not considered premalignant.

Answer 3

Squamous hyperplasia

Question 4

Lesions of the anogenital area that may be papillary and distinctly elevated or may be somewhat flat and rugose; characteristic cellular morphology is the presence of cytoplasmic vacuolization with nuclear angular polymorphism and koilocytic atypia: hallmark of HPV infection; not precancerous.

Answer 4

Condyloma acuminata

Question 5

HPV subtypes associated with condyloma acuminata.

Answer 5

HPV 6 and 11

Question 6

Most common histology of vulvar carcinoma.

Answer 6

Squamous cell carcinoma (Note: most vulvar Cas are non-HPV related (70%))

Question 7

Clinically presents as eczematoid lesion on the vulva; characterized by proliferation of malignant epithelial cells within the epidermis; usually not associated with underlying carcinoma, unlike its breast counterpart; PAS-positive (positive for mucin), unlike vulvar melanoma.

Answer 7

Vulvar Paget disease

Question 8

Most common histology of vaginal carcinoma.

Answer 8

Squamous cell carcinoma

Question 9

A soft polypoid mass, which is a rare form of primary vaginal cancer; Usually encountered in infants and children less than 5 y/o.

Answer 9

Sarcoma botryoides (Embryonal rhabdomyosarcoma)

Question 10

Condition characterized by Areas of columnar mucinous epithelium (endocervical-like); 35-90% of patients with in utero exposure to DES; associated with clear cell CA of vagina.

Answer 10

Vaginal adenosis

Question 11

Premalignant lesion of the cervix; can be low-grade (I; <1/3 of the entire epithelium), moderate (II; up to 2/3 of the entire epithelium), and severe (III or CIS; full-thickness of epithelium without invasion of the basement membrane).

Answer 11

Cervical intraepithelial neoplasia (CIN)

Question 12

Another term for CIN I in the recent two-tiered classification system; regresses in 60% of cases.

Answer 12

Low-grade squamous intraepithelial lesion (LSIL)

Question 13

Another term for CIN II and III in the recent two-tiered classification system; persists in 60% of cases, with 10% of cases progressing to carcinoma within 10 years.

Answer 13

High-grade squamous intraepithelial lesion (HSIL)

Question 14

High-risk HPV implicated in the development of cervical carcinoma.

Answer 14

HPV 16, 18, 31 and 33

Question 15

Viral oncoprotein responsible for koilocytic atypia in HPV-infected cells.

Answer 15

E5

Question 16

HPV viral gene products that promote tumorigenesis and the tumor suppressor genes they inactivate.

Answer 16

E6 (inactivates p53) and E7 (inactivates Rb)

Question 17

Most commonly develops in the transformation zone of the cervix; produces a “barrel cervix” if the tumor encircles the cervix and invades the underlying stroma; most common histology is squamous cell carcinoma (80%), followed by adenocarcinoma (15%) and neuroendocrine carcinoma (5%); all of the types are caused by HPV.

Answer 17

Invasive cancer of the cervix

Question 18

Most common cause of death in cervical cancer.

Answer 18

Uremia

Question 19

Most common cause of dysfunctional uterine bleeding.

Answer 19

Anovulatory cycle

Question 20

Refers to the growth of the basal layer of the endometrium down to the myometrium; nests of endometrial stroma, glands or both are found in the myometrium, in between muscle bundles.

Answer 20

Adenomyosis

Question 21

Characterized by the presence of endometrial glands and stroma in a location outside the myometrium.

Answer 21

Endometriosis

Question 22

Exophytic masses that project into endometrial cavity; may be clinically silent or may cause abnormal uterine bleeding.

Answer 22

Endometrial polyp

Question 23

Tumor suppressor gene commonly mutated in atypical endometriosis, endometrial hyperplasia and endometrial carcinomas; also mutated in endometrioid and clear cell carcinomas of the ovary.

Answer 23

PTEN

Question 24

Precursor lesion of endometrial carcinoma secondary to prolonged and marked increased estrogen to progestin ratio; can be simple or complex, with or without atypia.

Answer 24

Endometrial hyperplasia

Question 25

Atypical hyperplasia is now also called endometrial intraepithelial neoplasia (EIN).

Answer 25

Endometrial hyperplasia

Question 26

Most common malignancy of the female genital tract.

Answer 26

Endometrial carcinoma

Question 27

Most common histology of endometrial carcinoma found in 80% of cases; associated with atypical hyperplasia; maybe exophytic or infiltrative; histologically resembles endometrial glands to solid sheets, depending on differentiation; low-grade nuclei is a usual feature.

Answer 27

Endometrioid carcinoma (Type I)

Question 28

Accounts for 15% of cases of endometrial carcinoma; forms small tufts and papillae with high nuclear grade.

