JCU MB4 Term 4 Week 7 (Ovaries)

1

A picture of an ovarian tumour is shown. What is the most likely diagnosis?

Benign teratoma


  Benign teratoma

  Mucinous cystadenoma

  Cystadenocarcinoma

  Serous cystadenoma

  Embryonal carcinoma


Cell of origin? Germ cell/totipotent cells

Microscopic features? Mixture of many mature tissues (epithelial and connective)

Prognosis? Benign

Synonyms of this condition? Mature teratoma, dermoid cyst

2

A gross specimen of an ovarian tumour is shown. What is the type?

Malignant ovarian tumour


  Benign

  Borderline

  Malignant

  Recurrent

  Indeterminate


Commonest cancer of ovary? Serous cystadenocarcinoma (papillary) Gross and microscopic features? Solid, infiltrating, papillar, pleomorphic Risk factors? Nulliparity, BRCA1

3

21yo woman G2P1, LGA at 14/40. Ultrasound reports "snowstorm" of multicystic mass but no fetus seen. Image shows specimen recovered at D&C. What is the most likely diagnosis?

Partial mole


  Cystadenocarcinoma

  Endometrial polyps

  Choriocarcinoma

  Complete mole

  Partial mole

4

A 38yo woman presented with abdominal pain, left ovarian mass and weight loss. Her pregnancy test was strongly positive. Iomages of gross appearance and microscopy shown. What is the most likely diagnosis?

Choriocarcinoma


  Cystadenocarcinoma

  Endometrial polyps

  Choriocarcinoma

  Chocolate cyst

  Hydatiform mole


Note appearance of very large cells on microscopy with no obvious tissue differentiation - very characteristic of choriocarcinoma.

5

35yo woman with fishy-smelling vaginal discharge has pap smear report of clue cells and dysplastic cells. Image shows appearance of biopsy on colonoscopy and smear. What is the most likely diagnosis?

Cervix HSIL

Pap smear clue cells


  Candida + LSIL

  Trichomonas + HSIL

  Bacterial vaginitis + HSIL

  HSIL with infiltraction (cervical carcinoma)

  HPV induced dysplasia


Etiology of discharge? **Gardnerella vaginalis (no relation to dysplasia) Microscopic features of areas A & B? A:Koilocytes, no dysplasia; B: HSIL/CIN3 Etiology of dysplasia? HPV 16,18

6

39yo obese female, DUB, infertility and T2DM. Specimen of ovary shown. What is the diagnosis?

PCOS


  Serous cystadenoma

  Mucinous adenoma

  Polycystic ovary syndrome

  MEN syndrome IIa

  Chocolate cysts/endometriosis

7

45yo woman blood tinged vaginal discharge for 1 month, previously had 2 episodes of postcoital bleeding in past 12 months. Images (A & B) show two cases with similar history. What is the most likely diagnosis?

Cervical carcinoma


  Candida + LSIL

  HPV + HSIL

  Bacterial vaginitis + HSIL

  Carcinoma cervix

  Condyloma accuminata


What is the disease stage? Limited to cervix, >4mm - 1B Gross features? Irregular growth, haemorrhage Microscopic features? Infiltration, keratin pearls, inflammation Risk factors? STD, HPV

8

30yo female, large ovarian tumour filled by thick mucoid fluid. No dysplasia or infiltration. Gross specimen shown. Diagnosis?

Mucinous cystadenoma


  Serous cystadenoma

  Benign teratoma

  Mucinous cystadenoma

  Mucoid cystadenocarcinoma

  Dermoid cyst

9

31yo woman with a 3 month history of warty, non-pruritic, non-haemorrhagic lesions on her perineum and labia majora. Images show two similar history cases and biopsy. What is the most likely diagnosis?

Condyloma accimunata


  Genital herpes

  Candidiasis

  Condlyomata lata

  CIN3/HSIL

  Condyloma accuminata


Etiology? HPV 6,11 Gross features? Flat to raised, soft/hard, warty growth Microscopic features? Acanthosis, koilocytes, para/hyperkeratosis

10

42yo female, ascites, weight loss, image shows gross ovary specimen. Diagnosis?

Borderline cystadenoma


  Cystadenocarcinoma

  Benign cystadenoma

  Borderline cystadenoma

  Metastatic carcinoma

  Ectopic pregnancy


Answer C would also be correct, but err on the side of caution.

11

25 mildly obese female, presents with hirsutism, irregular menstrual periods and recently diagnosed T2DM. Both ovaries are symmetrically moderately enlarged. This patient's ovaries would likely show which of the following pathologic findings?


  Bilateral endometriosis

  Cystic benign teratoma

  Endometriosis

  Serous cystadenoma

  Subcapsular cysts

12

38yo woman, infertility, dull pelvic pain for 9/12 accentuated during menstruation. Physical exam and endocrine studies are normal. Laparoscopy multiple small haemorrhagic lesions over the surface of both ovaries and fallopian tube with pelvic scarring. Laparoscopic microscopic views both shown. Diagnosis?

Endometriosis on laparoscopy

Endometriosis microscopy


  Cystadenocarcinoma

  Endometriosis

  Choriocarcinoma

  Metstatic carcinoma

  Ectopic pregnancy

13

18yo student, fever, vaginal discharge, lower abdominal pain and painful swollen right knee with no history of trauma. Blood work shows neutrophilia. Colposcopy view and smear are shown. If untreated, which of the following would be the most likely chronic complication in this patient.

Vaginal infection colposcopy

Vaginal infection smear


  Bronchopneumonia

  Lung abscess

  Meningitis & septicaemia

  Tubo-ovarian abscess

  Chorioamnionitis

14

A 20yo woman in the third trimester of her second pregnancy complains of a 3/7 history of painful urination and flank pain. Urinalysis shows pyuria. Which of the following bacteria is most likely to be isolated on urine culture.

Urine Escherichia coli microscopy

Urine Escherichia coli culture


  Beta-haemolytic Streptococcus

  Coagulase positive Staphylococcus

  Escherichia coli

  Haemophilus ducreyi

  Neisseria gonorrhoeae


Gram-negative bacteria from the faeces, most commonly E. coli, cause 80% of upper and lower UTI's.

15

Markedly enlarged ovary in an asymptomatic 38yo female. Gross specimen shown; cysts contain clear fluid. Diagnosis?

Ovary - Benign cystadenoma


  Cystadenocarcinoma

  Benign cystadenoma

  Borderline cystadenoma

  Metstatic carcinoma

  Ectopic pregnancy


Commonest tumour of ovary? Serous cystadenoma Gross and microscopic features? Solid, infiltrating, papillary, pleomorphic Risk factors? Nulliparity, BRCA1

16

31yo female, tumour of ovary shown. Diagnosis?

Benign teratoma


  Benign cystadenoma

  Borderline cystadenoma

  Benign teratoma

  Cystadenocarcinoma

  Malignant teratoma

17

42yo female, presents with menorrhagia & infertility. Microscopy of endometrium shown. Diagnosis?

Endometrium simple hyperplasia


  Atypical hyperplasia

  Simple hyperplasia

  Adenocarcinoma

  Adenomyosis

  Endometriosis

18

42yo female, DUB, abortion. Uterus specimen shown. Diagnosis?

leiomyoma


  Metastasis

  Choriocarcinoma

  Leiomyoma

  Endometrial polyp

  Endometrial carcinoma

19

Solid ovarian tumour, biopsy shown. Diagnosis?

Choriocarcinoma - Micro


  Cystadenocarcinoma

  Benign cystadenoma

  Metastatic carcinoma

  Benign teratoma

  Choriocarcinoma

20

42yo female, DUB, abortion. Uterus specimen shown. Diagnosis?

Endometrial hyperplasia


  Endometrial hyperplasia

  Choriocarcinoma

  Hydatidiform mole

  Endometrial carcinoma

  Endometriosis

21

19yo female, 5/7 vaginal bleeding. Home pregnancy test positive for 1wk. D&C revealed this specimen. Diagnosis?

Hydatidiform mole


  Serous cystadenoma

  Benign teratoma

  Mucinous cystadenoma

  Endometrial carcinoma

  Hydatidiform mole

22

59yo vaginal bleeding for 2/52. Endometrial biopsy shown. Diagnosis?

Endometrial hyperplasia micro


  Adenocarcinoma

  Adenomyosis

  Endometrial hyperplasia

  Endometrial carcinoma

  Endometriosis

23

A 20yo woman, 3/7 history of vaginal bleeding. An ultrasound shows a dilated endometrial cavity. Evacuation of the uterus reveals grapelike clusters and fetal parts. Cytogenetic examination of this tissue will most likely demonstrate which of the following genetic patterns?


  Aneuploidy

  Diploidy

  Euploidy

  Haploidy

  Triploidy

24

A 55yo nulliparous woman presents for physical examination. The patient is obese (BMI 33) and has mild, adult-onset diabetes. Compared with multiparous women, this patient is at increased risk of developing a neoplasm in which of the following anatomic locations?


  Cervix

  Endometrium

  Vagina

  Vulva

  Myometrium

25

A 45yo female, 6/12 history of increasing abdominal girth and pain. G0P0. Exam: 10cm right adnexal mass and ascites. Fluid reveals malignant cells in papillary clusters. A mutation in which of the following genes is most likely associated with this patient's malignant disease?


  BRCA1

  p53

  HER2/neu

  Rb

  VHL