Answer 28

Serous carcinoma (Type II)

Question 29

Common gene mutated in leiomyomas and leiomyosarcomas.

Answer 29

MED12

Question 30

Most common benign tumor in females; grossly appears as sharply circumscribed firm gray white masses with a characteristic whorled cut surface; histologically similar to normal smooth muscle cells.

Answer 30

Leiomyoma

Question 31

Malignant counterpart of leiomyoma; grossly appears as soft, hemorrhagic, necrotic masses; diagnostic features include: tumor necrosis, cytologic atypia and mitotic activity; necrosis being the most important criterion among the three.

Answer 31

Leiomyosarcoma

Question 32

Most common major type of ovarian tumors; 90% of which are malignant.

Answer 32

Surface epithelial-stromal tumors (65-70%)

Question 33

Most common ovarian epithelial tumors; tumors with tubal-like epithelium; most are benign or borderline (70%).

Answer 33

Serous tumors

Question 34

Grossly appears as large, spherical structures with smooth glistening serosal covering with less papillary projections; histologically, with a single layer of tall columnar epithelial cells without atypia and invasion; usually with Psammoma bodies.

Answer 34

Serous cystadenoma

Question 35

Serous cystadenoma with micropapillary architecture and epithelial stratification, mild nuclear atypia but without invasion of stroma.

Answer 35

Bordeline serous tumor

Question 36

Grossly appears as large, spherical structures with nodular serosal covering with prominent papillar projections; histologically, with layers of anaplastic epithelial cells and invasion; usually with Psammoma bodies; cancers are divided into low-grade (well-differentiated) or high-grade (moderately-differentiated or poorly-differentiated), based on general architecture, nuclear atypia and severity of stromal invasion.

Answer 36

Serous cystadenocarcinoma

Question 37

Mutations associated with low-grade serous carcinomas.

Answer 37

KRAS, BRAF, ERBB2

Question 38

Mutation associated with high-grade serous carcinomas.

Answer 38

TP53

Question 39

Mucin-containing cystic masses; can be benign or malignant, but most of them are benign; tend to be larger, multicystic and unilateral; can rupture into the peritoneum and produce mucinous ascites (pseudomyxoma peritonei).

Answer 39

Mucinous tumors

Question 40

Most consistent mutation in mucinous tumors.

Answer 40

KRAS

Question 41

Tumors are usually malignant; 15-20% coexist with endometriosis; histologic hallmark is presence of tubular glands resembling benign or malignant endometrium.

Answer 41

Endometrioid tumors

Question 42

Metastatic mucinous adenocarcinoma of the ovary from a gastrointestinal primary; often produces bilateral ovarian masses.

Answer 42

Krukenberg tumor

Question 43

Cystic, lined by skin-like structures; usually occur in reproductive age women; histologically, derivatives from more than one germ layer can be seen; generally benign.

Answer 43

Mature teratoma

Question 44

Solid masses that usually occur in younger women and children; histologically composed of neuroepithelium; generally malignant.

Answer 44

Immature teratoma

Question 45

A type of teratoma that produces hyperthyroidism due to presence of mature thyroid tissue.

Answer 45

Struma ovarii

Question 46

Ovarian tumor that may elaborate large amounts of estrogen; two thirds occur in post-menopausal women; potentially malignant; histologically composed of mixture of cuboidal granulosa cells in cords, sheets, or strands and spindled or plump lipid-laden theca cells; granulosa elements may recapitulate ovarian follicle as Call-Exner bodies.

Answer 46

Granulosa cell tumor

Question 47

Sex cord tumor that recapitulates development of testis with tubules or cords and plump pink Sertoli cells; masculinizing and rarely malignant.

Answer 47

Sertoli-Leydig cell tumor

Question 48

Sex cord stromal tumor composed of solid gray fibrous cells to yellow (lipid-laden) plump thecal cells; rarely malignant; associated with hydrothorax and ascites (Meig syndrome).

Answer 48

Thecoma-fibroma

Question 49

A type of hydatidiform mole with the following features: diploid karyotype with diffuse villus edema and trophoblast proliferation; markedly elevated hCG with increased risk of developing subsequent choriocarcinoma.

Answer 49

Complete hydatidiform mole

Question 50

A type of hydatidiform mole with the following features: triploid karyotype with focal villus edema and trophoblast proliferation; less elevated hCG with rare chance of developing subsequent choriocarcinoma.

Answer 50

Incomplete (Partial) hydatidiform mole

Question 51

Complete moles that are more invasive locally but do not have the aggressive metastatic potential of a choriocarcinoma.

Answer 51

Invasive mole

Question 52

Main difference between ovarian and gestational choriocarcinoma.

Answer 52

Ovarian chorioCAs are more difficult to treat